1
|
Jackson MG, Lightman SL, Robinson ESJ. Characterisation of behaviours relevant to apathy syndrome in the aged male rat. Behav Brain Res 2024; 466:114977. [PMID: 38570074 DOI: 10.1016/j.bbr.2024.114977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Apathy is a complex psychiatric syndrome characterised by motivational deficit, emotional blunting and cognitive changes. It occurs alongside a broad range of neurological disorders, but also occurs in otherwise healthy ageing. Despite its clinical prevalence, apathy does not yet have a designated treatment strategy. Generation of a translational animal model of apathy syndrome would facilitate the development of novel treatments. Given the multidimensional nature of apathy, a model cannot be achieved with a single behavioural test. Using a battery of behavioural tests we investigated whether aged rats exhibit behavioural deficits across different domains relevant to apathy. Using the effort for reward and progressive ratio tasks we found that aged male rats (21-27 months) show intact reward motivation. Using the novelty supressed feeding test and position-based object exploration we found aged rats showed increased anxiety-like behaviour inconsistent with emotional blunting. The sucrose preference test and reward learning assay showed intact reward sensitivity and reward-related cognition in aged rats. However, using a bowl-digging version of the probabilistic reversal learning task, we found a deficit in cognitive flexibility in aged rats that did not translate across to a touchscreen version of the task. While these data reveal important changes in cognitive flexibility and anxiety associated with ageing, aged rats do not show deficits across other behavioural domains relevant to apathy. This suggests that aged rats are not a suitable model for age-related apathy syndrome. These findings contrast with previous work in mice, revealing important species differences in behaviours relevant to apathy syndrome in ageing.
Collapse
Affiliation(s)
- Megan G Jackson
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
| | - Stafford L Lightman
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Emma S J Robinson
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| |
Collapse
|
2
|
Maggi G, Loayza F, Vitale C, Santangelo G, Obeso I. Anatomical correlates of apathy and impulsivity co-occurrence in early Parkinson's disease. J Neurol 2024; 271:2798-2809. [PMID: 38416170 PMCID: PMC11055726 DOI: 10.1007/s00415-024-12233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Although apathy and impulse control disorders (ICDs) are considered to represent opposite extremes of a continuum of motivated behavior (i.e., hypo- and hyperdopaminergic behaviors), they may also co-occur in Parkinson's disease (PD). OBJECTIVES We aimed to explore the co-occurrence of ICDs and apathy and its neural correlates analyzing gray matter (GM) changes in early untreated PD patients. Moreover, we aimed to investigate the possible longitudinal relationship between ICDs and apathy and their putative impact on cognition during the first five years of PD. METHODS We used the Parkinson's Progression Markers Initiative (PPMI) database to identify the co-occurrence of apathy and ICDs in 423 early drug-naïve PD patients at baseline and at 5-year follow-up. Baseline MRI volumes and gray matter changes were analyzed between groups using voxel-based morphometry. Multi-level models assessed the longitudinal relationship (across five years) between apathy and ICDs and cognitive functioning. RESULTS At baseline, co-occurrence of apathy and ICDs was observed in 23 patients (5.4%). This finding was related to anatomical GM reduction along the cortical regions involved in the limbic circuit and cognitive control systems. Longitudinal analyses indicated that apathy and ICDs were related to each other as well as to the combined use of levodopa and dopamine agonists. Worse apathetic and ICDs states were associated with poorer executive functions. CONCLUSIONS Apathy and ICDs are joint non-exclusive neuropsychiatric disorders also in the early stages of PD and their co-occurrence was associated with GM decrease in several cortical regions of the limbic circuit and cognitive control systems.
Collapse
Affiliation(s)
- Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Francis Loayza
- Neurosciences and Bioengineering Laboratory, Faculty of Mechanical and Production Sciences Engineering, Polytechnic University (ESPOL), Guayaquil, Ecuador
| | - Carmine Vitale
- Department of Medical, Motor Sciences and Wellness, University "Parthenope", Naples, Italy
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Ignacio Obeso
- HM-CINAC, Centro Integral de Neurociencias AC. HM Hospitales, Av. Carlos V, 70, Móstoles, 28938, Madrid, Spain.
- CINC, CSIC, Madrid, Spain.
| |
Collapse
|
3
|
Gilmour W, Mackenzie G, Feile M, Tayler-Grint L, Suveges S, Macfarlane JA, Macleod AD, Marshall V, Grunwald IQ, Steele JD, Gilbertson T. Impaired value-based decision-making in Parkinson's disease apathy. Brain 2024; 147:1362-1376. [PMID: 38305691 PMCID: PMC10994558 DOI: 10.1093/brain/awae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/07/2023] [Accepted: 01/13/2024] [Indexed: 02/03/2024] Open
Abstract
Apathy is a common and disabling complication of Parkinson's disease characterized by reduced goal-directed behaviour. Several studies have reported dysfunction within prefrontal cortical regions and projections from brainstem nuclei whose neuromodulators include dopamine, serotonin and noradrenaline. Work in animal and human neuroscience have confirmed contributions of these neuromodulators on aspects of motivated decision-making. Specifically, these neuromodulators have overlapping contributions to encoding the value of decisions, and influence whether to explore alternative courses of action or persist in an existing strategy to achieve a rewarding goal. Building upon this work, we hypothesized that apathy in Parkinson's disease should be associated with an impairment in value-based learning. Using a four-armed restless bandit reinforcement learning task, we studied decision-making in 75 volunteers; 53 patients with Parkinson's disease, with and without clinical apathy, and 22 age-matched healthy control subjects. Patients with apathy exhibited impaired ability to choose the highest value bandit. Task performance predicted an individual patient's apathy severity measured using the Lille Apathy Rating Scale (R = -0.46, P < 0.001). Computational modelling of the patient's choices confirmed the apathy group made decisions that were indifferent to the learnt value of the options, consistent with previous reports of reward insensitivity. Further analysis demonstrated a shift away from exploiting the highest value option and a reduction in perseveration, which also correlated with apathy scores (R = -0.5, P < 0.001). We went on to acquire functional MRI in 59 volunteers; a group of 19 patients with and 20 without apathy and 20 age-matched controls performing the Restless Bandit Task. Analysis of the functional MRI signal at the point of reward feedback confirmed diminished signal within ventromedial prefrontal cortex in Parkinson's disease, which was more marked in apathy, but not predictive of their individual apathy severity. Using a model-based categorization of choice type, decisions to explore lower value bandits in the apathy group activated prefrontal cortex to a similar degree to the age-matched controls. In contrast, Parkinson's patients without apathy demonstrated significantly increased activation across a distributed thalamo-cortical network. Enhanced activity in the thalamus predicted individual apathy severity across both patient groups and exhibited functional connectivity with dorsal anterior cingulate cortex and anterior insula. Given that task performance in patients without apathy was no different to the age-matched control subjects, we interpret the recruitment of this network as a possible compensatory mechanism, which compensates against symptomatic manifestation of apathy in Parkinson's disease.
Collapse
Affiliation(s)
- William Gilmour
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Graeme Mackenzie
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Mathias Feile
- Rehabilitation Psychiatry, Murray Royal Hospital, Perth PH2 7BH, UK
| | | | - Szabolcs Suveges
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jennifer A Macfarlane
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Medical Physics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
- SINAPSE, University of Glasgow, Imaging Centre of Excellence, Level 2, Queen Elizabeth University Hospital, Glasgow G51 4TF, Scotland, UK
| | - Angus D Macleod
- Institute of Applied Health Sciences, School of Medicine, University of Aberdeen, Foresterhill, Aberdeen AB24 2ZD, UK
- Department of Neurology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB24 2ZD, UK
| | - Vicky Marshall
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Iris Q Grunwald
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - J Douglas Steele
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Tom Gilbertson
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| |
Collapse
|
4
|
Parrotta I, Cacciatore S, D'Andrea F, D'Anna M, Giancaterino G, Lazzaro G, Arcara G, Manzo N. Prevalence, treatment, and neural correlates of apathy in different forms of dementia: a narrative review. Neurol Sci 2024; 45:1343-1376. [PMID: 38015288 PMCID: PMC10942903 DOI: 10.1007/s10072-023-07197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The aim of this review is to provide an overview on prevalence and clinical tools for the diagnosis of apathy, as well as on neurophysiological and neuroimaging findings obtained from studies in patients with apathy in different forms of dementia, including Alzheimer's disease (AD), vascular (VaD) and mixed dementia, frontotemporal dementia (FTD), and Parkinson's disease dementia (PDD). METHODS Randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series from four databases (WebOfScience, Scopus, Pubmed, and PsycINFO) addressing apathy in adults or older people aged over 65 years of age affected by dementia were included. RESULTS The prevalence of apathy was 26-82% for AD, 28.6-91.7 for VaD, 29-97.5% in PDD, and 54.8-88.0 in FTD. The assessment of apathy was not consistent in the reviewed studies. Methylphenidate was the most successful pharmacological treatment for apathy. Neurobiological studies highlighted the relationship between both structural and functional brain areas and the presence or severity of apathy. CONCLUSION Apathy is a very common disorder in all types of dementia, although it is often underdiagnosed and undertreated. Further studies are needed to investigate its diagnosis and management. A consensus on the different evaluation scales should be achieved.
Collapse
Affiliation(s)
- Ilaria Parrotta
- Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001, Louvain, Belgium
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
- Young Epidemiologists of the Italian Society of Gerontology and Geriatrics (SIGG) (YES) Working Group, Italian Society of Gerontology and Geriatrics, Via Giulio Cesare Vanini 5, 50129, Florence, Italy
| | - Stefano Cacciatore
- Young Epidemiologists of the Italian Society of Gerontology and Geriatrics (SIGG) (YES) Working Group, Italian Society of Gerontology and Geriatrics, Via Giulio Cesare Vanini 5, 50129, Florence, Italy.
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy.
| | - Flavio D'Andrea
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Marianna D'Anna
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giulia Giancaterino
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giovanni Lazzaro
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Giorgio Arcara
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Nicoletta Manzo
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| |
Collapse
|
5
|
Lafond-Brina G, Pham BT, Bonnefond A. Specific mechanisms underlying executive and emotional apathy: A phenotyping study. J Psychiatr Res 2024; 172:35-46. [PMID: 38359616 DOI: 10.1016/j.jpsychires.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/11/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
Apathy is a behavioral symptom prevalent both in neuropsychiatric pathologies and in the healthy population. However, the knowledge of the cognitive and neural mechanisms underlying apathy is still very limited, even if clinical and fMRI data support the existence of three forms of apathy (executive, emotional, initiative). These forms could be explained by the alteration of specific mechanisms. This present study's aim is to specify the cognitive and neuronal mechanisms of executive and emotional apathy. We used an EEG study conducted on 68 subjects comprising two groups of young people with specific executive or emotional phenotypes of apathy and one group with no apathy. Despite having symptom of apathy, participants were free of any neurological, metabolic, or psychiatric diagnoses and with high education. Two tasks were used: the DPX for cognitive control and the MID for motivation. Our results showed that distinct mechanisms underlie these two forms of apathy, and, for the first time, we specified these mechanisms. A deficit of the proactive control mode, reflected by a reduced probe-N2 amplitude in AY trials, underlies the executive form of apathy (p < .03), whereas liking motivational blunting, highlighted by a reduced LPP amplitude for financial loss, characterizes the emotional form (p < .04). The main limit of the results is that generalizability to the general population may be reduced since the apathetic samples were chosen for having a specific form of apathy. To conclude, better knowledge of these mechanisms informs new, more targeted treatments, both pharmacological and non-pharmacological, necessary for reducing the debilitating consequences of apathy.
Collapse
Affiliation(s)
| | | | - Anne Bonnefond
- INSERM, Unité 1114, Strasbourg, France; University of Strasbourg, France
| |
Collapse
|
6
|
Schneider RB, Auinger P, Dobkin RD, Mills KA, Kulick-Soper CV, Myers TL, Korell M, Pontone GM, Nirenberg MJ. Minor Phenomena in Parkinson's Disease-Prevalence, Associations, and Risk of Developing Psychosis. J Geriatr Psychiatry Neurol 2024; 37:134-145. [PMID: 37542397 DOI: 10.1177/08919887231195220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
BACKGROUND Minor phenomena, including passage phenomena, feeling of presence, and illusions, are common and may represent a prodromal form of psychosis in Parkinson's disease (PD). We examined the prevalence and clinical correlates of minor phenomena, and their potential role as a risk factor for PD psychosis. METHODS A novel questionnaire, the Psychosis and Mild Perceptual Disturbances Questionnaire for PD (PMPDQ), was completed by Fox Insight cohort participants with and without PD. Additional assessments included the Non-Motor Symptoms Questionnaire (NMSQuest), REM Sleep Behavior Disorder Single Question Screen (RBD1Q), Movement Disorder Society-Unified Parkinson Disease Rating Scale Part II, demographic features, and medication usage. For participants with PD, we used regression models to identify clinical associations and predictors of incident psychosis over one year of follow-up. RESULTS Among participants with PD (n = 5950) and without PD (n = 1879), the prevalence of minor phenomena was 43.1% and 31.7% (P < .001). Of the 3760 participants with PD and no baseline psychosis, independent correlates of minor phenomena included positive responses on the NMSQuest apathy/attention/memory (OR 1.7, 95% CI 1.3-2.1, P < .001) or sexual function domain (OR 1.3, 95% CI 1.1-1.6, P = .01) and positive RBD1Q (OR 1.3, 95% CI 1.05-1.5, P = .01). Independent risk factors for incident PD psychosis included the presence of minor phenomena (HR 3.0, 95% CI 2.4-3.9, P < .001), positive response on the NMSQuest apathy/attention/memory domain (HR 1.8, 95% CI 1.3-2.6, P < .001), and positive RBD1Q (HR 1.5, 95% CI 1.1-1.9, P = .004). CONCLUSIONS Minor phenomena are common, associated with specific non-motor symptoms, and an independent predictor of incident psychosis in PD.
