The apathy, gait impairment, and executive dysfunction (AGED) triad vascular variant

Abstract

Apathy, gait disturbances, and executive dysfunction (AGED) often occur together. Although they can arise independently, the presence of one might portend another. This recognition suggests the possible etiology. We focus on the most common, the vascular. We explain the AGED vascular mechanism through the ambibaric brain concept. The brain contains two complementary blood pressure systems: One high in the primitive brain (brainstem, basal ganglia, and thalamus) and a low‐pressure system in the Homo sapiens brain (cerebral hemispheres). Hypertension inflicts the most damage on the primitive brain. The frontal systems connect to the basal ganglia, then the thalamus and back to the cortex. Many connections converge on the primitive brain where they are damaged by vascular disease. We need methods of determining optimal, individual blood pressures. Although the AGED triad can result from other causes, it should first signal a vascular etiology, the most prevalent, treatable, and preventable one.

Association between behavioral and psychological symptoms and cerebral small vessel disease MRI findings in memory clinic patients

“…Cai et al showed the association between MRI findings and apathy, such that lacunar infarcts, CMBs, and severe WMH were detected in patients with apathy (Cai et al, 2022). Hypertension and blood pressure fluctuations can cause damage to brain connections and are associated with white matter disruption, apathy and depression (Hachinski et al, 2022). Moreover, both hypertension and CAA have been associated with apathy (Smith et al, 2021), indicating that small-vessel lesions may also be associated with apathy.…”

Detecting apathy in patients with cerebral small vessel disease

“…In detail, the brain circuits such as the frontal regions with their projections to the prefrontal regions, the basal ganglia, the parietal regions, and the anterior cingulate, which play key roles in planning, motivation, and autoactivation, could be injured in CSVD ( Wouts et al, 2020 ). More recently, apathy, combined with gait impairment and executive dysfunction, was conveyed as a new vascular triad in patients with CSVD by Hachinski et al (2022) . Hypertension, cerebral hypoperfusion, white matter tract disconnection, and other CSVD etiological factors were reported to cause apathy ( Moretti et al, 2015 ; Tay et al, 2019 ; Hachinski et al, 2022 ).…”

“…More recently, apathy, combined with gait impairment and executive dysfunction, was conveyed as a new vascular triad in patients with CSVD by Hachinski et al (2022) . Hypertension, cerebral hypoperfusion, white matter tract disconnection, and other CSVD etiological factors were reported to cause apathy ( Moretti et al, 2015 ; Tay et al, 2019 ; Hachinski et al, 2022 ).…”

“…Apathy, defined as a disorder of goal-directed behavior, has attracted more and more attention in aging neuroscience ( Hachinski et al, 2022 ). It has been evidenced that apathy is be found in many neurodegenerative disorders, such as Alzheimer’s disease (AD), Parkinson’s disease (PD), and multiple sclerosis (MS) ( Zhao et al, 2012 ; Niino et al, 2014 ; Brown et al, 2019 ), and apathy has been confirmed to be correlated with cognitive impairments in cross-sectional studies ( Niino et al, 2014 ; Yu et al, 2020 ).…”

Brain health and mental health: Common vascular risk factors and practical implications

“…In older adults, depression sometimes manifests as apathy and often occurs concomitantly with gait disorders and executive dysfunction. 12 In older adults with progressive cerebrovascular disease, one encounters the triad of cognitive impairment, lower body Parkinsonism, and depression. A further example of the association between mental and brain health links obsessive compulsive disorder (OCD) with an increased risk of developing an ischemic stroke.…”