The MRI brain correlates of depressed mood, anhedonia, apathy, and anergia in older adults with and without cognitive impairment or dementia

Abstract

SUMMARY Objectives We examined the magnetic resonance imaging (MRI) correlates of depressed mood, apathy, anhedonia, and anergia in older adults with and without cognitive impairment or dementia. Methods This analysis included 270 community-dwelling older adults (59% male; 79% Caucasian; mean age 74.4 years) who were recruited into a multi-center longitudinal observational study of subcortical ischemic vascular disease (SIVD).The distribution of cognitive status included: cognitively intact (38%), cognitively impaired (27%), or demented (35%). All subjects underwent MRI and 41% were classified as having subcortical lacunes. MRI measures included cortical gray and white matter volumes, lacunar volumes in subcortical white and gray matter structures, volume of white matter hyperintensities, and total hippocampal volume. Depressed mood, anhedonia, anergia, and apathy apparent at the time of assessment were assessed using a behavioral assessment Associations between neuropsychiatric symptoms and MRI variables were evaluated using logistic regression. Results Subjects with neuropsychiatric symptoms were more likely to be cognitively impaired or demented than those without neuropsychiatric symptoms. In multivariate models controlling for cognitive status, age, gender, and education, higher lacunar volume in white matter was independently associated with the presence of all four neuropsychiatric symptoms. Conclusions We report an association between the lacunar volumes in the white matter and depressed mood, anhedonia, apathy, and anergia, thus supporting the role of subcortical ischemic vascular disease in the pathogenesis of late-life neuropsychiatric disorders.

Neuroinflammation, Neurodegeneration, and Depression

“…An association has been seen between late-life depressed mood, anhedonia, apathy, anergia and higher lacunars volume in white matter, suggestive of a role of subcortical ischemic vascular disease in the pathogenesis of such late-life mood disorders (Lavretsky et al 2008). Additionally, human imaging studies showing cellular loss in key brain regions such as prefrontal cortex and amygdala of patients with mood disorders causally links select reduction in brain volume to depression (Cotter et al 2001; Rajkowska 2002; Rosso et al 2005; Sheline et al 1998).…”

The salience network in the apathy of late‐life depression

“…There is little knowledge of the functional neuroanatomy of apathy in depression despite the abundant geriatric psychiatry literature documenting the phenomenon of apathy syndromes in depression (Alexopoulos et al, 2013, Lavretsky et al, 2007, Lavretsky et al, 2008). Given the malignant effect of comorbid apathy on clinical outcomes and treatment response, apathetic depression appears to not be just a more severe form of depression but possibly a distinctive dimension with a unique neurobiological profile.…”

Effect of non-pharmacological intervention for apathy: response to one-on-one reminiscence-based intervention

“…Given that imaging studies have shown that apathy in Alzheimer's disease is associated with hypoperfusion in regions that are involved in frontal–subcortical networks,9 10 this finding suggests a possible beneficial effect of one-on-one reminiscence-based intervention.…”

“…Also, brain perfusion single-photon emission CT (SPECT) demonstrated distinct hypoperfusion in the frontal lobes bilaterally, especially in the prefrontal areas, which might be associated with the neuroanatomical basis of apathy (figure 2). 9 10 Based on these results, we diagnosed the patient as having apathy without comorbidity.…”