Zespół apatii w chorobach neurologicznych – stan wiedzy i aktualne kierunki badań
Magdalena Roessler-Górecka
Instytut Psychiatrii i Neurologii w Warszawie, II Klinika Neurologicznahttps://orcid.org/0000-0002-1375-5643
Abstrakt
Cel: Apatia bywa wskazywana jako symptom w różnych jednostkach chorobowych m.in. na gruncie psychiatrii, jednak od kilku dekad wyodrębnia się ją także jako niezależny syndrom towarzyszący wielu schorzeniom neurologicznym. Choć nadal pomijany w obowiązujących klasyfikacjach medycznych, zespół apatii stanowi przedmiot licznych analiz teoretycznych i klinicznych. Upowszechnienie wiedzy na jego temat wśród klinicystów – w tym możliwości jego rozpoznawania i różnicowania, zwłaszcza od depresji – ma podstawowe znaczenie dla efektywności oddziaływań terapeutycznych. Praca prezentuje proponowane w literaturze definicje oraz kryteria diagnostyczne zespołu apatii. Przedstawia dane dotyczące jego częstości w różnych schorzeniach, związków z patologią mózgu oraz szeregiem zmiennych klinicznych.
Tezy: Współczesne koncepcje podkreślają syndromiczny charakter, wielowymiarowość zespołu apatii oraz powiązania z szeroko rozumianymi funkcjami płatów czołowych. Domeny funkcjonowania, w których mogą być ujawniane objawy apatii, obejmują sferę poznawczą, emocjonalną, interakcje społeczne oraz zachowanie (inicjowanie i podtrzymywanie dowolnej celowej aktywności). Wskazuje się na relatywną niezależność zespołu od depresji, podkreśla znaczenie jako czynnika prognostycznego rozwoju otępień, związek z jakością życia, efektywnością rehabilitacji oraz psychologicznym obciążeniem opiekunów. Poszukując mózgowego podłoża apatii rozpatruje się szereg częściowo nakładających się procesów oraz znaczącą rolę jąder podstawy i wybranych obszarów kory przedczołowej.
Konkluzja: Dla wystąpienia symptomów apatii kluczowa może być dysfunkcja dowolnego ogniwa złożonych obwodów przedczołowo-podkorowych, czym tłumaczy się wysoką częstość omawianego zespołu w chorobach mózgu, zwłaszcza przebiegających z uszkodzeniami jąder podstawy i/lub kory przedczołowej. Zróżnicowanie nasilenia symptomów w poszczególnych domenach oraz powtarzalność profilów nieprawidłowości obserwowana zależnie od analizowanej jednostki chorobowej i/lub lokalizacji patologii mózgu skłaniają do poszukiwania podtypów zespołu apatii.
Słowa kluczowe:
zespół apatii, jądra podstawy, kora przedczołowa, dysfunkcje wykonawczeBibliografia
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Instytut Psychiatrii i Neurologii w Warszawie, II Klinika Neurologiczna
https://orcid.org/0000-0002-1375-5643
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