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