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Apathy

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Neuropsychiatric Symptoms of Cerebrovascular Diseases

Part of the book series: Neuropsychiatric Symptoms of Neurological Disease ((NSND))

Abstract

Apathy is a disorder of motivation. Apathetic patients have difficulties in starting, sustaining, or finishing any goal-directed activity. They lose self-activation or self-initiated behavior and may present emotional indifference. Apathy is mostly related to damage to subcortical brain structures linked to the anterior cingulate circuit, the so-called motivational circuit. Stroke lesions encompassing the frontal lobe, the cingulum, or subcortical structures such as the pallidus, internal capsule, caudate, putamen, and anterior or medial thalamic nuclei are associated with apathy. Validated scales are used to assess apathy in stroke patients.

Apathy is frequent in stroke patients affecting 1 in every 3 patients. Apathetic patients are older than non-apathetic patients. Cognitive impairment is three times more frequent in apathetic than in non-apathetic stroke patients. Although some studies claimed an association between apathy and right-sided stroke lesions, there is no consistent evidence to support this association. Apathy without depression is about two times more frequent than depression without apathy, reinforcing the view that although these two neuropsychiatric disturbances can be associated, one can occur separately from the other.

The management of apathy includes pharmacological and non-pharmacological interventions. Drugs with potential effect in improving apathy include dopaminergic agents, stimulants, antidepressants with dopaminergic or noradrenergic activity, and acetylcholinesterase inhibitors. However, there are no randomized controlled trials to prove the efficacy and safety of these interventions in apathetic stroke patients.

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Authors and Affiliations

  1. Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal

    Lara Caeiro PsyD & José M. Ferro MD, PhD

  2. Department of Neurosciences, Neurology Service, Hospital de Santa Maria, Av. Professor Egas Moniz, 1649-035, Lisbon, Portugal

    Lara Caeiro PsyD & José M. Ferro MD, PhD

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  1. Lara Caeiro PsyD
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  2. José M. Ferro MD, PhD
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Correspondence to Lara Caeiro PsyD .

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  1. , Serviço de Neurologia, Hospital de Santa Maria, Av. Prof. Egas Moniz, Lisboa, 1649-035, Portugal

    José M. Ferro

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Caeiro, L., Ferro, J.M. (2013). Apathy. In: Ferro, J. (eds) Neuropsychiatric Symptoms of Cerebrovascular Diseases. Neuropsychiatric Symptoms of Neurological Disease. Springer, London. https://doi.org/10.1007/978-1-4471-2428-3_6

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