Apathy is usually defined as the overt manifestation of a lack of motivation, and decreased emotional engagement, lack of concern or indifference, and a flattening of affect. Apathy is a major clinical condition which strongly impacts in every day life events, affects the common daily living abilities, reduced the inner goal directed behavior, and gives the heaviest burden on caregivers. Is a quite common comorbidity of many neurological disease, However, there is no definite consensus on the role of apathy in clinical practice, no definite data on anatomical circuits involved in its development, and no definite instrument to detect it at bedside. As a general observation, the occurrence of apathy is connected to damage of prefrontal cortex (PFC) and basal ganglia; “emotional affective” apathy may be related to the orbitomedial PFC and ventral striatum; “cognitive apathy” may be associated with dysfunction of lateral PFC and dorsal caudate nuclei; deficit of “autoactivation” may be due to bilateral lesions of the internal portion of globus pallidus, bilateral paramedian thalamic lesions, or the dorsomedial portion of PFC. On the other hand, apathy severity has been connected to neurofibrillary tangles density in the anterior cingulate gyrus and to grey matter atrophy in the anterior cingulate (ACC) and in the left medial frontal cortex, confirmed by functional imaging studies. Specifically, these regions are involved in evaluating action and outcomes and, via the basolateral amygdala and nucleus accumbens, feed into an ascending frontostriatal pathway to the dorsolateral prefrontal cortex, which is ultimately responsible for selecting and executing behavioural responses. Damage to the ACC and OFC leads to a disruption of this circuit resulting in impaired decision-making and impaired response initiation, which presents as apathy. Emergent role concerns also the parietal. We will discuss the importance of these circuits in different pathologies, degenerative or vascular, acute or chronic.

Apathy is an uncertain nosographical entity, which includes reduced motivation, abulia, decreased empathy, and lack of emotional involvement; it is an important and heavy-burden clinical condition which strongly impacts in everyday life events, affects the common daily living abilities, reduced the inner goal directed behavior, and gives the heaviest burden on caregivers. Is a quite common comorbidity of many neurological disease, However, there is no definite consensus on the role of apathy in clinical practice, no definite data on anatomical circuits involved in its development, and no definite instrument to detect it at bedside. As a general observation, the occurrence of apathy is connected to damage of prefrontal cortex (PFC) and basal ganglia; "emotional affective" apathy may be related to the orbitomedial PFC and ventral striatum; "cognitive apathy" may be associated with dysfunction of lateral PFC and dorsal caudate nuclei; deficit of "autoactivation" may be due to bilateral lesions of the internal portion of globus pallidus, bilateral paramedian thalamic lesions, or the dorsomedial portion of PFC. On the other hand, apathy severity has been connected to neurofibrillary tangles density in the anterior cingulate gyrus and to gray matter atrophy in the anterior cingulate (ACC) and in the left medial frontal cortex, confirmed by functional imaging studies. These neural networks are linked to projects, judjing and planning, execution and selection common actions, and through the basolateral amygdala and nucleus accumbens projects to the frontostriatal and to the dorsolateral prefrontal cortex. Therefore, an alteration of these circuitry caused a lack of insight, a reduction of decision-making strategies, and a reduced speedness in action decision, major responsible for apathy. Emergent role concerns also the parietal cortex, with its direct action motivation control. We will discuss the importance of these circuits in different pathologies, degenerative or vascular, acute or chronic.

Neural Correlates for Apathy: Frontal-Prefrontal and Parietal Cortical- Subcortical Circuits

MORETTI, Rita;
2016

Abstract

Apathy is usually defined as the overt manifestation of a lack of motivation, and decreased emotional engagement, lack of concern or indifference, and a flattening of affect. Apathy is a major clinical condition which strongly impacts in every day life events, affects the common daily living abilities, reduced the inner goal directed behavior, and gives the heaviest burden on caregivers. Is a quite common comorbidity of many neurological disease, However, there is no definite consensus on the role of apathy in clinical practice, no definite data on anatomical circuits involved in its development, and no definite instrument to detect it at bedside. As a general observation, the occurrence of apathy is connected to damage of prefrontal cortex (PFC) and basal ganglia; “emotional affective” apathy may be related to the orbitomedial PFC and ventral striatum; “cognitive apathy” may be associated with dysfunction of lateral PFC and dorsal caudate nuclei; deficit of “autoactivation” may be due to bilateral lesions of the internal portion of globus pallidus, bilateral paramedian thalamic lesions, or the dorsomedial portion of PFC. On the other hand, apathy severity has been connected to neurofibrillary tangles density in the anterior cingulate gyrus and to grey matter atrophy in the anterior cingulate (ACC) and in the left medial frontal cortex, confirmed by functional imaging studies. Specifically, these regions are involved in evaluating action and outcomes and, via the basolateral amygdala and nucleus accumbens, feed into an ascending frontostriatal pathway to the dorsolateral prefrontal cortex, which is ultimately responsible for selecting and executing behavioural responses. Damage to the ACC and OFC leads to a disruption of this circuit resulting in impaired decision-making and impaired response initiation, which presents as apathy. Emergent role concerns also the parietal. We will discuss the importance of these circuits in different pathologies, degenerative or vascular, acute or chronic.
Pubblicato
https://www.frontiersin.org/articles/10.3389/fnagi.2016.00289/full
File in questo prodotto:
File Dimensione Formato  
fnagi-08-00289.pdf

accesso aperto

Descrizione: articolo principale
Tipologia: Documento in Versione Editoriale
Licenza: Creative commons
Dimensione 294.03 kB
Formato Adobe PDF
294.03 kB Adobe PDF Visualizza/Apri
fnagy supplemental data.pdf

accesso aperto

Descrizione: Supplementary data
Tipologia: Altro materiale allegato
Licenza: Creative commons
Dimensione 210.83 kB
Formato Adobe PDF
210.83 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11368/2888688
Citazioni
  • ???jsp.display-item.citation.pmc??? 26
  • Scopus 60
  • ???jsp.display-item.citation.isi??? 55
social impact