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Pepping N, Weinborn M, Pestell CF, Preece DA, Malkani M, Moore S, Gross JJ, Becerra R. Improving emotion regulation ability after brain injury: A systematic review of targeted interventions. Neuropsychol Rehabil 2024:1-41. [PMID: 39230344 DOI: 10.1080/09602011.2024.2398029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/25/2024] [Indexed: 09/05/2024]
Abstract
Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.
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Affiliation(s)
- Natalie Pepping
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - David A Preece
- School of Psychological Science, The University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
- Psychological Sciences Research Institute, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Maya Malkani
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Sammy Moore
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Rodrigo Becerra
- School of Psychological Science, The University of Western Australia, Perth, Australia
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2
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Quang H, Wearne T, Filipcikova M, Pham N, Nguyen N, McDonald S. A Biopsychosocial Framework for Apathy Following Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09620-4. [PMID: 38112938 DOI: 10.1007/s11065-023-09620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/19/2023] [Indexed: 12/21/2023]
Abstract
Apathy, the deficit of goal-directed behaviour, is well recognised as one of the most debilitating syndromes after moderate-to-severe traumatic brain injury (TBI). However, mechanisms underlying apathy, or at least factors associated with apathy, are sporadically reported. Based on a biopsychosocial framework, this systematic review and meta-analysis synthesised evidence regarding neurobiological, socio-environmental and individual factors associated with apathy. Our searches identified 21 studies satisfying inclusion and exclusion criteria. Results showed that the majority of work has focused on cognitive dysfunction, TBI-related factors, demographic variables and psychological correlates of apathy, while evidence for neural substrates and socio-cultural and premorbid aspects is scant. Overall, the current literature suggests that TBI-related and patient demographic factors did not contribute to apathy after TBI, whereas complex neurocognitive alterations, socio-environmental and cultural factors as well as patients' self-related factors may be important components. The evidence points to the multifaceted interplay of certain biopsychosocial contributors to apathy and suggests future investigations of more complex behavioural traits, cultural elements and pre-injury levels to better characterise the aetiology of this detrimental impairment after TBI.
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Affiliation(s)
- Halle Quang
- School of Health Sciences and Brain & Mind Centre, University of Sydney, Sydney, Australia.
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia.
| | | | - Michaela Filipcikova
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia
| | - Nhi Pham
- School of Psychology, Ho Chi Minh City University of Education, Ho Chi Minh City, Vietnam
| | - Nhi Nguyen
- Ho Chi Minh City University of Social Sciences and Humanities, Ho Chi Minh City, Vietnam
| | - Skye McDonald
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia
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3
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Quang H, Le Heron C, Balleine B, Nguyen TV, Nguyen TQ, Nguyen MN, Kumfor F, McDonald S. Reduced Sensitivity to Background Reward Underlies Apathy After Traumatic Brain Injury: Insights From an Ecological Foraging Framework. Neuroscience 2023; 528:26-36. [PMID: 37536610 DOI: 10.1016/j.neuroscience.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Altered reward processing is increasingly recognised as a crucial mechanism underpinning apathy in many brain disorders. However despite its clinical relevance, little is known about the mechanisms of apathy following moderate-to-severe traumatic brain injury (TBI). In real-life situations, reward representations encompass both foreground (gains from current activity) and background (potential gains from the broader environment) elements. This latter variable provides a crucial set-point for switching behaviour in many naturalistic settings. We hypothesised apathy post-TBI would be associated with disrupted background reward sensitivity. METHODS We administered a computer-based foraging task to 45 people with moderate-to-severe TBI (20 with apathy, 39 males) and 37 matched controls. Participants decided when to leave locations (patches) where foreground reward rates depleted at differing rates, to pursue greater rewards from other patches in the environment, which had either a high or low background reward rate. Primary analysis was performed using linear mixed effects models, with patch leaving time the dependent variable. RESULTS Findings showed a significant interaction between apathy and background reward sensitivity, driven by apathetic TBI participants not altering patch-leaving decisions as environmental reward rate changed. In contrast, although TBI was associated with reduced sensitivity to changing foreground rewards, this did not vary as a function of apathy. CONCLUSIONS These results provide the first evidence directly linking disrupted background reward processing to apathy in any brain disorder. They identify a novel mechanism for apathy following moderate-to-severe TBI, and point towards novel interventions to improve this debilitating complication of head injury.
