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

The authors report the occurrence of apathy, indifference, inattention, and perseveration in an obsessive compulsive patient taking high doses of fluoxetine. These changes were associated with a decrease in cerebral blood flow in the frontal lobes and changes in neuropsychological tests generally associated with frontal lobe impairment. These clinical manifestations disappeared 4 weeks after discontinuation of fluoxetine.
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PMID:A fluoxetine-induced frontal lobe syndrome in an obsessive compulsive patient. 142 80

Vascular dementia (VAD) is common, and small vessel disease is one of the most frequent etiologies of the disorder. Lacunar state and Binswanger's disease are the two types of VAD associated with small vessel disease. Lacunar state and Binswanger's disease produce a dementia syndrome with characteristics of subcortical dementia including slowing of information processing, impaired memory, and poor sustained attention. Executive dysfunction includes poor word list generation and verbal fluency (design generation), impaired motor programming with perseveration and impersistence, and difficulty with set shifting. Memory loss in subcortical VAD is characterized by poor retrieval and intact recognition. Apathy is ubiquitous in VAD and depression and psychosis are common. Parkinsonism with prominent gait disturbances in conjunction with pyramidal tract signs, dysarthria, pseudobulbar affect, and incontinence are frequent motor manifestations of VAD with small vessel disease. The lesions of subcortical VAD affect the structures--caudate nucleus, globus pallidus, thalamus-and connecting fibers of frontal--subcortical circuits and produce a clinical syndrome similar to that seen in other subcortical diseases.
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PMID:Vascular subcortical dementias: clinical aspects. 808 75

A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.
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PMID:Akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction. 1022 14

A personality and behavioral disorder is an important and defining feature of frontal lobe dementia (FLD) or frontotemporal degeneration (FTD). The diagnosis usually depends on the progressive development of various behavioral symptoms rather than a set of neuropsychological measures. Quantification of the personality-behavior disorder is important for standardizing the diagnosis. An inventory was constructed to capture the major positive and negative behaviors and personality change, and it was administered prospectively to caregivers of 108 patients in a cognitive neurology clinic, at the time of first diagnostic assessment. The prevalence and extent of behavioral abnormality was quantitated in the clinic population of FLD, vascular dementia (VaD), Alzheimer's disease (AD), primary progressive aphasia (PPA), and depressive disorder (DD) patients. The mean scores of FLD patients were significantly above all other groups. Scores in VaD were also higher than in AD, PPA, and DD. Interrater reliability (Cohen's kappa of .90) and item consistency (a Cronbach alpha of .89) were both high. Perseveration, indifference, inattention, inappropriateness, and loss of insight rated highest in FLD, significantly different from all other groups. Apathy, aspontaneity, inflexibility, disorganization, impulsivity, personal neglect, and poor judgment were also significantly higher in FLD. Discriminant function correctly classified 92.7% versus all other patients (NON-FLD) in the study. A total of 18.8% of VaD patients were misclassified as FLD. Indifference, alien hand, and inappropriateness were the highest discriminant functions. Perseveration and verbal apraxia were important discriminatory items for FLD and PPA, respectively. The FBI is a standardized behavioral inventory useful to diagnose FLD, to differentiate it from other dementias, and to quantify the behavior disorder.
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PMID:The Frontal Behavioral Inventory in the differential diagnosis of frontotemporal dementia. 1090 15

The authors aimed to contribute a clinically rich description of personality change due to traumatic brain injury (PC) in children. The sample consisted of consecutively injured children. Ninety-four subjects ages 5 to 14 years were assessed at the time of hospitalization after a traumatic brain injury (TBI). A standardized psychiatric interview, the Neuropsychiatric Rating Schedule, was used to elicit symptoms of PC. PC occurred in 59% of severe (22/37) and 5% of mild/moderate (3/57) TBI subjects. Among the 37 severe TBI subjects, the labile subtype of PC was the most common (49%), followed by the aggressive and disinhibited subtypes (38% each), apathy (14%), and paranoia (5%). Also frequent in severe TBI was perseveration (35%). A detailed case example, numerous clinical vignettes of PC symptoms, and a tabulation of their frequencies provide clinicians a broader frame of reference for eliciting symptoms of PC.
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PMID:The phenomenology of personality change due to traumatic brain injury in children and adolescents. 1144 23

