1
|
Premnath PY, Locascio JJ, Mimmack KJ, Gonzalez C, Properzi MJ, Udeogu O, Rosenberg PB, Marshall GA, Gatchel JR. Longitudinal associations of apathy and regional tau in mild cognitive impairment and dementia: Findings from the Alzheimer's Disease Neuroimaging Initiative. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12442. [PMID: 38356477 PMCID: PMC10865481 DOI: 10.1002/trc2.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 02/16/2024]
Abstract
Introduction It is important to study apathy in Alzheimer's disease (AD) to better understand its underlying neurobiology and develop effective interventions. In the current study, we sought to examine the relationships between longitudinal apathy and regional tau burden in cognitively impaired older adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Methods Three hundred and nineteen ADNI participants with mild cognitive impairment (MCI) or AD dementia underwent flortaucipir (FTP) tau positron emission tomography (PET) imaging and clinical assessment with the Neuropsychiatric Inventory (NPI) annually. Longitudinal NPI Apathy (NPI-A) scores were examined in relation to baseline tau PET signal in three a priori selected regions implicated in AD and AD-related apathy (supramarginal gyrus, entorhinal cortex [EC] and rostral anterior cingulate cortex [rACC]). Secondary models were adjusted for global cognition (Mini-Mental State Examination score) and cortical amyloid (florbetapir PET). Results Higher baseline supramarginal gyrus and EC tau burden were each significantly associated with greater NPI-A over time, while rACC tau was associated with higher NPI-A but did not predict its trajectory over time. These results were retained for supramarginal and EC tau after adjusting models for global cognition and cortical amyloid. Discussion Our findings suggest that baseline in vivo tau burden in parietal and temporal brain regions affected in AD, and less so in a medial frontal region involved in motivational control, is associated with increasing apathy over time in older adults with MCI and AD dementia. Future work studying emergent apathy in relation to not only core AD pathology but also circuit level dysfunction may provide additional insight into the neurobiology of apathy in AD and opportunities for intervention. Highlights Tau (Flortaucipir PET) in regions implicated in AD was associated with increasing apathy over timeCortical amyloid was also found to be a robust predictor of the trajectory of apathyEvidence of synergy between regional tau and amyloid in overall higher levels of apathy.
Collapse
Affiliation(s)
- Pranitha Y. Premnath
- Department of PsychologyThe Graduate Center, City University of New YorkNew YorkNew YorkUSA
| | - Joseph J. Locascio
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Kayden J. Mimmack
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | | | - Michael J. Properzi
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
- Department of NeurologyAthinoula A. Martinos Center for Biomedical ImagingCharlestownMassachusettsUSA
| | - Onyinye Udeogu
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Gad A. Marshall
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
- Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyBrigham and Women's HospitalBostonMassachusettsUSA
- Center for Alzheimer Research and TreatmentBrigham and Women's HospitalBostonMassachusettsUSA
| | - Jennifer R. Gatchel
- Division of Geriatric PsychiatryMcLean HospitalBelmontMassachusettsUSA
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
- Department of Veterans AffairsMichael E. DeBakey VA Medical CenterHoustonTexasUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | | |
Collapse
|
2
|
Dolphin H, Dyer AH, McHale C, O'Dowd S, Kennelly SP. An Update on Apathy in Alzheimer's Disease. Geriatrics (Basel) 2023; 8:75. [PMID: 37489323 PMCID: PMC10366907 DOI: 10.3390/geriatrics8040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Apathy is a complex multi-dimensional syndrome that affects up to 70% of individuals with Alzheimer's disease (AD). Whilst many frameworks to define apathy in AD exist, most include loss of motivation or goal-directed behaviour as the central feature. Apathy is associated with significant impact on persons living with AD and their caregivers and is also associated with accelerated cognitive decline across the AD spectrum. Neuroimaging studies have highlighted a key role of fronto-striatial circuitry including the anterior cingulate cortex (ACC), orbito-frontal cortex (OFC) and associated subcortical structures. Importantly, the presence and severity of apathy strongly correlates with AD stage and neuropathological biomarkers of amyloid and tau pathology. Following from neurochemistry studies demonstrating a central role of biogenic amine neurotransmission in apathy syndrome in AD, recent clinical trial data suggest that apathy symptoms may improve following treatment with agents such as methylphenidate-which may have an important role alongside emerging non-pharmacological treatment strategies. Here, we review the diagnostic criteria, rating scales, prevalence, and risk factors for apathy in AD. The underlying neurobiology, neuropsychology and associated neuroimaging findings are reviewed in detail. Finally, we discuss current treatment approaches and strategies aimed at targeting apathy syndrome in AD, highlighting areas for future research and clinical trials in patient cohorts.
Collapse
Affiliation(s)
- Helena Dolphin
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
| | - Adam H Dyer
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
| | - Cathy McHale
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
| | - Sean O'Dowd
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Neurology, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Academic Unit of Neurology, Trinity College Dublin, D02R590 Dublin, Ireland
| | - Sean P Kennelly
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
| |
Collapse
|
3
|
Yan H, Wu H, Cai Z, Du S, Li L, Xu B, Chang C, Wang N. The neural correlates of apathy in the context of aging and brain disorders: a meta-analysis of neuroimaging studies. Front Aging Neurosci 2023; 15:1181558. [PMID: 37396666 PMCID: PMC10311641 DOI: 10.3389/fnagi.2023.1181558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Apathy is a prevalent mood disturbance that occurs in a wide range of populations, including those with normal cognitive aging, mental disorders, neurodegenerative disorders and traumatic brain injuries. Recently, neuroimaging technologies have been employed to elucidate the neural substrates underlying brain disorders accompanying apathy. However, the consistent neural correlates of apathy across normal aging and brain disorders are still unclear. Methods This paper first provides a brief review of the neural mechanism of apathy in healthy elderly individuals, those with mental disorders, neurodegenerative disorders, and traumatic brain injuries. Further, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, the structural and functional neuroimaging meta-analysis using activation likelihood estimation method is performed on the apathy group with brain disorders and the healthy elderly, aiming at exploring the neural correlates of apathy. Results The structural neuroimaging meta-analysis showed that gray matter atrophy is associated with apathy in the bilateral precentral gyrus (BA 13/6), bilateral insula (BA 47), bilateral medial frontal gyrus (BA 11), bilateral inferior frontal gyrus, left caudate (putamen) and right anterior cingulate, while the functional neuroimaging meta-analysis suggested that the functional connectivity in putamen and lateral globus pallidus is correlated with apathy. Discussion Through the neuroimaging meta-analysis, this study has identified the potential neural locations of apathy in terms of brain structure and function, which may offer valuable pathophysiological insights for developing more effective therapeutic interventions for affected patients.
Collapse
Affiliation(s)
- Hongjie Yan
- Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Huijun Wu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zenglin Cai
- Department of Neurology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
- Department of Neurology, Gusu School, Suzhou Science and Technology Town Hospital, Nanjing Medical University, Suzhou, China
| | - Shouyun Du
- Department of Neurology, Guanyun People’s Hospital, Guanyun, China
| | - Lejun Li
- Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Bingchao Xu
- Department of Neurology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Chunqi Chang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- Pengcheng Laboratory, Shenzhen, China
| | - Nizhuan Wang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| |
Collapse
|
4
|
Mehak SF, Shivakumar AB, Saraf V, Johansson M, Gangadharan G. Apathy in Alzheimer's disease: A neurocircuitry based perspective. Ageing Res Rev 2023; 87:101891. [PMID: 36871779 DOI: 10.1016/j.arr.2023.101891] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In addition to memory deficits and other cognitive disturbances, patients with Alzheimer's disease (AD) experience neuropsychiatric symptoms, notably apathy, which is a state of impaired motivation observed by deficits in goal directed behavior. Apathy is a multifaceted neuropsychiatric condition and appears to be a prognostic indicator, correlating with the progression of AD. Strikingly, recent studies point out that the neurodegenerative pathology of AD may drive apathy independent of cognitive decline. These studies also highlight that neuropsychiatric symptoms, in particular apathy, might manifest early in AD. Here, we review the current understanding of the neurobiological underpinnings of apathy as a neuropsychiatric symptom of AD. Specifically, we highlight the neural circuits and brain regions recognized to be correlated with the apathetic symptomatology. We also discuss the current evidence that supports the notion that apathy and cognitive deficits may develop as independent but concurrent phenomena driven by AD pathology, suggesting its efficacy as an additional outcome measure in Alzheimer's disease clinical trials. The current and prospective therapeutic interventions for apathy in AD from a neurocircuitry based perspective are also reviewed.
Collapse
Affiliation(s)
- Sonam Fathima Mehak
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Apoorva Bettagere Shivakumar
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Vikyath Saraf
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Maurits Johansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, SUS, Sweden; Division of Clinical Sciences, Helsingborg, Department of Clinical Sciences Lund, Lund University, Sweden; Department of Psychiatry, Helsingborg Hospital, Sweden.
| | - Gireesh Gangadharan
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| |
Collapse
|
5
|
Bogdan A, Fabre R, Desmidt T, Golebiowski J, Topin J, Bethus I, Hanon O, Boutoleau-Bretonniere C, Wagemann N, Annweiler C, Ousset PJ, Godefroy O, Rouch I, Paccalin M, Sukhorukova M, Gabelle A, Robert G, David R. Different Trajectories of Apathy and Depression Among Subjective Cognitive Impairment Individuals with or without Conversion to Dementia: Results from the Memento Cohort in France. J Alzheimers Dis 2023; 95:415-426. [PMID: 37545236 DOI: 10.3233/jad-230162] [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] [Indexed: 08/08/2023]
Abstract
BACKGROUND Apathy and depression are two early behavioral symptoms in Alzheimer's disease (AD) and related disorders that often occur prior to the onset of cognitive decline and memory disturbances. Both have been associated with an increased risk of conversion to dementia, with a distinct neuropathology. OBJECTIVE The assessment of the trajectories of apathy and depression and their independent impact on dementia conversion. METHODS Apathy and Depression were measured using the Neuropsychiatric Inventory for caregiver (NPI) and clinician (NPI-C), among the nondemented individuals reporting subjective cognitive decline (SCD) at baseline. They were followed up over a 60-month period. Some converted to dementia, according to the methodology carried out by the French Memento Cohort. RESULTS Among individuals with SCD (n = 2,323), the levels of apathy and depression were low and did not evolve significantly over the 60-month period, despite a trend in apathy increasing as of month 24. Regarding SCD individuals who converted to dementia within the 60-month period (n = 27), the prevalence of depression remained globally steady, while the levels of apathy increased over time. CONCLUSION Apathy and depression have different trajectories among individuals with SCD and apathy alone is more likely-compared to depression-to be associated with conversion to dementia.
