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Query: UMLS:C0085632 (apathy)
 4,089 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Frontal lobe syndromes with personality change are well known for about 150 years but mysteries of their underlying anatomophysiological mechanisms have started to unfold in recent years. The frontal lobe accommodates an extension of the primary motor (precentral) cortex, the premotor region and the interhemispherically located supplementary motor region, both of them forming area 6 and its subdivisions. The anterior and inferior frontal structures (and also the eye field, area 8) belong to the prefrontal region. The prefrontal cortex is also involved in motor action: in its initiation, planning, designing and sequencing rather than its mere execution. This requires drive and initiative to move, their deficits resulting in moderate to extreme apathy. Forces of motivation are likely to be mediated via the fronto-orbital cortex (known as an extension of the temporo-limbic system) which also exerts inhibitory influences on prefrontal functioning, and disinhibitory frontal lobe syndromes (from tactlessness to aggression) are the result of frontobasal impairment. A special form of frontal-motor cortex disconnection may occur in childhood: in the rare Rett syndrome and, with limitation to the prefrontal cortex, in the common Attention Deficit Hyperactivity Disorder (ADHD). The initiation of movement is based upon the constant influx of afferent-sensory messages from posterior cerebral regions and strong mesiodorsal thalamic connections, providing information for each following initiatory prefrontal motor impulse which depends on such information from the past moment. This "Working Memory" appears to be the keystone of mental and motor prefrontal function. Becoming unnecessary in the next moments, the afferent signals undergo immediate extinction due to inhibitory fronto-orbital impulses. It is assumed that the classical absence attack with generalized spike-waves of frontal onset causes a "suspension of the working memory" and thus permits immediate postictal recuperation of frontal functions. The gap between afferent and efferent signals in the working memory is likely to permit neurocognitive-processes and, in Homo sapiens, a widened gap is thought to provide a basis for reflection and cogitation uniquely human properties.
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PMID:Frontal lobe functions and dysfunctions. 957 Dec 95

The physiological basis for the striking decrease of attention to novel events following frontal lobe injury is poorly understood. In this study, event-related potentials (ERPs) were recorded from patients with frontal lobe damage and matched subjects, who controlled the duration of viewing of background, novel and target stimuli. Frontal lobe patients did not differ from normal controls in terms of age, education, estimated IQ or mood. However, they were judged to be more apathetic as measured by self-report and informants' ratings. Patients with frontal lobe damage exhibited markedly reduced amplitude of the novelty P3 response and the duration of viewing of novel stimuli. In contrast, injury to the frontal lobes had a limited impact on P3 amplitude and behavioural responses (viewing duration and reaction time) to target stimuli. A strong correlation was found between measures of apathy and both attenuated P3 amplitude and viewing duration in response to novel but not target stimuli. Differences in amplitude of the novelty P3 response explained a large portion of the variance associated with duration of viewing of novel stimuli. After controlling for the influence of P3 amplitude, there was no association between frontal lobe injury and reduced viewing of novel stimuli. The results of this study suggest that frontal lobe damage leads to diminished visual attention to novel events through its disruption of neural processes underlying the novelty P3 response. These processes appear to regulate the allocation of attentional resources and early exploratory behaviours, and are not limited to immediate orienting responses. Damage to the frontal lobes may prevent the generation of a signal which indicates that a novel event in the environment requires additional attention due to its potential behavioural significance. The disruption of these processes is likely to contribute to the apathy observed in patients after injury to the frontal lobes.
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PMID:The central role of the prefrontal cortex in directing attention to novel events. 1077 38

Frontal lobe dysfunction is a prominent feature of many neurological disorders. Early diagnosis may be enhanced by establishing a profile of cognitive, behavioral, and emotional change. Traditional psychometric assessment focuses on cognitive dysfunction and fails to identify behavioral changes, particularly those associated with orbitofrontal dysfunction. We examined progressive supranuclear palsy (PSP), a prototypical subcortical dementia with frontal features, using commonly available neuropsychological measures and a modification of the Katz Adjustment Scale-Relatives (KAS-R), an instrument first developed to assess dysexecutive changes in head-injured patients. Executive tests identified deficits in reasoning, planning, set shifting, verbal fluency, information processing speed, and response initiation. On the KAS-R, changes in apathy, social withdrawal, and independence were observed, with little change in belligerence, social irresponsibility, uncooperativeness, obstreperousness, anxiety, and depression. The results show the potential utility of this instrument in characterizing behavioral and emotional changes associated with frontal lobe dysfunction in neurodegenerative disease.
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PMID:Characterizing behavioral and cognitive dysexecutive changes in progressive supranuclear palsy. 1620 May 34