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Affiliation(s)
- Halle Quang
- University of New South Wales, School of Psychology, Sydney, NSW 2052, Australia.
| | - Campbell Le Heron
- University of Otago, Department of Medicine, Christchurch 8011, New Zealand; New Zealand Brain Research Institute, Christchurch 8011, New Zealand; Department of Neurology, Canterbury District Health Board, 8011, New Zealand
| | - Bernard Balleine
- University of New South Wales, School of Psychology, Sydney, NSW 2052, Australia
| | - Tuong-Vu Nguyen
- Cho Ray Hospital, Department of Neurosurgery, Ho Chi Minh City 70000, Vietnam
| | - Truc-Quynh Nguyen
- Ho Chi Minh City University of Education, School of Psychology, Ho Chi Minh City 70000, Vietnam
| | - My-Ngan Nguyen
- Ho Chi Minh City University of Education, School of Psychology, Ho Chi Minh City 70000, Vietnam
| | - Fiona Kumfor
- University of Sydney, School of Psychology and Brain & Mind Centre, Sydney, NSW 2050, Australia
| | - Skye McDonald
- University of New South Wales, School of Psychology, Sydney, NSW 2052, Australia
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4
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Hanrahan JG, Burford C, Nagappan P, Adegboyega G, Rajkumar S, Kolias A, Helmy A, Hutchinson PJ. Is dementia more likely following traumatic brain injury? A systematic review. J Neurol 2023; 270:3022-3051. [PMID: 36810827 DOI: 10.1007/s00415-023-11614-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The association between traumatic brain injury (TBI) and dementia is controversial, and of growing importance considering the ageing demography of TBI. OBJECTIVE To review the scope and quality of the existing literature investigating the relationship between TBI and dementia. METHODS We conducted a systematic review following PRISMA guidelines. Studies that compared TBI exposure and dementia risk were included. Studies were formally assessed for quality with a validated quality-assessment tool. RESULTS 44 studies were included in the final analysis. 75% (n = 33) were cohort studies and data collection was predominantly retrospective (n = 30, 66.7%). 25 studies (56.8%) found a positive relationship between TBI and dementia. Clearly defined and valid measures of assessing TBI history were lacking (case-control studies-88.9%, cohort studies-52.9%). Most studies failed to justify a sample size (case-control studies-77.8%, cohort studies-91.2%), blind assessors to exposure (case-control-66.7%) or blind assessors to exposure status (cohort-3.00%). Studies that identified a relationship between TBI and dementia had a longer median follow-up time (120 months vs 48 months, p = 0.022) and were more likely to use validated TBI definitions (p = 0.01). Studies which clearly defined TBI exposure (p = 0.013) and accounted for TBI severity (p = 0.036) were also more likely to identify an association between TBI and dementia. There was no consensus method by which studies diagnosed dementia and neuropathological confirmation was only available in 15.5% of studies. CONCLUSIONS Our review suggests a relationship between TBI and dementia, but we are unable to predict the risk of dementia for an individual following TBI. Our conclusions are limited by heterogeneity in both exposure and outcome reporting and by poor study quality. Future studies should; (a) use validated methods to define TBI, accounting for TBI severity; (b) follow consensus agreement on criteria for dementia diagnosis; and (c) undertake follow-up that is both longitudinal, to determine if there is a progressive neurodegenerative change or static post-traumatic deficit, and of sufficient duration.
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Affiliation(s)
- John Gerrard Hanrahan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Charlotte Burford
- Department of General Surgery, East Kent University Hospitals NHS Foundation Trust, Ashford, UK.
| | - Palani Nagappan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Gideon Adegboyega
- Bart's and the London Medical School, Queen Mary University of London, London, UK
| | - Shivani Rajkumar
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Adel Helmy
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Peter John Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Pugh M, Perrin PB, Arango-Lasprilla JC. Predicting caregiver burden over the first 4 months after acute traumatic brain injury in Latin America: a multi-country study. Brain Inj 2021; 35:769-777. [PMID: 33822684 PMCID: PMC8217148 DOI: 10.1080/02699052.2021.1907861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Background: Traumatic brain injury (TBI) rates and outcomes are worse in Latin American countries relative to high-income countries. This study examined whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation in individuals with an acute TBI in Latin America predict longitudinal trajectories of caregiver burden during the first 4 months post-discharge.Method: A sample of 109 caregivers of individuals with a new TBI from Colombia and Mexico completed the observer European Brain Injury Questionnaire before hospital discharge and the Zarit Burden Inventory at the same time and again at 2 and 4 months after discharge. A hierarchical linear model (HLM) was used to assess whether cognitive dysfunction, depressive mood, and poor social and emotional self-regulation at hospital discharge predicted longitudinal trajectories of caregiver burden.Results: Results suggested that burden trajectories decreased over time and men reported higher burden than women. Additionally, results showed that poor patient social and emotional self-regulation predicted higher burden trajectories.Conclusions: Men and caregivers providing care for those experiencing poor social and emotional self-regulation may be at risk for burden. Culturally sensitive interventions focusing on social functioning of individuals with TBI and gender-informed caregiver interventions aimed at burden should be implemented in Latin America.