Collapse
Affiliation(s)
- Anamaria Bogdan
- Cote d'Azur University, Nice University Hospital, Department of Old Age Psychiatry, Nice, France
| | - Roxane Fabre
- Nice University Hospital, Department of Public Health, Nice, France
| | | | | | - Jérémie Topin
- Côte D'Azur University, Chemistry Institute of Nice, France
| | - Ingrid Bethus
- Côte d'Azur University, IPMC (Institut de Pharmacologie Moléculaire et cellulaire), Sophia Antipolis, France
| | - Olivier Hanon
- Université Paris Cité - EA4468 APHP-Hôpitaux Universitaires Paris Centre - Service de Gériatrie- hôpital Broca, Paris, France
| | | | | | | | - Pierre-Jean Ousset
- Toulouse Clinical Research Center, Toulouse University Hospital, Toulouse, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Isabelle Rouch
- Memory Clinic (CMRR) Saint Etienne, INSERM U1219, Bordeaux, France
| | - Marc Paccalin
- Department of Geriatry, Memory Clinic (CMRR), CIC U1402, Poitiers University Hospital, Poitiers, France
| | | | - Audrey Gabelle
- Memory Clinic (CMRR), Montpellier University Hospital, Montpellier, France
| | | | - Renaud David
- Cote d'Azur University, Nice University Hospital, Department of Old Age Psychiatry, Nice, France
- NICE BRAIN non-profitorganization for research on brain, Nice, France
| |
Collapse
|
6
|
Steffens DC, Fahed M, Manning KJ, Wang L. The neurobiology of apathy in depression and neurocognitive impairment in older adults: a review of epidemiological, clinical, neuropsychological and biological research. Transl Psychiatry 2022; 12:525. [PMID: 36572691 PMCID: PMC9792580 DOI: 10.1038/s41398-022-02292-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022] Open
Abstract
Apathy is a common condition that involves diminished initiative, diminished interest and diminished emotional expression or responsiveness. It is highly prevalent in the context of a variety of neuropsychiatric disorders and is related to poor health outcomes. Presence of apathy is associated with cognitive and functional decline in dementia. Despite its negative impact on health, there is no definitive treatment for apathy, a clinical reality that may be due in part to lack of knowledge about assessment, neuropsychological features and neurobiological underpinnings. Here, we review and synthesize evidence from clinical, epidemiological, neuropsychological, peripheral biomarker and neuroimaging research. Apathy is a common feature of depression and cognitive disorders and is associated with impairment in executive function. Neuropsychological and neuroimaging studies point to dysfunction of brain circuitry involving the prefrontal cortex, especially the dorsolateral prefrontal cortex circuit, the dorsomedial prefrontal cortex circuit, and the ventromedial prefrontal cortex circuit. However, inconsistent findings, particularly in neuroimaging may be due to heterogeneity of apathy symptoms (with a need to better elucidate subtypes), neuropsychiatric comorbidities, the severity of cognitive impairment and other factors. These factors need to be accounted for in future studies so that biomarker research can make progress. On the whole, the literature on apathy has identified likely neurocognitive, peripheral biomarker and neuroimaging targets for understanding apathy, but also points to the need to address methodological issues that will better inform future studies. In turn, as we learn more about the underpinning of apathy and its subtypes, subsequent research can focus on new neurally based interventions that will strengthen the clinical management of apathy in the context of its comorbidities.
Collapse
Affiliation(s)
- David C Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Mario Fahed
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Kevin J Manning
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| |
Collapse
|
7
|
Manca R, Jones SA, Venneri A. Macrostructural and Microstructural White Matter Alterations Are Associated with Apathy across the Clinical Alzheimer's Disease Spectrum. Brain Sci 2022; 12:1383. [PMID: 36291317 PMCID: PMC9599811 DOI: 10.3390/brainsci12101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/30/2022] Open
Abstract
Apathy is the commonest neuropsychiatric symptom in Alzheimer's disease (AD). Previous findings suggest that apathy is caused by a communication breakdown between functional neural networks involved in motivational-affective processing. This study investigated the relationship between white matter (WM) damage and apathy in AD. Sixty-one patients with apathy (AP-PT) and 61 without apathy (NA-PT) were identified from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database and matched for cognitive status, age and education. Sixty-one cognitively unimpaired (CU) participants were also included as controls. Data on cognitive performance, cerebrospinal fluid biomarkers, brain/WM hyperintensity volumes and diffusion tensor imaging indices were compared across groups. No neurocognitive differences were found between patient groups, but the AP-PT group had more severe neuropsychiatric symptoms. Compared with CU participants, only apathetic patients had deficits on the Clock Drawing Test. AP-PT had increased WM damage, both macrostructurally, i.e., larger WM hyperintensity volume, and microstructurally, i.e., increased radial/axial diffusivity and reduced fractional anisotropy in the fornix, cingulum, anterior thalamic radiations and superior longitudinal and uncinate fasciculi. AP-PT showed signs of extensive WM damage, especially in associative tracts in the frontal lobes, fornix and cingulum. Disruption in structural connectivity might affect crucial functional inter-network communication, resulting in motivational deficits and worse cognitive decline.
Collapse
Affiliation(s)
- Riccardo Manca
- Department of Life Sciences, Brunel University London, Uxbridge UB8 3BH, UK
| | - Sarah A. Jones
- Rotherham Doncaster and South Humber NHS Foundation Trust, Rotherham DN4 8QN, UK
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, Uxbridge UB8 3BH, UK
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| |
Collapse
|
8
|
Valotassiou V, Sifakis N, Tzavara C, Lykou E, Tsinia N, Kamtsadeli V, Sali D, Angelidis G, Psimadas D, Tsougos I, Papageorgiou SG, Georgoulias P, Papatriantafyllou J. Differences of apathy perfusion correlates between Alzheimer's disease and frontotemporal dementia. A 99mTc-HMPAO SPECT study with automated Brodmann areas analysis. Int J Psychiatry Clin Pract 2022; 26:14-22. [PMID: 33207961 DOI: 10.1080/13651501.2020.1846752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To explore differences of apathy perfusion correlates between Alzheimer's disease (AD) and Frontotemporal dementia (FTD) using perfusion SPECT. METHODS We studied 75 FTD and 66 AD patients. We evaluated apathy using Neuropsychiatric Inventory (NPI). We compared perfusion of BAs on left (L) and right (R) hemisphere in AD and FTD. RESULTS Apathy in AD was significantly and negatively correlated with dorsolateral prefrontal cortex bilaterally, right anterior prefrontal cortex, inferior frontal cortex bilaterally, especially on the right, orbital part of inferior frontal gyrus bilaterally, left dorsal anterior cingulate cortex, right primary and secondary visual cortex, and with bilateral anterior and dorsolateral prefrontal cortex, inferior frontal cortex and orbital part of inferior frontal gyrus, bilaterally, bilateral anterior -ventral and dorsal- cingulate cortex, left posterior ventral cingulate cortex, right inferior, middle and anterior temporal gyri, entorhinal and parahippocampal cortex in FTD. CONCLUSIONS Significant overlapping of apathy perfusion correlates between AD and FTD is seen in frontal areas and anterior cingulate. Right occipital cortex is also involved in AD, while right temporal cortex and left posterior cingulate are involved in FTD. Nuclear imaging could be a useful biomarker for revealing apathy underlying mechanisms, resulting in directed treatments.KEYPOINTSUnderlying neural networks and clinical manifestation of apathy may differ between AD and FTD.Apathy in AD is correlated with hypoperfusion in bilateral frontal areas, more prominent on the right, left anterior cingulate and right occipital cortex.Apathy in FTD is correlated with hypoperfusion in bilateral frontal areas, bilateral anterior cingulate, left posterior cingulate and right temporal cortex.Brain perfusion SPECT with automated BAs analysis and comparison with normal healthy subjects may provide significant information for apathy mechanisms in neurodegenerative disorders, affecting patients' treatment.
Collapse
Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Nikolaos Sifakis
- Nuclear Medicine Department, "Alexandra" General Hospital, Athens, Greece
| | - Chara Tzavara
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Evi Lykou
- 3rd Age Day Care Center, IASIS, Athens, Greece
| | - Niki Tsinia
- 1st University Psychiatric Department, Aeginition Hospital, Athens, Greece
| | | | - Dimitra Sali
- Neurology Department, Evrokliniki, Athens, Greece
| | - George Angelidis
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Dimitrios Psimadas
- Nuclear Medicine Department, University Hospital of Larissa, Thessaly, Greece
| | - Ioannis Tsougos
- Medical Physics Department, Medical School, University of Thessaly, Thessaly, Greece
| | | | | | - John Papatriantafyllou
- 3rd Age Day Care Center, IASIS, Athens, Greece.,Memory Disorders Clinic, Medical Center, Athens, Greece
| |
Collapse
|
9
|
Altunkaya S, Huang SM, Hsu YH, Yang JJ, Lin CY, Kuo LW, Tu MC. Dissociable Functional Brain Networks Associated With Apathy in Subcortical Ischemic Vascular Disease and Alzheimer’s Disease. Front Aging Neurosci 2022; 13:717037. [PMID: 35185511 PMCID: PMC8851472 DOI: 10.3389/fnagi.2021.717037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023] Open
Abstract
Few studies have investigated differences in functional connectivity (FC) between patients with subcortical ischemic vascular disease (SIVD) and Alzheimer’s disease (AD), especially in relation to apathy. Therefore, the aim of this study was to compare apathy-related FC changes among patients with SIVD, AD, and cognitively normal subjects. The SIVD group had the highest level of apathy as measured using the Apathy Evaluation Scale-clinician version (AES). Dementia staging, volume of white matter hyperintensities (WMH), and the Beck Depression Inventory were the most significant clinical predictors for apathy. Group-wise comparisons revealed that the SIVD patients had the worst level of “Initiation” by factor analysis of the AES. FCs from four resting state networks (RSNs) were compared, and the connectograms at the level of intra- and inter-RSNs revealed dissociable FC changes, shared FC in the dorsal attention network, and distinct FC in the salient network across SIVD and AD. Neuronal correlates for “Initiation” deficits that underlie apathy were explored through a regional-specific approach, which showed that the right inferior frontal gyrus, left middle frontal gyrus, and left anterior insula were the critical hubs. These findings broaden the disconnection theory by considering the effect of FC interactions across multiple RSNs on apathy formation.
Collapse
Affiliation(s)
- Sabri Altunkaya
- Department of Electrical and Electronics Engineering, Necmettin Erbakan University, Konya, Turkey
| | - Sheng-Min Huang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chaiyi, Taiwan
| | - Jir-Jei Yang
- Department of Radiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chien-Yuan Lin
- GE Healthcare, GE Medical Systems Taiwan, Ltd., Taipei, Taiwan
| | - Li-Wei Kuo
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli, Taiwan
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
- *Correspondence: Min-Chien Tu,
| |
Collapse
|
10
|
Quantitative susceptibility mapping reveals brain iron deficiency in children with attention-deficit/hyperactivity disorder: a whole-brain analysis. Eur Radiol 2022; 32:3726-3733. [DOI: 10.1007/s00330-021-08516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
|
11
|
Chaudhary S, Zhornitsky S, Chao HH, van Dyck CH, Li CSR. Cerebral Volumetric Correlates of Apathy in Alzheimer's Disease and Cognitively Normal Older Adults: Meta-Analysis, Label-Based Review, and Study of an Independent Cohort. J Alzheimers Dis 2022; 85:1251-1265. [PMID: 34924392 PMCID: PMC9215906 DOI: 10.3233/jad-215316] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Affecting nearly half of the patients with Alzheimer's disease (AD), apathy is associated with higher morbidity and reduced quality of life. Basal ganglia and cortical atrophy have been implicated in apathy. However, the findings have varied across studies and left unclear whether subdomains of apathy may involve distinct neuroanatomical correlates. OBJECTIVE To identify neuroanatomical correlates of AD-associated apathy. METHODS We performed a meta-analysis and label-based review of the literature. Further, following published routines of voxel-based morphometry, we aimed to confirm the findings in an independent cohort of 19 patients with AD/mild cognitive impairment and 25 healthy controls assessed with the Apathy Evaluation Scale. RESULTS Meta-analysis of 167 AD and 56 healthy controls showed convergence toward smaller basal ganglia gray matter volume (GMV) in apathy. Label-based review showed anterior cingulate, putamen, insula, inferior frontal gyrus (IFG) and middle temporal gyrus (MTG) atrophy in AD apathy. In the independent cohort, with small-volume-correction, right putamen and MTG showed GMVs in negative correlation with Apathy Evaluation Scale total, behavioral, and emotional scores, and right IFG with emotional score (p < 0.05 family-wise error (FWE)-corrected), controlling for age, education, intracranial volume, and depression. With the Mini-Mental State Examination scores included as an additional covariate, the correlation of right putamen GMV with behavioral and emotional score, right MTG GMV with total and emotional score, and right IFG GMV with emotional score were significant. CONCLUSION The findings implicate putamen, MTG and IFG atrophy in AD associated apathy, potentially independent of cognitive impairment and depression, and suggest potentially distinct volumetric correlates of apathy.