Collapse
Affiliation(s)
- Ruth B Schneider
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health & Technology, University of Rochester, Rochester, NY, USA
| | - Peggy Auinger
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Center for Health & Technology, University of Rochester, Rochester, NY, USA
| | - Roseanne D Dobkin
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Kelly A Mills
- Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Taylor L Myers
- Center for Health & Technology, University of Rochester, Rochester, NY, USA
| | - Monica Korell
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gregory M Pontone
- Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa J Nirenberg
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
7
|
Yi HJ, Tan CH, Hong WP, Yu RL. Development and validation of the geriatric apathy scale: Examining multi-dimensional apathy profiles in a neurodegenerative population with cultural considerations. Asian J Psychiatr 2024; 93:103924. [PMID: 38232445 DOI: 10.1016/j.ajp.2024.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Apathy is a common motivational deficit in neurodegenerative diseases, but lacks a culturally sensitive tool accounting for ethnic Chinese culture's impact on motivation initiation. This study developed and validated the Geriatric Apathy Scale (GAS), comprehensively incorporating cultural nuances, setting diagnostic cutoffs, and examining apathy's multi-dimensional aspects in a neurodegenerative cohort. METHODS The 16-item GAS was developed by considering ethnic Chinese cultural characteristics and conducting a literature review. The study involved 296 participants, comprising 113 with Parkinson's disease (PD), 66 with Alzheimer's disease (AD), and 117 healthy controls (HC). All participants completed the GAS, Apathy Evaluation Scale (AES), Geriatric Depression Scale (GDS-15), Mini-Mental State Examination, and Activities of Daily Living (ADLs). RESULTS The GAS showed good internal consistency (r = 0.862) and test-retest reliability (r = 0.767). It correlated moderately with the AES (r = 0.639, p < .001), weakly with GDS-15 (r = 0.166, p < .01), and negatively with ADLs (r = -1.19, p < .05). Clinical diagnosis cutoff scores were identified at 15.5 for PD (sensitivity: 0.789; specificity: 0.693) and 12.5 for AD (sensitivity: 0.821; specificity: 0.632). Noteworthy disparities were observed in the Cognition and Social Motivation dimension, with elevated severity in both PD and AD compared to HC (p < .01). Interestingly, within-group comparisons revealed greater apathy severity in the Cognition and Social Motivation dimension for PD (p < .001) and AD (p = .001) versus Emotional Response and Expression and Spontaneous Behavioral Activation. CONCLUSIONS The GAS, a psychometrically validated scale, assesses apathy in neurodegenerative populations, accounting for ethnic Chinese culture's influence. It establishes clinical cutoff points and explores the multi-dimensional nature of apathy.
Collapse
Affiliation(s)
- Hsin-Jou Yi
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsiang Tan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Pin Hong
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Rwei-Ling Yu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Office of Strategic Planning, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
8
|
Béreau M, Kibleur A, Servant M, Clément G, Dujardin K, Rolland AS, Wirth T, Lagha-Boukbiza O, Voirin J, Santin MDN, Hainque E, Grabli D, Comte A, Drapier S, Durif F, Marques A, Eusebio A, Azulay JP, Giordana C, Houeto JL, Jarraya B, Maltete D, Rascol O, Rouaud T, Tir M, Moreau C, Danaila T, Prange S, Tatu L, Tranchant C, Corvol JC, Devos D, Thobois S, Desmarets M, Anheim M. Motivational and cognitive predictors of apathy after subthalamic nucleus stimulation in Parkinson's disease. Brain 2024; 147:472-485. [PMID: 37787488 DOI: 10.1093/brain/awad324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 10/04/2023] Open
Abstract
Postoperative apathy is a frequent symptom in Parkinson's disease patients who have undergone bilateral deep brain stimulation of the subthalamic nucleus. Two main hypotheses for postoperative apathy have been suggested: (i) dopaminergic withdrawal syndrome relative to postoperative dopaminergic drug tapering; and (ii) direct effect of chronic stimulation of the subthalamic nucleus. The primary objective of our study was to describe preoperative and 1-year postoperative apathy in Parkinson's disease patients who underwent chronic bilateral deep brain stimulation of the subthalamic nucleus. We also aimed to identify factors associated with 1-year postoperative apathy considering: (i) preoperative clinical phenotype; (ii) dopaminergic drug management; and (iii) volume of tissue activated within the subthalamic nucleus and the surrounding structures. We investigated a prospective clinical cohort of 367 patients before and 1 year after chronic bilateral deep brain stimulation of the subthalamic nucleus. We assessed apathy using the Lille Apathy Rating Scale and carried out a systematic evaluation of motor, cognitive and behavioural signs. We modelled the volume of tissue activated in 161 patients using the Lead-DBS toolbox and analysed overlaps within motor, cognitive and limbic parts of the subthalamic nucleus. Of the 367 patients, 94 (25.6%) exhibited 1-year postoperative apathy: 67 (18.2%) with 'de novo apathy' and 27 (7.4%) with 'sustained apathy'. We observed disappearance of preoperative apathy in 22 (6.0%) patients, who were classified as having 'reversed apathy'. Lastly, 251 (68.4%) patients had neither preoperative nor postoperative apathy and were classified as having 'no apathy'. We identified preoperative apathy score [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.10, 1.22; P < 0.001], preoperative episodic memory free recall score (OR 0.93; 95% CI 0.88, 0.97; P = 0.003) and 1-year postoperative motor responsiveness (OR 0.98; 95% CI 0.96, 0.99; P = 0.009) as the main factors associated with postoperative apathy. We showed that neither dopaminergic dose reduction nor subthalamic stimulation were associated with postoperative apathy. Patients with 'sustained apathy' had poorer preoperative fronto-striatal cognitive status and a higher preoperative action initiation apathy subscore. In these patients, apathy score and cognitive status worsened postoperatively despite significantly lower reduction in dopamine agonists (P = 0.023), suggesting cognitive dopa-resistant apathy. Patients with 'reversed apathy' benefited from the psychostimulant effect of chronic stimulation of the limbic part of the left subthalamic nucleus (P = 0.043), suggesting motivational apathy. Our results highlight the need for careful preoperative assessment of motivational and cognitive components of apathy as well as executive functions in order to better prevent or manage postoperative apathy.
Collapse
Affiliation(s)
- Matthieu Béreau
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
| | - Astrid Kibleur
- LIP/PC2S, Université Grenoble Alpes, Université Savoie Mont Blanc, 38040 Grenoble Cedex 9, France
| | - Mathieu Servant
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
| | - Gautier Clément
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
| | - Kathy Dujardin
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
| | - Anne-Sophie Rolland
- Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Univ. Lille, Inserm, 59045 Lille, France
| | - Thomas Wirth
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
| | - Ouhaid Lagha-Boukbiza
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
| | - Jimmy Voirin
- Department of Neurosurgery, NS-PARK/F-CRIN network, Strasbourg University Hospital, 67200 Strasbourg, France
| | - Marie des Neiges Santin
- Department of Neurosurgery, NS-PARK/F-CRIN network, Strasbourg University Hospital, 67200 Strasbourg, France
| | - Elodie Hainque
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - David Grabli
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - Alexandre Comte
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
- Centre d'investigation clinique Inserm CIC 1431, CHU Besançon, F-25000 Besançon, France
| | - Sophie Drapier
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Rennes, 35000 Rennes, France
| | - Franck Durif
- CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN network, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Ana Marques
- CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN network, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille Univ., 13005 Marseille, France
| | - Jean-Philippe Azulay
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille Univ., 13005 Marseille, France
| | - Caroline Giordana
- Department of Neurology, NS-Park/F-CRIN network, Centre Hospitalier Universitaire de Nice, 06002 Nice, France
| | - Jean-Luc Houeto
- Department of Neurology, NS-Park/F-CRIN network, Limoges University Hospital, Inserm, U1094, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges University Hospital,87042 Limoges, France
| | - Béchir Jarraya
- Neuroscience Pole, NS-Park/F-CRIN network, Hôpital Foch, Suresnes, University of Versailles Paris-Saclay, INSERM-CEA NeuroSpin, 91191 Gif-sur-Yvette, France
| | - David Maltete
- Department of Neurology, NS-Park/F-CRIN network, Rouen University Hospital and University of Rouen, 76000 Rouen, France
- INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, 76130 Mont-Saint-Aignan, France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neuroscience, CIC1436, NS-Park/F-CRIN network, NeuroToul Center of Excellence, Toulouse University Hospital, INSERM, CHU of Toulouse, 31000 Toulouse, France
| | - Tiphaine Rouaud
- Department of Neurology, Centre Expert Parkinson, NS-Park/F-CRIN network, CHU Nantes, 44093 Nantes, France
| | - Mélissa Tir
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
| | - Caroline Moreau
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
| | - Teodor Danaila
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
| | - Stéphane Prange
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
- Service de Neurologie C, NS-Park/F-CRIN network, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500 Bron, France
| | - Laurent Tatu
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
| | - Christine Tranchant
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
| | - Jean-Christophe Corvol
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - David Devos
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
- Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Univ. Lille, Inserm, 59045 Lille, France
| | - Stephane Thobois
- Service de Neurologie C, NS-Park/F-CRIN network, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500 Bron, France
- Institut des Sciences Cognitives Marc Jeannerot, CNRS, UMR5229, 69675 Bron, France
| | - Maxime Desmarets
- Centre d'investigation clinique Inserm CIC 1431, CHU Besançon, F-25000 Besançon, France
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, 25000 Besançon, France
| | - Mathieu Anheim
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
| |
Collapse
|
9
|
Boi L, Fisone G. Investigating affective neuropsychiatric symptoms in rodent models of Parkinson's disease. Int Rev Neurobiol 2023; 174:119-186. [PMID: 38341228 DOI: 10.1016/bs.irn.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Affective neuropsychiatric disorders such as depression, anxiety and apathy are among the most frequent non-motor symptoms observed in people with Parkinson's disease (PD). These conditions often emerge during the prodromal phase of the disease and are generally considered to result from neurodegenerative processes in meso-corticolimbic structures, occurring in parallel to the loss of nigrostriatal dopaminergic neurons. Depression, anxiety, and apathy are often treated with conventional medications, including selective serotonin reuptake inhibitors, tricyclic antidepressants, and dopaminergic agonists. The ability of these pharmacological interventions to consistently counteract such neuropsychiatric symptoms in PD is still relatively limited and the development of reliable experimental models represents an important tool to identify more effective treatments. This chapter provides information on rodent models of PD utilized to study these affective neuropsychiatric symptoms. Neurotoxin-based and genetic models are discussed, together with the main behavioral tests utilized to identify depression- and anxiety-like behaviors, anhedonia, and apathy. The ability of various therapeutic approaches to counteract the symptoms observed in the various models is also reviewed.
Collapse
Affiliation(s)
- Laura Boi
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gilberto Fisone
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
10
|
Horne KS, Ceslis A, Mosley P, Adam R, Robinson GA. The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration. Cogn Behav Neurol 2023; 36:178-193. [PMID: 37378480 DOI: 10.1097/wnn.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/23/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases. OBJECTIVE To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response). METHOD We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks. RESULTS The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task's construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring. CONCLUSION Our work presents a novel experimental task for measuring spontaneous action initiation-a key symptom of apathy-and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.
Collapse
Affiliation(s)
- Kristina S Horne
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
| | - Amelia Ceslis
- School of Psychology, The University of Queensland, Queensland, Australia
| | - Philip Mosley
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Biomedical Informatics Group, Commonwealth Scientific and Industrial Research Organisation, Queensland, Australia
| | - Robert Adam
- University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Gail A Robinson
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
- School of Psychology, The University of Queensland, Queensland, Australia
| |
Collapse
|
11
|
Altieri M, Maggi G, Rippa V, Santangelo G. Evaluation of apathy in non-clinical populations: validation, psychometric properties, and normative data of the Italian version of Apathy-Motivation Index (AMI). Neurol Sci 2023; 44:3099-3106. [PMID: 37012520 PMCID: PMC10415455 DOI: 10.1007/s10072-023-06774-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Evaluation of apathy in non-clinical populations is relevant to identify individuals at risk for developing cognitive decline in later stages of life, and it should be performed with questionnaires specifically designed for healthy individuals, such as the Apathy-Motivation Index (AMI); therefore, the aim of the present study was to validate the AMI in a healthy Italian population, and to provide normative data of the scale. MATERIALS AND METHODS Data collection was performed using a survey completed by 500 healthy participants; DAS, MMQ-A, BIS-15, PHQ-9, and GAD-7 were used to investigate convergent and divergent validity. Internal consistency and factorial structure were also evaluated. A regression-based procedure and receiver operating characteristics (ROC) analyses were used to evaluate the influence of socio-demographic variables on AMI scores and to provide adjusting factors and three cut-offs for the detection of mild, moderate, and severe apathy. RESULTS The Italian version of the AMI included 17 items (one item was removed because it was not internally consistent) and demonstrated good psychometric properties. The three-factor structure of AMI was confirmed. Multiple regression analysis revealed no effect of sociodemographic variables on the total AMI score. ROC analyses revealed three cut-offs of 1.5, 1.66, and 2.06 through the Youden's J statistic to detect mild, moderate, and severe apathy, respectively. CONCLUSION The Italian version of the AMI reported similar psychometric properties, factorial structure, and cut-offs to the original scale. This may help researchers and clinicians to identify people at risk and address them in specific interventions to lower their apathy levels.
