中医呆病淡漠行为评价及药物干预研究进展

Behavioral Assessment and Drug Treatment of Apathy in Dementia in Traditional Chinese Medicine： A Review

摘要:

中医呆病主见“健忘”“神呆”“善忘”，阿尔茨海默病、血管性痴呆均可属于中医呆病的范畴。此类进行性的神经系统疾病病因复杂，病程漫长，尚未出现可以逆转病程的治疗药物，因此早期干预对延缓病情有至关重要的作用。淡漠主要指动机缺乏导致目标导向性行为、认知功能及情感反应的减弱甚至消失。淡漠症状存在于多种呆病早期，是呆病的早期诊断关键症状之一；淡漠症状的严重程度与呆病严重程度相关，因此针对淡漠的干预对延缓呆病进程有重要意义。目前，呆病中的淡漠临床前研究还处于早期，尚未规定系统的评价方法，临床诊治也处于探索阶段，淡漠与呆病发展的复杂病理生理机制至今尚未完全阐明。该文综述了近年来中西医对呆病表现中淡漠的认识，呆病相关动物模型的淡漠样行为及临床中淡漠表现，治疗方法研究等成果，总结了呆病中淡漠的研究现状，为进一步探究呆病淡漠行为，进行临床前致病机制研究与评价提供了理论基础，为呆病中淡漠的治疗方案奠定基础。

Abstract:

Dementia in traditional Chinese medicine （TCM） mainly presents amnesia and dullness. Alzheimer's disease and vascular dementia belong to the category of dementia in TCM. These progressive neurological diseases have a complex etiology and a long course， and the drugs that can reverse the disease course remain to be developed. Therefore， early intervention plays a vital role in delaying the disease progression. Apathy refers to a lack of motivation that leads to the attenuation or disappearance of goal-directed behaviors， cognitive functions， and emotional responses. Clinical studies have suggested that apathy exists in the early stage of a variety of neurodegenerative diseases， being one of the key symptoms to the early diagnosis of dementia. The severity of apathy is related to the severity of dementia. Therefore， early diagnosis and treatment of apathy are of great significance to the prevention and treatment of dementia. The preclinical research on apathy in dementia is still in its infancy， and the systematic evaluation method has not been prescribed. The clinical diagnosis and treatment are also in the exploratory stage， and the complex pathophysiological mechanisms of apathy and dementia development have not been fully elucidated. This article reviews the research progress of apathy in dementia， the apathetic behaviors of dementia animal models， the behaviors of patients with apathy， and the treatment methods in recent years and summarizes the research status of apathy in dementia. This review aims to provide a theoretical basis for exploring the behavior of apathy in dementia and conducting preclinical research and evaluation of the pathogenesis and to lay a foundation for the treatment of apathy in dementia.