Collapse
Affiliation(s)
- Shefali Chaudhary
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Herta H Chao
- Comprehensive Cancer Center, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Cancer Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher H van Dyck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| |
Collapse
|
12
|
Chen Y, Dang M, Zhang Z. Brain mechanisms underlying neuropsychiatric symptoms in Alzheimer's disease: a systematic review of symptom-general and -specific lesion patterns. Mol Neurodegener 2021; 16:38. [PMID: 34099005 PMCID: PMC8186099 DOI: 10.1186/s13024-021-00456-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022] Open
Abstract
Neuropsychiatric symptoms (NPSs) are common in patients with Alzheimer's disease (AD) and are associated with accelerated cognitive impairment and earlier deaths. This review aims to explore the neural pathogenesis of NPSs in AD and its association with the progression of AD. We first provide a literature overview on the onset times of NPSs. Different NPSs occur in different disease stages of AD, but most symptoms appear in the preclinical AD or mild cognitive impairment stage and develop progressively. Next, we describe symptom-general and -specific patterns of brain lesions. Generally, the anterior cingulate cortex is a commonly damaged region across all symptoms, and the prefrontal cortex, especially the orbitofrontal cortex, is also a critical region associated with most NPSs. In contrast, the anterior cingulate-subcortical circuit is specifically related to apathy in AD, the frontal-limbic circuit is related to depression, and the amygdala circuit is related to anxiety. Finally, we elucidate the associations between the NPSs and AD by combining the onset time with the neural basis of NPSs.
Collapse
Affiliation(s)
- Yaojing Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
- BABRI Centre, Beijing Normal University, Beijing, 100875 China
| | - Mingxi Dang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
- BABRI Centre, Beijing Normal University, Beijing, 100875 China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
- BABRI Centre, Beijing Normal University, Beijing, 100875 China
| |
Collapse
|
13
|
Fahed M, Steffens DC. Apathy: Neurobiology, Assessment and Treatment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2021; 19:181-189. [PMID: 33888648 PMCID: PMC8077060 DOI: 10.9758/cpn.2021.19.2.181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/22/2022]
Abstract
Apathy is a highly prevalent, disabling and treatment resistant syndrome. It is defined as a quantitative reduction of goal- directed activity in comparison to the patient’s previous level of in multiple dimensions including behavior/cognition, emotion and social interaction. It has been described in major depressive disorder, Alzheimer’s disease, frontotemporal dementia, Parkinson’s Disease, cerebrovascular disease, and vascular dementia, among others. This review will address the neuropsychology and associated neurobiological underpinnings of apathy in the above conditions, identify specific methods to assess apathy clinically, and review the literature on managing apathy across these various disorders.
Collapse
Affiliation(s)
- Mario Fahed
- Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT, USA
| | - David C Steffens
- Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT, USA
| |
Collapse
|
14
|
Savarraj JPJ, Kitagawa R, Kim DH, Choi HA. White matter connectivity for early prediction of Alzheimer's disease. Technol Health Care 2021; 30:17-28. [PMID: 33998562 DOI: 10.3233/thc-192012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early diagnosis of Alzheimer's disease (AD) remains challenging. It is speculated that structural atrophy in white matter tracts commences prior to the onset of AD symptoms. OBJECTIVE We hypothesize that disruptions in white matter tract connectivity precedes the onset of AD symptoms and these disruptions could be leveraged for early prediction of AD. METHODS Diffusion tensor images (DTI) from 52 subjects with mild cognitive impairment (MCI) were selected. Subjects were dichotomized into two age and gender matched groups; the MCI-AD group (22 subjects who progressed to develop AD) and the MCI-control group (who did not develop AD). DTI images were anatomically parcellated into 90 distinct regions ROIs followed by tractography methods to obtain different biophysical networks. Features extracted from these networks were used to train predictive algorithms with the objective of discriminating the MCI-AD and MCI-control groups. Model performance and best features are reported. RESULTS Up to 80% prediction accuracy was achieved using a combination of features from the 'right anterior cingulum' and 'right frontal superior medial'. Additionally, local network features were more useful than global in improving the model's performance. CONCLUSION Connectivity-based characterization of white matter tracts offers potential for early detection of MCI-AD and in the discovery of novel imaging biomarkers.
Collapse
|
15
|
Büyükgök D, Bayraktaroğlu Z, Buker HS, Kulaksızoğlu MIB, Gurvit İH. Resting-state fMRI analysis in apathetic Alzheimer's disease. ACTA ACUST UNITED AC 2021; 26:363-369. [PMID: 32490831 DOI: 10.5152/dir.2019.19445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Diagnosis of comorbid psychiatric conditions are a significant determinant for the prognosis of neurodegenerative diseases. Apathy, which is a behavioral executive dysfunction, frequently accompanies Alzheimer's disease (AD) and leads to higher daily functional loss. We assume that frontal lobe hypofunction in apathetic AD patients are more apparent than the AD patients without apathy. This study aims to address the neuroanatomical correlates of apathy in the early stage of AD using task-free functional magnetic resonance imaging (MRI). METHODS Patients (n=20) were recruited from the Neurology and Psychiatry Departments of İstanbul University, İstanbul School of Medicine whose first referrals were 6- to 12-month history of progressive cognitive decline. Patients with clinical dementia rating 0.5 and 1 were included in the study. The patient group was divided into two subgroups as apathetic and non-apathetic AD according to their psychiatric examination and assessment scores. A healthy control group was also included (n=10). All subjects underwent structural and functional MRI. The resting-state condition was recorded eyes open for 5 minutes. RESULTS The difference between the three groups came up in the pregenual anterior cingulate cortex (pgACC) at the trend level (P = 0.056). Apathetic AD group showed the most constricted activation area at pgACC. CONCLUSION The region in and around anterior default mode network (pgACC) seems to mediate motivation to initiate behavior, and this function appears to weaken as the apathy becomes more severe in AD.
Collapse
Affiliation(s)
- Deniz Büyükgök
- Department of Psychiatry, Geriatric Psychiatry Unit, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Zübeyir Bayraktaroğlu
- Department of Physiology, İstanbul Medipol University International School of Medicine, İstanbul, Turkey;Regenerative and Restorative Medicine Research Center (REMER), Istanbul University, İstanbul, Turkey
| | - H Seda Buker
- Department of Neurology, Behavioral Neurology and Movement Disorders Unit, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - M Işın Baral Kulaksızoğlu
- Department of Psychiatry, Geriatric Psychiatry Unit, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - İ Hakan Gurvit
- Department of Neurology, Behavioral Neurology and Movement Disorders Unit, İstanbul University İstanbul School of Medicine, İstanbul, Turkey;Hulusi Behcet Life Sciences Laboratory, Istanbul University, İstanbul, Turkey
| |
Collapse
|
16
|
Chan NK, Gerretsen P, Chakravarty MM, Blumberger DM, Caravaggio F, Brown E, Graff-Guerrero A. Structural Brain Differences Between Cognitively Impaired Patients With and Without Apathy. Am J Geriatr Psychiatry 2021; 29:319-332. [PMID: 33423870 DOI: 10.1016/j.jagp.2020.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 11/21/2020] [Accepted: 12/06/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Since apathy increases in prevalence with severity of dementia pathology, we sought to distinguish concomitant neurodegenerative processes from brain differences associated with apathy in persons with mild cognitive impairment (MCI) and Alzheimer's Disease (AD). We examined relative structural brain differences between case-control matched cognitively impaired patients with and without apathy. DESIGN Cross-sectional case-control study. SETTING Fifty-eight clinical sites in phase 2 of the AD Neuroimaging Initiative across the United States and Canada. PARTICIPANTS The ≥ 55 years of age with MCI or AD dementia and no major neurological disorders aside from suspected incipient AD dementia. Participants with apathy (n=69) were age-, sex-, apolipoprotein E ε4 allele carrier status-, Mini-Mental State Exam score-, and MCI or AD dementia diagnosis-matched to participants without apathy (n=149). INTERVENTIONS The 3-tesla T1-weighted MRI scan and neurocognitive assessments. Using the Neuropsychiatric Inventory apathy domain scores, participants were dichotomized into a with-apathy group (score ≥ 1) and a without-apathy group (score = 0). MEASUREMENTS Cortical thicknesses from 24 a priori regions of interest involved in frontostriatal circuits and frontotemporal association areas. RESULTS False-discovery rate adjusted within-group comparisons between participants with apathy and participants without apathy showed thinner right medial orbitofrontal (mOFC; meandifference(MD)±standarderrorofMD(SE)=-0.0879±0.0257mm; standardizedMD(d)=-0.4456) and left rostral anterior cingulate (rACC; MD±SE=-0.0905±0.0325mm; d=-0.3574) cortices and thicker left middle temporal cortices (MTC; MD±SE=0.0688±0.0239mm; d=0.3311) in those with apathy. CONCLUSION Atrophy of the right mOFC and left rACC and sparing of atrophy in the left MTC are associated with apathy in cognitively impaired persons.
Collapse
Affiliation(s)
- Nathan K Chan
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - M Mallar Chakravarty
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | | | - Eric Brown
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
17
|
Kesserwani H. Apathy Antedating and Evolving With Dementia: A Case Report and Insights Into Apathy as a Network Dysfunction. Cureus 2021; 13:e13802. [PMID: 33850671 PMCID: PMC8034504 DOI: 10.7759/cureus.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Apathy is a motivational disorder characterized by a lack of drive or indifference to salient endogenous or exogenous influences or stimuli. In the classical literature, it was referred to as a lack of mental energy or vitality and attributed to dysfunction of the ergotropic sympathetic pathway involving the posterior hypothalamus, thalamus, cingulate cortex, and hippocampal formation. Recent advanced imaging studies have expanded the ambit of network dysfunction to include the dopaminergic mesolimbic system and the salience network that gauges the valence or energy of the mesolimbic system. The classic Papez circuit also has a role in the pathogenesis of apathy. In order to understand the mechanisms of apathy seen with a wide range of diseases including neurodegenerative disorders, trauma, and strokes, one needs to think of apathy as a network disorder. In this report, we present a case of apathy antedating and evolving with Alzheimer’s disease and delve into the network theory of apathy and explore potential pharmacological therapies.
Collapse
|
18
|
Setiadi TM, Martens S, Opmeer EM, Marsman JBC, Tumati S, Reesink FE, De Deyn PP, Aleman A, Ćurčić-Blake B. Widespread white matter aberration is associated with the severity of apathy in amnestic Mild Cognitive Impairment: Tract-based spatial statistics analysis. NEUROIMAGE-CLINICAL 2021; 29:102567. [PMID: 33545500 PMCID: PMC7856325 DOI: 10.1016/j.nicl.2021.102567] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
In aMCI, apathy severity was associated with lower FA in widespread WM pathways. WM aberrations are related to apathy severity after controlling for depression. Disruptions related to apathy severity are not limited to frontal-subcortical area.