Collapse
Affiliation(s)
- Manuela Altieri
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Valentina Rippa
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| |
Collapse
|
12
|
Babicz MA, Matchanova A, Woods SP. Apathy Among Persons Living With HIV Is Associated With Lower Self-efficacy for Health Care Provider Interactions. J Assoc Nurses AIDS Care 2023; 34:389-397. [PMID: 37141172 DOI: 10.1097/jnc.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT Apathy is common in persons with HIV (PWH) and has been associated with a variety of health outcomes. We examined the association between apathy and self-efficacy for health care provider interactions in 142 PWH. A composite score comprised of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation scale of the Profile of Mood States was used to measure apathy. Self-efficacy for health care provider interactions was measured using the Beliefs Related to Medication Adherence - Dealing with Health Professional subscale. Higher levels of apathy were associated with lower self-efficacy for health care provider interactions at a medium effect size, independent of mood disorders, health literacy, and neurocognition. Findings suggest that apathy plays a unique role in self-efficacy for health care provider interactions and support the importance of assessment and management of apathy to maximize health outcomes among PWH.
Collapse
Affiliation(s)
- Michelle A Babicz
- Michelle A. Babicz, PhD, is a Neuropsychology Resident, Mental Health and Behavioral Services, James A. Haley Veteran's Hospital, Tampa, Florida, USA, and is a formerly Graduate Student, Department of Psychology, University of Houston, Houston, Texas, USA. Anastasia Matchanova, MA, is a Graduate Student, Department of Psychology, University of Houston, Houston, Texas, USA. Steven Paul Woods, PsyD, is a Professor, Department of Psychology, University of Houston, Houston, Texas, USA
| | | | | |
Collapse
|
13
|
Lanctôt KL, Ismail Z, Bawa KK, Cummings JL, Husain M, Mortby ME, Robert P. Distinguishing apathy from depression: A review differentiating the behavioral, neuroanatomic, and treatment-related aspects of apathy from depression in neurocognitive disorders. Int J Geriatr Psychiatry 2023; 38:e5882. [PMID: 36739588 PMCID: PMC10107127 DOI: 10.1002/gps.5882] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This narrative review describes the clinical features of apathy and depression in individuals with neurocognitive disorders (NCDs), with the goal of differentiating the two syndromes on the basis of clinical presentation, diagnostic criteria, neuropathological features, and contrasting responses to treatments. METHODS Literature was identified using PubMed, with search terms to capture medical conditions of interest; additional references were also included based on our collective experience and knowledge of the literature. RESULTS Evidence from current literature supports the distinction between the two disorders; apathy and depression occur with varying prevalence in individuals with NCDs, pose different risks of progression to dementia, and have distinct, if overlapping, neurobiological underpinnings. Although apathy is a distinct neuropsychiatric syndrome, distinguishing apathy from depression can be challenging, as both conditions may occur concurrently and share several overlapping features. Apathy is associated with unfavorable outcomes, especially those with neurodegenerative etiologies (e.g., Alzheimer's disease) and is associated with an increased burden for both patients and caregivers. Diagnosing apathy is important not only to serve as the basis for appropriate treatment, but also for the development of novel targeted interventions for this condition. Although there are currently no approved pharmacologic treatments for apathy, the research described in this review supports apathy as a distinct neuropsychiatric condition that warrants specific treatments aimed at alleviating patient disability. CONCLUSIONS Despite differences between these disorders, both apathy and depression pose significant challenges to patients, their families, and caregivers; better diagnostics are needed to develop more tailored treatment and support.
Collapse
Affiliation(s)
- Krista L. Lanctôt
- Departments of Psychiatry and of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Neuropsychopharmacology Research GroupHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Bernick Chair in Geriatric PsychopharmacologySunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health SciencesHotchkiss Brain InstituteO'Brien Institute of Public HealthUniversity of CalgaryCalgaryAlbertaCanada
| | - Kritleen K. Bawa
- Departments of Psychiatry and of Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
- Neuropsychopharmacology Research GroupHurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Jeffrey L. Cummings
- Department of Brain HealthChambers‐Grundy Center for Transformative NeuroscienceSchool of Integrated Health SciencesUniversity of Nevada Las Vegas (UNLV)Las VegasNevadaUSA
| | - Masud Husain
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Moyra E. Mortby
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Philippe Robert
- Cognition Behaviour Technology LabUniversity Côte d'Azur (UCA)NiceFrance
- Centre MémoireLe Centre Hospitalier Universitaire de NiceNiceFrance
| |
Collapse
|
14
|
Salem H, Suchting R, Gonzales MM, Seshadri S, Teixeira AL. Apathy as a Predictor of Conversion from Mild Cognitive Impairment to Alzheimer's Disease: A Texas Alzheimer's Research and Care Consortium (TARCC) Cohort-Based Analysis. J Alzheimers Dis 2023; 92:129-139. [PMID: 36710674 DOI: 10.3233/jad-220826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Apathy is among the neuropsychiatric symptoms frequently observed in people with cognitive impairment. It has been postulated to be a potential predictor of conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD). OBJECTIVE To detect conversion rates from MCI to AD, and to determine the effect of apathy on the progression to AD in patients with MCI enrolled in the Texas Alzheimer's Research and Care Consortium (TARCC) cohort. METHODS Apathy was determined by a positive response to the respective item in the Neuropsychiatric Inventory -Questionnaire (NPI-Q) completed by family members or caregivers. The final dataset included 2,897 observations from 1,092 individuals with MCI at the baseline. Kaplan-Meier survival curves were estimated to provide indices of the probability of conversion to AD over time across all individuals as well as between those with and without apathy. Cox proportional hazards regression measured the hazard associated with apathy and several other predictors of interest. RESULTS Over a period of 8.21 years, 17.3% of individuals had conversion from MCI to AD (n = 190 of 1,092 total individuals) across observations. The median time-to-conversion across all participants was 6.41 years. Comparing individuals with apathy (n = 158) versus without apathy (n = 934), 36.1% and 14.2% had conversion to AD, respectively. The median time-to-conversion was 3.79 years for individuals with apathy and 6.83 years for individuals without apathy. Cox proportional hazards regression found significant effects of several predictors, including apathy, on time-to-conversion. Age and cognitive performance were found to moderate the relationship between apathy and time-to-conversion. CONCLUSIONS Apathy is associated with progression from MCI to AD, suggesting that it might improve risk prediction and aid targeted intervention delivery.
Collapse
Affiliation(s)
- Haitham Salem
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Mitzi M Gonzales
- Biggs Institute, University of Texas Health Science Center, San Antonio, TX, USA
| | - Sudha Seshadri
- Biggs Institute, University of Texas Health Science Center, San Antonio, TX, USA
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
| |
Collapse
|
15
|
McLaurin KA, Cranston MN, Li H, Mactutus CF, Harrod SB, Booze RM. Synaptic dysfunction is associated with alterations in the initiation of goal-directed behaviors: Implications for HIV-1-associated apathy. Exp Neurol 2022; 357:114174. [PMID: 35863502 PMCID: PMC9990912 DOI: 10.1016/j.expneurol.2022.114174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/05/2023]
Abstract
Individuals living with human immunodeficiency virus type 1 (HIV-1) exhibit an increased prevalence of neuropsychiatric comorbities (e.g., apathy) relative to their seronegative counterparts. Given the profound functional consequences associated with apathy, characterizing the multidimensional neuropsychiatric syndrome, and associated neural mechanisms, following chronic HIV-1 viral protein exposure remains a critical need. HIV-1-associated apathy was examined by quantifying goal-directed behaviors, indexed using voluntary wheel running, during the diurnal and nocturnal cycle. Apathetic behaviors in the HIV-1 transgenic (Tg) rat were characterized by a profound decrease in the number of running bouts during both the diurnal and nocturnal cycle, supporting a prominent deficit in the self-initiation of spontaneous behaviors. Additionally, HIV-1 Tg animals exhibited a decreased reinforcing efficacy of voluntary wheel running during the nocturnal cycle. Following the completion of voluntary wheel running, synaptic dysfunction in medium spiny neurons (MSNs) of the nucleus accumbens core (NAcc) was examined as a potential neural mechanism underlying HIV-1-associated apathy. HIV-1 Tg animals displayed prominent synaptic dysfunction in MSNs of the NAcc, characterized by enhanced dendritic branching complexity and a population shift towards an immature dendritic spine phenotype relative to control animals. Synaptic dysfunction, which accounted for 42.0% to 68.5% of the variance in the number of running bouts, was strongly associated with the self-initiation of spontaneous behaviors. Establishment of the relationship between synaptic dysfunction and apathy affords a key target for the development of novel therapeutics and cure strategies for affective alterations associated with HIV-1.
Collapse
Affiliation(s)
- Kristen A McLaurin
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Michael N Cranston
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Hailong Li
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Charles F Mactutus
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Steven B Harrod
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Rosemarie M Booze
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America.
| |
Collapse
|
16
|
Ye R, O'Callaghan C, Rua C, Hezemans FH, Holland N, Malpetti M, Jones PS, Barker RA, Williams‐Gray CH, Robbins TW, Passamonti L, Rowe J. Locus Coeruleus Integrity from 7 T MRI Relates to Apathy and Cognition in Parkinsonian Disorders. Mov Disord 2022; 37:1663-1672. [PMID: 35576973 PMCID: PMC9541468 DOI: 10.1002/mds.29072] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neurodegeneration in the locus coeruleus (LC) contributes to neuropsychiatric symptoms in both Parkinson's disease (PD) and progressive supranuclear palsy (PSP). Spatial precision of LC imaging is improved with ultrahigh field 7 T magnetic resonance imaging. OBJECTIVES This study aimed to characterize the spatial patterns of LC pathological change in PD and PSP and the transdiagnostic relationship between LC signals and neuropsychiatric symptoms. METHODS Twenty-five people with idiopathic PD, 14 people with probable PSP-Richardson's syndrome, and 24 age-matched healthy controls were recruited. Participants underwent clinical assessments and high-resolution (0.08 mm3 ) 7 T-magnetization-transfer imaging to measure LC integrity in vivo. Spatial patterns of LC change were obtained using subregional mean contrast ratios and significant LC clusters; we further correlated the LC contrast with measures of apathy and cognition, using both mixed-effect models and voxelwise analyses. RESULTS PSP and PD groups showed significant LC degeneration in the caudal subregion relative to controls. Mixed-effect models revealed a significant interaction between disease-group and apathy-related correlations with LC degeneration (β = 0.46, SE [standard error] = 0.17, F(1, 35) = 7.46, P = 0.01), driven by a strong correlation in PSP (β = -0.58, SE = 0.21, t(35) = -2.76, P = 0.009). Across both disease groups, voxelwise analyses indicated that lower LC integrity was associated with worse cognition and higher apathy scores. CONCLUSIONS The relationship between LC and nonmotor symptoms highlights a role for noradrenergic dysfunction across both PD and PSP, confirming the potential for noradrenergic therapeutic strategies to address transdiagnostic cognitive and behavioral features in neurodegenerative disease. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Rong Ye
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical SciencesFaculty of Medicine and Health, University of SydneySydneyAustralia
- Department of PsychiatryUniversity of CambridgeCambridgeUnited Kingdom
| | - Catarina Rua
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Frank H. Hezemans
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUnited Kingdom
| | - Negin Holland
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - P. Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
| | - Roger A. Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain RepairUniversity of CambridgeCambridgeUnited Kingdom
- Wellcome Trust—Medical Research Council Stem Cell InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Caroline H. Williams‐Gray
- Department of Clinical Neurosciences, John van Geest Centre for Brain RepairUniversity of CambridgeCambridgeUnited Kingdom
| | - Trevor W. Robbins
- Department of PsychologyUniversity of CambridgeCambridgeUnited Kingdom
- Behavioural and Clinical Neuroscience InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- Istituto di Bioimmagini e Fisiologia MolecolareConsiglio Nazionale delle RicercheCefalùItaly
| | - James Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS TrustUniversity of CambridgeCambridgeUnited Kingdom
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUnited Kingdom
| |
Collapse
|
17
|
Golimbet VE, Klyushnik TP. [Molecular-genetic and immunological aspects of the formation of psychopathological symptoms in schizophrenia]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:66-71. [PMID: 36279230 DOI: 10.17116/jnevro202212210166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The authors present the data indicating that the formation of psychopathological symptoms of schizophrenia is due to complex and diverse genetic factors associated with various functional and metabolic pathways at different stages of ontogenesis. Despite the fact that at present the genetic basis of positive and negative symptoms as the main pathophysiological manifestations of schizophrenia remains largely unknown, the current level of research allows the identification of some common and unique associations for positive and negative disorders. Based on the analysis of the literature, the specificity of the association of genetic variants with negative symptoms of schizophrenia is shown. It has been also suggested that genes of the immune system may be specifically associated with negative symptoms of schizophrenia. The relevance of studying the relationship of immune system genes, in particular, pro- and anti-inflammatory cytokines, with dimensional characteristics of negative symptoms (abulia-apathy and expressive deficit) is substantiated. Studies of this type have not yet been conducted, despite accumulating data indicating that the heterogeneity of negative symptoms is based on different neurobiological mechanisms. It is concluded that the immunological and molecular genetic study of the subdomains of psychopathological symptoms can be promising as part of the transition to deep phenotyping, which seems to be especially relevant for the study of such an extremely heterogeneous disease from a clinical point of view as schizophrenia. The development of this area is important for solving the problems of precision medicine, which aims to provide the most effective therapy for a particular patient by stratifying the disease into subclasses, taking into account their biological basis.
