Apathy: Why Care?

Abstract

This review presents data showing that apathy is common across a number of disorders. Apathy is not only common, but is also associated with significant problems: reduced functional level, decreased response to treatment, poor illness outcome, caregiver distress, and chronicity. Preliminary evidence of treatment efficacy exists for dopaminergic drugs and for amphetamines. Strong evidence of efficacy exists for acetylcholinesterase inhibitors in Alzheimer's disease, and for atypical antipsychotics in schizophrenia. Frontal-subcortical system(s) dysfunction is implicated in the causation of apathy; apathy subtypes based on the various frontal-subcortical loops may thus exist. Further research involving diagnosis, pathophysiology, and treatment is suggested.

Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment

“…Clinical observations as well as studies in animal models of motivated behavior support the view that frontal-subcortical system dysfunction contributes to the appearance of apathy (van Reekum et al 2005;Levy and Dubois 2006;Dellu et al 1996;Peters et al 2006;Farrar et al 2007;Filali et al 2009). Focal lesions (such as stroke) as well as diffuse neurodegenerative processes (such as Alzheimer's disease) or predominantly white matter disorders (including multiple sclerosis) or generalized encephalopathies can give rise to abnormalities in goal-directed behavior, if critical components of this frontal lobe-basal ganglia system are affected.…”

“…With these steps toward increasing definitional clarity, academic studies and research publications on the subject have climbed exponentially. Insight into the concept and pathophysiology and treatment of apathy has substantially advanced (McAllister 2000;van Reekum et al 2005;Levy and Dubois 2006). Nevertheless, confusion lingers regarding its proper definition, nosologic position, diagnostic, and assessment procedures, and even regarding its fundamental syndromic validity (Mizrahi and Starkstein 2007).…”

Prevalence, Comorbidities, and Correlates of Challenging Behavior Among Community-Dwelling Adults With Severe Traumatic Brain Injury

“…[20][21][22] A possible reason is that the rates in the earlier studies were based on clinical criteria delineating apathy (score >35 on Apathy Evaluation Scale), whereas the OBS focused on those clients who posed a challenge due to the amount of daily prompting required. It was difficult to compare the rates of inappropriate social behavior to other studies because of the heterogeneity of behaviors to which this descriptor is applied across the literature.…”

“…The majority of research has focused on aggression, whereas our knowledge about the other domains is based on a handful of studies. Prevalence rates for aggression (both physical and verbal) and lower-grade irritability range from as low as 11% to as high as 96%, 5,[9][10][11][12][13][14][15][16][17][18][19] lack of initiation from 40.5% to 71%, [20][21][22][23] inappropriate sexual behavior from 6.5% to 30.4%, [23][24][25] wandering/absconding from 6% to 14%, 23,26,27 and perseveration in real-world behavioral domains (as distinct from perseveration on neuropsychological tests) at 25.3%. 23 Rates for inappropriate social behavior are harder to determine, due to a lack of consensus as to which behaviors fall under this construct.…”

Role of Socioeconomic Status and Political Participation in Construction of Apathy Among Youth

“…Apathy has been a common subject matter in research in neurology, psychiatry (Ishii, Weintraub, & Mervis, 2009), and medicine (Van Reekum, Stuss, & Ostrander, 2005). It has also been studied in political science as political apathy or voter's apathy (Diehl & Blohm, 2001) or as electoral apathy (Temple, 2005).…”