The Role of Apathy and Depression on Verbal Learning and Memory Performance After Stroke

Fishman, Keera N; Ashbaugh, Andrea R.; Lanctôt, Krista L.; Cayley, Megan L.; Herrmann, Nathan; Murray, Brian J.; Sicard, Michelle; Lien, Karen; Sahlas, Demetrios J.; Swartz, Richard H.

doi:10.1093/arclin/acy044

Cited by 16 publications

(13 citation statements)

References 64 publications

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“…2 Apathy has also been associated with impairments in specific cognitive domains such as verbal learning, short-and long-term verbal recall, semantic fluency, abstract reasoning, and attention and concentration. 11,14,15,29 This suggests that some post-stroke patients with apathy suffer from cognitive impairment, particularly in executive and memory-related domains, supporting the notion that similar neurobiological networks underlie cognitive function and motivated behavior. 24,26 These cognitive deficits may have functional consequences.…”

Section: Effects Of Apathy On Functional Outcomesmentioning

confidence: 66%

“…Furthermore, apathy and depression have different trajectories 10,11 and effects on outcomes such as functional disability 12,13 and cognition. 6,14,15 Negative emotionality is a key characteristic of depression that distinguishes it from apathy. Depressed patients may present with pessimism and hopelessness, while those with apathy show a lack of emotional distress.…”

Section: Differential Diagnosis Of Post-stroke Apathymentioning

confidence: 99%

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Apathy after stroke: Diagnosis, mechanisms, consequences, and treatment

Tay

Morris

Markus

2021

International Journal of Stroke

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Apathy is a reduction in goal-directed activity in the cognitive, behavioural, emotional, or social domains of a patient's life, and occurs in one out of three patients after stroke. Despite this, apathy is clinically under-recognised and poorly understood. This overview provides a contemporary introduction to apathy in stroke for researchers and practitioners, covering topics including diagnosis, neurobiological mechanisms, associated consequences, and potential treatments for apathy. Apathy is often misdiagnosed as other post-stroke conditions such as depression. Accurate differential diagnosis of apathy, which manifests as reductions in initiative, and depression, which manifests as negative emotionality, is important as it informs prognosis. Research on the neurobiology of apathy suggests that there are few consistent associations between stroke lesion location and the development of apathy. These may be resolved by adopting a network neuroscience approach, which conceptualises of apathy as a pathology arising from structural or functional damage to brain networks underlying motivated behaviour. Importantly, networks can be affected by physiological changes related to stroke, including the acute infarct but also diaschisis and neurodegeneration. Aside from neurobiological changes, apathy is also associated with other negative outcome measures such as functional disability, cognitive impairment, and emotional distress, suggesting that apathy is indicative of a worse prognosis following stroke. Unfortunately, high-quality trials aimed at treating apathy are scarce. Antidepressants may have limited effects on apathy. Acetylcholine and dopamine pharmacotherapy, behavioural interventions, and transcranial magnetic stimulation may be more promising avenues for treatment.

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Section: Effects Of Apathy On Functional Outcomesmentioning

confidence: 66%

Section: Differential Diagnosis Of Post-stroke Apathymentioning

confidence: 99%

Apathy after stroke: Diagnosis, mechanisms, consequences, and treatment

Tay

Morris

Markus

2021

International Journal of Stroke

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“…Importantly, apathy can be dissociated from depression in cerebrovascular diseases and in other neurological conditions more generally (Oguru et al, 2010;Starkstein et al, 2005;Tay et al, 2019;Withall et al, 2011). A substantial body of evidence suggests that the two constructs, when examined as broad syndromes, are dissociable in terms of neurobiology (Douven et al, 2017a), cognition (Fishman et al, 2018a(Fishman et al, , 2018bLohner et al, 2017), longitudinal trajectories (Caeiro et al, 2013b;Withall et al, 2011), and impact on functional outcomes (Hama et al, 2007;Hollocks et al, 2015;Mayo et al, 2009). Comorbidity estimates range between 3.8-41.9 % (Matsuzaki et al, 2015;Withall et al, 2011), although these vary by population, assessment time, and measures of apathy and depression.…”