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Affiliation(s)
- Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonweath University, Richmond, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Cruces University Hospital Barakaldo, Barakaldo, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Bilbao, Spain
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6
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Palmisano S, Fasotti L, Bertens D. Neurobehavioral Initiation and Motivation Problems After Acquired Brain Injury. Front Neurol 2020; 11:23. [PMID: 32153486 PMCID: PMC7049782 DOI: 10.3389/fneur.2020.00023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022] Open
Abstract
Motivation is a primary and permanent source of human behavior and adaptation. Motivational deficits, along with deficiencies in initiation, frequently occur in individuals with acquired brain injury (ABI). These neurobehavioral problems are associated with consequences at the participation level: patients are reluctant to engage in rehabilitation, and their subsequent social reintegration is often at risk. The same problems may also become a heavy burden for the families of individuals with ABI. In the present paper, we will critically review both the current definitions and the instruments used to measure motivational disorders following ABI. We will also describe the neural system underlying motivation and its impairments. What emerges is the need to develop specific rehabilitative treatments, still absent at the moment, with the ultimate aim of ensuring a better quality of life for both the patients and their proxies.
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Affiliation(s)
- Simona Palmisano
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, Netherlands
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7
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Apathy following traumatic brain injury: A review. Neuropsychologia 2018; 118:40-47. [PMID: 29660377 DOI: 10.1016/j.neuropsychologia.2018.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 02/27/2018] [Accepted: 04/09/2018] [Indexed: 01/19/2023]
Abstract
Apathy is a common problem after traumatic brain injury (TBI) and can have a major impact on cognitive function, psychosocial outcome and engagement in rehabilitation. For scientists and clinicians it remains one of the least understood aspects of brain-behaviour relationships encompassing disturbances of cognition, motivation, emotion and action, and is variously an indication of organic brain disease or psychiatric disorder. Apathy can be both sign and symptom and has been proposed as a diagnosis in its own right as well as a secondary feature of other conditions. This review considers previous approaches to apathy in terms of relevant psychological constructs and those neural counterparts most likely to be implicated after TBI. Neurobehavioural disorders of apathy are characterised chiefly by dysfunction of executive control of goal-oriented behaviour or the neural substrates of reward-based and emotional learning. We argue that it is possible to distinguish a primary disorder of apathy as an organic neurobehavioural state from secondary presentations due to an impoverished environment or psychological disturbance which has implications for treatment.
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8
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Abstract
Systematic reviews have developed over the past 40 years as a method for integrating findings from the available studies relating to clinical problems and interventions into one publication. Systematic reviews employ a variety of data analytic techniques including meta-analysis, which combines treatment effects across disparate studies in order to produce a truer estimate of treatment effect. The Cochrane Collaboration was established in order to facilitate access to high-quality evidence and specifies stringent guidelines for the production of systematic reviews. A Cochrane Systematic Review (CSR) includes consideration of the risk-of-bias of the selected studies in reaching conclusions. A recent CSR is used as an example to demonstrate the process of conducting a CSR, the data analytic methods employed and the assumptions made when employing these methods. There is a discussion of issues the reader will need to be aware of when considering the findings of a CSR and how this might differ from other systematic reviews including some consideration of how CSRs apply to the brain impairment literature.