Apathy is recognized as a prevalent behavioral symptom of amnestic Mild Cognitive Impairment (aMCI). In aMCI, apathy is associated with an increased risk and increases the risk of progression to Alzheimer’s Disease (AD). Previous DTI study in aMCI showed that apathy has been associated with white matter alterations in the cingulum, middle and inferior longitudinal fasciculus, fornix, and uncinate fasciculus. However, the underlying white matter correlates associated with apathy in aMCI are still unclear. We investigated this relationship using whole-brain diffusion tensor imaging (DTI). Twenty-nine aMCI patients and 20 matched cognitively healthy controls were included. Apathy severity was assessed using the Apathy Evaluation Scale Clinician version. We applied the tract-based spatial statistics analyses to DTI parameters: fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity to investigate changes in white matter pathways associated with the severity of apathy. No significant difference was found in any of the DTI parameters between aMCI and the control group. In aMCI, higher severity of apathy was associated with lower FA in various white matter pathways including the left anterior part of inferior fronto-occipital fasciculus/uncinate fasciculus, genu and body of the corpus callosum, superior and anterior corona radiata, anterior thalamic radiation of both hemispheres and in the right superior longitudinal fasciculus/anterior segment of arcuate fasciculus (p < .05, TFCE-corrected) after controlling for age, gender and GDS non-apathy. A trend association was observed in the right posterior corona radiata and corticospinal tract/internal capsule, and bilateral forceps minor (p < .065, TFCE-corrected). In conclusion, in aMCI, severity of apathy is associated with aberrant white matter integrity in widely distributed pathways, within and between hemispheres.
Collapse
Affiliation(s)
- Tania M Setiadi
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Sander Martens
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Esther M Opmeer
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Health and Welfare, Windesheim University of Applied Science, Zwolle, The Netherlands
| | - Jan-Bernard C Marsman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shankar Tumati
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Sunnybrook Research Institute and University of Toronto, Toronto, ON, Canada
| | - Fransje E Reesink
- Department of Neurology, Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter P De Deyn
- Department of Neurology, Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Branislava Ćurčić-Blake
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells & Systems, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
19
|
Pimontel MA, Kanellopoulos D, Gunning FM. Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review. J Geriatr Psychiatry Neurol 2020; 33:289-303. [PMID: 31635522 DOI: 10.1177/0891988719882100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. METHOD Systematic literature review. RESULTS The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. CONCLUSIONS Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.
Collapse
Affiliation(s)
- Monique A Pimontel
- Graduate Center, City University of New York, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
20
|
Abstract
Developing disease-modifying treatments for Alzheimer dementia requires innovative approaches to identify novel biological targets during the course of the disease. Treatment development for the neuropsychiatric symptoms of Alzheimer may benefit from a mechanistic approach to treatment. There has been progress in identifying mild forms of behavioral impairment along the Alzheimer spectrum that may lead to additional insights into progression to dementia as well as the fundamental mechanisms of the symptoms. Developing therapies for complex neurobehavioral syndromes may require the translation of mechanistic insights into therapy, which may both improve the symptoms and delay progression to dementia in certain patients.
Collapse
Affiliation(s)
- Milap A Nowrangi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
21
|
Marshall GA, Gatchel JR, Donovan NJ, Muniz MC, Schultz AP, Becker JA, Chhatwal JP, Hanseeuw BJ, Papp KV, Amariglio RE, Rentz DM, Sperling RA, Johnson KA. Regional Tau Correlates of Instrumental Activities of Daily Living and Apathy in Mild Cognitive Impairment and Alzheimer's Disease Dementia. J Alzheimers Dis 2020; 67:757-768. [PMID: 30689584 DOI: 10.3233/jad-170578] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Instrumental activities of daily living (IADL) impairment and apathy occur in early-stage Alzheimer's disease (AD) and are associated with regional atrophy and hypometabolism in vivo and greater tau burden at autopsy. OBJECTIVE To explore the association between IADL impairment, apathy, and in vivo regional tau in mild cognitive impairment (MCI) and AD dementia. METHODS Forty participants (24 MCI, 16 AD dementia) underwent assessments of IADL (Functional Activities Questionnaire, FAQ) and apathy (Apathy Evaluation Scale Informant report, AES-I). Regional tau was assessed using flortaucipir positron emission tomography (PET) and amyloid using Pittsburgh Compound B PET. Regions with unadjusted associations of p≤0.01 were entered into regression models assessing the relationship between tau and FAQ or AES-I, adjusting for age, sex, and cognition, with/without a tau by amyloid interaction. RESULTS Unadjusted IADL impairment but not apathy was associated with greater tau in multiple regions. After adjusting for covariates, for medial orbitofrontal and entorhinal cortex the interaction between tau and amyloid was associated with IADL impairment and for anterior cingulate it was not but independent associations with both tau and amyloid were retained. With whole brain analyses, similar results were seen for IADL, while for apathy tau in small clusters within the right anterior cingulate and dorsolateral prefrontal cortices were seen, which were more pronounced in individuals with greater amyloid. CONCLUSIONS This exploratory study suggests that IADL impairment in AD is associated with medial temporal and frontal tau, especially in individuals with elevated amyloid, while apathy may be associated with right frontal tau.
Collapse
Affiliation(s)
- Gad A Marshall
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Gatchel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Nancy J Donovan
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha C Muniz
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Alex Becker
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bernard J Hanseeuw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Cliniques Universitaires Saint-Luc, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium
| | - Kathryn V Papp
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca E Amariglio
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dorene M Rentz
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
22
|
Bogdan A, Manera V, Koenig A, David R. Pharmacologic Approaches for the Management of Apathy in Neurodegenerative Disorders. Front Pharmacol 2020; 10:1581. [PMID: 32038253 PMCID: PMC6989486 DOI: 10.3389/fphar.2019.01581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/05/2019] [Indexed: 01/10/2023] Open
Abstract
Apathy is one of the most frequent behavioral disturbances in many neurodegenerative disorders and is known to have a negative impact on the disease progression, particularly in Alzheimer’s disease. Therapeutic options are currently limited and non-pharmacological approaches should constitute first line treatments. Pharmacological agents likely to reduce apathy levels are lacking. The objective of the present article is to review recent pharmacological treatments for apathy in neurodegenerative disorders. The Pubmed database was searched with a particular focus on articles published as of January 2017. Current main levels of evidence have been reported so far with cholinergic, glutamatergic and dopaminergic agents to reduce levels of apathy, despite several conflicting results. Treatment duration and samples sizes may have however decreased the validity of previous results. Ongoing studies involving more participants/treatment duration or distinct neural pathways may provide new insights in the treatment of apathy in neurodegenerative disorders.
Collapse
Affiliation(s)
- Anamaria Bogdan
- Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressources et de Recherche, Nice, France
| | - Valeria Manera
- CoBTeK Lab "Cognition Behaviour Technology", University of Nice Sophia Antipolis, Nice, France
| | - Alexandra Koenig
- CoBTeK Lab "Cognition Behaviour Technology", University of Nice Sophia Antipolis, Nice, France
| | - Renaud David
- Centre Hospitalier Universitaire de Nice, Centre Mémoire de Ressources et de Recherche, Nice, France
| |
Collapse
|
23
|
Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame? Int J Mol Sci 2019; 20:ijms20153647. [PMID: 31349706 PMCID: PMC6695658 DOI: 10.3390/ijms20153647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Alzheimer’s disease and vascular dementia are estimated to be the most common causes of dementia, although mixed dementia could represent the most prevalent form of dementia in older adults aged more than 80 years. Behavioral disturbances are common in the natural history of dementia. However, so far, there is a paucity of studies that investigated the causal association between behavioral psychological symptoms of dementia and dementia sub-types, due to the high heterogeneity of methodology, study design and type of clinical assessment. To understand the scant evidence on such a relevant clinical issue, it could be hypothesized that a new shifting paradigm could result in a better identification of the relationship between behavioral disturbances and dementia. This narrative review provides an update of evidence on the behavioral patterns associated with different dementia sub-types and offers a potential future perspective as common ground for the development of new translational studies in the field of behavioral disturbances in dementia and the appropriateness of psychoactive treatments.
Collapse
|
24
|
García-Alberca JM, Florido M, Cáceres M, Sánchez-Toro A, Lara JP, García-Casares N. Medial temporal lobe atrophy is independently associated with behavioural and psychological symptoms in Alzheimer's disease. Psychogeriatrics 2019; 19:46-54. [PMID: 30084177 DOI: 10.1111/psyg.12363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/31/2018] [Accepted: 06/29/2018] [Indexed: 01/10/2023]
Abstract
AIM Evidence describing the contribution of cerebral white matter disease and medial temporal atrophy (MTA) to behavioural and psychological symptoms of dementia (BPSD) has been conflicting. The aim of this study was to assess the relationship of white matter hyperintensities (WMH) and MTA observed on magnetic resonance imaging with BPSD among patients with Alzheimer's disease. METHODS In a cross-sectional study of a prospective cohort of patients attending a memory clinic, 46 patients with probable Alzheimer's disease (mean age: 72.38 ± 7.05 years) were studied. Sociodemographic, cognitive, and BPSD data were collected. BPSD were assessed using the Neuropsychiatric Inventory. Magnetic resonance imaging, WMH, and MTA were rated using the Scheltens scales for the assessment of signal hyperintensities and atrophy of medial temporal lobes. For multivariate analysis, two binary logistic regression analyses were carried out, with presence or absence of each BPSD as the dependent variable and with WMH or MTA as the predictor variable. Results of the logistic regression were analyzed to see if the significance of the WMH or MTA score was maintained in a model that factored in other possible confounding variables identified in univariate analysis. RESULTS The results of binary logistic regression analysis showed that in models that accounted for confounding variables, increased total MTA was significantly associated with apathy (odds ratio = 1.605, adjusted P = 0.042) and disinhibition (odds ratio = 0.607, adjusted P = 0.042). WMH measures did not significantly predict any BPSD item. CONCLUSIONS These findings indicate that MTA potentially contributes to the aetiology of BPSD, and they provide evidence to support the hypothesis that Alzheimer's disease pathology itself can contribute to BPSD.
Collapse
Affiliation(s)
| | - Mercedes Florido
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - Marta Cáceres
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - Alicia Sánchez-Toro
- Alzheimer Research Center and Memory Clinic, Andalusian Institute for Neuroscience, Málaga, Spain
| | - José Pablo Lara
- Unit of Cognitive Neurophysiology, Research Medical Center of Málaga University, Biomedical Research Institute of Málaga, Málaga, Spain
| | - Natalia García-Casares
- Department of Medicine, Faculty of Medicine, University of Málaga, Research Medical Center of Málaga University, Biomedical Research Institute of Málaga, Málaga, Spain
| |
Collapse
|
25
|
Le Heron C, Manohar S, Plant O, Muhammed K, Griffanti L, Nemeth A, Douaud G, Markus HS, Husain M. Dysfunctional effort-based decision-making underlies apathy in genetic cerebral small vessel disease. Brain 2018; 141:3193-3210. [PMID: 30346491 PMCID: PMC6202575 DOI: 10.1093/brain/awy257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/24/2018] [Accepted: 08/31/2018] [Indexed: 12/30/2022] Open
Abstract
Apathy is a syndrome of reduced motivation that commonly occurs in patients with cerebral small vessel disease, including those with the early onset form, CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). The cognitive mechanisms underlying apathy are poorly understood and treatment options are limited. We hypothesized that disrupted effort-based decision-making, the cognitive process by which potential rewards and the effort cost required to obtain them is integrated to drive behaviour, might underlie the apathetic syndrome. Nineteen patients with a genetic diagnosis of CADASIL, as a model of 'pure' vascular cognitive impairment, and 19 matched controls were assessed using two different behavioural paradigms and MRI. On a decision-making task, participants decided whether to accept or reject sequential offers of monetary reward in return for exerting physical effort via handheld dynamometers. Six levels of reward and six levels of effort were manipulated independently so offers spanned the full range of possible combinations. Choice, decision time and force metrics were recorded. Each participant's effort and reward sensitivity was estimated using a computational model of choice. On a separate eye movement paradigm, physiological reward sensitivity was indexed by measuring pupillary dilatation to increasing monetary incentives. This metric was related to apathy status and compared to the behavioural metric of reward sensitivity on the decision-making task. Finally, high quality diffusion imaging and tract-based spatial statistics were used to determine whether tracts linking brain regions implicated in effort-based decision-making were disrupted in apathetic patients. Overall, apathetic patients with CADASIL rejected significantly more offers on the decision-making task, due to reduced reward sensitivity rather than effort hypersensitivity. Apathy was also associated with blunted pupillary responses to incentives. Furthermore, these independent behavioural and physiological markers of reward sensitivity were significantly correlated. Non-apathetic patients with CADASIL did not differ from controls on either task, whilst actual motor performance of apathetic patients in both tasks was also normal. Apathy was specifically associated with reduced fractional anisotropy within tracts connecting regions previously associated with effort-based decision-making. These findings demonstrate behavioural, physiological and anatomical evidence that dysfunctional effort-based decision-making underlies apathy in patients with CADASIL, a model disorder for sporadic small vessel disease. Reduced incentivization by rewards rather than hypersensitivity to effort costs drives this altered pattern of behaviour. The study provides empirical evidence of a cognitive mechanism for apathy in cerebral small vessel disease, and identifies a promising therapeutic target for interventions to improve this debilitating condition.
