Overview of Alzheimer’s disease in Down syndrome
Vee P. Prasher in Down Syndrome and Alzheimer’s Disease, 2018
Perhaps one of the toughest differentials to untangle is that between depression and apathy associated with DAD. Landes and colleagues45 have attempted to distinguish between the two. They list the symptoms of apathy as blunted emotional response, indifference, low social engagement, diminished initiation and poor persistence. The symptoms common to apathy and depression include diminished interest, psychomotor retardation, fatigue/hypersomnia and lack of insight. Landes and colleagues list the symptoms of depression as dysphoria, suicidal ideation, self-criticism, guilt feelings, pessimism and hopelessness. The sobering question for clinicians and researchers is ‘How many adults with DS at their premorbid functioning could spontaneously voice suicidal thoughts, show self-criticism, or express guilt, pessimism or hopelessness?’
Depression, Anxiety, and Apathy
Marc E. Agronin in Alzheimer's Disease and Other Dementias, 2014
Treatment of a reversible cause of apathy often results in clinical improvement. Apathy due to the specific brain damage associated with dementia is more difficult to treat, since it responds poorly to environmental, behavioral, or psychotherapeutic intervention. The individual simply does not have enough motivation to engage in such therapy. Instead, psychopharmacologic treatment must often be used to attempt some improvement. Stimulating antidepressants, such as bupropion or the SSRIs, are usually the treatment of choice, particularly bupropion because of its dopaminergic properties. In addition, the psychostimulant methylphenidate (in doses between 5 mg and 20 mg daily) has been shown to increase motivation and activity levels in individuals with apathy associated with AD (Padala et al., 2010), stroke (Spiegel et al., 2009), and Parkinson's disease (Chatterjee & Fahn, 2002).
Terminal neurological disorders
Ad (Sandy) Macleod, Ian Maddocks in The Psychiatry of Palliative Medicine, 2018
Movement is the fundamental nervous system function. For it to be slowed (bradykinesia) and inefficienct is a primal wound to any organism. Anxiety is a consequence. To be frozen in movement is an innate fear. A state of utter helplessness ensues. This brief moment of ‘death’ may induce unease, panic and even PTSD. In patients with on–off fluctuations, anxiety is more often related to the off phase. Anxiety is higher if mobility is less.4 Depression may be precipitated during the latter phases of PD, particularly if other risk factors are present. Differentiating psychomotor retardation and bradykinesia is difficult. Depression, probably an integral part of the disease, occurs in more than 40%.4 Anxiety tends to be a prominent feature of this depression. Depression is commoner in those with more severe cognitive impairments and a past affective history. Apathy and depression may coexist. Depression is a risk factor for PD, and may be the presenting symptom.4 Suicide and alcoholism rates in PD are low. SSRIs are the most tolerable antidepressant choice. Tricylics’ anticholinergic properties potentiate the risk of delirium but may have a mild anti-parkinsonian action. The response rates in ‘organic’ depressions are often disappointing. ECT should not be discounted, and it has the added advantage of improving motor symptoms as well as mood.5
Identifying emotional contributors to participation post-stroke
Published in Topics in Stroke Rehabilitation, 2023
Yejin Lee, Marjorie L. Nicholas, Lisa Tabor Connor
Emotional factors have distinctive features and agreed-upon definitions. Anxiety is defined as a subjective feeling of tension, nervousness, and worry associated with an arousal of the autonomic nervous system.28 Apathy is defined as lack of motivation accompanied by diminished goal-directed behavior (e.g. lack of effort), diminished goal-directed cognitive activity (e.g. lack of interest and concern), or diminished concomitants of goal-directed behavior (e.g. unchanging affect or lack of responsivity to positive or negative events).29 Depression includes emotional distress such as sadness, anxiety, agitation, insomnia, anorexia, feelings of worthlessness and hopelessness, and recurrent thoughts of death.30 As each emotional factor has distinctive aspects, it is possible that each emotional factor may play a different role in participation post-stroke. In fact, a previous study reported that depression was a strong correlate for participation in social activities, but not for family role and outdoor activity.31 Moreover, the distinction between depression and apathy also has been confirmed for functional recovery in persons with stroke: apathy, not depression, was associated with poorer functional recovery.32,33 Therefore, it is critical to explore the association that each emotional factor has with participation post-stroke. To further understand the extent to which emotions contribute to participation post-stroke, this study aimed to identify both the variety and strength of various emotional contributors to participation post-stroke.
Effectiveness of life story book intervention on apathy and verbal fluency in people with dementia
Published in Clinical Gerontologist, 2023
Tomoaki Asano, Chih-Wen Wang, Megumi Tsugaruya, Takashi Ishikawa
Apathy has symptoms that are also found in depression, such as lack of vigor. However, Boyle and Malloy (2004) differentiated between the two by highlighting the distinctive symptoms of apathy, namely, loss of motivation and initiation, lack of persistence, emotional indifference or diminished emotional reactivity, and decreased social engagement. The neural basis of apathy is thought to be reduced blood flow in the frontal and cingulate cortices and in reward system neural circuits related to motivation (Benoit et al., 2004; Migneco et al., 2001). In the present study, the apathy scores in the NPI–NH showed an improvement immediately after the LSB intervention in the participants with severe dementia. This suggests that even people with advanced dementia may retain the ability to respond to and enjoy appropriate external stimulus input.
Apathetic symptoms and white matter integrity after traumatic brain injury
Published in Brain Injury, 2021
B Navarro-Main, AM Castaño-León, A Hilario, A Lagares, G Rubio, JA Periañez, M Rios-Lago
Apathy is a multidimensional symptom present in different neurological pathologies. The anatomical substrate of apathy has not been explored in depth, but certain findings obtained from patients suffering apathetic manifestations in different conditions, have suggested the role of a widespread neural network being involved, instead of isolated brain structures (37). There is currently some agreement pointing out that dysfunction in a system-level mechanism, common to different pathological conditions, may account for apathy. Specifically, the anterior cingulate cortex, medial orbitofrontal cortex, ventral striatum and their inter-connections have been identified as a relevant neuroanatomical network, which impairment would be related to the development of apathetic features in different neurological pathologies (38). In this line, neuroimaging techniques that focus on white mater integrity could provide interesting information about apathy and its neuroanatomical substrate. TBI is a pathology with a strong relationship with white matter integrity and apathy symptoms. The aim of this paper is to study the association of apathy with initial clinical variables, functionality scores and white matter integrity in patients with TBI. Summarizing, the main result of this study revealed the important role of white matter lesions as registered in the initial MR of a sample of patients with TBI in relation to the development of apathetic traits in the chronic phase.
Related Knowledge Centers
- Akinetic Mutism
- Lethargy
- Motivation
- Psychomotor Agitation
- Worry
- Passion
- Abulia
- Involuntary Commitment
- Positive Psychology
- Flow