Collapse
|
18
|
Favier M, Carcenac C, Savasta M, Carnicella S. Dopamine D3 Receptors: A Potential Target to Treat Motivational Deficits in Parkinson's Disease. Curr Top Behav Neurosci 2022; 60:109-132. [PMID: 35469394 DOI: 10.1007/7854_2022_316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Parkinson's disease (PD), which is traditionally viewed as a motor disorder involving the degeneration of dopaminergic (DA) neurons, has recently been identified as a quintessential neuropsychiatric condition. Indeed, a plethora of non-motor symptoms may occur in PD, including apathy. Apathy can be defined as a lack of motivation or a deficit of goal-directed behaviors and results in a pathological decrease of self-initiated voluntary behavior. Apathy in PD appears to fluctuate with the DA state of the patients, suggesting a critical role of DA neurotransmission in the pathophysiology of this neuropsychiatric syndrome. Using a lesion-based approach, we developed a rodent model which exhibits specific alteration in the preparatory component of motivational processes, reminiscent to apathy in PD. We found a selective decrease of DA D3 receptors (D3R) expression in the dorsal striatum of lesioned rats. Next, we showed that inhibition of D3R neurotransmission in non-lesioned animals was sufficient to reproduce the motivational deficit observed in our model. Interestingly, we also found that pharmacologically targeting D3R efficiently reversed the motivational deficit induced by the lesion. Our findings, among other recent data, suggest a critical role of D3R in parkinsonian apathy and highlight this receptor as a promising target for treating motivational deficits.
Collapse
Affiliation(s)
- Mathieu Favier
- Douglas Mental Health University Institute, McGill University, Verdun, QC, Canada
| | - Carole Carcenac
- Inserm, U1216, Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Marc Savasta
- Inserm, Délégation régionale Provence-Alpes-Côte d'Azur et Corse, Marseille CEDEX 09, France
| | - Sebastien Carnicella
- Inserm, U1216, Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
| |
Collapse
|
19
|
Abstract
Amotivation is related to value representation. A comprehensive account of amotivation requires a mechanistic understanding of how the brain exploits external information to represent value. To achieve maximal value discriminability, brain valuation system will dynamically adapt its coding sensitivity to the range of values available in any given condition, so-called range adaptive coding. We administered an experimental task to 30 patients with chronic schizophrenia (C-SCZ), 30 first-episode schizophrenia (FE-SCZ), 34 individuals with high social anhedonia (HSoA), and their paired controls to assess range adaptation ability. C-SCZ patients exhibited over-adaptation and their performances were negatively correlated with avolition symptoms and positive symptoms and positively correlated with blunted-affect symptoms and self-reported consummatory interpersonal pleasure scores, though the results were non-significant. FE-SCZ patients exhibited reduced adaptation, which was significantly and negatively correlated with avolition symptoms and positively correlated with the overall proportion of choosing to exert more effort. Although HSoA participants exhibited comparable range adaptation to controls, their performances were significantly and negatively correlated with the proportion of choosing to exert more effort under the lowest value condition. Our results suggest that different stages of schizophrenia spectrum showed distinct range adaptation patterns. Range adaptation impairments may index a possible underlying mechanism for amotivation symptoms in FE-SCZ and more complicated and pervasive effects on clinical symptoms in C-SCZ.
Collapse
Affiliation(s)
- Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Christina Y T Lam
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Jia Huang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S Y Lui
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
20
|
Hogeveen J, Aragon DF, Rogge-Obando K, Campbell RA, Shuttleworth CW, Avila-Rieger RE, Yeo RA, Wilson JK, Fratzke V, Brandt E, Story-Remer J, Gill D, Mayer AR, Cavanagh JF, Quinn DK. Ventromedial Prefrontal-Anterior Cingulate Hyperconnectivity and Resilience to Apathy in Traumatic Brain Injury. J Neurotrauma 2021; 38:2264-2274. [PMID: 33787328 PMCID: PMC8328044 DOI: 10.1089/neu.2020.7363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Apathy is a common and impairing sequela of traumatic brain injury (TBI). Yet, little is known about the neural mechanisms determining in which patients apathy does or does not develop post-TBI. We aimed to elucidate the impact of TBI on motivational neural circuits and how this shapes apathy over the course of TBI recovery. Resting-state functional magnetic resonance imaging data were collected in patients with subacute mild TBI (n = 44), chronic mild-to-moderate TBI (n = 26), and nonbrain-injured control participants (CTRL; n = 28). We measured ventromedial prefrontal cortex (vmPFC) functional connectivity (FC) as a function of apathy, using an a priori vmPFC seed adopted from a motivated decision-making study in an independent TBI study cohort. Patients reported apathy using a well-validated tool for assaying apathy in TBI. The vmPFC-to-wholebrain FC was contrasted between groups, and we fit regression models with apathy predicting vmPFC FC. Subacute and chronic TBI caused increased apathy relative to CTRL, replicating previous work suggesting that apathy has an enduring impact in TBI. The vmPFC was functionally connected to the canonical default network, and this architecture did not differ between subacute TBI, chronic TBI, and CTRL groups. Critically, in TBI, increased apathy scores predicted decreased vmPFC-dorsal anterior cingulate cortex (dACC) FC. Last, we subdivided the TBI group based on patients above versus below the threshold for "clinically significant apathy," finding that TBI patients with clinically significant apathy demonstrated comparable vmPFC-dACC FC to CTRLs, whereas TBI patients with subthreshold apathy scores demonstrated vmPFC-dACC hyperconnectivity relative to both CTRLs and patients with clinically significant apathy. Post-TBI vmPFC-dACC hyperconnectivity may represent an adaptive compensatory response, helping to maintain motivation and enabling resilience to the development of apathy after neurotrauma. Given the role of vmPFC-dACC circuits in value-based decision making, rehabilitation strategies designed to improve this ability may help to reduce apathy and improve functional outcomes in TBI.
Collapse
Affiliation(s)
- Jeremy Hogeveen
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Denicia F. Aragon
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kimberly Rogge-Obando
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard A. Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - C. William Shuttleworth
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca E. Avila-Rieger
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
- Montefiore Medical Center, Bronx, New York, USA
| | - Ronald A. Yeo
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - J. Kevin Wilson
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Violet Fratzke
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- College of Education, Clemson University, Clemson, South Carolina, USA
| | - Emma Brandt
- Department of Neurosciences, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jacqueline Story-Remer
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Rosalind Franklin University, Chicago Medical School, North Chicago, Illinois, USA
| | - Darbi Gill
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Andrew R. Mayer
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- The Mind Research Network/LBERI, Albuquerque, New Mexico, USA
| | - James F. Cavanagh
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| |
Collapse
|
21
|
Murley AG, Rouse MA, Coyle-Gilchrist ITS, Jones PS, Li W, Wiggins J, Lansdall C, Vázquez Rodríguez P, Wilcox A, Patterson K, Rowe JB. Predicting loss of independence and mortality in frontotemporal lobar degeneration syndromes. J Neurol Neurosurg Psychiatry 2021; 92:737-744. [PMID: 33563798 PMCID: PMC8223632 DOI: 10.1136/jnnp-2020-324903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test the hypothesis that in syndromes associated with frontotemporal lobar degeneration, behavioural impairment predicts loss of functional independence and motor clinical features predict mortality, irrespective of diagnostic group. METHODS We used a transdiagnostic approach to survival in an epidemiological cohort in the UK, testing the association between clinical features, independence and survival in patients with clinical diagnoses of behavioural variant frontotemporal dementia (bvFTD n=64), non-fluent variant primary progressive aphasia (nfvPPA n=36), semantic variant primary progressive aphasia (svPPA n=25), progressive supranuclear palsy (PSP n=101) and corticobasal syndrome (CBS n=68). A principal components analysis identified six dimensions of clinical features. Using Cox proportional hazards and logistic regression, we identified the association between each of these dimensions and both functionally independent survival (time from clinical assessment to care home admission) and absolute survival (time to death). Analyses adjusted for the covariates of age, gender and diagnostic group. Secondary analysis excluded specific diagnostic groups. RESULTS Behavioural disturbance, including impulsivity and apathy, was associated with reduced functionally independent survival (OR 2.46, p<0.001), even if patients with bvFTD were removed from the analysis. Motor impairments were associated with reduced absolute survival, even if patients with PSP and CBS were removed from the analysis. CONCLUSION Our results can assist individualised prognostication and planning of disease-modifying trials, and they support a transdiagnostic approach to symptomatic treatment trials in patients with clinical syndromes associated with frontotemporal lobar degeneration.
Collapse
Affiliation(s)
- Alexander G Murley
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Matthew A Rouse
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ian T S Coyle-Gilchrist
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Neurology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - P Simon Jones
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Win Li
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Julie Wiggins
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Claire Lansdall
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Alicia Wilcox
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Karalyn Patterson
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
22
|
Abstract
BACKGROUND Successful development of agents that improve cognition and behavior in Alzheimer's disease (AD) is critical to improving the lives of patients manifesting the symptoms of this progressive disorder. DISCUSSION There have been no recent approvals of cognitive enhancing agents for AD. There are currently 6 cognitive enhancers in Phase 2 trials and 4 in phase 3. They represent a variety of novel mechanisms. There has been progress in developing new treatments for neuropsychiatric symptoms in AD with advances in treatment of insomnia, psychosis, apathy, and agitation in AD. There are currently 4 AD-related psychotropic agents in Phase 2 trials and 7 in Phase 3 trials. Many novel mechanisms are being explored for the treatment of cognitive and behavioral targets. Progress in trial designs, outcomes measures, and population definitions are improving trial conduct for symptomatic treatment of AD. CONCLUSIONS Advances in developing new agents for cognitive and behavioral symptoms of AD combined with enhanced trial methods promise to address the unmet needs of patients with AD for improved cognition and amelioration of neuropsychiatric symptoms.
Collapse
Affiliation(s)
- Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.
| |
Collapse
|
23
|
Gupta T, Cowan HR, Strauss GP, Walker EF, Mittal VA. Deconstructing Negative Symptoms in Individuals at Clinical High-Risk for Psychosis: Evidence for Volitional and Diminished Emotionality Subgroups That Predict Clinical Presentation and Functional Outcome. Schizophr Bull 2020; 47:54-63. [PMID: 32955097 PMCID: PMC7825091 DOI: 10.1093/schbul/sbaa084] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Negative symptoms are characteristic of schizophrenia and closely linked to numerous outcomes. A body of work has sought to identify homogenous negative symptom subgroups-a strategy that can promote mechanistic understanding and precision medicine. However, our knowledge of negative symptom subgroups among individuals at clinical high-risk (CHR) for psychosis is limited. Here, we investigated distinct negative symptom profiles in a large CHR sample (N = 244) using a cluster analysis approach. Subgroups were compared on external validators that are (1) commonly observed in the schizophrenia literature and/or (2) may be particularly relevant for CHR individuals, informing early prevention and prediction. We observed 4 distinct negative symptom subgroups, including individuals with (1) lower symptom severity, (2) deficits in emotion, (3) impairments in volition, and (4) global elevations. Analyses of external validators suggested a pattern in which individuals with global impairments and volitional deficits exhibited more clinical pathology. Furthermore, the Volition group endorsed more disorganized, anxious, and depressive symptoms and impairments in functioning compared to the Emotion group. These data suggest there are unique negative symptom profiles in CHR individuals, converging with studies in schizophrenia indicating motivational deficits may be central to this symptom dimension. Furthermore, observed differences in CHR relevant external validators may help to inform early identification and treatment efforts.