Collapse
Affiliation(s)
- Campbell Le Heron
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Sanjay Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Olivia Plant
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Kinan Muhammed
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Ludovica Griffanti
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Andrea Nemeth
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gwenaëlle Douaud
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| |
Collapse
|
26
|
The neuroimaging basis of apathy: Empirical findings and conceptual challenges. Neuropsychologia 2018; 118:48-53. [DOI: 10.1016/j.neuropsychologia.2018.01.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 01/23/2018] [Accepted: 01/31/2018] [Indexed: 01/02/2023]
|
27
|
Le Heron C, Apps MAJ, Husain M. The anatomy of apathy: A neurocognitive framework for amotivated behaviour. Neuropsychologia 2018; 118:54-67. [PMID: 28689673 PMCID: PMC6200857 DOI: 10.1016/j.neuropsychologia.2017.07.003] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/19/2017] [Accepted: 07/06/2017] [Indexed: 12/23/2022]
Abstract
Apathy is a debilitating syndrome associated with many neurological disorders, including several common neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease, and focal lesion syndromes such as stroke. Here, we review neuroimaging studies to identify anatomical correlates of apathy, across brain disorders. Our analysis reveals that apathy is strongly associated with disruption particularly of dorsal anterior cingulate cortex (dACC), ventral striatum (VS) and connected brain regions. Remarkably, these changes are consistent across clinical disorders and imaging modalities. Review of the neuroimaging findings allows us to develop a neurocognitive framework to consider potential mechanisms underlying apathy. According to this perspective, an interconnected group of brain regions - with dACC and VS at its core - plays a crucial role in normal motivated behaviour. Specifically we argue that motivated behaviour requires a willingness to work, to keep working, and to learn what is worth working for. We propose that deficits in any one or more of these processes can lead to the clinical syndrome of apathy, and outline specific approaches to test this hypothesis. A richer neurobiological understanding of the mechanisms underlying apathy should ultimately facilitate development of effective therapies for this disabling condition.
Collapse
Affiliation(s)
- C Le Heron
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - M A J Apps
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - M Husain
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| |
Collapse
|
28
|
Agüera-Ortiz L, Hernandez-Tamames JA, Martinez-Martin P, Cruz-Orduña I, Pajares G, López-Alvarez J, Osorio RS, Sanz M, Olazarán J. Structural correlates of apathy in Alzheimer's disease: a multimodal MRI study. Int J Geriatr Psychiatry 2017; 32:922-930. [PMID: 27428560 DOI: 10.1002/gps.4548] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/16/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Apathy is one of the most frequent symptoms of dementia, whose underlying neurobiology is not well understood. The objective was to analyze the correlations of apathy and its dimensions with gray and white matter damage in the brain of patients with advanced Alzheimer's disease (AD). METHODS The setting of the study was at the Alzheimer Center Reina Sofía Foundation Research Unit. Participants include 37 nursing home patients with moderate to severe AD, 78.4% were women, and mean Standard Deviation (SD) age is 82.7 (5.8). Several measurements were taken: severe mini-mental state examination and Global Deterioration Scale for cognitive and functional status, Neuropsychiatric Inventory for behavioral problems, and Apathy In Dementia-Nursing Home Version Scale for apathy, including total score and subscores of emotional blunting, deficit of thinking, and cognitive inertia. 3T magnetic resonance imaging measures (voxel-based morphometry, fluid-attenuated inversion recovery, and diffusion tensor imaging) were also conducted. RESULTS Moderate levels of apathy (mean Apathy In Dementia-Nursing Home Version Scale: 31.1 ± 18.5) were found. Bilateral damage to the corpus callosum and internal capsule was associated with apathy severity (cluster size 2435, p < 0.0005, family-wise error [FWE]-corrected). A smaller and more anteriorly located region of the right internal capsule and corpus callosum was associated with higher emotional blunting (cluster size 334, p < 0.0005, FWE-corrected). Ischemic damage in the right periventricular frontal region was associated with higher deficit of thinking (cluster size 3805, p < 0.005, FWE-corrected). CONCLUSIONS Brain damage related to apathy may have different features in the advanced stages of AD and differs between the three apathy dimensions. Besides atrophy, brain connectivity and vascular lesions are relevant in the study of apathy, especially in the more severe stages of dementia. Further magnetic resonance imaging studies should include multimodal techniques. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Luis Agüera-Ortiz
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Spain
| | - Juan A Hernandez-Tamames
- Medical Image and BIometry Laboratory, Rey Juan Carlos University, Madrid, Spain.,MR Physics Group, Radiology and Nuclear Medicine Department, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Isabel Cruz-Orduña
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain
| | - Gonzalo Pajares
- Medical Image and BIometry Laboratory, Rey Juan Carlos University, Madrid, Spain
| | - Jorge López-Alvarez
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain
| | - Ricardo S Osorio
- Department of Psychiatry, NYU Langone Medical Center, New York, USA
| | - Marta Sanz
- Instituto Psiquiátrico José Germain, Madrid, Spain
| | - Javier Olazarán
- Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.,Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| |
Collapse
|
29
|
Tu MC, Huang WH, Hsu YH, Lo CP, Deng JF, Huang CF. Comparison of neuropsychiatric symptoms and diffusion tensor imaging correlates among patients with subcortical ischemic vascular disease and Alzheimer's disease. BMC Neurol 2017; 17:144. [PMID: 28754095 PMCID: PMC5534111 DOI: 10.1186/s12883-017-0911-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/05/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The causes of behavioral and psychological symptoms of dementia (BPSD) vary according to the dementia subtype and associated neuropathology. The present study aimed to (i) compare BPSD between patients with subcortical ischemic vascular disease (SIVD) and Alzheimer's disease (AD) across stages, and (ii) explore the associations with diffusion tensor imaging (DTI) in the corpus callosum (CC) and other major fibers. METHODS Twenty-four patients with SIVD and 32 with AD were recruited. Four domains of the Neuropsychiatric Inventory (NPI) (hyperactivity, psychosis, affective, and apathy) and two DTI parameters [fractional anisotropy (FA) and mean diffusivity (MD)] within the genu, body (BCC), and splenium (SCC) of the CC and other major fibers were assessed. RESULTS Overall, the patients with clinical dementia rating (CDR) 1 ~ 2 had higher scores in apathy domain than those with CDR0.5. Among those with CDR1 ~ 2, SIVD had higher scores in apathy domain than AD. MD values in the BCC/SCC were positively correlated with total NPI score and psychosis, hyperactivity, and apathy domains. FA values in the SCC were inversely correlated with total NPI score and psychosis domain. The correlations were modified by age, the CASI, and CDR scores. Stepwise linear regression models suggested that FA value within the left superior longitudinal fasciculus predicted the hyperactivity domain. MD value within the SCC/left uncinate fasciculus and FA value within the GCC/left forceps major predicted the psychosis domain. MD value within the right superior longitudinal fasciculus and CDR predicted the apathy domain. Further analysis suggested distinct patterns of regression models between SIVD and AD patients. CONCLUSION White matter integrity within the BCC/SCC had associations with multi-domains of BPSD. Our study also identified important roles of regions other than the CC to individual domain of BPSD, including the left superior longitudinal fasciculus to the hyperactivity domain, the left uncinate fasciculus/forceps major to the psychosis domain, and the right superior longitudinal fasciculus to the apathy domain. The neuronal substrates in predicting BPSD were different between SIVD and AD patients. Of note, apathy, which was more profound in SIVD, was associated with corresponding fiber disconnection in line with dementia severity and global cognition decline.
Collapse
Affiliation(s)
- Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Hui Huang
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Chung-Ping Lo
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Radiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Jie Fu Deng
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
| | - Ching-Feng Huang
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
30
|
Zhang Y, Wu J, Wu W, Liu R, Pang L, Guan D, Xu Y. Reduction of white matter integrity correlates with apathy in Parkinson's disease. Int J Neurosci 2017. [PMID: 28648111 DOI: 10.1080/00207454.2017.1347170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Apathy is a common non-motor symptom in Parkinson's disease (PD), but little is known about apathy and white matter (WM) change. In this study, we investigated whether fractional anisotropy (FA) of the WM can distinguish apathetic patients from non-apathetic PD patients, and whether the FA value correlates with the severity of apathy in PD. METHODS Thirty-nine PD patients participated in our study, of which 18 participants were with apathy symptom, and 21 without apathy symptom. Diffusion tensor imaging was performed on all the subjects. RESULTS Compared to non-apathetic PD patients, the apathetic group had reduced FA values in the genu and body of corpus callosum, bilateral anterior corona radiata, left superior corona radiata and left cingulum. Furthermore, in these WM regions, the FA values were negatively correlated with the Lille Apathy Rating Scale scores in apathetic subjects. CONCLUSION The WM change is associated with apathy in PD patients. In addition, the FA values of specific regions of WM could be a promising marker to predict the severity of apathy.