Behavioral changes in patients with FTD can be interpreted by considering damage to the frontal lobes themselves and considering the interaction between the frontal lobes and other neural systems such as the posterior association cortices, the limbic system, and basal ganglia. Loss of insight and apathy primarily result from frontal lobes involvement. The latter is probably correlated with the severity of medial frontal-anterior cingulate involvement. Stimulus-bound behavior such as imitation behavior, utilization behavior and environmental dependency syndrome is caused by an imbalance between the activities of the frontal and parietal lobes. Frontal lobe damage, particularly damage to the medial frontal area, result in liberation of the parietal lobe activity, leaving the patient subject to any stimuli from the external environment. Disinhibition such as antisocial behavior is produced by an imbalance between the activities of the frontal and limbic lobes. Namely, loss of control of the frontal lobe, especially the orbitofrontal area, over the limbic system results in acts led by instinctive desires and uncontrolled by reason. Stereotypic behavior is due to an imbalance between the activities of the frontal cortex and basal ganglia. These behaviors range from simple stereotypies to complex repeated actions such as roaming, clock-watching or adherence to a strict daily timetable.
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PMID:[Symptomatology of fronto-temporal dementia]. 1919 45

Despite growing interest, the frequency and characteristics of frontal lobe functional and behavioral deficits in Chinese people with amyotrophic lateral sclerosis (ALS), as well as their impact on the survival of ALS patients, remain unknown. The Chinese version of the frontal assessment battery (FAB) and frontal behavioral inventory (FBI) were used to evaluate 126 sporadic ALS patients and 50 healthy controls. The prevalence of frontal lobe dysfunction was 32.5%. The most notable impairment domain of the FAB was lexical fluency (30.7%). The binary logistic regression model revealed that an onset age older than 45 years (OR 5.976, P = 0.002) and a lower educational level (OR 0.858, P = 0.002) were potential determinants of an abnormal FAB. Based on the FBI score, 46.0% of patients showed varied degrees of frontal behavioral changes. The most common impaired neurobehavioral domains were irritability (25.4%), logopenia (20.6%) and apathy (19.0%). The binary logistic regression model revealed that the ALS Functional Rating Scale-Revised scale score (OR 0.127, P = 0.001) was a potential determinant of an abnormal FBI. Frontal functional impairment and the severity of frontal behavioral changes were not associated with the survival status or the progression of ALS by the cox proportional hazard model and multivariate regression analyses, respectively. Frontal lobe dysfunction and frontal behavioral changes are common in Chinese ALS patients. Frontal lobe dysfunction may be related to the onset age and educational level. The severity of frontal behavioral changes may be associated with the ALSFRS-R. However, the frontal functional impairment and the frontal behavioral changes do not worsen the progression or survival of ALS.
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PMID:Frontal lobe function and behavioral changes in amyotrophic lateral sclerosis: a study from Southwest China. 2524 95

Traumatic brain injury often produces executive dysfunction. This characteristic cognitive impairment often causes long-term problems with behaviour and personality. Frontal lobe injuries are associated with executive dysfunction, but it is unclear how these injuries relate to corticostriatal interactions that are known to play an important role in behavioural control. We hypothesized that executive dysfunction after traumatic brain injury would be associated with abnormal corticostriatal interactions, a question that has not previously been investigated. We used structural and functional MRI measures of connectivity to investigate this. Corticostriatal functional connectivity in healthy individuals was initially defined using a data-driven approach. A constrained independent component analysis approach was applied in 100 healthy adult dataset from the Human Connectome Project. Diffusion tractography was also performed to generate white matter tracts. The output of this analysis was used to compare corticostriatal functional connectivity and structural integrity between groups of 42 patients with traumatic brain injury and 21 age-matched controls. Subdivisions of the caudate and putamen had distinct patterns of functional connectivity. Traumatic brain injury patients showed disruption to functional connectivity between the caudate and a distributed set of cortical regions, including the anterior cingulate cortex. Cognitive impairments in the patients were mainly seen in processing speed and executive function, as well as increased levels of apathy and fatigue. Abnormalities of caudate functional connectivity correlated with these cognitive impairments, with reductions in right caudate connectivity associated with increased executive dysfunction, information processing speed and memory impairment. Structural connectivity, measured using diffusion tensor imaging between the caudate and anterior cingulate cortex was impaired and this also correlated with measures of executive dysfunction. We show for the first time that altered subcortical connectivity is associated with large-scale network disruption in traumatic brain injury and that this disruption is related to the cognitive impairments seen in these patients.
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PMID:Altered caudate connectivity is associated with executive dysfunction after traumatic brain injury. 2918 56

Objectives: We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia.Method/Design: This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items 'hitting', pushing', 'biting' and 'kicking' of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on 'screaming' and 'making strange noises'. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses.Results: We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63-2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23-12.98). Very frequent PA was only associated with apathy (odds ratio (OR)=1.93, 95% CI: 1.04-3.61). Correlates of very frequent vocalizations were age (OR = 0.97, 95% CI: 0.951-0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR = 1.56, 95% CI: 1.08-2.26), antiepileptic drug use (OR = 2.75, 95% CI: 1.34-5.68) and euphoria (OR = 2.01, 95% CI: 1.22-3.31).Conclusion: Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life.
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PMID:Very frequent physical aggression and vocalizations in nursing home residents with dementia. 3260 46