"Orbitofrontal" and "cingulate" striatofrontal loops and the mesolimbic dopaminergic system that modulates their function have been implicated in motivation and sensitivity to reinforcement in animals. Parkinson's disease (PD) provides a model to assess their implications in humans. The aims of the study were to investigate motivation and sensitivity to reinforcement in non-demented and -depressed PD patients and to evaluate the influence of dopaminergic therapy by comparing patients in "on" (with L-Dopa) and "off" (without L-Dopa) states. Twenty-three PD patients were compared, in both the "on" and "off" states, to 28 controls, using: (1) an Apathy Scale; (2) Stimulus-Reward Learning, Reversal, and Extinction tasks; and (3) a Gambling task. PD patients were found: (1) mildly apathetic; (2) impaired on Stimulus-Reward Learning and Reversal, but not on Extinction; and (3) able to progress in the Gambling task during the first, but not the second assessment. There was no significant correlation between these various deficits. L-Dopa treatment clearly improved motivation, but had more limited and contrasting effects on other variables, decreasing the number of omission errors in Reversal, but increasing the number of perseveration errors in Extinction. These results suggest: (1) an implication of striatofrontal loops in human motivation and explicit and implicit sensitivity to reinforcement; (2) a positive influence of L-Dopa treatment on the subjective evaluation of motivation, but contrasting effects on reward sensitivity.
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PMID:Motivation, reward, and Parkinson's disease: influence of dopatherapy. 1241 56

Production of art is a complex process involving a combination of technical skill and a unique talent. Changes in artistic ability may accompany neurodegenerative disorders when they occur in an artist. The nature of these changes in the context of definable regional neuropathological disturbances may provide insight into the structural basis of the creative process. We describe a professional artist in whom presumed corticobasal degeneration (CBD) was associated with an alteration of his artistic judgement and production. Disinhibition, perseveration, and left hemispatial neglect, features of his cognitive profile were readily discernible in his work. The differences in his style are examined with respect to his main neuroanatomic abnormalities, namely right cerebral hemiatrophy as defined by magnetic resonance and single-photon emission computed tomography imaging. Cognitive deficits, including visuoconstructive and motor neglect, apathy, perseveration, and disinhibition as determined by neuropsychological testing, contributed to the dissolution of his artistic skills. Our case study adds to the growing literature on the effects of brain damage on artistic expression in the graphic arts.
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PMID:Neurodegenerative disease and the evolution of art: the effects of presumed corticobasal degeneration in a professional artist. 1262 33

Macdonald Critchley, a world renowned neurologist, is best remembered as the person who challenged to solve the mystery and enigma of higher cerebral functions. He was the author of over 200 published articles and 20 books on neurology including his pioneer work on developmental dyslexia, the parietal lobe, cerebral hemisphere dominance and aphasiology. He also published articles on migraine, epilepsy, dementia, visual perseveration, anterior cerebral artery syndromes, indifference to pain, sleep disorders, movement disorders, and myotonia. He was very erudite and talented in linguistics; his interests were broad and eclectic. He wrote extensively on non-medical topics, such as plays, horror stories, mythology, and biographies of distinguished neuroscientists, philosophers or artists. His articles were written in the elegant prose style with thorough reference citations and extensive reviews of the literature worldwide. He was born in Bristol in 1900. From an early age, he was fascinated with the functioning brain and retained a life-long interest in languages. He was appointed to the Consultant staff of the National Hospital, Queen Square, and to King's College Hospital at the age of 27, and was elected to become FRCP at 30. He was Dean of the Institute of Neurology from 1948 to 1953. When I was studying advanced neurology at Queen Square in 1960-1961, I was fascinated by his outstanding lectures on Huntington's Disease and Non-verbal Communication. Although he did not read the manuscripts and used only a few slides for illustrations in his lectures, he could describe the details of historical accounts and relevant figures. He was an altruistic, instructive teacher with keen attention to responses from the audience. His clinical demonstrations, teaching rounds and tutorials were hugely popular among postgraduate students from all over the world. He emphasized the importance of shrewd observation and careful history taking in neurological practice. Macdonald Critchley was President of the World Federation of Neurology (1965-1973) and Editor of Journal of the Neurological Sciences. I met him at the 2nd Asian and Oceanian Congress of Neurology held in Melbourne in 1967. He was interested to know more about aphasia and dyslexia among people speaking and reading Chinese. He kindly invited me to speak on 'Linguistic Implications of Chinese Characters' at the meeting of the Research Group on Developmental Dyslexia in Dallas. Critchley's prominent achievements in teaching, writings and research on neurology derived from his creative thinking, powers of shrewd observation, wide knowledge of literature, and indefatigable assiduity in scientific pursuits. He died peacefully at home at the age of 97 and entered the pantheon of distinguished neuroscientists of the 20th century.
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PMID:[Tributes to Macdonald Critchley and his achievements in neurolinguistics]. 1868 54