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9
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Campbell IN, Gallagher M, McLeod HJ, O'Neill B, McMillan TM. Brief compassion focused imagery for treatment of severe head injury. Neuropsychol Rehabil 2017; 29:917-927. [PMID: 28664763 DOI: 10.1080/09602011.2017.1342663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine whether participants with severe head injury (SHI) allocated to a brief compassion focused imagery (CFI) intervention show greater change in compassion than those exposed to relaxation imagery (RI). METHOD Participants were exposed to a preparatory video to promote engagement and then randomly allocated to intervention. Pre- and post-preparatory measures were Motivation for Intervention and Fears of Compassion Scales, State-Trait Anxiety Inventory (STAI) and PANAS. Pre- and post-intervention self-report measures were the Empathy Quotient, Self-Compassion Scale, STAI and Relaxation Scale. Heart rate variability (HRV) was monitored throughout. RESULTS Motivation for therapy increased after the preparatory video (z = 3.44, p = 0.001). Across the intervention, group differences were not found on self-report measures or HRV changes. When CFI and RI groups were pooled, improvement in relaxation (r = .41, p < 0.01) and state anxiety (r = .29, p < 0.05) were found across the intervention; these outcomes were not associated with changes in self-compassion or HRV. CONCLUSION Brief CFI, a central aspect of compassion focused therapy, did not produce a reliable change in people with SHI. Enhanced motivation for psychological therapy after a brief preparatory video is relevant and underlines the need to understand mechanisms of action rather than the pursuing whole protocol approaches to therapy.
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Affiliation(s)
- Iain N Campbell
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| | - Melanie Gallagher
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| | - Hamish J McLeod
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| | - Brian O'Neill
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
| | - Tom M McMillan
- a Institute of Health and Wellbeing , College of Veterinary, Medical and Life Sciences, University of Glasgow, Gartnavel Royal Hospital , Glasgow , UK
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10
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Khan F, Amatya B, Galea MP, Gonzenbach R, Kesselring J. Neurorehabilitation: applied neuroplasticity. J Neurol 2016; 264:603-615. [PMID: 27778158 DOI: 10.1007/s00415-016-8307-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 12/28/2022]
Abstract
The prevalence of disability due to neurological conditions is escalating worldwide. Neurological disorders have significant disability-burden with long-term functional and psychosocial issues, requiring specialized rehabilitation services for comprehensive management, especially treatments tapping into brain recovery 'neuroplastic' processes. Neurorehabilitation is interdisciplinary and cross-sectorial, requiring coordinated effort of diverse sectors, professions, patients and community to manage complex condition-related disability. This review provides evidence for a range of neurorehabilitation interventions for four common neurological conditions: multiple sclerosis (MS), stroke, traumatic brain injury and Parkinson's disease using the Grade of Recommendation, Assessment, Development and Evaluation tool for quality of evidence. Although, existing best-evidence for many interventions is still sparse, the overall findings suggest 'strong' evidence for physical therapy and psychological intervention for improved patient outcomes; and. 'moderate' evidence for multidisciplinary rehabilitation for longer term gains at the levels of activity (disability) and participation in MS and stroke population. The effect of other rehabilitation interventions is inconclusive, due to a paucity of methodologically robust studies. More research is needed to improve evidence-base for many promising rehabilitation interventions.
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Affiliation(s)
- Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia.
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Mary P Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Roman Gonzenbach
- Department of Neurology and Neurorehabilitation, Rehabilitation Center, Valens, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Center, Valens, Switzerland
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11
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Abstract
Traumatic brain injury (TBI) may result in significant emotional and behavioral changes, such as depression, impulsivity, anxiety, aggressive behavior, and posttraumatic stress disorder. Apathy has been increasingly recognized as a relevant sequela of TBI, with a negative impact on the patients' quality of life as well as their participation in rehabilitation activities. This article reviews the nosologic and phenomenological aspects of apathy in TBI, diagnostic issues, frequency and prevalence, relevant comorbid conditions, potential mechanisms, and treatment.
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Affiliation(s)
- Sergio E Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Fremantle Hospital T-7, Fremantle, Western Australia 6959, Australia.
