Apathy following stroke

Department of Psychiatry, The University of Iowa, Iowa City, 52242, USA. <>
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 06/2010; 55(6):350-4.
Source: PubMed


We will review the available evidence on the frequency, clinical correlates, mechanism, and treatment of apathy following stroke.
We have explored relevant databases (that is, PubMed, MEDLINE, and PsycINFO) using the following key words and their combinations: apathy, motivation, abulia, stroke, cerebrovascular disease, basal ganglia, prefrontal cortex, anterior cerebral infarction, and thalamus.
The frequency of apathy following stroke has been consistently estimated between 20% and 25%. It appears to be associated with the presence of cognitive impairment, a chronic course characterized by progressive functional decline, and with disruption of neural networks connecting the anterior cingulate gyrus, the dorsomedial frontal cortex, and the frontal pole with the ventral aspects of the caudate nucleus, the anterior and ventral globus pallidus, and the dorsomedian and intralaminar thalamic nuclei. Published treatment studies have been mostly limited to anecdotal case reports, generally using dopamine agonists or stimulant medications. Cholinesterase inhibitors and nefiracetam may significantly reduce apathetic symptoms. However, their efficacy was examined in relatively small clinical trials that require replication.
Apathy is a frequent neuropsychiatric complication of stroke that, although often associated with depression and cognitive impairment, may occur independently of both. Its presence has been consistently associated with greater functional decline. However, there is no conclusive evidence about which is the best treatment for this condition.

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Available from: Ricardo E. Jorge, Aug 14, 2015
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    • "In psychiatry, it can be observed in schizophrenia (Blanchard and Cohen, 2006), major depression (Marin et al., 1993), and as a consequence of drug abuse (Lynskey and Hall, 2000). In neurological disorders, apathy has been observed independently of other psychiatric symptoms; for example in basal ganglia disease (Levy and Czernecki, 2006; Starkstein et al., 2009), Alzheimer's disease (Starkstein et al., 2001; Robert et al., 2010) and stroke (Jorge et al., 2010; Caeiro et al., 2013). "
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    ABSTRACT: Apathy, a quantitative reduction in goal-directed behavior, is a prevalent symptom dimension with a negative impact on functional outcome in various neuropsychiatric disorders including schizophrenia and depression. The aim of this review is to show that interview-based assessment of apathy in humans and observation of spontaneous rodent behavior in an ecological setting can serve as an important complementary approach to already existing task-based assessment, to study and understand the neurobiological bases of apathy. We first discuss the paucity of current translational approaches regarding animal equivalents of psychopathological assessment of apathy. We then present the existing evaluation scales for the assessment of apathy in humans and propose five sub-domains of apathy, namely self-care, social interaction, exploration, work/education and recreation. Each of the items in apathy evaluation scales can be assigned to one of these sub-domains. We then show that corresponding, well-validated behavioral readouts exist for rodents and that, indeed, three of the five human apathy sub-domains have a rodent equivalent. In conclusion, the translational ecological study of apathy in humans and rodents is possible and will constitute an important approach to increase the understanding of the neurobiological bases of apathy and the development of novel treatments.
    Frontiers in Behavioral Neuroscience 10/2015; 9:241. DOI:10.3389/fnbeh.2015.00241 · 3.27 Impact Factor
    • "En dehors des troubles cognitifs, les autres facteurs associé s a ` l'apathie seraient l'a ˆ ge e ´ levé , le degré d'invalidité , un faible taux d'hé moglobine glycosilé e (HgA1), les anté cé dents de maladies cé ré brovasculaires [23] [24] [25] [26] [27]. Les ré sultats obtenus dans cette e ´ tude semblent en accord avec ceux retrouvé s dans la litté rature mê me si l'apathie, fré quente aprè s un AVC, reste encore assez mal connue [21]. A ` propos de la fatigue post-AVC, le score moyen de FSS a significativement augmenté sur un an. "
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    ABSTRACT: Objectives: To describe the evolution of the clinical profile of post-stroke depression over a period of one year and to determine factors associated with changes in post-stroke depression. Methods: Prospective cohort study with a follow-up of 1year including 30 consecutive eligible patients. The severity of depression was assessed with the patient health questionnaire (PHQ9). Results: The mean age was 55.87±12.67years. Seventy percent of patients were men. The two assessments for neurological status, perceived health status and test results of attention were not statistically different. The rate of depressive symptoms was 26.67% in 2011 and 20% in 2012. Disability and apathy were significantly improved. The average for disability increased from 2.77±1.19 to 2.46±2.19 (P=0.002). From 66.7% in 2011, the proportion of patients able to walk without assistance rose to 93.3% in 2012 (P=0.03). In addition, the proportion of patients apathetic decreased from 43.3% to 13.3% (P=0.01). Greater age, female sex, sleep disorders and post-stroke apathy remained associated with DPAVC between the two assessments, with an increase in the strength of the association for apathy. Conclusions: The frequency of post-stroke depression is high and remains stable over time. Disability is the clinical feature that evolved more favorably. The association with apathy, present at the beginning, of the study was strengthened one year later.
    Revue Neurologique 05/2014; 170(10). DOI:10.1016/j.neurol.2014.03.002 · 0.66 Impact Factor
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    • "For the present analyses, the population is considered as a cohort, irrespective of randomization group. Because both apathy and depression may be a consequence of vascular disease (Starkstein et al., 1993; Aben et al., 2003; Hackett et al., 2005; Jorge et al., 2010; Naismith et al., 2012), caused either directly through a stroke lesion (Starkstein et al., 1993; Hackett et al., 2005) or indirectly through disability caused by vascular disease (Singh et al., 2000; Mayo et al., 2009), we investigated the predictive value of these symptoms in subjects without previous cardiovascular disease or stroke. Participants with a history of cardiovascular disease or stroke or with missing data on this variable were therefore excluded from the analysis. "
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    ABSTRACT: Although depression is considered to be associated with cardiovascular disease (CVD), specifically symptoms of apathy have been strongly associated with a history of CVD in recent studies. In this study, we prospectively assess whether symptoms of apathy and depression are independent risk factors for incident CVD and stroke. We carried out a prospective cohort study of 1810 community-dwelling older individuals (70-78 years) without a history of CVD or stroke. Symptoms of apathy and depression were assessed with the 15-item Geriatric Depression Scale. Incident CVD and stroke were assessed after 2 years follow-up. The associations of symptoms of apathy and depression with incident CVD and stroke were analyzed separately using logistic regression analysis. Symptoms of apathy and depression were present in 281 (15.5%) and 266 (14.7%) participants, respectively. Incident CVD occurred in 62 (3.5%) participants and stroke in 55 (3.1%) participants. Apathy was associated with incident CVD after adjustment for demographics and cardiovascular risk factors (odds ratio (OR) = 2.60, 95% CI = 1.46-4.65). Exclusion of subjects with depressive symptoms yielded a similar OR (2.94, 95% CI = 1.45-5.96, n = 1544). No association was found between depressive symptoms and incident CVD. Neither apathy symptoms nor depressive symptoms were associated with incident stroke. Apathy, but not depression, is a strong, independent risk factor for incident CVD. It may be a marker of underlying vascular disease. By its nature, apathy may cause non-adherence to a healthy lifestyle, diminished activities, and possibly even withdrawal from clinical care aimed at improving vascular risk profiles. Copyright © 2013 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 05/2014; 29(5). DOI:10.1002/gps.4026 · 2.87 Impact Factor
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