Collapse
Affiliation(s)
- Tina Gupta
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
- To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; tel: 847-467-5907, fax: 847-467-5707, e-mail:
| | - Henry R Cowan
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | | | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, GA
| | - Vijay A Mittal
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| |
Collapse
|
24
|
Hezemans FH, Wolpe N, Rowe JB. Apathy is associated with reduced precision of prior beliefs about action outcomes. J Exp Psychol Gen 2020; 149:1767-1777. [PMID: 32039624 PMCID: PMC7397861 DOI: 10.1037/xge0000739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 01/06/2023]
Abstract
Apathy is a debilitating syndrome that is associated with reduced goal-directed behavior. Although apathy is common and detrimental to prognosis in many neuropsychiatric diseases, its underlying mechanisms remain controversial. We propose a new model of apathy, in the context of Bayesian theories of brain function, whereby actions require predictions of their outcomes to be held with sufficient precision for "explaining away" differences in sensory inputs. In the active inference model, apathy results from reduced precision of prior beliefs about action outcomes. We tested this hypothesis using a visuomotor task in healthy adults (N = 47), with experimental manipulation of physical effort and financial reward. Bayesian modeling of performance and participants' perception of their performance was used to infer the precision of their priors. We confirmed that the perception of performance was biased toward the target, which was accounted for by relatively precise prior beliefs about action outcomes. These priors were consistently more precise than the corresponding performance distribution, and were scaled to effort and reward. Crucially, prior precision was negatively associated with trait apathy, suggesting that apathetic individuals had less precise prior beliefs about action outcomes. The results support a Bayesian account of apathy that could inform future studies of clinical populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- Frank H Hezemans
- Medical Research Council (MRC) Cognition, University of Cambridge
| | - Noham Wolpe
- Medical Research Council (MRC) Cognition, University of Cambridge
| | - James B Rowe
- Medical Research Council (MRC) Cognition, University of Cambridge
| |
Collapse
|
25
|
Chang WC, Wong CSM, Or PCF, Chu AOK, Hui CLM, Chan SKW, Lee EMH, Suen YN, Chen EYH. Inter-relationships among psychopathology, premorbid adjustment, cognition and psychosocial functioning in first-episode psychosis: a network analysis approach. Psychol Med 2020; 50:2019-2027. [PMID: 31451127 DOI: 10.1017/s0033291719002113] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP. METHOD This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses. RESULTS Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength. CONCLUSION Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.
Collapse
Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - C S M Wong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - P C F Or
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - A O K Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - C L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - S K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - E M H Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Y N Suen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
26
|
Zhang Y, Zhang GY, Zhang ZE, He AQ, Gan J, Liu Z. White matter hyperintensities: a marker for apathy in Parkinson's disease without dementia? Ann Clin Transl Neurol 2020; 7:1692-1701. [PMID: 32857484 PMCID: PMC7480903 DOI: 10.1002/acn3.51159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/07/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the relationship between white matter hyperintensities (WMH) and the occurrence and progression of apathy in Parkinson's disease (PD). METHODS We recruited patients with PD who underwent baseline evaluation, which included apathy assessment and magnetic resonance imaging (MRI) head scans. After 2.5 years of follow-up, we re-evaluated patient apathy symptoms. The severity and location of WMH were assessed with fluid-attenuated inversion recovery (FLAIR) sequences using the Fazekas visual rating scale. Logistic regression and linear regression analyses of baseline WMH characteristics were conducted to explore the potential association between apathy and WMH. RESULTS A total of 141 PD patients were recruited. The apathy group had a higher proportion of male patients, advanced disease, and depression, which was coupled with a lower quality of life. Morever, higher WMH severity was significantly associated with apathy. Logistic regression analyses demonstrated that WMH severity was a risk factor for apathy. In addition, linear regression analysis also suggests that apathy severity is positively correlated with baseline WMH Fazekas scales (ϐ = 0.959, P < 0.001). Baseline WMH severity was also a risk factor for apathy progression. INTERPRETATION WMH is associated with apathy and could be a promising marker to predict apathy progression in PD.
Collapse
Affiliation(s)
- Yu Zhang
- Department of NeurologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine1665 Kong jiang RoadShanghai200092People's Republic of China
| | - Guo yong Zhang
- Department of NeurologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine1665 Kong jiang RoadShanghai200092People's Republic of China
| | - Zi en Zhang
- Department of NeurologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine1665 Kong jiang RoadShanghai200092People's Republic of China
| | - An qi He
- Department of NeurologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine1665 Kong jiang RoadShanghai200092People's Republic of China
| | - Jing Gan
- Department of NeurologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine1665 Kong jiang RoadShanghai200092People's Republic of China
| | - Zhenguo Liu
- Department of NeurologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine1665 Kong jiang RoadShanghai200092People's Republic of China
| |
Collapse
|
27
|
Campbell MC, Myers PS, Weigand AJ, Foster ER, Cairns NJ, Jackson JJ, Lessov‐Schlaggar CN, Perlmutter JS. Parkinson disease clinical subtypes: key features & clinical milestones. Ann Clin Transl Neurol 2020; 7:1272-1283. [PMID: 32602253 PMCID: PMC7448190 DOI: 10.1002/acn3.51102] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Based on multi-domain classification of Parkinson disease (PD) subtypes, we sought to determine the key features that best differentiate subtypes and the utility of PD subtypes to predict clinical milestones. METHODS Prospective cohort of 162 PD participants with ongoing, longitudinal follow-up. Latent class analysis (LCA) delineated subtypes based on score patterns across baseline motor, cognitive, and psychiatric measures. Discriminant analyses identified key features that distinguish subtypes at baseline. Cox regression models tested PD subtype differences in longitudinal conversion to clinical milestones, including deep brain stimulation (DBS), dementia, and mortality. RESULTS LCA identified distinct subtypes: "motor only" (N = 63) characterized by primary motor deficits; "psychiatric & motor" (N = 17) characterized by prominent psychiatric symptoms and moderate motor deficits; "cognitive & motor" (N = 82) characterized by impaired cognition and moderate motor deficits. Depression, executive function, and apathy best discriminated subtypes. Since enrollment, 22 had DBS, 48 developed dementia, and 46 have died. Although there were no subtype differences in rate of DBS, dementia occurred at a higher rate in the "cognitive & motor" subtype. Surprisingly, mortality risk was similarly elevated for both "cognitive & motor" and "psychiatric & motor" subtypes compared to the "motor only" subtype (relative risk = 3.15, 2.60). INTERPRETATION Psychiatric and cognitive features, rather than motor deficits, distinguish clinical PD subtypes and predict greater risk of subsequent dementia and mortality. These results emphasize the value of multi-domain assessments to better characterize clinical variability in PD. Further, differences in dementia and mortality rates demonstrate the prognostic utility of PD subtypes.
Collapse
Affiliation(s)
- Meghan C. Campbell
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Department of RadiologyWashington University School of MedicineSt. LouisMO
| | - Peter S. Myers
- Department of NeurologyWashington University School of MedicineSt. LouisMO
| | - Alexandra J. Weigand
- Department of Psychological and Brain SciencesWashington University in St. LouisSt. LouisMO
| | - Erin R. Foster
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Program in Occupational TherapyWashington University School of MedicineSt. LouisMO
- Department of PsychiatryWashington University School of MedicineSt. LouisMO
| | - Nigel J. Cairns
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Joshua J. Jackson
- Department of Psychological and Brain SciencesWashington University in St. LouisSt. LouisMO
| | | | - Joel S. Perlmutter
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Department of RadiologyWashington University School of MedicineSt. LouisMO
- Program in Occupational TherapyWashington University School of MedicineSt. LouisMO
- Department of NeuroscienceWashington University School of MedicineSt. LouisMO
- Program in Physical TherapyWashington University School of MedicineSt. LouisMO
| |
Collapse
|
28
|
Strauss GP, Zamani Esfahlani F, Sayama H, Kirkpatrick B, Opler MG, Saoud JB, Davidson M, Luthringer R. Network Analysis Indicates That Avolition Is the Most Central Domain for the Successful Treatment of Negative Symptoms: Evidence From the Roluperidone Randomized Clinical Trial. Schizophr Bull 2020; 46:964-970. [PMID: 31989151 PMCID: PMC7342174 DOI: 10.1093/schbul/sbz141] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A recent conceptual development in schizophrenia is to view its manifestations as interactive networks rather than individual symptoms. Negative symptoms, which are associated with poor functional outcome and reduced rates of recovery, represent a critical need in schizophrenia therapeutics. MIN101 (roluperidone), a compound in development, demonstrated efficacy in the treatment of negative symptoms in schizophrenia. However, it is unclear how the drug achieved its effect from a network perspective. The current study evaluated the efficacy of roluperidone from a network perspective. In this randomized clinical trial, participants with schizophrenia and moderate to severe negative symptoms were randomly assigned to roluperidone 32 mg (n = 78), 64 mg (n = 83), or placebo (N = 83). Macroscopic network properties were evaluated to determine whether roluperidone altered the overall density of the interconnections among symptoms. Microscopic properties were evaluated to examine which individual symptoms were most influential (ie, interconnected) on other symptoms in the network and are responsible for successful treatment effects. Participants receiving roluperidone did not differ from those randomized to placebo on macroscopic properties. However, microscopic properties (degree and closeness centrality) indicated that avolition was highly central in patients receiving placebo and that roluperidone reduced this level of centrality. These findings suggest that decoupling the influence of motivational processes from other negative symptom domains is essential for producing global improvements. The search for pathophysiological mechanisms and targeted treatment development should be focused on avolition, with the expectation of improvement in the entire constellation of negative symptoms if avolition is effectively treated.
Collapse
Affiliation(s)
- Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA
- To whom correspondence should be addressed; 125 Baldwin St., Athens, GA 30602, US; tel: +1-706-542-030, fax: +1-706-542-3275, e-mail:
| | - Farnaz Zamani Esfahlani
- Department of Systems Science and Industrial Engineering & Center for Collective Dynamics of Complex Systems, Binghamton University, Binghamton, NY
| | - Hiroki Sayama
- Department of Systems Science and Industrial Engineering & Center for Collective Dynamics of Complex Systems, Binghamton University, Binghamton, NY
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, Reno School of Medicine, University of Nevada, Reno, NV
| | | | | | - Michael Davidson
- Minerva Neurosciences, Waltham, MA
- University of Nicosia Medical School, Nicosia, Cyprus
| | | |
Collapse
|
29
|
Tay J, Lisiecka-Ford DM, Hollocks MJ, Tuladhar AM, Barrick TR, Forster A, O'Sullivan MJ, Husain M, de Leeuw FE, Morris RG, Markus HS. Network neuroscience of apathy in cerebrovascular disease. Prog Neurobiol 2020; 188:101785. [PMID: 32151533 DOI: 10.1016/j.pneurobio.2020.101785] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 01/15/2023]
Abstract
Apathy is a reduction in motivated goal-directed behavior (GDB) that is prevalent in cerebrovascular disease, providing an important opportunity to study the mechanistic underpinnings of motivation in humans. Focal lesions, such as those seen in stroke, have been crucial in developing models of brain regions underlying motivated behavior, while studies of cerebral small vessel disease (SVD) have helped define the connections between brain regions supporting such behavior. However, current lesion-based models cannot fully explain the neurobiology of apathy in stroke and SVD. To address this, we propose a network-based model which conceptualizes apathy as the result of damage to GDB-related networks. A review of the current evidence suggests that cerebrovascular disease-related pathology can lead to network changes outside of initially damaged territories, which may propagate to regions that share structural or functional connections. The presentation and longitudinal trajectory of apathy in stroke and SVD may be the result of these network changes. Distinct subnetworks might support cognitive components of GDB, the disruption of which results in specific symptoms of apathy. This network-based model of apathy may open new approaches for investigating its underlying neurobiology, and presents novel opportunities for its diagnosis and treatment.
Collapse
Affiliation(s)
- Jonathan Tay
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | | | - Matthew J Hollocks
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Thomas R Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | - Michael J O'Sullivan
- University of Queensland Centre for Clinical Research, University of Queensland Australia, Brisbane, Australia
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences & Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Robin G Morris
- Department of Psychology, King's College London, London, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| |
Collapse
|
30
|
Kirschner M, Cathomas F, Manoliu A, Habermeyer B, Simon JJ, Seifritz E, Tobler PN, Kaiser S. Shared and dissociable features of apathy and reward system dysfunction in bipolar I disorder and schizophrenia. Psychol Med 2020; 50:936-947. [PMID: 30994080 DOI: 10.1017/s0033291719000801] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bipolar disorder I (BD-I) is defined by episodes of mania, depression and euthymic states. These episodes are among other symptoms characterized by altered reward processing and negative symptoms (NS), in particular apathy. However, the neural correlates of these deficits are not well understood. METHODS We first assessed the severity of NS in 25 euthymic BD-I patients compared with 25 healthy controls (HC) and 27 patients with schizophrenia (SZ). Then, we investigated ventral (VS) and dorsal striatal (DS) activation during reward anticipation in a Monetary Incentive Delayed Task and its association with NS. RESULTS In BD-I patients NS were clearly present and the severity of apathy was comparable to SZ patients. Apathy scores in the BD-I group but not in the SZ group correlated with sub-syndromal depression scores. At the neural level, we found significant VS and DS activation in BD-I patients and no group differences with HC or SZ patients. In contrast to patients with SZ, apathy did not correlate with striatal activation during reward anticipation. Explorative whole-brain analyses revealed reduced extra-striatal activation in BD-I patients compared with HC and an association between reduced activation of the inferior frontal gyrus and apathy. CONCLUSION This study found that in BD-I patients apathy is present to an extent comparable to SZ, but is more strongly related to sub-syndromal depressive symptoms. The findings support the view of different pathophysiological mechanisms underlying apathy in the two disorders and suggest that extra-striatal dysfunction may contribute to impaired reward processing and apathy in BD-I.