Collapse
Affiliation(s)
- Yang Zhang
- a Department of Neurology , Drum Tower Hospital , Medical School of Nanjing University , Nanjing , China
| | - Jiayong Wu
- a Department of Neurology , Drum Tower Hospital , Medical School of Nanjing University , Nanjing , China
| | - Wenbo Wu
- b Department of Medical Imaging , Drum Tower Hospital , Medical School of Nanjing University , Nanjing , China
| | - Renyuan Liu
- b Department of Medical Imaging , Drum Tower Hospital , Medical School of Nanjing University , Nanjing , China
| | - Lingen Pang
- a Department of Neurology , Drum Tower Hospital , Medical School of Nanjing University , Nanjing , China
| | - Dening Guan
- a Department of Neurology , Drum Tower Hospital , Medical School of Nanjing University , Nanjing , China
| | - Yun Xu
- a Department of Neurology , Drum Tower Hospital , Medical School of Nanjing University , Nanjing , China
| |
Collapse
|
31
|
Gatchel JR, Donovan NJ, Locascio JJ, Becker JA, Rentz DM, Sperling RA, Johnson KA, Marshall GA. Regional 18F-Fluorodeoxyglucose Hypometabolism is Associated with Higher Apathy Scores Over Time in Early Alzheimer Disease. Am J Geriatr Psychiatry 2017; 25:683-693. [PMID: 28410856 PMCID: PMC5906700 DOI: 10.1016/j.jagp.2016.12.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 12/09/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Apathy is among the earliest and most pervasive neuropsychiatric symptoms in prodromal and mild Alzheimer disease (AD) dementia that correlates with functional impairment and disease progression. We investigated the association of apathy with regional 18F-fluorodeoxyglucose (FDG) metabolism in cognitively normal, mild cognitive impairment, and AD dementia subjects from the Alzheimer's Disease Neuroimaging Initiative database. DESIGN Cross-sectional and longitudinal studies. SETTING 57 North American research sites. PARTICIPANTS 402 community dwelling elders. MEASUREMENTS Apathy was assessed using the Neuropsychiatric Inventory Questionnaire. Baseline FDG metabolism in five regions implicated in the neurobiology of apathy and AD was investigated in relationship to apathy at baseline (cross-sectional general linear model) and longitudinally (mixed random/fixed effect model). Covariates included age, sex, diagnosis, apolipoprotein E genotype, premorbid intelligence, cognition, and antidepressant use. RESULTS Cross-sectional analysis revealed that posterior cingulate hypometabolism, diagnosis, male sex, and antidepressant use were associated with higher apathy scores. Longitudinal analysis revealed that the interaction of supramarginal hypometabolism and time, posterior cingulate hypometabolism, and antidepressant use were associated with higher apathy scores across time; only supramarginal hypometabolism was positively related to rate of increase of apathy. CONCLUSIONS Results support an association of apathy with hypometabolism in parietal regions commonly affected in early stages of AD, rather than medial frontal regions implicated in the neurobiology of apathy in later stages. Further work is needed to substantiate whether this localization is specific to apathy rather than to disease stage, and to investigate the potential role of AD proteinopathies in the pathogenesis of apathy.
Collapse
Affiliation(s)
- Jennifer R Gatchel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA.
| | - Nancy J Donovan
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J Alex Becker
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Dorene M Rentz
- Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Reisa A Sperling
- Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Keith A Johnson
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gad A Marshall
- Center of Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
32
|
Liu X, Chen W, Hou H, Chen X, Zhang J, Liu J, Guo Z, Bai G. Decreased functional connectivity between the dorsal anterior cingulate cortex and lingual gyrus in Alzheimer's disease patients with depression. Behav Brain Res 2017; 326:132-138. [DOI: 10.1016/j.bbr.2017.01.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 12/31/2022]
|
33
|
Anor CJ, O'Connor S, Saund A, Tang-Wai DF, Keren R, Tartaglia MC. Neuropsychiatric Symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia. NEURODEGENER DIS 2017; 17:127-134. [PMID: 28245482 DOI: 10.1159/000455127] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/13/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/AIMS Neuropsychiatric symptoms (NPS) are common in Alzheimer disease (AD) and vascular dementia (VaD), and are distressful to patients and caregivers. NPS are likely related to the underlying pathology. Previous studies suggest that frontal lobe lesions and vascular changes such as white matter hyperintensities (WMH) have a significant association with specific NPS. The current study aimed to compare NPS in patients with AD, VaD, and mixed AD/VaD, and to evaluate the differences in the prevalence of NPS in relation to frontal WMH volume. METHODS In total, 180 patients with NPS and MRI data (92 probable AD, 51%; 34 probable VaD, 19%; and 54 probable mixed AD/VaD, 30%) were included in the study. Regression analyses were performed to determine the relationships between NPS prevalence and diagnosis, and between NPS and frontal WMH. RESULTS VaD patients had significantly more agitation (p < 0.05; 40 vs. 14%) and sleep disturbances (p < 0.05; 57 vs. 32%) than AD patients, and significantly more depression (p < 0.05; 48 vs. 20%) and aberrant motor behaviors (p < 0.05; 31 vs. 13%) than mixed AD/VaD patients. AD patients with delusions had significantly greater right frontal WMH volumes than those without (p < 0.05; delusions 1/0 = 314.8/112.6 mm3). CONCLUSION Differences in NPS prevalence are likely related to the underlying pathology and warrant further study as they have implications for treatment.
Collapse
Affiliation(s)
- Cassandra J Anor
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | |
Collapse
|
34
|
Joo SH, Lee CU, Lim HK. Apathy and intrinsic functional connectivity networks in amnestic mild cognitive impairment. Neuropsychiatr Dis Treat 2017; 13:61-67. [PMID: 28096673 PMCID: PMC5207457 DOI: 10.2147/ndt.s123338] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although several prior works reported that apathy is associated with conversion to Alzheimer's disease in individuals with amnestic mild cognitive impairment (aMCI), effects of apathy on the functional connectivity (FC) of the brain remain unclear. In this study, we assessed the pattern of association between apathy and default mode network (DMN), salience network and central executive network (CEN) in aMCI subjects. METHODS Fifty subjects with aMCI and 50 controls (CONs) participated in this study. They underwent clinical assessments and magnetic resonance imaging for the structural and resting-state scan. We explored the patterns of association between apathy inventory (IA) total score and the whole-brain voxel-wise FCs of the DMN, salience network and CEN in aMCI subjects. RESULTS We observed that the FCs of the DMN were less and those of CEN were more in the aMCI group than the CON group. Total IA score was negatively correlated with FCs of the anterior cingulate within the DMN, and positively correlated with FCs of the middle frontal, inferior frontal, and supramarginal gyrus within the CEN in the aMCI group. CONCLUSION Our findings suggest that distinctive patterns of association between apathy and FCs in the DMN and CEN in the aMCI group might reflect the putative role of functional network change in the development of apathy in aMCI.
Collapse
Affiliation(s)
- Soo Hyun Joo
- Department of Psychiatry, Seoul St Mary's Hospital, Seoul
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St Mary's Hospital, Seoul
| | - Hyun Kook Lim
- Department of Psychiatry, Saint Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| |
Collapse
|
35
|
Moretti R, Signori R. Neural Correlates for Apathy: Frontal-Prefrontal and Parietal Cortical- Subcortical Circuits. Front Aging Neurosci 2016; 8:289. [PMID: 28018207 PMCID: PMC5145860 DOI: 10.3389/fnagi.2016.00289] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
Apathy is an uncertain nosographical entity, which includes reduced motivation, abulia, decreased empathy, and lack of emotional involvement; it is an important and heavy-burden clinical condition which strongly impacts in everyday life events, affects the common daily living abilities, reduced the inner goal directed behavior, and gives the heaviest burden on caregivers. Is a quite common comorbidity of many neurological disease, However, there is no definite consensus on the role of apathy in clinical practice, no definite data on anatomical circuits involved in its development, and no definite instrument to detect it at bedside. As a general observation, the occurrence of apathy is connected to damage of prefrontal cortex (PFC) and basal ganglia; “emotional affective” apathy may be related to the orbitomedial PFC and ventral striatum; “cognitive apathy” may be associated with dysfunction of lateral PFC and dorsal caudate nuclei; deficit of “autoactivation” may be due to bilateral lesions of the internal portion of globus pallidus, bilateral paramedian thalamic lesions, or the dorsomedial portion of PFC. On the other hand, apathy severity has been connected to neurofibrillary tangles density in the anterior cingulate gyrus and to gray matter atrophy in the anterior cingulate (ACC) and in the left medial frontal cortex, confirmed by functional imaging studies. These neural networks are linked to projects, judjing and planning, execution and selection common actions, and through the basolateral amygdala and nucleus accumbens projects to the frontostriatal and to the dorsolateral prefrontal cortex. Therefore, an alteration of these circuitry caused a lack of insight, a reduction of decision-making strategies, and a reduced speedness in action decision, major responsible for apathy. Emergent role concerns also the parietal cortex, with its direct action motivation control. We will discuss the importance of these circuits in different pathologies, degenerative or vascular, acute or chronic.
Collapse
Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste Trieste, Italy
| | - Riccardo Signori
- Neurology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste Trieste, Italy
| |
Collapse
|
36
|
Makovac E, Serra L, Spanò B, Giulietti G, Torso M, Cercignani M, Caltagirone C, Bozzali M. Different Patterns of Correlation between Grey and White Matter Integrity Account for Behavioral and Psychological Symptoms in Alzheimer's Disease. J Alzheimers Dis 2016; 50:591-604. [PMID: 26836635 DOI: 10.3233/jad-150612] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Behavioral disorders and psychological symptoms (BPSD) in Alzheimer's disease (AD) are known to correlate with grey matter (GM) atrophy and, as shown recently, also with white matter (WM) damage. WM damage and its relationship with GM atrophy are reported in AD, reinforcing the interpretation of the AD pathology in light of a disconnection syndrome. It remains uncertain whether this disconnection might account also for different BPSD observable in AD. Here, we tested the hypothesis of different patterns of association between WM damage of the corpus callosum (CC) and GM atrophy in AD patients exhibiting one of the following BPSD clusters: Mood (i.e., anxiety and depression; ADmood), Frontal (i.e., dishinibition and elation; ADfrontal), and Psychotic (delusions and hallucinations; ADpsychotic) related symptoms, as well as AD patients without BPSD. Overall, this study brings to light the strict relationship between WM alterations in different parts of the CC and GM atrophy in AD patients exhibiting BPSD, supporting the hypothesis that such symptoms are likely to be caused by characteristic patterns of neurodegeneration of WM and GM, rather than being a reactive response to accumulation of cognitive disabilities, and should therefore be regarded as potential markers of diagnostic and prognostic value in AD.
Collapse
Affiliation(s)
- Elena Makovac
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Laura Serra
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Barbara Spanò
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Mario Torso
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mara Cercignani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.,Brighton and Sussex Medical School, Clinical Imaging Sciences Centre, University of Sussex, Brighton, Falmer, UK
| | - Carlo Caltagirone
- Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Neuroscience, University of Rome 'Tor Vergata', Rome, Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| |
Collapse
|
37
|
Chapleau M, Aldebert J, Montembeault M, Brambati SM. Atrophy in Alzheimer’s Disease and Semantic Dementia: An ALE Meta-Analysis of Voxel-Based Morphometry Studies. J Alzheimers Dis 2016; 54:941-955. [DOI: 10.3233/jad-160382] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Marianne Chapleau
- Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Joséphine Aldebert
- Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Maxime Montembeault
- Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Simona M. Brambati
- Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| |
Collapse
|
38
|
Neural correlates of apathy in patients with neurodegenerative disorders, acquired brain injury, and psychiatric disorders. Neurosci Biobehav Rev 2016; 69:381-401. [DOI: 10.1016/j.neubiorev.2016.08.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 03/11/2016] [Accepted: 08/06/2016] [Indexed: 11/21/2022]
|
39
|
Munro CE, Donovan NJ, Guercio BJ, Wigman SE, Schultz AP, Amariglio RE, Rentz DM, Johnson KA, Sperling RA, Marshall GA. Neuropsychiatric Symptoms and Functional Connectivity in Mild Cognitive Impairment. J Alzheimers Dis 2016; 46:727-35. [PMID: 25854929 DOI: 10.3233/jad-150017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS), such as apathy and depression, commonly accompany cognitive and functional decline in early Alzheimer's disease (AD). Prior studies have shown associations between affective NPS and neurodegeneration of medial frontal and inferior temporal regions in mild cognitive impairment (MCI) and AD dementia. OBJECTIVE To investigate the association between functional connectivity in four brain networks and NPS in elderly with MCI. METHODS NPS were assessed using the Neuropsychiatric Inventory in 42 subjects with MCI. Resting-state functional connectivity in four networks (default mode network, fronto-parietal control network (FPCN), dorsal attention network, and ventral attention network) was assessed using seed-based magnetic resonance imaging. Factor analysis was used to identify two factors of NPS: Affective and Hyperactivity. Linear regression models were utilized with the neuropsychiatric factors as the dependent variable and the four networks as the predictors of interest. Covariates included age, gender, premorbid intelligence, processing speed, memory, head movement, and signal-to-noise ratio. These analyses were repeated with the individual items of the affective factor, using the same predictors. RESULTS There was a significant association between greater Affective factor symptoms and reduced FPCN connectivity (p = 0.03). There was no association between the Hyperactivity factor and any of the networks. Secondary analyses revealed an association between greater apathy and reduced FPCN connectivity (p = 0.005), but none in other networks. CONCLUSIONS Decreased connectivity in the FPCN may be associated with greater affective symptoms, particularly apathy, early in AD. These findings extend prior studies, using different functional imaging modalities in individuals with greater disease severity.