In order to understand the physiological role of the caudate nucleus, we combine here our laboratory data on cats with reports of patients with selective damage to this nucleus. Cats with bilateral removal of the caudate nuclei showed a stereotyped behavior consisting of persistently approaching and then following a person, another cat, or any object, and attempting to contact the target. Simultaneously, the animals exhibited a friendly disposition and persistent docility together with purring and forelimbs treading/kneading. The magnitude and duration of this behavior was proportional to the extent of the removal reaching a maximum after ablations of 65% or more of the caudate tissue. These cats were hyperactive but they had lost the feline elegance of movements. Additional features of acaudate cats were: (1) postural and accuracy deficits (plus perseveration) in paw usage tasks including bar pressing for food reward; (2) cognitive and perceptual impairments on a T-maze battery of tasks and on the bar pressing tasks; (3) blockage or blunting of the species-specific behavioral response to a single injection of morphine; Unilateral caudate nucleus removal did not produce global behavioral effects, but only deficit in the contralateral paw contact placing reaction and paw usage/bar pressing. Moreover and surprisingly, we found hypertrophy of the ipsilateral caudate nucleus following prenatal focal neocortical removal. The findings in human were also behavioral (not neurological) and also occurred with unilateral caudate damage. The main manifestations consisted of loss of drive (apathy), obsessive-compulsive behavior, cognitive deficits, stimulus-bound perseverative behavior, and hyperactivity. Based on all of the above data we propose that the specific function of the caudate nucleus is to control approach-attachment behavior, ranging from plain approach to a target, to romantic love. This putative function would account well for the caudate involvement in the pathophysiology of a number of clinical syndromes that we mention, all of which compromise approach-attachment- affect behaviors. In addition we conclude that the caudate nucleus contributes importantly to body and limbs posture as well as to the accuracy and speed of directed movements.
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PMID:Why do we have a caudate nucleus? 2040 91

Descriptions of extrapyramidal (EP) involvement in Pick's disease (renamed recently as FTD) appeared 80 years ago. CBD pathology was confirmed as a common substrate for primary progressive aphasia (PPA). We suggested that CBD and PPA should be included with frontal lobe dementia as Pick complex. PSP was prototype for "subcortical dementia", and aphasia and apraxia, considered unusual for PSP, are now seen as a rule. The overlap of PSP and CBD is considerable. We recently reviewed our cohort with EPS in FTD and identified 22 patients with the movement disorder as a first syndrome and another larger group of 48 patients who developed EPS after an initial onset with a cognitive disorder: aphasic, behavioral or both. All cognitive onset CBD/PSP patients and all but two with motor onset developed aphasia during the course of their illness. General cognitive and behavioral measures are similar for each presentation, but language scores are worse in cognitive onset cases, reflecting the frequency of aphasic presentations. Anomic patients become non-fluent, logopenic, agrammatic and mute. Using the Frontal Behavioral Inventory (FBI), a questionnaire specifically designed for the spectrum of apathy and disinhibition displayed by patients with FTD, we have documented the behavior change in CBD/PSP with motor and cognitive onsets. The significant personality changes consisted of apathy, disinhibition, perseveration and inattention, some of the core symptoms of FTD. In 18 autopsied cases, 15 had tau pathology. The overlap of CBD/PSP with PPA and bvFTD suggests a spectrum of related entities and predicts tau-positive pathology. Cross-sectional studies without significant follow-up may not observe the subsequent development language or behavior deficit, or the evolution from PPA and/or FTD-bv to CBD/PSP.
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PMID:Extrapyramidal syndromes in frontotemporal degeneration. 2188 21


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