Collapse
Affiliation(s)
- Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Flurin Cathomas
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom
| | | | - Joe J Simon
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, Heidelberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, 8057Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, 8057Zurich, Switzerland
| | - Philippe N Tobler
- Neuroscience Center Zurich, University of Zurich, 8057Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, 8057Zurich, Switzerland
- Department of Economics, Laboratory for Social and Neural Systems Research, University of Zurich, 8006Zurich, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Chemin du Petit-Bel-Air, 1225 Chêne-Bourg, Switzerland
| |
Collapse
|
31
|
Wei G, Irish M, Hodges JR, Piguet O, Kumfor F. Disease-specific profiles of apathy in Alzheimer's disease and behavioural-variant frontotemporal dementia differ across the disease course. J Neurol 2019; 267:1086-1096. [PMID: 31873787 DOI: 10.1007/s00415-019-09679-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 11/25/2022]
Abstract
Apathy is one of the most prevalent and disabling non-cognitive symptoms of dementia. This loss of motivation and pervasive decline in goal-directed behaviour represents a core diagnostic feature of behavioural-variant frontotemporal dementia (bvFTD) and is also common in Alzheimer's disease (AD). However, despite growing recognition of a multidimensional model, apathy has typically been examined as a unitary symptom. Here, we employed a cross-sectional design to characterise the multidimensional nature of apathy across syndromes and disease course. 92 participants (44 bvFTD, 20 AD, 28 controls) completed the Dimensional Apathy Scale (DAS) to quantify emotional, executive, and initiation apathy. Patients were divided into early and late stages based on time since symptom onset. All participants underwent structural MRI and voxel-based morphometry was used to identify neural correlates of apathy dimensions. In the early stage of the disease (< 5 years since onset), emotional apathy was greater in bvFTD than AD. In contrast, in the late stage (> 5 years since onset), executive apathy was greater in AD than bvFTD, although apathy was elevated across all dimensions compared to controls. Notably, apathy was observed in the absence of self-reported depression in 46.2% of patients, with no patients classified as depressed only. Neuroimaging analyses revealed both common and divergent prefrontal and subcortical neural correlates associated with apathy dimensions. Our results reveal differing profiles of apathy across the disease course, in AD and bvFTD, with distinct brain regions mediating these dimensions. These findings will inform the development of appropriate treatment targets to ameliorate the impact of apathy in dementia.
Collapse
Affiliation(s)
- Grace Wei
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Muireann Irish
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Psychology, The University of Sydney, Sydney, Australia
| | - John R Hodges
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Fiona Kumfor
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.
- School of Psychology, The University of Sydney, Sydney, Australia.
| |
Collapse
|
32
|
Raimo S, Trojano L, Gaita M, Spitaleri D, Santangelo G. Assessing apathy in multiple sclerosis: Validation of the dimensional apathy scale and comparison with apathy evaluation scale. Mult Scler Relat Disord 2019; 38:101870. [PMID: 31830701 DOI: 10.1016/j.msard.2019.101870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/09/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Apathy is a predictor of cognitive decline in the course of multiple sclerosis (MS). Early identification of apathetic patients is relevant in clinical settings. OBJECTIVE To assess applicability and psychometric properties of the self-rated version of the Dimensional Apathy Scale (DAS) in a large cohort of patients with MS and to compare its diagnosing accuracy with that of the Apathy Evaluation Scale (AES). METHODS One hundred and twenty-four patients underwent clinical interview based on diagnostic criteria for apathy, DAS, AES, and assessment of depression, global cognitive functioning, and non-verbal intelligence. RESULTS According to diagnostic criteria, apathy occurred in 33.4% of the patients. The DAS showed high consistency, and good convergent, discriminant and criterion validity. Factor analysis indicated a three-factor structure: executive, behavioural and emotional apathy. Unlike AES, no significant association between DAS score and severity of neurological disability (expressed by EDSS total score) was found, suggesting that the DAS might be less related to levels of disability. Receiver operating characteristics analyses, with clinical diagnostic criteria for apathy as the gold standard, revealed that a DAS score of 28/29 and an AES score of 35/36 were optimal cut-off values for identifying clinically relevant apathy. The two scales had similar diagnostic accuracy in the present sample. CONCLUSIONS The DAS is a valid and reliable multidimensional tool to assess apathy in MS, with diagnostic accuracy similar to that of the AES. However, the DAS score appears to be less strongly related to neurological disability.
Collapse
Affiliation(s)
- S Raimo
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli," Viale Ellittico, 31, Caserta 81100, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - L Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli," Viale Ellittico, 31, Caserta 81100, Italy
| | - M Gaita
- Department of Psychology, University of Campania "Luigi Vanvitelli," Viale Ellittico, 31, Caserta 81100, Italy
| | - D Spitaleri
- Neurology Unit "San Giuseppe Moscati," Hospital Avellino, Avellino, Italy
| | - G Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli," Viale Ellittico, 31, Caserta 81100, Italy.
| |
Collapse
|
33
|
Jones JD, Kurniadi NE, Kuhn TP, Szymkowicz SM, Bunch J, Rahmani E. Depressive symptoms precede cognitive impairment in de novo Parkinson's disease patients: Analysis of the PPMI cohort. Neuropsychology 2019; 33:1111-1120. [PMID: 31343240 PMCID: PMC6823115 DOI: 10.1037/neu0000583] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Nonmotor symptoms, including depression, anxiety, apathy, and cognitive dysfunction, are common in Parkinson's disease (PD). Although a link between mood symptoms and cognitive impairment in PD has been theorized vis-à-vis striatal dopamine depletion, studies have been inconsistent regarding the relationship between mood symptoms and cognitive function. Inconsistencies may reflect the cross-sectional nature of previous studies. The current study examined the bidirectional longitudinal relationship between mood and cognition. METHOD Data were obtained from 310 individuals newly diagnosed with PD, who were followed up to 4 years (baseline, 1st, 2nd, 3rd, and 4th annual follow-ups). Apathy, anxiety, depressive symptoms, motor severity, and neurocognitive functioning were assessed at each annual assessment. The longitudinal relationship between apathy, anxiety, depressive symptoms, and cognition was analyzed with multilevel models. RESULTS Over the 4-year period, more severe depressive symptoms were related to worse performance on tasks of processing speed, verbal learning, and verbal delayed recall. Additionally, there was a significant Depression × Time interaction, suggesting that individuals with more severe depressive symptoms experience more rapid declines in global cognitive functioning and verbal learning. Apathy and anxiety were not significantly related to performance in any cognitive test. Lagged models revealed that changes in depression precede declines in working memory, verbal learning, delayed verbal recall, and global cognition. CONCLUSION Findings suggest depressive symptoms may be a harbinger for future cognitive decline among individuals with PD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
34
|
Ruthirakuhan M, Herrmann N, Vieira D, Gallagher D, Lanctôt KL. The Roles of Apathy and Depression in Predicting Alzheimer Disease: A Longitudinal Analysis in Older Adults With Mild Cognitive Impairment. Am J Geriatr Psychiatry 2019; 27:873-882. [PMID: 30910421 PMCID: PMC6646066 DOI: 10.1016/j.jagp.2019.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Apathy and depression have each been associated with an increased risk of conversion from mild cognitive impairment (MCI) to Alzheimer disease (AD).These symptoms often co-occur and the contribution of each to risk of AD is not clear. METHODS National Alzheimer's Coordinating Center participants diagnosed with MCI at baseline and followed until development of AD or loss to follow-up (n = 4,932) were included. The risks of developing AD in MCI patients with neuropsychiatric symptoms (NPS) (apathy only, depression only, or both) were compared to that in those without NPS in a multivariate Cox regression survival analysis adjusting for baseline cognitive impairment, years of smoking, antidepressant use, and AD medication use. RESULTS Thirty-seven percent (N = 1713) of MCI patients developed AD (median follow-up 23 months). MCI patients with both apathy and depression had the greatest risk (hazard ratio [HR] = 1.37; 95% confidence interval [CI]: 1.17-1.61; p < 0.0001; Wald χ2 = 14.70; df = 1). Those with apathy only also had a greater risk (HR = 1.24; 95% CI: 1.05-1.47; p = 0.01; Wald χ2 = 6.22; df = 1), but not those with depression only (HR = 1.08; 95% CI: 0.95-1.22; p=0.25; Wald χ2 = 1.30; df = 1). Post-hoc analyses suggested depression may exacerbate cognitive decline in MCI patients with apathy (odds ratio = 0.70; 95% CI 0.52-0.95; p = 0.02; Wald χ2 = 5.28; df = 1), compared to those without apathy. CONCLUSION MCI patients with apathy alone or both apathy and depression are at a greater risk of developing AD compared to those with no NPS. Interventions targeting apathy and depression may reduce risk of AD.
Collapse
Affiliation(s)
- Myuri Ruthirakuhan
- Hurvitz Brain Sciences Program (MR, NH, DV, KLL), Sunnybrook Research Institute, Toronto; Departments of Pharmacology and Toxicology (MR, KLL), and Psychiatry (NH, DG, KLL), University of Toronto, Toronto
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program (MR, NH, DV, KLL), Sunnybrook Research Institute, Toronto; Departments of Pharmacology and Toxicology (MR, KLL), and Psychiatry (NH, DG, KLL), University of Toronto, Toronto; Department of Psychiatry (NH, DG), Sunnybrook Health Sciences Centre, Toronto
| | - Danielle Vieira
- Hurvitz Brain Sciences Program (MR, NH, DV, KLL), Sunnybrook Research Institute, Toronto
| | - Damien Gallagher
- Departments of Pharmacology and Toxicology (MR, KLL), and Psychiatry (NH, DG, KLL), University of Toronto, Toronto; Department of Psychiatry (NH, DG), Sunnybrook Health Sciences Centre, Toronto
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program (MR, NH, DV, KLL), Sunnybrook Research Institute, Toronto; Departments of Pharmacology and Toxicology (MR, KLL), and Psychiatry (NH, DG, KLL), University of Toronto, Toronto.
| |
Collapse
|
35
|
Borges LG, Rademaker AW, Bigio EH, Mesulam MM, Weintraub S. Apathy and Disinhibition Related to Neuropathology in Amnestic Versus Behavioral Dementias. Am J Alzheimers Dis Other Demen 2019; 34:337-343. [PMID: 31170813 PMCID: PMC7256964 DOI: 10.1177/1533317519853466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Investigating the frequency of apathy and disinhibition in patients clinically diagnosed with dementia of the Alzheimer type (DAT) or behavioral variant frontotemporal dementia (bvFTD) with neuropathology of either Alzheimer disease (AD) or frontotemporal lobar degeneration (FTLD). METHODS Retrospective data from 887 cases were analyzed, and the frequencies of apathy and disinhibition were compared at baseline and longitudinally in 4 groups: DAT/AD, DAT/FTLD, bvFTD/FTLD, and bvFTD/AD. RESULTS Apathy alone was more common in AD (33%) than FTLD (25%), and the combination of apathy and disinhibition was more common in FTLD (43%) than AD (14%; P < .0001). Over time, apathy became more frequent in AD with increasing dementia severity (33%-41%; P < .006). CONCLUSIONS Alzheimer disease neuropathology had the closest association with the neuropsychiatric symptom of apathy, while FTLD was most associated with the combination of apathy and disinhibition. Over time, the frequency of those with apathy increased in both AD and FTLD neuropathology.
Collapse
Affiliation(s)
- Letizia G. Borges
- Cognitive Neurology and Alzheimer’s Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alfred W. Rademaker
- Cognitive Neurology and Alzheimer’s Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eileen H. Bigio
- Cognitive Neurology and Alzheimer’s Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neuropathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M-Marsel Mesulam
- Cognitive Neurology and Alzheimer’s Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer’s Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
36
|
De Paepe AE, Sierpowska J, Garcia-Gorro C, Martinez-Horta S, Perez-Perez J, Kulisevsky J, Rodriguez-Dechicha N, Vaquer I, Subira S, Calopa M, Muñoz E, Santacruz P, Ruiz-Idiago J, Mareca C, de Diego-Balaguer R, Camara E. White matter cortico-striatal tracts predict apathy subtypes in Huntington's disease. Neuroimage Clin 2019; 24:101965. [PMID: 31401404 PMCID: PMC6700450 DOI: 10.1016/j.nicl.2019.101965] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Apathy is the neuropsychiatric syndrome that correlates most highly with Huntington's disease progression, and, like early patterns of neurodegeneration, is associated with lesions to cortico-striatal connections. However, due to its multidimensional nature and elusive etiology, treatment options are limited. OBJECTIVES To disentangle underlying white matter microstructural correlates across the apathy spectrum in Huntington's disease. METHODS Forty-six Huntington's disease individuals (premanifest (N = 22) and manifest (N = 24)) and 35 healthy controls were scanned at 3-tesla and underwent apathy evaluation using the short-Problem Behavior Assessment and short-Lille Apathy Rating Scale, with the latter being characterized into three apathy domains, namely emotional, cognitive, and auto-activation deficit. Diffusion tensor imaging was used to study whether individual differences in specific cortico-striatal tracts predicted global apathy and its subdomains. RESULTS We elucidate that apathy profiles may develop along differential timelines, with the auto-activation deficit domain manifesting prior to motor onset. Furthermore, diffusion tensor imaging revealed that inter-individual variability in the disruption of discrete cortico-striatal tracts might explain the heterogeneous severity of apathy profiles. Specifically, higher levels of auto-activation deficit symptoms significantly correlated with increased mean diffusivity in the right uncinate fasciculus. Conversely, those with severe cognitive apathy demonstrated increased mean diffusivity in the right frontostriatal tract and left dorsolateral prefrontal cortex to caudate nucleus tract. CONCLUSIONS The current study provides evidence that white matter correlates associated with emotional, cognitive, and auto-activation subtypes may elucidate the heterogeneous nature of apathy in Huntington's disease, as such opening a door for individualized pharmacological management of apathy as a multidimensional syndrome in other neurodegenerative disorders.