Collapse
Affiliation(s)
- Catherine E Munro
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy J Donovan
- Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sarah E Wigman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca E Amariglio
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dorene M Rentz
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gad A Marshall
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
40
|
Apathy associated with neurocognitive disorders: Recent progress and future directions. Alzheimers Dement 2016; 13:84-100. [PMID: 27362291 DOI: 10.1016/j.jalz.2016.05.008] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/10/2016] [Accepted: 05/22/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Apathy is common in neurocognitive disorders (NCDs) such as Alzheimer's disease and mild cognitive impairment. Although the definition of apathy is inconsistent in the literature, apathy is primarily defined as a loss of motivation and decreased interest in daily activities. METHODS The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Neuropsychiatric Syndromes Professional Interest Area (NPS-PIA) Apathy workgroup reviewed the latest research regarding apathy in NCDs. RESULTS Progress has recently been made in three areas relevant to apathy: (1) phenomenology, including the use of diagnostic criteria and novel instruments for measurement, (2) neurobiology, including neuroimaging, neuropathological and biomarker correlates, and (3) interventions, including pharmacologic, nonpharmacologic, and noninvasive neuromodulatory approaches. DISCUSSION Recent progress confirms that apathy has a significant impact on those with major NCD and those with mild NCDs. As such, it is an important target for research and intervention.
Collapse
|
41
|
Qiu L, He Y, Tang H, Zhou Y, Wang J, Zhang W, Chen G, Zhao F, Ouyang T, Ju B, Li Z, Wang L, Zou L, Gong Q. Genetically-mediated Grey and White Matter Alteration in Normal Elderly Individuals with the CLU-C Allele Gene. Curr Alzheimer Res 2016; 13:1302-1310. [PMID: 27396407 PMCID: PMC5112753 DOI: 10.2174/1567205013666160703180531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/20/2016] [Accepted: 06/29/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several genome-wide association studies have found that the rs11136000 polymorphism of the C allele (CLU-C) is associated with the risk for developing late-onset Alzheimer's disease (LOAD). However, the effects of the CLU-C/C genotype on brain structure, including gray and white matter, are not adequately understood. OBJECTIVES We aimed to clarify the gray matter and white matter integrity changes in non-demented ageing individuals with the AD risk gene of the rs11136000 polymorphism of the C allele (CLU-C) and the correlation with cognitive performance. METHODS Voxel-based analysis was used to compare the differences in high-resolution structural T1 and diffusion tensor imaging data between 31 CLU-C/C and 15 non-CLU-C/C carriers in nondemented older adults. RESULTS Compared to non-CLU-C/C carriers, CLU-C homozygotes showed a reduced gray matter concentration (GMC) in the left parahippocampal gyrus, right middle frontal and temporal middle gyri, increased GMC in the left middle frontal and right fusiform gyri and increased gray matter volume (GMV) in the left middle frontal gyrus (P < 0.001). Decreased fractional anisotropy (FA) in the sub-gyral white matter of the left external capsule and left anterior cingulate and increased FA in the sub-gyral white matter of the left temporal lobe were also found in CLU-C/C genotype carriers. Moreover, the FA value in the left external capsule correlated with several cognitive measures. CONCLUSION Our findings provide further evidence for the CLU risk variant as a candidate gene for AD and may serve as a pre-clinical neuroimaging phenotype of late-onset AD.
Collapse
Affiliation(s)
- Lihua Qiu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Department of Radiology, The Second People’s Hospital of Yibin, China
| | - Yong He
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Hehan Tang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Zhou
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jinhong Wang
- Department of Radiology, Tong Ji Hospital, Tong Ji University, Shanghai, China
| | - Weiwei Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Guangxiang Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Fei Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Tingxue Ouyang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Bin Ju
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhengyan Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lanlan Wang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Ling Zou
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
42
|
Hollocks MJ, Lawrence AJ, Brookes RL, Barrick TR, Morris RG, Husain M, Markus HS. Differential relationships between apathy and depression with white matter microstructural changes and functional outcomes. Brain 2015; 138:3803-15. [PMID: 26490330 PMCID: PMC4655344 DOI: 10.1093/brain/awv304] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/26/2015] [Indexed: 01/30/2023] Open
Abstract
Small vessel disease is a stroke subtype characterized by pathology of the small perforating arteries, which supply the sub-cortical structures of the brain. Small vessel disease is associated with high rates of apathy and depression, thought to be caused by a disruption of white matter cortical-subcortical pathways important for emotion regulation. It provides an important biological model to investigate mechanisms underlying these key neuropsychiatric disorders. This study investigated whether apathy and depression can be distinguished in small vessel disease both in terms of their relative relationship with white matter microstructure, and secondly whether they can independently predict functional outcomes. Participants with small vessel disease (n = 118; mean age = 68.9 years; 65% male) defined as a clinical and magnetic resonance imaging confirmed lacunar stroke with radiological leukoaraiosis were recruited and completed cognitive testing, measures of apathy, depression, quality of life and diffusion tensor imaging. Healthy controls (n = 398; mean age = 64.3 years; 52% male) were also studied in order to interpret the degree of apathy and depression found within the small vessel disease group. Firstly, a multilevel structural equation modelling approach was used to identify: (i) the relationships between median fractional anisotropy and apathy, depression and cognitive impairment; and (ii) if apathy and depression make independent contributions to quality of life in patients with small vessel disease. Secondly, we applied a whole-brain voxel-based analysis to investigate which regions of white matter were associated with apathy and depression, controlling for age, gender and cognitive functioning. Structural equation modelling results indicated both apathy (r = -0.23, P ≤ 0.001) and depression (r = -0.41, P ≤ 0.001) were independent predictors of quality of life. A reduced median fractional anisotropy was significantly associated with apathy (r = -0.38, P ≤ 0.001), but not depression (r = -0.16, P = 0.09). On voxel-based analysis, apathy was associated with widespread reduction in white matter integrity, with the strongest effects in limbic association tracts such as the anterior cingulum, fornix and uncinate fasciculus. In contrast, when controlling for apathy, we found no significant relationship between our white matter parameters and symptoms of depression. In conclusion, white matter microstructural changes in small vessel disease are associated with apathy but not directly with depressive symptoms. These results suggest that apathy, but not depression, in small vessel disease is related to damage to cortical-subcortical networks associated with emotion regulation, reward and goal-directed behaviour.
Collapse
Affiliation(s)
- Matthew J Hollocks
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Andrew J Lawrence
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Rebecca L Brookes
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Thomas R Barrick
- 2 St. Georges, University of London, Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, London, UK
| | - Robin G Morris
- 3 King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK
| | - Masud Husain
- 4 University of Oxford, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Hugh S Markus
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| |
Collapse
|
43
|
Onoda K, Yamaguchi S. Dissociative contributions of the anterior cingulate cortex to apathy and depression: Topological evidence from resting-state functional MRI. Neuropsychologia 2015; 77:10-8. [PMID: 26235668 DOI: 10.1016/j.neuropsychologia.2015.07.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/15/2015] [Accepted: 07/30/2015] [Indexed: 12/20/2022]
Abstract
Apathy is defined as a mental state characterized by a lack of goal-directed behavior. However, the underlying mechanisms of apathy remain to be fully understood. Apathy shares certain symptoms with depression and both these affective disorders are known to be associated with dysfunctions of the frontal cortex-basal ganglia circuits. It is expected that clarifying differences in neural mechanisms between the two conditions would lead to an improved understanding of apathy. The present study was designed to investigate whether apathy and depression depend on different network properties of the frontal cortex-basal ganglia circuits, by using resting state fMRI. Resting-state fMRI measurement and neuropsychological testing were conducted on middle-aged and older adults (N=392). Based on graph theory, we estimated nodal efficiency (functional integration), local efficiency (functional segregation), and betweenness centrality. We conducted multiple regression analyses for the network parameters using age, sex, apathy, and depression as predictors. Interestingly, results indicated that the anterior cingulate cortex showed lower nodal efficiency, local efficiency, and betweenness centrality in apathy, whereas in depression, it showed higher nodal efficiency and betweenness centrality. The anterior cingulate cortex constitutes the so-called "salience network", which detects salient experiences. Our results indicate that apathy is characterized by decreased salience-related processing in the anterior cingulate cortex, whereas depression is characterized by increased salience-related processing.
Collapse
Affiliation(s)
- Keiichi Onoda
- Department of Neurology, Shimane University, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan.
| | - Shuhei Yamaguchi
- Department of Neurology, Shimane University, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan
| |
Collapse
|
44
|
Rosenberg PB, Nowrangi MA, Lyketsos CG. Neuropsychiatric symptoms in Alzheimer's disease: What might be associated brain circuits? Mol Aspects Med 2015; 43-44:25-37. [PMID: 26049034 DOI: 10.1016/j.mam.2015.05.005] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 12/15/2022]
Abstract
Neuropsychiatric symptoms (NPS) are very common in Alzheimer's disease (AD), particularly agitation, apathy, depression, and delusions. Brain networks or circuits underlying these symptoms are just starting to be understood, and there is a growing imaging and neurochemical evidence base for understanding potential mechanisms for NPS. We offer a synthetic review of the recent literature and offer hypotheses for potential networks/circuits underlying these NPS, particularly agitation, apathy, and delusions. Agitation in AD appears to be associated with deficits in structure and function of frontal cortex, anterior cingulate cortex, posterior cingulate cortex, amygdala, and hippocampus, and may be associated with mechanisms underlying misinterpretation of threats and affective regulation. Apathy in AD is associated with frontal cortex, anterior cingulate cortex, posterior cingulate cortex, as well as orbitofrontal cortex, and inferior temporal cortex, and may be associated with mechanisms underlying avoidance behaviors.
Collapse
Affiliation(s)
- Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA.
| | - Milap A Nowrangi
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins School of Medicine, USA
| |
Collapse
|
45
|
White matter disease contributes to apathy and disinhibition in behavioral variant frontotemporal dementia. Cogn Behav Neurol 2015; 27:206-14. [PMID: 25539040 DOI: 10.1097/wnn.0000000000000044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To relate changes in fractional anisotropy associated with behavioral variant frontotemporal dementia to measures of apathy and disinhibition. BACKGROUND Apathy and disinhibition are the 2 most common behavioral features of behavioral variant frontotemporal dementia, and these symptoms are associated with accelerated patient decline and caregiver stress. However, little is known about how white matter disease contributes to these symptoms. METHODS We collected neuropsychiatric data, volumetric magnetic resonance imaging, and diffusion-weighted imaging in 11 patients who met published criteria for behavioral variant frontotemporal dementia and had an autopsy-validated cerebrospinal fluid profile consistent with frontotemporal lobar degeneration. We also collected imaging data on 34 healthy seniors for analyses defining regions of disease in the patients. We calculated and analyzed fractional anisotropy with a white matter tract-specific method. This approach uses anatomically guided data reduction to increase sensitivity, and localizes results within canonically defined tracts. We used nonparametric, cluster-based statistical analysis to relate fractional anisotropy to neuropsychiatric measures of apathy and disinhibition. RESULTS The patients with behavioral variant frontotemporal dementia had widespread reductions in fractional anisotropy in anterior portions of frontal and temporal white matter, compared to the controls. Fractional anisotropy correlated with apathy in the left uncinate fasciculus and with disinhibition in the right corona radiata. CONCLUSIONS In patients with behavioral variant frontotemporal dementia, apathy and disinhibition are associated with distinct regions of white matter disease. The implicated fiber tracts likely support frontotemporal networks that are involved in goal-directed behavior.
