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

During a ten year study, 10% of patients at a general hospital in-patient unit had unsolved diagnostic problems at the time of discharge from hospital. These 132 cases were designated 'uncertain' and were followed up. Eighty-three patients were ultimately diagnosed, and 300 consecutive in-patients discharged from the same unit with a definite diagnosis were also studied. The clinical features and diagnoses of the two groups were compared. Special features associated with uncertainty were: a presenting complaint of pain; apathy without apparent mental or physical cause; hallucinosis or major paranoid symptoms without other good evidence of psychosis. Age was found to be relevant; compared with patients receiving confident diagnoses, those with uncertain diagnosis due to depressive psychosis were more often younger, while those due to neurosis or personality disorder tended to be older. Atypical psychotic depression was the condition most commonly associated with diagnostic doubt.
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PMID:Diagnosis 'uncertain': a follow-up study. 59 87

The clinical presentation of three patients with meningiomas at different frontal sites is described. They had been ill for 3, 25, and 43 years before the tumour was demonstrated radiologically. Apathy, incontinence, dementia, and fits were seen in association with middle and superior frontal lesions, and may be mistaken for symptoms of involutional depression or presenile cerebral atrophy. In contrast, excitement and hallucinosis were seen in association with a basal frontal lesion, and may mimic psychotic syndromes like hypomania and schizophrenia, particularly if the tumour encroaches on the third ventricle and adjacent structures. Irreversible loss of myelin and axons in the frontal areas of brain surrounding the tumour may have contributed to the clinical picture of the syndrome shown by these patients.
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PMID:Three cases of frontal meningiomas presenting psychiatrically. 496 22

The psychiatric manifestations of Huntington's Disease (HD) include dementia, irritability and apathy, a major affective syndrome, and hallucinosis. The theoretical and practical utility of chorea as a focus of research interest in HD is questioned, whereas the data reviewed suggest that assessments of cognition, functional capacity and motor impairment are better correlated neuropathologically, and are better indicators of disease severity and progress than chorea. The high incidence of major affective disorders on modified DSM III criteria among HD patients (41 per cent) may be explained either as a manifestation of genetic heterogeneity within the HD phenotype or on the basis of genetic linkage between HD and manic depressive illness (MDI). This is supported by the high coincidence of HD and MDI (20 out of 23) among secondary cases of HD ascertained through probands having both disorders, indicating a strong familial clustering of the association. This implies that a young adult at risk for HD who has had episodes of severe depression has considerably more than 50 per cent likelihood of progressing to manifest HD. Although auditory hallucinations appear occasionally in patients with HD, most do not meet current criteria for schizophrenia.
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PMID:Psychiatric features of Huntington's disease: recent approaches and findings. 623 7

Cognitive decline and dementia affect approximately 30% to 40% of patients with idiopathic Parkinson's disease during the course of their illness. PD-dementia (PDD) and dementia with Lewy bodies (DLB) are second to Alzheimer's disease in causing degenerative dementia in the elderly. The nosological distinction of the conditions has remained controversial because of broad clinical and pathological overlap. Treatment issues in both clinical settings are virtually identical. Treatment of Parkinsonism is often complicated by drug-induced psychosis and reduced levodopa responsiveness. Cognition, alertness, attention, as well as apathy or aggressive behavior have been shown to respond to treatment with cholinesterase inhibitors in randomized controlled trials both in DLB and PDD. Such treatment may also improve hallucinosis, but many patients will require add-on treatment with atypical neuroleptics to control drug-induced psychotic reactions. Clozapine and quetiapine are the drugs most commonly used and, contrary to classic neuroleptics, risperidone or olanzapine do not seem to cause severe side effects according to published data.
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PMID:Treatment of dementia with Lewy bodies and Parkinson's disease dementia. 1609 95

The posterior fossa syndrome (PFS) consists of a variety of symptoms, including cerebellar mutism, behavioral disturbances and personality changes. We report longitudinal clinical, neuroradiological and neurobehavioral findings in a 19-year-old left-handed patient, diagnosed with attentional deficit hyperactivity disorder (ADHD) at the age of 12, who underwent posterior fossa tumor resection. Although the patient did not develop cerebellar mutism after surgery, marked apathy and emotional indifference, urinary retention, eye-lid apraxia and visual hallucinosis became apparent after a brief interval of normal functioning. Based on these findings it is argued that the PFS might be considered a semiological heterogeneous condition with variable clinical expressions. Long-term follow-up investigations revealed subtle, but significant cognitive and affective deficits, resembling the cerebellar cognitive affective syndrome in adults. As demonstrated by functional neuroimaging studies with SPECT, symptoms were associated with perfusional deficits in the anatomoclinically suspected supratentorial regions, reflecting the distant impact of the cerebellum on cognitive and affective functions.
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PMID:Neurobehavioral alterations in an adolescent following posterior fossa tumor resection. 1713 92

Although still considered a paradigmatic movement disorder, Parkinson's disease (PD) is associated with a broad spectrum of non-motor symptoms. These include disorders of mood and affect with apathy, anhedonia and depression, cognitive dysfunction and hallucinosis, as well as complex behavioural disorders. Sensory dysfunction with hyposmia or pain is almost universal, as are disturbances of sleep-wake cycle regulation. Autonomic dysfunction including orthostatic hypotension, urogenital dysfunction and constipation is also present to some degree in a majority of patients. Whilst overall non-motor symptoms become increasingly prevalent with advancing disease, many of them can also antedate the first occurrence of motor signs - most notably depression, hyposmia or rapid eye movement sleep behaviour disorder (RBD). Although exact clinicopathological correlations for most of these non-motor features are still poorly understood, the occurrence of constipation, RBD or hyposmia prior to the onset of clinically overt motor dysfunction would appear consistent with the ascending hypothesis of PD pathology proposed by Braak and colleagues. Screening these early non-motor features might, therefore, be one approach towards early 'preclinical' diagnosis of PD. This review article provides an overview of the clinical spectrum of non-motor symptoms in PD together with a brief review of treatment options.
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PMID:Non-motor symptoms in Parkinson's disease. 1835 32

Parkinson's disease is the second most frequent neurodegenerative disorder. There is significantly elevated risk of cognitive decline and associated neuropsychiatric symptoms. Dementia may develop insidiously several years after manifestation of Parkinson motor symptoms (dementia associated with Parkinson's disease; Parkinson's disease dementia) or in close temporal relationship (within one year) after onset of motor symptoms (Dementia with Lewy bodies). There are clinical, pathophysiological and therapeutic similarities between these two conditions. Men are more frequently affected than women. Risk factor or indicators are advanced age at disease onset, disease duration, rigidity, akinesia and posture and gait impairment and falls as opposed to tremor dominance, and associated neuropsychiatric symptoms (depression, apathy, hallucinosis, delirium). Dementia is treatable with cholinesterase inhibitors (rivastigmine, donepezil), memantine, and adjustment of the pharmacological regimen of parkinsonian motor symptoms. Concomitant autonomic nervous system symptoms and neuropsychiatric complications warrant early clinical awareness and are accessible to pharmacological therapy.
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PMID:Cognitive impairment in Parkinson's disease. 2660 64