Collapse
Affiliation(s)
- Audrey E De Paepe
- Department of Neuroscience, Pomona College, Claremont, CA, United States; Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joanna Sierpowska
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Education Psychology, Universitat de Barcelona, Barcelona, Spain; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Department of Medical Psychology, Nijmegen, The Netherlands
| | - Clara Garcia-Gorro
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Education Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Saül Martinez-Horta
- European Huntington's Disease Network, Germany; Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jesus Perez-Perez
- European Huntington's Disease Network, Germany; Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jaime Kulisevsky
- European Huntington's Disease Network, Germany; Movement Disorders Unit, Department of Neurology, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBERNED (Center for Networked Biomedical Research on Neurodegenerative Diseases), Carlos III Institute, Madrid, Spain
| | | | - Irene Vaquer
- Hestia Duran i Reynals. Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Subira
- Hestia Duran i Reynals. Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matilde Calopa
- Movement Disorders Unit, Neurology Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Esteban Muñoz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain; IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Facultat de Medicina, University of Barcelona, Barcelona, Spain
| | - Pilar Santacruz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Celia Mareca
- Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Ruth de Diego-Balaguer
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Education Psychology, Universitat de Barcelona, Barcelona, Spain; Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain; ICREA (Catalan Institute for Research and Advanced Studies), Barcelona, Spain
| | - Estela Camara
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain.
| |
Collapse
|
37
|
Osborne-Crowley K, Andrews SC, Labuschagne I, Nair A, Scahill R, Craufurd D, Tabrizi SJ, Stout JC. Apathy Associated With Impaired Recognition of Happy Facial Expressions in Huntington's Disease. J Int Neuropsychol Soc 2019; 25:453-461. [PMID: 30767839 PMCID: PMC6542690 DOI: 10.1017/s1355617718001224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Previous research has demonstrated an association between emotion recognition and apathy in several neurological conditions involving fronto-striatal pathology, including Parkinson's disease and brain injury. In line with these findings, we aimed to determine whether apathetic participants with early Huntington's disease (HD) were more impaired on an emotion recognition task compared to non-apathetic participants and healthy controls. METHODS We included 43 participants from the TRACK-HD study who reported apathy on the Problem Behaviours Assessment - short version (PBA-S), 67 participants who reported no apathy, and 107 controls matched for age, sex, and level of education. During their baseline TRACK-HD visit, participants completed a battery of cognitive and psychological tests including an emotion recognition task, the Hospital Depression and Anxiety Scale (HADS) and were assessed on the PBA-S. RESULTS Compared to the non-apathetic group and the control group, the apathetic group were impaired on the recognition of happy facial expressions, after controlling for depression symptomology on the HADS and general disease progression (Unified Huntington's Disease Rating Scale total motor score). This was despite no difference between the apathetic and non-apathetic group on overall cognitive functioning assessed by a cognitive composite score. CONCLUSIONS Impairment of the recognition of happy expressions may be part of the clinical picture of apathy in HD. While shared reliance on frontostriatal pathways may broadly explain associations between emotion recognition and apathy found across several patient groups, further work is needed to determine what relationships exist between recognition of specific emotions, distinct subtypes of apathy and underlying neuropathology. (JINS, 2019, 25, 453-461).
Collapse
Affiliation(s)
- Katherine Osborne-Crowley
- 1Huntington's Disease Centre,University College London,Institute of Neurology, and National Hospital for Neurology and Neurosurgery,London,United Kingdom
| | - Sophie C Andrews
- 2Monash Institute of Cognitive and Clinical Neurosciences,School of Psychological Sciences,Monash University,Melbourne,Australia
| | - Izelle Labuschagne
- 3Cognition and Emotion Research Centre,School of Psychology,Australian Catholic University,Melbourne,Australia
| | - Akshay Nair
- 1Huntington's Disease Centre,University College London,Institute of Neurology, and National Hospital for Neurology and Neurosurgery,London,United Kingdom
| | - Rachael Scahill
- 1Huntington's Disease Centre,University College London,Institute of Neurology, and National Hospital for Neurology and Neurosurgery,London,United Kingdom
| | - David Craufurd
- 4Manchester Centre for Genomic Medicine,Division of Evolution and Genomic Sciences,School of Biological Sciences, Faculty of Biology,Medicine and Health,University of Manchester,Manchester Academic Health Science Centre,Manchester,United Kingdom
| | - Sarah J Tabrizi
- 1Huntington's Disease Centre,University College London,Institute of Neurology, and National Hospital for Neurology and Neurosurgery,London,United Kingdom
| | - Julie C Stout
- 2Monash Institute of Cognitive and Clinical Neurosciences,School of Psychological Sciences,Monash University,Melbourne,Australia
| |
Collapse
|
38
|
Servaas MN, Kos C, Gravel N, Renken RJ, Marsman JBC, van Tol MJ, Aleman A. Rigidity in Motor Behavior and Brain Functioning in Patients With Schizophrenia and High Levels of Apathy. Schizophr Bull 2019; 45:542-551. [PMID: 30053198 PMCID: PMC6483574 DOI: 10.1093/schbul/sby108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this study was to investigate whether apathy in schizophrenia is associated with rigidity in behavior and brain functioning. To this end, we studied associations between variability in dynamic functional connectivity (DFC) in relevant functional brain networks, apathy, and variability in physical activity in schizophrenia. Thirty-one patients with schizophrenia, scoring high on apathy, were included and wore an actigraph. Activity variability was calculated on the activity counts using the root of the Mean Squared Successive Difference (MSSD). Furthermore, we calculated DFC on resting-state data as phase interactions between blood oxygen-level dependent (BOLD) signals of 270 brain regions per volume. Variability (MSSD) in DFC was calculated for 3 networks, including the default-mode network (DMN), frontoparietal network, and salience-reward network (SRN). Finally, we calculated correlations between these DFC estimates and apathy and activity variability. First, lower activity variability was associated with higher levels of apathy. Second, higher levels of apathy were associated with lower variability in DFC in the DMN and SRN. Third, higher activity variability was associated with higher variability in DFC in the SRN. In conclusion, patients with schizophrenia and more severe levels of apathy showed less variability in their physical activity and more rigid functional brain network behavior in the DMN and SRN. These networks have been shown relevant for self-reflection, mental simulation, and reward processing, processes that are pivotal for self-initiated goal-directed behavior. Functional rigidity of these networks may therefore contribute to reduced goal-directed behavior, which is characteristic for these patients.
Collapse
Affiliation(s)
- Michelle N Servaas
- Neuroimaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Claire Kos
- Neuroimaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nicolás Gravel
- Neuroimaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Remco J Renken
- Neuroimaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Bernard C Marsman
- Neuroimaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie-José van Tol
- Neuroimaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - André Aleman
- Neuroimaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
39
|
Schneider K, Michels L, Hartmann-Riemer MN, Burrer A, Tobler PN, Stämpfli P, Kirschner M, Seifritz E, Kaiser S. Cerebral blood flow in striatal regions is associated with apathy in patients with schizophrenia. J Psychiatry Neurosci 2019; 44:102-110. [PMID: 30246686 PMCID: PMC6397041 DOI: 10.1503/jpn.170150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Striatal dysfunction has been proposed as a pathomechanism for negative symptoms in schizophrenia. There is consensus that negative symptoms can be grouped into 2 dimensions: apathy and diminished expression. Recent studies suggest that different neural mechanisms underlie these dimensions, but the relationship between regional resting-state cerebral blood flow (rCBF) and negative symptom dimensions has not been investigated. METHODS This study included 29 patients with schizophrenia and 20 healthy controls. We measured rCBF in the striatum using arterial spin labelling (ASL) MRI. We assessed negative symptoms using the Brief Negative Symptom Scale. RESULTS In the ventral and dorsal striatum, rCBF was not different between patients with schizophrenia and controls. However, we did find a positive association between the severity of apathy and increased rCBF in the ventral and dorsal striatum in patients with schizophrenia. This effect was not present for diminished expression. LIMITATIONS All patients were taking atypical antipsychotics, so an effect of antipsychotic medication on rCBF could not be excluded, although we did not find a significant association between rCBF and chlorpromazine equivalents. CONCLUSION The main finding of this study was a specific association between increased striatal rCBF and the negative symptom dimension of apathy. Our results further support the separate assessment of apathy and diminished expression when investigating the neural basis of negative symptoms. The ASL technique can provide a direct and quantitative approach to investigating the role of rCBF changes in the pathophysiology of negative symptoms.
Collapse
Affiliation(s)
- Karoline Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Lars Michels
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Matthias N Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Achim Burrer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Philippe N Tobler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| |
Collapse
|
40
|
Mahmood Z, Clark JMR, Twamley EW. Compensatory Cognitive Training for psychosis: Effects on negative symptom subdomains. Schizophr Res 2019; 204:397-400. [PMID: 30293693 PMCID: PMC6402965 DOI: 10.1016/j.schres.2018.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/06/2018] [Accepted: 09/27/2018] [Indexed: 01/30/2023]
Abstract
Research identifying the effects of cognitive training on negative symptoms of psychosis is limited. We examined the effects of Compensatory Cognitive Training (CCT) on expressive deficits and social amotivation in a randomized controlled trial comparing CCT to standard pharmacotherapy alone in 43 individuals with psychosis. ANCOVA analyses demonstrated significant CCT-associated effects on both expressive deficits and social amotivation. Moreover, improvements in both sub-domains were associated with improvements in global life satisfaction, with improvements in social amotivation also related to increased social contact. CCT appears to be a beneficial treatment approach for improving multiple aspects of negative symptoms.
Collapse
Affiliation(s)
- Zanjbeel Mahmood
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, United States of America
| | - Jillian M R Clark
- Center of Excellence for Stress and Mental Health and Research Service, VA San Diego Healthcare System, United States of America; Department of Psychiatry, University of California San Diego, United States of America
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, United States of America; Center of Excellence for Stress and Mental Health and Research Service, VA San Diego Healthcare System, United States of America.
| |
Collapse
|
41
|
Valentino V, Iavarone A, Amboni M, Moschiano F, Picillo M, Petretta V, Cicarelli G. Apathy in Parkinson's disease: differences between caregiver's report and self-evaluation. Funct Neurol 2019; 33:31-35. [PMID: 29633694 DOI: 10.11138/fneur/2018.33.1.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Apathy is a state of diminished goal-directed speech, motor activity and emotions. The prevalence of apathy in Parkinson's disease (PD) ranges from 16 to 62%. Several studies have investigated the relationships between apathy and other dimensions of PD, but little is known about possible discrepancies between self-evaluation (SE) and caregiver reporting (CR) of this symptom. The aim of this study is twofold: 1) to investigate the differences in apathy evaluations according to the point of view from which apathy is reported (SE vs CR); 2) to identify the possible relationships between each of the two evaluations (SE and CR) and cognitive and affective dimensions of PD. Forty-eight patients with PD were assessed using the Apathy Evaluation Scale (AES) in its SE and CR versions (AES-SE and AES-CR); cognitive, affective and behavioral symptoms were also assessed. AES-SE scores were significantly higher than AESCR ones. Neither AES version correlated with depression, whereas both correlated with motor impairment, disease stage and behavioral symptoms. Mini-Mental State Examination and Frontal Assessment Battery scores showed significant negative correlations only with AES-SE scores. Our findings suggest that the point of view from which apathy is seen can lead to significant discrepancies, even when using the same tool. This should be taken into account in order to obtain correct assessment of this disabling and distressing symptom.
Collapse
|
42
|
Brown DS, Barrett MJ, Flanigan JL, Sperling SA. Clinical and demographic correlates of apathy in Parkinson's disease. J Neurol 2019; 266:507-514. [PMID: 30604055 DOI: 10.1007/s00415-018-9166-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To better understand the demographic, neuropsychiatric, cognitive, and motor predictors of apathy in Parkinson's disease (PD). METHOD 112 participants (Mage = 68.53 years; Mdisease duration = 6.17 years) were administered the Apathy Scale (AS), Beck Depression Inventory-II (BDI-II), Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Trail Making Test (TMT), Wechsler Adult Intelligence Scale-IV Matrix Reasoning subtest, letter (F-A-S) and category (Animals) fluency, and Hopkins Verbal Learning Test-Revised. Psychosis was assessed. A stepwise logistic regression analysis was performed to investigate the ability of demographic factors and clinical assessments to predict nonapathetic (AS ≤ 13) versus apathetic (AS > 13) group membership. RESULTS The regression analysis yielded a robust model in which older age, less education, elevated BDI-II, current psychosis, higher MDS-UPDRS Part III (motor score), and slower TMT-B performance predicted membership in the apathetic group, with a correct classification rate of 77.5% (Nagelkerke R2 = 0.48, p < .001). Depression (OR = 9.20, p < .001) and education (OR = 0.66, p = 0.002) contributed significantly to the overall model. A linear regression with AS score as the outcome variable was similar, but TMT-B additionally contributed significantly (p = 0.02) to the overall model, F(6, 86) = 12.02, p < .001, adjusted R2 = 0.42. CONCLUSIONS Of the factors examined, depression, education, and executive functioning were the strongest correlates of apathy in PD. These results support the idea that common underlying frontosubcortical disruptions in this population contribute to apathy, depression, and executive dysfunction.