Collapse
|
46
|
Peng Y, Shao C, Gong Y, Wu X, Tang W, Shi S. Relationship between apathy and tumor location, size, and brain edema in patients with intracranial meningioma. Neuropsychiatr Dis Treat 2015; 11. [PMID: 26203250 PMCID: PMC4508073 DOI: 10.2147/ndt.s85288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this study is to assess the relationship between apathy and tumor location, size, and brain edema in patients with intracranial meningioma. METHODS We enrolled 65 consecutive patients with meningioma and 31 normal controls matched for age, gender, and education. The patients were divided into frontal or non-frontal (NF) meningioma groups based on magnetic resonance imaging; the frontal group was then subdivided to dorsolateral frontal (DLF), medial frontal (MF), and ventral frontal (VF) groups. Tumor size and brain edema were also recorded. Apathy was assessed by the Apathy Evaluation Scale (AES). Assessments were carried out 1 week before and 3 months after surgery, respectively. Logistic regression analysis was performed to identify the predictive effect of tumor size, location, and brain edema on apathy. Analysis of variance and chi-square analysis were applied to compare apathy scores and apathy rates among the frontal, NF, and normal control groups, and all subgroups within the frontal group. RESULTS Compared with the NF and control groups, the mean AES score was much higher in the frontal group (34.0±8.3 versus 28.63±6.0, P=0.008, and 26.8±4.2, P<0.001). Subgroup analysis showed that AES scores in the MF group (42.1±6.6) and VF group (34.7±8.0) were higher than in the DLF group (28.5±4.36), NF group, and control group (P<0.05). The apathy rate was 63.6% in the MF group and 25% in the VF group, and significantly higher than in the DLF (5.6%), NF (5.3%), and control (0%) groups (P<0.001). A moderate correlation was found between AES score and mean diameter of the meningioma in all patient groups. Further analysis demonstrated that the correlation existed in the DLF (r=0.52, P=0.032), MF (r=0.84, P<0.001), and VF (r=0.64, P=0.008) groups, but not in the NF group (r=0.19, P=0.448). The AES score was much higher in patients with brain edema than in those without brain edema (34.73±8.28 versus 28.77±4.20, t=3.545, P=0.001). In subgroups within frontal meningioma patients, the statistical significance above only existed in the MF group (43.50±5.26 versus 25.67±6.03, P=0.001). Also, we examined the effect of related factors, such as age, sex, education, tumor size, tumor location and edema on the occurrence of apathy. The binary logistic regression analysis showed that MF [P=0.023, Exp(B) =145.6] and size [P=0.012, Exp(B) =1.20] got into the regression equation. Thirty-two patients underwent follow-up post-surgery. A significant reduction in AES was found in the MF group (AES1 - AES2 =6.86±6.82, t=2.68, P=0.04), but not in any of the other groups. CONCLUSION Apathy occurs frequently in patients with frontal meningioma, and is more severe, especially in the MF region. Apathy is probably correlated with tumor location and size. Brain edema might increase the severity of apathy.
Collapse
Affiliation(s)
- Yihua Peng
- Psychiatry Department, Fudan University, People's Republic of China
| | - Chunhong Shao
- Psychiatry Department, Fudan University, People's Republic of China
| | - Ye Gong
- Neurosurgery Department, Fudan University, People's Republic of China
| | - Xuehai Wu
- Neurosurgery Department, Fudan University, People's Republic of China
| | - Weijun Tang
- Radiology Department, Huashan Hospital, Fudan University, People's Republic of China
| | - Shenxun Shi
- Psychiatry Department, Fudan University, People's Republic of China
| |
Collapse
|
47
|
Guercio B, Donovan NJ, Ward A, Schultz A, Lorius N, Amariglio RE, Rentz DM, Johnson KA, Sperling RA, Marshall GA. Apathy is associated with lower inferior temporal cortical thickness in mild cognitive impairment and normal elderly individuals. J Neuropsychiatry Clin Neurosci 2015; 27:e22-7. [PMID: 25716491 PMCID: PMC4342844 DOI: 10.1176/appi.neuropsych.13060141] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Apathy is a common neuropsychiatric symptom in Alzheimer's disease dementia and amnestic mild cognitive impairment and is associated with cortical atrophy in Alzheimer's disease dementia. This study investigated possible correlations between apathy and cortical atrophy in 47 individuals with mild cognitive impairment and 19 clinically normal elderly. Backward elimination multivariate linear regression was used to evaluate the cross-sectional relationship between scores on the Apathy Evaluation Scale and thickness of several cortical regions and covariates. Lower inferior temporal cortical thickness was predictive of greater apathy. Greater anterior cingulate cortical thickness was also predictive of greater apathy, suggesting an underlying reactive process.
Collapse
Affiliation(s)
- Brendan Guercio
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Nancy J. Donovan
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Andrew Ward
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Aaron Schultz
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Natacha Lorius
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Rebecca E. Amariglio
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dorene M. Rentz
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Keith A. Johnson
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA,Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Reisa A. Sperling
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gad A. Marshall
- Harvard Medical School, Boston, MA 02115, USA,Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA,Correspondence to: Gad A. Marshall, MD, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, 221 Longwood Avenue, BL-104H, Boston, MA 02115, P: 617-732-8085, F: 617-264-5212,
| |
Collapse
|
48
|
Donovan NJ, Wadsworth LP, Lorius N, Locascio JJ, Rentz DM, Johnson KA, Sperling RA, Marshall GA. Regional cortical thinning predicts worsening apathy and hallucinations across the Alzheimer disease spectrum. Am J Geriatr Psychiatry 2014; 22:1168-79. [PMID: 23890751 PMCID: PMC3960369 DOI: 10.1016/j.jagp.2013.03.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 02/23/2013] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To examine regions of cortical thinning and cerebrospinal fluid (CSF) Alzheimer disease (AD) biomarkers associated with apathy and hallucinations in a continuum of individuals including clinically normal elderly, mild cognitive impairment, and mild AD dementia. DESIGN Cross-sectional and longitudinal studies. SETTING Fifty-seven research sites across North America. PARTICIPANTS Eight-hundred twelve community-dwelling volunteers; 413 participants in the CSF sub-study. MEASUREMENTS Structural magnetic resonance imaging data and CSF concentrations of amyloid-β 1-42, total tau, and phosphorylated tau derived from the Alzheimer Disease Neuroimaging Initiative database were analyzed. Apathy and hallucinations were measured at baseline and over 3 years using the Neuropsychiatric Inventory-Questionnaire. General linear models and mixed effects models were used to evaluate the relationships among baseline cortical thickness in seven regions, and baseline CSF biomarkers, apathy, and hallucinations at baseline and longitudinally. Covariates included diagnosis, sex, age, apolipoprotein E genotype, premorbid intelligence, memory performance, processing speed, antidepressant use, and AD duration. RESULTS Reduced baseline inferior temporal cortical thickness was predictive of increasing apathy over time, and reduced supramarginal cortical thickness was predictive of increasing hallucinations over time. There was no association with cortical thickness at baseline. CSF biomarkers were not related to severity of apathy or hallucinations in cross-sectional or longitudinal analyses. CONCLUSIONS These results suggest that greater baseline temporal and parietal atrophy is associated with worsening apathy and hallucinations in a large AD spectrum cohort, while adjusting for multiple disease-related variables. Localized cortical neurodegeneration may contribute to the pathophysiology of apathy and hallucinations and their adverse consequences in AD.
Collapse
Affiliation(s)
- Nancy J. Donovan
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Correspondence and reprint requests to: Nancy J. Donovan, MD, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, 221 Longwood Avenue, BL-104H, Boston, MA 02115, P: 617-732-8085, F: 617-264-6831, E:
| | - Lauren P. Wadsworth
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Natacha Lorius
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Joseph J. Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dorene M. Rentz
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Keith A. Johnson
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Reisa A. Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Gad A. Marshall
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | | |
Collapse
|
49
|
Diffusion tensor imaging in Alzheimer's disease and affective disorders. Eur Arch Psychiatry Clin Neurosci 2014; 264:467-83. [PMID: 24595744 DOI: 10.1007/s00406-014-0496-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/20/2014] [Indexed: 12/18/2022]
Abstract
The functional organization of the brain in segregated neuronal networks has become a leading paradigm in the study of brain diseases. Diffusion tensor imaging (DTI) allows testing the validity and clinical utility of this paradigm on the structural connectivity level. DTI in Alzheimer's disease (AD) suggests a selective impairment of intracortical projecting fiber tracts underlying the functional disorganization of neuronal networks supporting memory and other cognitive functions. These findings have already been tested for their utility as clinical markers of AD in large multicenter studies. Affective disorders, including major depressive disorder (MDD) and bipolar disorder (BP), show a high comorbidity with AD in geriatric populations and may even have a pathogenetic overlap with AD. DTI studies in MDD and BP are still limited to small-scale monocenter studies, revealing subtle abnormalities in cortico-subcortial networks associated with affect regulation and reward/aversion control. The clinical utility of these findings remains to be further explored. The present paper presents the methodological background of diffusion imaging, including DTI and diffusion spectrum imaging, and discusses key findings in AD and affective disorders. The results of our review strongly point toward the necessity of large-scale multicenter multimodal transnosological networks to study the structural and functional basis of neuronal disconnection underlying different neuropsychiatric diseases.
Collapse
|
50
|
Rog LA, Park LQ, Harvey DJ, Huang CJ, Mackin S, Farias ST. The independent contributions of cognitive impairment and neuropsychiatric symptoms to everyday function in older adults. Clin Neuropsychol 2014; 28:215-36. [PMID: 24502686 DOI: 10.1080/13854046.2013.876101] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The everyday functional capacities of older adults are determined by multiple factors. The primary goal of the present study was to evaluate whether apathy and depression have unique influences on degree of functional impairment, independent of the effects of specific cognitive impairments. Participants included 344 older adults (199 normal, 87 with MCI, 58 with dementia). The Everyday Cognition (ECog) scales were used to measure both global and domain-specific functional abilities. Neuropsychiatric symptoms of depression and apathy were measured by the Neuropsychiatric Inventory (NPI), and specific neuropsychological domains measured included episodic memory and executive functioning. Results indicated that worse memory and executive function, as well as greater depression and apathy, were all independent and additive determinants of poorer functional abilities. Apathy had a slightly more restricted effect than the other variables across the specific functional domains assessed. Secondary analysis suggested that neuropsychiatric symptoms may be more strongly associated with everyday function within cognitively normal and MCI groups, while cognitive impairment is more strongly associated with everyday function in dementia. Thus, a somewhat different set of factors may be associated with functional status across various clinical groups.
Collapse
Affiliation(s)
- Lauren A Rog
- a VeteransAffairs Northern California Health Care System , Martinez , CA , USA
| | | | | | | | | | | |
Collapse
|