Distinct neuropsychological correlates of cognitive, behavioral, and affective apathy sub-domains in acquired brain injury

Apathy has a high prevalence and a significant contribution to treatment and rehabilitation outcomes in acquired brain damage. Research on the disorder's neuropsychological correlates has produced mixed results. While the mixed picture may be due to the use of varied assessment tools on different patient populations, it is also the case that most studies treat apathy as a unitary syndrome. This is despite the evidence that apathy is a multifaceted and multidimensional syndrome. This study investigates the neuropsychological correlates of apathy in 49 patients with acquired brain damage. It further fractionates apathy symptoms into affective, cognitive, and behavioral sub-domains and investigates their individual relations with standard measures of affective, cognitive, and behavioral functioning. Global apathy scores were not related to any of these measures. Affective apathy was associated with emotion perception deficits, and cognitive apathy was associated with executive deficits on the Brixton test. These results demonstrate that treating apathy as a single entity may hide important correlates to apathy symptoms that become visible when the disorder is fractionated into its sub-domains. The study highlights the research and clinical importance of treating apathy as a multidimensional syndrome

Empirical support for the vascular apathy hypothesis:A structured review

Objectives: A systematic review of the relationship between subclinical small vessel disease (SSVD) in the general population and apathy to examine the hypothesis that apathy has a vascular basis. Methods: We searched for studies on associations between apathy and SSVD, operationalized as white matter hyperintensities (WMH) or white matter diffusivity changes, lacunar infarcts, cerebral microbleeds, decreasing cortical thickness, and perivascular spaces, while also peripheral proxies for SSVD were considered, operationalized as ankle brachial pressure index (ABI), intima media thickness, arterial stiffness, cardio-femoral pulse wave velocity, hypertension, or cardiovascular disease. Only eligible retrospective and prospective observational studies conducted in the general population were included. Results: The 14 studies eligible for review examined the associations between apathy and hypertension (3), ABI (1), arterial stiffness (1), cardiovascular disease (2), WMH (3), white matter diffusivity (2), cerebral microbleeds (1), or cortical thickness (3). Arterial stiffness and white matter diffusivity were not related to apathy, while the associations with cortical thickness were contradictory. Cross-sectional studies in the general population did find evidence of apathy being associated with WMH, CM, cardiovascular disease, hypertension, and ABI, and cardiovascular disease was prospectively associated with apathy. The methodologies of the studies reviewed were too heterogeneous to perform meta-analyses. Conclusions: Although more prospective evidence is needed and vascular depression needs to be controlled for, cardiovascular disease, hypertension, and ABI as proxies for SSVD, and WMH and cerebral microbleeds as direct measures of SSVD have been found to be associated with apathy in the general population, supporting the hypothesis of vascular apathy

Different aspects of emotional processes in apathy: Application of the French translated dimensional apathy scale

Apathy is a behavioural symptom that occurs in neuropsychiatric, neurological and neurodegenerative disease. It is defined as a lack of motivation and/or a quantitative reduction of goal-directed behaviour. Levy and Dubois Cerebral Cortex, 16(7), 916–928 (2006) proposed a triadic substructure of apathy and similar subtypes can be assessed using the Dimensional Apathy Scale (DAS), via the Executive, Emotional and Initiation subscales. The aim of this study was to translate the DAS in to French (f-DAS), examine its psychometric properties and the substructure of apathy using Confirmatory Factor Analysis (CFA). The results showed an acceptable internal consistency reliability of the f-DAS and a similar relationship to depression as in the original DAS development study. The CFA supported a triadic dimensional substructure of the f-DAS, similar to the original DAS but suggested a more complex substructure, specifically, two further processes of the Emotional apathy dimension relating to “Social Emotional” and “Individual Emotional” aspects of demotivation. To conclude, the f-DAS is a robust and reliable tool for assessing multidimensional apathy. Further research should explore the utility of the f-DAS in patients with neuropsychiatric diseases in view of social emotional aspects in apathy

Apathy and executive functions: Insights from brain damage involving the anterior cingulate cortex

Patients with anterior cingulate cortex (ACC) lesions present an opportunity for understanding apathy 's disputed neuropsychiatric features, as well as its associated neurocognitive phenotype. In this case report, two male patients (patient A and patient B) with lesions involving the ACC bilaterally were assessed for apathy, depressive symptoms, executive functioning, and also tested on the Iowa Gambling Task (IGT). Twenty neurologically intact controls also provided normative scores on the IGT. Patient A and patient B had high scores for apathy and low depressive symptoms scores. Patient A had relatively intact performance on standard executive function tests, but patient B had significant impairments. Both patients were significantly impaired on the IGT. Our findings suggest that executive function deficits are not crucial for the presence of apathy symptoms. These findings not only shed light on the relationship between apathy and executive function deficits, but also have important implications for patient care and rehabilitation. Copyright 2012 BMJ Publishing Group. All rights reserved

Dissociation between decoding and reasoning about mental states in patients with theory of mind reasoning impairments.

Theory of mind (ToM) reasoning may involve a multiplicity of processes, including an initial stage, where cues relevant for social processes are detected and decoded, and a mentalizing stage, where the decoded information is used to reason about mental states. Here we report that the processing of lower-order facial cues relevant to social judgments can be relatively spared in patients with impaired ToM reasoning. We discuss the implications for understanding the mechanisms underlying social judgments in brain-lesioned patients

Exploring social cognition in patients with apathy following acquired brain damage

Background: Research on cognition in apathy has largely focused on executive functions. To the best of our knowledge, no studies have investigated the relationship between apathy symptoms and processes involved in social cognition. Apathy symptoms include attenuated emotional behaviour, low social engagement and social withdrawal, all of which may be linked to underlying socio-cognitive deficits. Methods: We compared patients with brain damage who also had apathy symptoms against similar patients with brain damage but without apathy symptoms. Both patient groups were also compared against normal controls on key socio-cognitive measures involving moral reasoning, social awareness related to making judgements between normative and non-normative behaviour, Theory of Mind processing, and the perception of facial expressions of emotion. We also controlled for the likely effects of executive deficits and depressive symptoms on these comparisons. Results: Our results indicated that patients with apathy were distinctively impaired in making moral reasoning decisions and in judging the social appropriateness of behaviour. Deficits in Theory of Mind and perception of facial expressions of emotion did not distinguish patients with apathy from those without apathy. Conclusion: Our findings point to a possible socio-cognitive profile for apathy symptoms and provide initial insights into how socio-cognitive deficits in patients with apathy may affect social functioning. </p

Apathy and executive functions: Insights from brain damage involving the anterior cingulate cortex

Patients with anterior cingulate cortex (ACC) lesions present an opportunity for understanding apathy 's disputed neuropsychiatric features, as well as its associated neurocognitive phenotype. In this case report, two male patients (patient A and patient B) with lesions involving the ACC bilaterally were assessed for apathy, depressive symptoms, executive functioning, and also tested on the Iowa Gambling Task (IGT). Twenty neurologically intact controls also provided normative scores on the IGT. Patient A and patient B had high scores for apathy and low depressive symptoms scores. Patient A had relatively intact performance on standard executive function tests, but patient B had significant impairments. Both patients were significantly impaired on the IGT. Our findings suggest that executive function deficits are not crucial for the presence of apathy symptoms. These findings not only shed light on the relationship between apathy and executive function deficits, but also have important implications for patient care and rehabilitation. Copyright 2012 BMJ Publishing Group. All rights reserved