Collapse
Affiliation(s)
- Daniel S Brown
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Matthew J Barrett
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Joseph L Flanigan
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA
| | - Scott A Sperling
- Department of Neurology, University of Virginia, PO Box 800394, 22908-0394, Charlottesville, VA, USA.
| |
Collapse
|
43
|
Dondaine T, Philippot P, Batail JM, Le Jeune F, Sauleau P, Drapier S, Vérin M, Millet B, Drapier D, Robert G. Apathy alters emotional arousal in chronic schizophrenia. J Psychiatry Neurosci 2019; 44:54-61. [PMID: 30565906 PMCID: PMC6306283 DOI: 10.1503/jpn.170172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/10/2018] [Accepted: 05/22/2018] [Indexed: 02/01/2023] Open
Abstract
Background Within the heterogeneity of schizophrenia, apathy constitutes an independent cluster of negative symptoms associated with poor outcomes. Attempts to identify an emotional deficit in patients who have schizophrenia with negative symptoms have yielded mixed results, and studies that focus on the relationship between apathy and emotional disorders are lacking. Methods We set out to remedy this shortcoming using a validated battery of film excerpts to induce positive and negative emotions in patients with chronic schizophrenia with (n = 20) or without (n = 20) apathy, and in controls (n = 20) comparable for age, sex and socioeconomic status. We assessed emotions using an innovative but validated technique to evaluate tonic and phasic electrodermal activity and subjective feelings using a standardized visual analogue scale. Results Using a qualitative measure of apathy, we did not find a specific decrease in tonic activity during the induction of positive emotions. However, we did observe that patients with apathy showed reduced tonic activity independent of valence (i.e., for both positive and negative emotions) compared with controls and patients without apathy. Moreover, the quantitative measure of apathy (Apathy Evaluation Scale) was the only significant factor, explaining 24% of the variance in tonic activity during induction of positive emotions after controlling for confounding factors. Limitations Electrodermal activity was the only physiologic measure we acquired. We induced several emotions sequentially that might have overlapped with each other, but we added an emotional “washout” period and randomized the order of each film excerpt to limit this possibility. Conclusion Taken together, these results suggest that apathy in schizophrenia could impair tonic activity during positive emotions. Treatments aimed at enhancing positive emotions may help alleviate apathy in schizophrenia.
Collapse
Affiliation(s)
- Thibaut Dondaine
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Pierre Philippot
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Jean-Marie Batail
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Florence Le Jeune
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Paul Sauleau
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Sophie Drapier
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Marc Vérin
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Bruno Millet
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Dominique Drapier
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| | - Gabriel Robert
- From the University Department of Psychiatry, Guillaume Régnier Hospital, Rennes, France (Batail, D. Drapier, Robert); University of Lille, Inserm, CHU Lille, U1171, Degenerative and Vascular Cognitive Disorders, F-59000, Lille, France (Dondaine); Behaviour and Basal Ganglia Laboratory (EA 4712), University of Rennes, Rennes, France (Batail, Le Jeune, Sauleau, S. Drapier, Vérin, D. Drapier, Robert); Eugène Marquis Centre, Rennes, France (Le Jeune); Neurophysiology Department, Rennes University Hospital, Rennes, France (Sauleau); Movement Disorders Unit, Rennes University Hospital, Rennes, France (S. Drapier, Vérin); Psychiatry Department, Pitié-Salpêtrière Hospital, Paris, France (Millet); University of Louvain-la-Neuve, Louvain-la-Neuve, Belgium (Philippot)
| |
Collapse
|
44
|
Chang WC, Lee HC, Chan SI, Chiu SY, Lee HM, Chan KW, Wong MC, Chan KL, Yeung WS, Choy LW, Chong SY, Siu MW, Lo TL, Yan WC, Ng MK, Poon LT, Pang PF, Lam WC, Wong YC, Chung WS, Mo YM, Lui SY, Hui LM, Chen EYH. Negative symptom dimensions differentially impact on functioning in individuals at-risk for psychosis. Schizophr Res 2018; 202:310-315. [PMID: 29935882 DOI: 10.1016/j.schres.2018.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/20/2018] [Accepted: 06/14/2018] [Indexed: 12/24/2022]
Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
| | - H C Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S I Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S Y Chiu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - H M Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - M C Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - K L Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - W S Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - L W Choy
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - S Y Chong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - M W Siu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - T L Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - W C Yan
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - M K Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - L T Poon
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - P F Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - W C Lam
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Y C Wong
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - W S Chung
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Y M Mo
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - S Y Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | - L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| |
Collapse
|
45
|
Kitamura S, Shimada H, Niwa F, Endo H, Shinotoh H, Takahata K, Kubota M, Takado Y, Hirano S, Kimura Y, Zhang MR, Kuwabara S, Suhara T, Higuchi M. Tau-induced focal neurotoxicity and network disruption related to apathy in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2018; 89:1208-1214. [PMID: 29884723 PMCID: PMC6227800 DOI: 10.1136/jnnp-2018-317970] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/16/2018] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Apathy is a common neuropsychological symptom in Alzheimer's disease (AD), and previous studies demonstrated that neuronal loss and network disruption in some brain regions play pivotal roles in the pathogenesis of apathy. However, contributions of tau and amyloid-β (Aβ) depositions, pathological hallmarks of AD, to the manifestation of apathy remain elusive. METHODS Seventeen patients with AD underwent positron emission tomography (PET) with 11C-pyridinyl-butadienyl-benzothiazole 3 (11C-PBB3) and 11C-Pittsburgh compound-B (11C-PiB) to estimate tau and Aβ accumulations using standardised uptake value ratio (SUVR) images. 11C-PBB3 and 11C-PiB SUVR were compared between AD patients with high and low Apathy Scale (AS) scores. Additionally, volumetric and diffusion tensor MRI was performed in those areas where any significant difference was observed in PET analyses. Correlation and path analyses among AS and estimated imaging parameters were also conducted. RESULTS AD patients with high AS scores showed higher 11C-PBB3 SUVR in the orbitofrontal cortex (OFC) than those with low AS scores, while 11C-PiB SUVR in any brain regions did not differ between them. Elevated 11C-PBB3 SUVR in OFC, decreased OFC thickness and decreased fractional anisotropy (FA) in the uncinate fasciculus (UNC), which is structurally connected to OFC, correlated significantly with increased scores of the AS. Path analysis indicated that increased 11C-PBB3 SUVR in OFC affects apathy directly and through reduction of OFC thickness and subsequent decrease of FA in UNC. CONCLUSIONS The present findings suggested that tau pathology in OFC may provoke focal neurotoxicity in OFC and the following disruption of the OFC-UNC network, leading to the emergence and progression of apathy in AD.
Collapse
Affiliation(s)
- Soichiro Kitamura
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Hitoshi Shimada
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Fumitoshi Niwa
- Department of Neurology and Gerontology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hironobu Endo
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hitoshi Shinotoh
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Neurology Chiba Clinic, Chiba, Japan
| | - Keisuke Takahata
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Manabu Kubota
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yuhei Takado
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuyuki Kimura
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Department of Clinical and Experimental Neuroimaging, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ming-Rong Zhang
- Department of Radiopharmaceutics Development, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuya Suhara
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Makoto Higuchi
- Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| |
Collapse
|
46
|
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: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
47
|
Femiano C, Trojsi F, Caiazzo G, Siciliano M, Passaniti C, Russo A, Bisecco A, Cirillo M, Monsurrò MR, Esposito F, Tedeschi G, Santangelo G. Apathy Is Correlated with Widespread Diffusion Tensor Imaging (DTI) Impairment in Amyotrophic Lateral Sclerosis. Behav Neurol 2018; 2018:2635202. [PMID: 30425751 PMCID: PMC6217902 DOI: 10.1155/2018/2635202] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/06/2018] [Accepted: 09/12/2018] [Indexed: 01/17/2023] Open
Abstract
Apathy is recognized as the most common behavioral change in several neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), a multisystem neurodegenerative disorder. Particularly, apathy has been reported to be associated with poor ALS prognosis. However, the brain microstructural correlates of this behavioral symptom, reported as the most common in ALS, have not been completely elucidated. Using diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS), here we aimed to quantify the correlation between brain microstructural damage and apathy scores in the early stages of ALS. Twenty-one consecutive ALS patients, in King's clinical stage 1 or 2, and 19 age- and sex-matched healthy controls (HCs) underwent magnetic resonance imaging and neuropsychological examination. Between-group comparisons did not show any significant difference on cognitive and behavioral variables. When compared to HCs, ALS patients exhibited a decreased fractional anisotropy (FA) [p < .05, threshold-free cluster enhancement (TFCE) corrected] in the corpus callosum and in bilateral anterior cingulate cortices. Self-rated Apathy Evaluation Scale (AES) scores and self-rated apathy T-scores of the Frontal Systems Behavior (FrSBe) scale were found inversely correlated to FA measures (p < .05, TFCE corrected) in widespread white matter (WM) areas, including several associative fiber tracts in the frontal, temporal, and parietal lobes. These results point towards an early microstructural degeneration of brain areas biologically involved in cognition and behavior regulation in ALS. Moreover, the significant correlations between apathy and DTI measures in several brain areas may suggest that subtle WM changes may be associated with mild behavioral symptoms in ALS even in the absence of overt cognitive and behavioral impairment.
Collapse
Affiliation(s)
- Cinzia Femiano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Trojsi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppina Caiazzo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mattia Siciliano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Psychology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carla Passaniti
- Department of Psychology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alvino Bisecco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Cirillo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Rosaria Monsurrò
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| |
Collapse
|
48
|
Faerden A, Lyngstad SH, Simonsen C, Ringen PA, Papsuev O, Dieset I, Andreassen OA, Agartz I, Marder SR, Melle I. Reliability and validity of the self-report version of the apathy evaluation scale in first-episode Psychosis: Concordance with the clinical version at baseline and 12 months follow-up. Psychiatry Res 2018; 267:140-147. [PMID: 29906681 DOI: 10.1016/j.psychres.2018.05.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 05/04/2018] [Accepted: 05/25/2018] [Indexed: 11/15/2022]
Abstract
Negative symptoms have traditionally been assessed based on clinicians' observations. The subjective experience of negative symptoms in people with psychosis may bring new insight. The Apathy Evaluation Scale (AES) is commonly used to study apathy in psychosis and has corresponding self-rated (AES-S) and clinician-rated (AES-C) versions. The aim of the present study was to determine the validity and reliability of the AES-S by investigating its concordance with the AES-C. Eighty-four first-episode (FEP) patients completed the shortened 12-item AES-S and AES-C at baseline (T1) and 12 months (T2). Concordance was studied by degree of correlation, comparison of mean scores, and change and difference between diagnostic groups. The Positive and Negative Symptom Scale (PANSS) was used to study convergent and discriminative properties. High concordance was found between AES-S and AES-C at both T1 and T2 regarding mean values, change from T1 to T2, and the proportion with high levels of apathy. Both versions indicated high levels of apathy in FEP, while associations with PANSS negative symptoms were weaker for AES-S than AES-C. Controlling for depression did not significantly alter results. We concluded that self-rated apathy in FEP patients is in concordance with clinician ratings, but in need of further study.
Collapse
Affiliation(s)
- Ann Faerden
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway.
| | - Siv Hege Lyngstad
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Carmen Simonsen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Petter Andreas Ringen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Oleg Papsuev
- Outpatient Psychiatry and Organization of Psychiatric Care Department, Moscow Research Institute of Psychiatry, Russia
| | - Ingrid Dieset
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Ole A Andreassen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
| | - Ingrid Agartz
- NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway; Diakonhjemmet Hospital, Oslo 0319, Norway
| | - Stephen R Marder
- Semel Institute for Neuroscience, University of California in Los Angeles, USA
| | - Ingrid Melle
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
| |
Collapse
|
49
|
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
|
50
|
Abstract
Corticobasal degeneration is a rare disorder, which usually consists of a combination of complex movement disorders, apraxia and cortical changes. Its definition is still evolving and in 2013 an international consortium tried to develop new criteria, based on a systematic literature review. Over a long period of time, we carefully selected 23 patients who fulfilled the criteria for a diagnosis of corticobasal degeneration; all had the so-called corticobasal syndrome phenotype, in accordance with Armstrong et al. (2013). Through a dedicated study, we set out to study behavioral alterations, specifically apathy, and to compare the results obtained with those deriving from a well-defined Parkinson's disease population. On the basis of our limited but specific results, we argue for a possible role of the parietal neural networks as a determinant of apathy, and provide an overview of emerging data in the imaging and pathology literature.
Collapse
Affiliation(s)
- Rita Moretti
- Department of Medical, Surgical and Health Science, Clinical Neurology, University of Trieste, Italy
| | - Riccardo Caberlotto
- Department of Medical, Surgical and Health Science, Clinical Neurology, University of Trieste, Italy
| | - Riccardo Signori
- Department of Medical, Surgical and Health Science, Clinical Neurology, University of Trieste, Italy
| |
Collapse
|