Article

Hypertension and white matter lesions are independently associated with apathetic behavior in healthy elderly subjects: The Sefuri brain MRI study

Center for Emotional and Behavioral Disorders, National Hospital Organization Hizen Psychiatric Center, Saga, Japan.
Hypertension Research (Impact Factor: 2.94). 05/2009; 32(7):586-90. DOI: 10.1038/hr.2009.65
Source: PubMed

ABSTRACT Apathy is defined as a syndrome of primary loss of motivation not attributable to emotional distress, intellectual impairment or consciousness disturbance. The aim of our study was to investigate the effects of vascular risk factors and silent ischemic brain lesions on apathetic behavior of community-dwelling elderly subjects. Brain MRI and other medical examinations were performed on 222 non-demented community-dwelling elderly subjects (96 men and 126 women, average age 70.1 years). The apathy group was defined as the most apathetic quintile determined by Starkstein's apathy scale. Silent infarction, deep white matter lesions (DWMLs) and periventricular hyperintensities were detected in 12.2, 39.2 and 22.5%, respectively. Linear regression analysis (Pearson) revealed that the scores on the apathy scale correlated slightly but significantly with logarithmically transformed scores of the Modified Stroop Test (r=0.135, P=0.045), but not with the Mini-Mental State Examination. The apathy group tended to have more high blood pressure (141.6/82.6 vs. 136.1/79.6 mm Hg), less prevalent hyperlipidemia (18 vs. 35%) and lower serum albumin. Multivariate analysis (the forward stepwise method of logistic analysis) revealed an independent correlation between the apathy and grade of DWMLs (odds ratio 1.826, 95% confidence interval (CI) 1.129-2.953 per grade) or diastolic blood pressure (DBP) (odds ratio 1.055, 95% CI 1.014-1.098 per mm Hg) after adjusting for possible confounders. The mean apathy scale score in the DBP>or=90 mm Hg group was significantly lower (more apathetic) than that in the DBP<80 group (P=0.011, analysis of covariance). This study showed that hypertension and DWMLs are independently associated with apathy in healthy elderly subjects.

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    • "The association of symptoms of apathy and depression with incident cardiovascular disease and stroke was analyzed using logistic regression analysis with incident non-fatal and fatal cardiovascular disease and stroke as dependent variables. Because silent ischemic brain lesions might contribute to apathy symptoms (Lavretsky et al., 2008; Yao et al., 2009) and subjects affected by this may have an increased risk of clinically overt stroke (Bernick et al., 2001), cardiovascular disease and stroke were analyzed as separate dependent variables. If participants suffered from incident stroke and cardiovascular disease, both events were analyzed separately. "
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    International Journal of Geriatric Psychiatry 05/2014; 29(5). DOI:10.1002/gps.4026 · 3.09 Impact Factor
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    • "Consistent with our finding of low FC among medial frontal structures and the ventral striatum are findings suggesting that lesions in the basal ganglia and in frontal subcortical regions have been associated with apathy (Levy and Dubois, 2006; van Reekum et al., 2005). Healthy elders with apathy have more subcortical white matter hyperintensities (WMH) than those without apathy (Yao et al., 2009). Apathy was associated with history of stroke/ TIA as well as cardiovascular risk factors in a large probability sample of community residing elders (Ligthart et al., 2012). "
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    ABSTRACT: BACKGROUND: Apathy is common in late-life depression and is associated with disability and poor antidepressant response. This study examined whether resting functional connectivity (FC) of the nucleus accumbens (NAcc) and the dorsal anterior cingulate (dACC) with other structures can distinguish apathetic depressed older patients from non-apathetic depressed patients and normal subjects. METHODS: Twenty-six non-demented, non-MCI older adults were studied. Of these, 16 had major depression (7 also had apathy) and 10 had no psychopathology. Resting state fMRI was performed prior to treatment in subjects who were psychotropic-free for at least two weeks. FC was determined by placing seeds in the NAcc and the dACC bilaterally. RESULTS: Apathetic depressed patients had lower FC of the NAcc with the amygdala, caudate, putamen, globus pallidus, and thalamus and increased FC with the dorsomedial prefrontal cortex, the superior frontal cortex, and the insula than non-apathetic patients. Further, apathetic patients had lower FC of the dACC with dorsolateral and ventrolateral prefrontal cortices and higher FC with the insula and the orbitofrontal cortex than non-apathetic patients. LIMITATIONS: Small number of subjects, lack of random sampling, use of a 1.5T MRI scanner. CONCLUSIONS: This preliminary study suggests that FC between the NAcc and the dACC and structures related to reward and related behavioral responses constitute the functional topography of abnormalities characterizing apathy of late life depression. However, replication is needed.
    Journal of Affective Disorders 12/2012; 149(1-3). DOI:10.1016/j.jad.2012.11.023 · 3.71 Impact Factor
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    • "In dementia, apathy as mental slowness was more frequently associated with vascular white-matter changes [45]. In a community-dwelling elderly subject sample, an association was found between apathy and hypertension and white matter lesions [46]. This relation had been otherwise considered as a depression-executive dysfunction syndrome of late life [47]. "
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