Characteristics of impulsiveness and aggressiveness in patients with hepatolenticular degeneration and its relationship with brain structure

Abstract

Objective To investigate the impulsivity and aggressiveness characteristics of patients with hepatolenticular degeneration(HLD) and its relationship with brain structure. Methods The Chinese version of the Barratt impulsiveness scale, 11 version(BIS-11-C) and Buss-Perry aggression questionnaire(BPAQ) were assessed in 78 patients with hepatolenticular degeneration(HLD group) and 86 normal adults(health control group). HLD patients were examined by 3.0T magnetic resonance imaging (MRI). The differences in impulsivity and aggressiveness of the two groups were compared, and the relationship was analyzed between impulsivity, aggressiveness and different brain structures in patients with HLD. Results The total impulsive score, unplanned factor score, the total aggressive score and anger factor score of patients with cerebral HLD(61.74±9.82, 26.08±5.06, 82.71±15.92, 20.06±5.74, respectively) were higher than those in patients with hepatic HLD (56.73±7.11, 23.02±4.20, 72.84±11.15, 16.64±5.01, respectively), and health control group(52.19±7.53, 21.50±3.93, 64.64±9.83, 14.27±4.38, respectively), and the differences were significant (F=3.193, 4.646, 11.830, 8.270, all P<0.05). Total impulsive score was positively correlated with aggressive score and physical aggression in HLD group(r=0.299, 0.290, both P<0.05). Unplanned score was positively correlated with aggressive total score (r=0.324) and physical aggression (r=0.320) in HLD group (P<0.05). Frontal lobe injury was the influencing factor of total impulsive score(B=10.263, 95%CI=0.467-19.946, P=0.008), attention score(B=2.837, 95%CI=0.382-5.600, P=0.010) and unplanned factor score(B=3.977, 95%CI=0.848-8.502, P=0.046). Thalamus injury was the influencing factor of aggressive total score and its factor score.Caudate nucleus injury was the influencing factor of aggressive total score (B=10.030, 95% CI=3.351-18.039, P=0.017) and physical aggression score (B=4.432, 95% CI=1.193-7.729, P=0.016). Conclusion Patients with HLD have higher impulsive and aggressive tendencies, which are mainly manifested in unplanned impulsive and anger tendencies.Brain injury may be an important factor affecting impulsiveness and aggression in patients with HLD.Impulsiveness is related with frontal lobe injury and aggression to thalamus and caudate nucleus injury.Impulsiveness and aggressiveness in patients with HLD are not caused by damage to isolated brain areas, but are related to damage to multiple brain areas. Key words: Hepatolenticular degeneration; Wilson's disease; Impulsivity; Aggressiveness; Brain structure damage