| | - Jaime Pahissa
- Department of Psychiatry, CEMIC University, Valdenegro 4337, Buenos Aires 1430, Argentina
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12
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Carroll C, Watson P, Spoudeas HA, Hawkins MM, Walker DA, Clare ICH, Holland AJ, Ring HA. Prevalence, associations, and predictors of apathy in adult survivors of infantile (<5 years of age) posterior fossa brain tumors. Neuro Oncol 2013; 15:497-505. [PMID: 23502428 DOI: 10.1093/neuonc/nos320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Apathy is associated with pervasive and disadvantageous effects on daily functioning. It has been observed transiently in some children after surgery for posterior fossa tumors. In this study, our objective was to examine prevalence, associations, and predictors of apathy in adult survivors of an infantile posterior fossa brain tumor (PFT). METHODS One hundred seventeen adult survivors of a childhood PFT diagnosed before age 5 years and 60 of their siblings were assessed in a cross-sectional study a mean of 32 years (range, 18-53 years) after survivors' initial tumor diagnoses, using the Marin Apathy Evaluation Scale (AES), the Weschler Abbreviated Scale of Intelligence and the Composite International Diagnostic Interview for psychiatric disorders. RESULTS Marin Apathy Evaluation Scale, the Weschler Abbreviated Scale of Intelligence reached or exceeded a criterion score for clinically significant apathy in 35% of survivors, compared with 18% in a sibling comparison group. In both siblings and survivors, apathy was associated with lower verbal and full-scale IQ and, among survivors, with having undergone partial rather than total tumor resection (independent of irradiation status). Apathy was not related to presence of concurrent International Classification of Diseases, 10(th) Revision, depression. Female sex was associated with late apathy after a PFT, with increased likelihood of women reaching the apathy criterion relative to men if they were survivors. CONCLUSIONS Clinically significant and potentially treatable apathy occurs relatively commonly in adult survivors of an infantile childhood PFT, particularly women. Clinicians, including those managing posterior fossa pathology in very young children, should be aware of this association, and future research should clarify whether specific treatment-related variables are implicated in increasing this risk of apathy.
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Affiliation(s)
- Cliodhna Carroll
- Cambridge Intellectual and Developmental Disability Research Group, University of Cambridge. Douglas House, 18b Trumpington Rd., Cambridge, CB2 8AH, UK
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13
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Starkstein SE, Tranel D. Neurological and psychiatric aspects of emotion. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:53-74. [PMID: 22608615 DOI: 10.1016/b978-0-444-52002-9.00004-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Neurological and psychiatric aspects of emotions have been the focus of intense research for the past 30 years. Studies in both acute (e.g., stroke, traumatic brain injury (TBI)) and chronic (e.g., dementia, Parkinson's disease) neurological disorders demonstrated a high frequency of both depression and apathy. Studies in stroke and TBI reported a significant association between lesion location and depression. Both depression and apathy are significant predictors of poor recovery among patients with brain injuries, and of steeper cognitive and functional decline among patients with neurodegenerative disorders. Poor insight and judgment are frequently found among patients with brain injury or degeneration. There is increasing evidence that damage to specific brain regions, such as the ventromedial prefrontal cortex, is associated with inappropriate emotional reactions in social contexts and diminished anxiety and concern for the future. In severe cases, behavioural changes may also include poor decision-making in the social realm, deficits in goal-directed behavior, and lack of insight into these changes. Future studies will validate specific diagnostic criteria for the various cognitive, emotional, and behavioral problems reported among patients with neurological disorders, which may result in more specific and effective treatments.
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Affiliation(s)
- Sergio E Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.
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14
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Dysthymia and apathy: diagnosis and treatment. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:893905. [PMID: 21747995 PMCID: PMC3130974 DOI: 10.1155/2011/893905] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 04/24/2011] [Indexed: 01/08/2023]
Abstract
Dysthymia is a depressive mood disorder characterized by chronic and persistent but mild depression. It is often difficult to be distinguished from major depression, specifically in its partially remitted state because "loss of interest" or "apathy" tends to prevail both in dysthymia, and remitted depression. Apathy may also occur in various psychiatric and neurological disorders, including schizophrenia, stroke, Parkinson's disease, progressive supranuclear palsy, Huntington's disease, and dementias such as Alzheimer's disease, vascular dementia, and frontotemporal dementia. It is symptomatologically important that apathy is related to, but different from, major depression from the viewpoint of its causes and treatment. Antidepressants, especially noradrenergic agents, are useful for depression-related apathy. However, selective serotonin reuptake inhibitors (SSRIs) may be less effective for apathy in depressed elderly patients and have even been reported to worsen apathy. Dopaminergic agonists seem to be effective for apathy. Acetylcholine esterase inhibitors, methylphenidate, atypical antipsychotics, nicergoline, and cilostazol are another choice. Medication choice should be determined according to the background and underlying etiology of the targeting disease.
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15
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Affiliation(s)
- Mary E Braine
- School of Nursing & Midwifery, University of Salford, Salford M6 6PU
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16
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Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment. Neurotox Res 2010; 19:266-78. [DOI: 10.1007/s12640-010-9196-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 04/28/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
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