Post on 12-Jul-2020
Apatia e Depressione nelle Patologie Associate
all’Invecchiamento
Gianfranco Spalletta
IRCCS Fondazione Santa Lucia
Int. Psychogeriatrics 2010
CLUSTERIZZAZIONE DEI BPSD(Lawlor et al, 2001)
APATIA E DEPRESSIONE
Apatia Comuni DepressioneRisposta emotiva appiattita Diminuzione dell’interesse DisforiaIndifferenza Rallentamento psicomotorio Ideazione suicidariaRiduzione delle attività sociali Faticabilità/Ipersonnia AutocriticaDiminuzione dell’iniziativa Ridotto insight Sensi di colpaRidotta persistenza (motivazione) Pessimismo
Hopelessness
Sintomi
Am J Geriatr Psychiatry 2009
Anziani istituzionalizzati non dementi
Factor 1:Depression
Factor 2:Hyperactiviy
Factor 3:Psychosis
Factor 4:Mania
Factor 5:Apathy
Delusions .072 .115 .873 .064 .053
Hallucinations -.020 .006 .878 .063 -.018
Agitation .263 .768 .186 .243 .077
Depression .775 .118 .155 -.056 .365
Anxiety .781 .052 -.020 .166 .197
Euphoria -.002 .075 .105 .836 -.082
Apathy .270 .163 .057 -.117 .780
Disinhibition .067 .090 .026 .840 .254
Irritability .276 .792 .100 .104 -.106
Aberrant motor behavior -.007 .023 -.015 .294 .745
Nighttime behavior disturbances .737 .190 -.026 -.042 -.174
Appetite and eating abnormalities -.105 .699 -.094 -.090 .311
Int psychogeriatrics, 2010
Proportion of people with different NPI syndromes undergoing specific psychotropic treatment.
Kaplein Meyer cumulative survival curves. Progression to dementia in MCI patients with depression or apathy
Depression Apathy
J Alzheimer Dis 2010
Risk of developing AD over up to four years in MCI patients with
depression or apathy.
Diffusion Tensor Imaging
"MD"
Ultra-structure damage
Mean Diffusivity (MD) Correlates of Apathy in 20 Amnestic MCI Patients
Panel A: shows the Uncinate Fasciculus (UF) at Talairach Tournox coordinates (x=31; and from y=10 to y=8).
Panel B: shows the Inferior Longitudinal Fasciculus (ILF) at Talairach Tournox coordinates (x=42; from y=-2 to y=-4).
Panel C: shows the Middle Longitudinal Fasciculus (MLF) at Talairach Tournox coordinates (x=47; from y=-8 to y=-10).
Panel D: shows the medial white matter area including parathalamic white matter (y=-30), fornix (y=-32), and posterior cingulum (y=-34). Talairach Tournox coordinates (x=15; from y=- 30 to y=-34).
Diffusion Tensor Imaging
"FA"
Loss of Anisotropy
Microstruttura cerebrale Soggetti sani di sesso femminile
Fractional anisotropy Mean Diffusivity
Change in MMSE performance between baseline and one-year follow-up in patients with and without baseline depression,
stratified by follow-up depression status
Cognitive outcome (change in MMSE between baseline and follow-up) in 51 patients with baseline depression
according to antidepressant medication use and depression status at follow-up
CONCLUSIONI
APATIA E DEPRESSIONE
Apatia Comuni DepressioneRisposta emotiva appiattita Diminuzione dell’interesse DisforiaIndifferenza Rallentamento psicomotorio Ideazione suicidariaRiduzione delle attività sociali Faticabilità/Ipersonnia AutocriticaDiminuzione dell’iniziativa Ridotto insight Sensi di colpaRidotta persistenza (motivazione) Pessimismo
Hopelessness
Sintomi