Subthalamic nucleus stimulation in Parkinson disease induces apathy

Jeune, Florence Le; Drapier, Dominique; Bourguignon, Anne; Péron, Julie Anne; Mesbah, H.; Drapier, Sophie; Sauleau, Paul; Haegelen, Claire; Travers, D.; Garin, Étienne; Malbert, Charles‐Henri; Millet, Bruno; Vérin, Marc

doi:10.1212/wnl.0b013e3181c34b34

Cited by 170 publications

(144 citation statements)

References 33 publications

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“…However, positive correlations between apathy and prefrontal, temporal, parietal and limbic areas were also noted in some studies 14, 56, 57, 58. Studies using T1‐weighted imaging reported reduced GM thickness in the temporal lobes 62 or increased atrophy in the frontal and parietal lobes (e.g.…”

Section: Methodsmentioning

confidence: 96%

Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies

Wen

Chan

Tan

et al. 2016

Euro J of Neurology

148

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Depression, anxiety and apathy are common mood disturbances in Parkinson's disease (PD) but their pathophysiology is unclear. Advanced neuroimaging has been increasingly used to unravel neural substrates linked to these disturbances. A systematic review is provided of neuroimaging findings in depression, anxiety and apathy in PD. A PubMed, MEDLINE and EMBASE search of peer‐reviewed original research articles on these mood disturbances in PD identified 38 studies on depression, eight on anxiety and 14 on apathy in PD. Most of the imaging studies used either position emission tomography or single‐photon emission computed tomography techniques. These studies generally suggest increased neural activity in the prefrontal regions and decreased functional connectivity between the prefrontal−limbic networks in depressed patients. Functional imaging studies revealed an inverse correlation between dopaminergic density in the caudate and putamen with the severity of anxiety in PD. There was no consistent correlation between dopaminergic density of thalamus and anxiety. Studies demonstrated both positive and inverse correlations between apathy and metabolism or activity in the striatum, amygdalar, prefrontal, temporal and parietal regions. The clinical variability of study subjects and differences in image pre‐processing and analytical strategies may contribute to discrepant findings in these studies. Both nigrostriatal and extra‐nigrostriatal pathways (in particular the frontal region and its connecting areas) are affected in mood disorders in PD. Identifying the relative contributions of these neural pathways in PD patients with overlapping motor and mood symptoms could provide new pathophysiological clues for the development of better therapeutic targets for affected patients.

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Section: Methodsmentioning

confidence: 96%

Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies

Wen

Chan

Tan

et al. 2016

Euro J of Neurology

148

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“…A PET study investigated apathy in nondemented PD patients (Average disease duration at surgery was 11.2 years) after deep brain stimulation of the subthalamic nucleus using the Apathy Evaluation Scale [105]. In this study, positive correlations were identified between apathy scores and glucose metabolism in the frontal lobe; whereas, apathy scores were negatively correlated with glucose metabolism in the posterior cingulate gyrus and the frontal lobe [104]. A VBM study has shown evidence that in PD low grey matter density in many cortical brain region within the frontal, parietal, cingulate cortex correlated with high apathy scores [50].…”

Section: Apathymentioning

confidence: 99%

“…We found 7 studies that have investigated the underlying mechanism of apathy in PD using a variety of imaging techniques [45,50,66,67,93,101,104] (See table 4). A PET study investigated apathy in nondemented PD patients (Average disease duration at surgery was 11.2 years) after deep brain stimulation of the subthalamic nucleus using the Apathy Evaluation Scale [105].…”

Section: Apathymentioning

confidence: 99%

“…In addition, only one VBM study has investigated grey matter volume in PD with apathy but this study had various limitations such as the inclusion of patients with only mild apathy scores and the use of only a correlational analysis design. Indeed, there is evidence that apathy is associated with atrophy of the frontal and cingulate cortex in PD [50,104].…”

Section: Apathymentioning

confidence: 99%

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Cognitive and neuroanatomical correlates of neuropsychiatric symptoms in Parkinson's disease: A systematic review

Alzahrani

Venneri

2015

Journal of the Neurological Sciences

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“…2 Several functional imaging studies 94,95 in patients with Parkinson's disease without dementia have supported this hypothesis, showing that these patients can present with abnormal activation at the level of the dorsolateral or ventrolateral prefrontal cortex and caudate nucleus during executive tasks. Results from glucose metabolism studies [96][97][98] with ¹⁸F-FDG PET in Parkinson's disease have shown that apathy severity is associated with metabolic activity in diff erent cognitive regions, including the inferior medial frontal gyrus, cingulate cortex, insula, cuneus, and tempo roparietal region.…”

Section: Lesions and Neuroimagingmentioning

confidence: 99%

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Pagonabarraga

Kulisevsky

Strafella

et al. 2015

The Lancet Neurology

420

394

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Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of diff erent networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of aff ected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely aff ect the quality of life of both patients and caregivers. Diff erentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.

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Subthalamic nucleus stimulation in Parkinson disease induces apathy

Abstract: These preliminary results confirm the role of the subthalamic nucleus in associative and limbic circuitry in humans and suggest that it is a key basal ganglia structure in motivation circuitry.

Cited by 170 publications

References 33 publications

Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies

Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies

Cognitive and neuroanatomical correlates of neuropsychiatric symptoms in Parkinson's disease: A systematic review

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

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