Section: Apathy: Concept and Challengesmentioning

confidence: 99%

Network neuroscience of apathy in cerebrovascular disease

Tay

Lisiecka-Ford

Hollocks

et al. 2020

Progress in Neurobiology

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Apathy is a reduction in motivated goal-directed behavior (GDB) that is prevalent in cerebrovascular disease, providing an important opportunity to study the mechanistic underpinnings of motivation in humans. Focal lesions, such as those seen in stroke, have been crucial in developing models of brain regions underlying motivated behavior, while studies of cerebral small vessel disease (SVD) have helped define the connections between brain regions supporting such behavior. However, current lesion-based models cannot fully explain the neurobiology of apathy in stroke and SVD. To address this, we propose a network-based model which conceptualizes apathy as the result of damage to GDB-related networks. A review of the current evidence suggests that cerebrovascular disease-related pathology can lead to network changes outside of initially damaged territories, which may propagate to regions that share structural or functional connections. The presentation and longitudinal trajectory of apathy in stroke and SVD may be the result of these network changes. Distinct subnetworks might support cognitive components of GDB, the disruption of which results in specific symptoms of apathy. This network-based model of apathy may open new approaches for investigating its underlying neurobiology, and presents novel opportunities for its diagnosis and treatment. Recent research on the fundamental neuroanatomical and neurocognitive mechanisms underlying apathy has broadened our understanding of apathy in cerebrovascular disease and across neurological disorders. Despite this, theoretical work has primarily focused on linking neurodegenerative pathology to apathy, such as in Alzheimer's disease or Parkinson's disease (e.g., Lanctôt et al., 2017; Pagonabarraga et al., 2015). This has left the mechanisms underlying apathy in cerebrovascular disease comparably under-explored. Given the high prevalence of comorbid vascular pathology in neurodegenerative

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“…Apathetic, but not depressive, symptoms were associated with widespread reduction in white matter integrity and impaired connectivity in premotor and cingulate regions in patients with small vessel disease [31,32]. Clinically, depressive symptoms could be dissociated from apathetic symptoms in terms of longitudinal trajectories [8,18] and a connection with poststroke cognitive function [33,34]. Our results provide further evidence that the symptoms of these two neuropsychiatric syndromes are related to different functional outcome and mortality.…”

Section: Discussionmentioning

confidence: 57%

Early apathetic, but not depressive, symptoms are associated with poor outcome after stroke

Lopatkiewicz

Pera

Słowik

et al. 2021

Euro J of Neurology

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Background and purpose Depression and apathy are frequent neuropsychiatric disturbances after stroke and may appear together. Despite the overlap in symptoms between poststroke depression and apathy, these two syndromes might be associated with different prognoses and benefit from different treatments. We aimed to disentangle the relationship between early depressive and apathetic symptoms and outcome after stroke. Methods Of 698 enrolled patients with ischemic stroke, we included 443 participants (median age = 69 years, 51% female) who underwent depressive and apathetic symptom assessment on Day 8 after stroke. We divided patients into four groups: without greater depressive and apathetic symptoms (Group 1), with only apathetic symptoms (Group 2), with only depressive symptoms (Group 3), and with both depressive and apathetic symptoms (Group 4). Results After adjusting for age and stroke severity, Group 2 and Group 4 had an increased risk of poor 3‐month outcome (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.16–3.38, p = 0.01 and OR = 1.58, 95% CI = 1.24–2.01, p < 0.01, respectively). Group 2 and Group 4 also had an increased risk of poor 12‐month outcome (OR = 3.85, 95% CI = 2.19–6.78, p < 0.01 and OR = 1.54, 95% CI = 1.22–1.96, p < 0.01, respectively) and mortality (hazard ratio [HR] = 2.76, 95% CI = 1.19–6.41, p = 0.02 and HR = 1.77, 95% CI = 1.32–2.38, p < 0.01, respectively). Compared with Group 1, Group 3 did not have an increased risk of unfavorable outcomes. Conclusions Early apathetic, but not depressive, symptoms are related to worse outcomes after stroke. Our study underscores the importance of recognizing apathetic symptoms independently from depressive symptoms.

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The Role of Apathy and Depression on Verbal Learning and Memory Performance After Stroke

Cited by 16 publications

References 64 publications

Apathy after stroke: Diagnosis, mechanisms, consequences, and treatment

Apathy after stroke: Diagnosis, mechanisms, consequences, and treatment

Network neuroscience of apathy in cerebrovascular disease

Early apathetic, but not depressive, symptoms are associated with poor outcome after stroke

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