轻度认知障碍患者共情能力和淡漠的变化研究及其与灰质萎缩的相关性分析

吴旱淋　汤其强

[摘要] 目的 研究輕度认知障碍患者共情能力与淡漠症状的变化，探索两者的联系及与脑灰质体积的相关性。 方法 纳入2019年7月至2020年7月诊断为MCI的病例22例，选择同时期性别、年龄、教育程度无差异的对照组21例，所有受试者完成神经心理学测评，包括MMSE、MoCA、SDS、IRI（包括PT、FS、EC、PD四个子项目）、BES（包括认知移情和情感移情）和AES-I评分，同时测量磁共振的灰质体积，两组结果进行对比并行相关性分析。 结果 MCI组的MMSE、MoCA评分明显低于对照组（P<0.05）;MCI组的共情测量评分中IRI总分及PT、FS评分显著低于对照组;在移情测评中，MCI组BES总分低于对照组（P<0.05），主要是情感移情评分;淡漠评定量表-知情者版（AES-I）的测评中，MCI组的评分显著升高（P<0.05）;MCI组的T1加权像VBM测量灰质体积显著小于对照组（P<0.05）。在进一步相关性及回归分析中，Pearson分析结果示共情能力与淡漠无相关性; IRI中的PD评分、淡漠评分与灰质萎缩呈显著负相关（B=-4.098，P=0.032;B=-2.987，P=0.022）;而情感移情评分与灰质萎缩呈显著正相关（B=3.623，P=0.013）。 结论 轻度认知障碍患者共情能力减退，情感移情能力较低，出现淡漠等早期精神行为症状，已有一定的灰质萎缩，且灰质萎缩与患者共情能力减低及淡漠的程度有相关性。

[关键词] 轻度认知障碍;共情;淡漠;脑萎缩

[中图分类号] R749.1          [文献标识码] A          [文章编号] 1673-9701（2021）04-0001-04

Changes of empathy and apathy in patients with mild cognitive impairment and its correlation with gray matter atrophy

WU Hanlin   TANG Qiqiang

Department of Neurology， Provincial Hospital Affiliated to Anhui Medical University， Hefei   230001， China

[Abstract] Objective To study the changes of empathy and apathy symptoms in patients with mild cognitive impairment（MCI）， and to explore the relationship between empathy and apathy symptoms and the correlation between empathy and gray matter volume. Methods A total of 22 cases diagnosed as MCI from July 2019 to July 2020 were enrolled in the study. 21 cases with no difference in gender， age and education level in the same period were taken as the control group. All subjects completed neuropsychological assessment， including MMSE， MoCA， SDS， IRI（including PT， FS， EC and PD）， BES（including cognitive empathy and emotional empathy） and AES-I scores. At the same time， the gray matter volume of MRI was measured. The results of the two groups were compared and the correlation was analyzed. Results MMSE and MoCA scores in MCI group were significantly lower than those in the control group（P<0.05）. The total score of IRI， PT and FS in empathy assessment scale of MCI group were significantly lower than those in the control group（P<0.05）. In empathy evaluation， the total score of BES in MCI group was lower than that in the control group（P<0.05）， which was mainly emotional empathy score. In apathy evaluation scale-insider version（AES-I）， the score of MCI group increased significantly（P<0.05）. The gray matter volume measured by VBM on T1 weighted images in MCI group was significantly smaller than that in control group（P<0.05）. In the further correlation and regression analysis， Pearson analysis showed that there was no correlation between empathy and apathy. PD score and apathy score in IRI were negatively correlated with gray matter atrophy（B=-4.098， P=0.032; B=-2.987， P=0.022）. The emotional empathy score was positively correlated with gray matter atrophy（B=3.623， P=0.013）. Conclusion MCI patients have a decreased empathy， a low emotional empathy， early mental and behavioral symptoms such as apathy， and gray matter atrophy to some extent， and gray matter atrophy is related to the degree of decreased empathy and apathy.

[Key words] Mild cognitive impairment; Empathy; Apathy; Brain atrophy

轻度认知功能障碍（Mild cognitive impairment，MCI）是处于正常老化和痴呆之间的一种过渡状态，并有着极高的向痴呆转化的风险，分为遗忘型MCI和非遗忘型MCI。2018年，全世界有5000万人患有痴呆症，到2050年，这一数字可能增加2倍，达到1.52亿人，到2030年全球老年痴呆人数将突破7000万人，届时所消耗的社会成本将超过2万亿美元[1]。据报道，60岁及以上人群中MCI的患病率为4%～19%[2]，约22%的受MCI影響的人在诊断MCI后3～10年内会进展为痴呆，而非MCI患者中只有3%发展为痴呆[3]。目前，MCI概念已逐渐扩大，涵盖记忆障碍、注意障碍、执行能力障碍等多个认知领域，同样包括其社会认知功能。关于神经退行性疾病的社会认知研究中，目前大多重心在额颞叶痴呆，对MCI及AD患者的心理理论研究则主要是探讨认知成分方面，关于情感成分研究较少[4-6]。共情是对他人的心理状态的理解能力，更为强调情绪状态，指理解并体验他人的情绪和知觉感受的能力，使我们能与他人分享高兴、悲伤、疼痛等体验，在认知障碍患者的心理理论中研究较多，但是在MCI患者的共情能力研究中仍存在争议。……