Article information
Abstract
Introduction
Apathy is a behavioural syndrome due to dysfunction of the process that gives rise to actions induced by external or personal stimuli. Apathy is very common in Parkinson's disease, with a prevalence that ranges between 16–48%. Three subtypes of apathy are currently accepted, which are anatomically and functionally different: cognitive, emotional and due to a deficit in auto-activation. Each of these subtypes is involved to a variable degree in the apathy of Parkinson's disease. The diagnosis is supported by clinical, diagnostic and neuropsychological tests. The evaluation of the apathy must be done simultaneously along with with depression cognitive deficit.
ConclusionsApathy has become a very important symptom to bear in mind in Parkinson's disease patients as it has significant repercussions on the quality of life of the patient. It is very important to do a differential diagnosis with the depression and the cognitive deficit since the therapeutic approach is different. Specific scales to measure this symptom should be included in the evaluation protocols of cognitive function in Parkinson's disease.
Keywords:
Apathy
Parkinson's disease
Striatum
LARS scale
Negative symptoms
Resumen
Introducción
La apatía es un síndrome comportamental por disfunción del proceso que origina los actos inducidos por estímulos externos o los propios. Es muy frecuente en la enfermedad de Parkinson, con una prevalencia que oscila en el 16–48%. Actualmente se aceptan tres subtipos diferentes de apatía con un correlato anatómico-funcional distintoen cado uno de los casos: cognitiva, emocional y por déficit en la autoactivación. Cada uno de estos subtipos está implicado en un grado variable en la apatía de la enfermedad de Parkinson. El diagnóstico es fundamentalmente clínico apoyado en escalas neuropsicológicas. La evaluación de la apatía debe hacerse simultáneamente con la de la depresión y el deterioro cognitivo.
ConclusionesLa apatía es un síntoma muy importante y de reciente consideración a tener muy en cuenta en los pacientes con enfermedad de Parkinson por la repercusión en la calidad de vida del paciente. Es importante el diagnóstico diferencial con la depresión y el deterioro cognitivo, pues el abordaje terapéutico es diferente. Para ello es necesario incluir en los protocolos de exploración escalas específicas para valorar este síntoma.
Palabras clave:
Apatía
Enfermedad de Parkinson
Estriado
Escala LARS
Síntomas negativos
Full text is only aviable in PDF
References
[1.]
K. Dujardin.
Apathy and neurodegenerative diseases: pathophysiology, diagnostic evaluation, and treatment.
Rev Neurol (Paris), 163 (2007), pp. 513-521
[2.]
S. Tekin, J.L. Cummings.
Frontal-subcortical neuronal circuits and clinical neuropsychiatry: an update.
J Psychosom Res, 53 (2002), pp. 647-654
[3.]
Diccionario de la Real Academia Española. 21st ed. Madrid: Espasa; 2005. p. 177.
[4.]
R. Audi.
Diccionario Akal de Filosofía.
Akal, (2001),
[5.]
S.E. Starkstein, A.F. Leentjens.
The nosological position of apathy in clinical practice.
J Neurol Neurosurg Psychiatry, 79 (2008), pp. 1088-1092
[6.]
R.S. Marin.
Apathy: a neuropsychiatric syndrome.
J Neuropsychiatry Clin Neurosci, 3 (1991), pp. 243-254
[7.]
R.S. Marin.
Apathy: concept, syndrome, neural mechanisms, and treatment.
Semin Clin Neuropsychiatry, 1 (1996), pp. 304-314
[8.]
S.E. Starkstein, G. Petracca, E. Chemerinski, J. Kremer.
Syndromic validity of apathy in Alzheimer's disease.
Am J Psychiatry, 158 (2001), pp. 872-877
[9.]
M.L. Levy, J.L. Cummings, L.A. Fairbanks, D. Masterman, B.L. Miller, A.H. Craig, et al.
Apathy is not depression.
J Neuropsychiatry Clin Neurosci, 10 (1998), pp. 314-319
[10.]
R.G. Brown, G. Pluck.
Negative symptoms: the ‘pathology’ of motivation and goal-directed behaviour.
Trends Neurosci, 23 (2000), pp. 412-417
[11.]
D.T. Stuss, R. Van Reekum, K.J. Murphy.
Differentiation of states and causes of apathy.
The Neuropsychology of emotion, pp. 340-363
[12.]
R. Levy, V. Czernecki.
Apathy and the basal ganglia.
J Neurol, 253 (2006), pp. 54-61
[13.]
P.H. Robert, C. Berr, M. Volteau, C. Bertogliati-Fileau, M. Benoit, O. Guerin, PréAL Study Group, et al.
Importance of lack of interest in patients with mild cognitive impairment.
Am J Geriatr Psychiatry, 16 (2008), pp. 770-776
[14.]
P.J. Eslinger, A.R. Damasio.
Severe disturbance of higher cognition after bilateral frontal lobe ablation: patient EVR.
Neurology, 35 (1985), pp. 1731-1741
[15.]
F. Peters, D. Perani, K. Herholz, V. Holthoff, B. Beuthien-Baumann, S. Sorbi, et al.
Orbitofrontal dysfunction related to both apathy and disinhibition in frontotemporal dementia.
Dement Geriatr Cogn Disord, 21 (2006), pp. 373-379
[16.]
R.M. Bonelli, J.L. Cummings.
Frontal-subcortical circuitry and behavior.
Dialogues Clin Neurosci, 9 (2007), pp. 141-151
[17.]
C. Cavada, T. Compañy, J. Tejedor, R.J. Cruz-Rizzolo, F. Reinoso-Suárez.
The anatomical connections of the macaque monkey orbitofrontal cortex. A review.
Cereb Cortex, 10 (2000), pp. 220-242
[18.]
X. Pan, K. Sawa, I. Tsuda, M. Tsukada, M. Sakagami.
Reward prediction based on stimulus categorization in primate lateral prefrontal cortex.
Nat Neurosci, 11 (2008), pp. 703-712
[19.]
S. Kobayashi, W. Schultz.
Influence of reward delays on responses of dopamine neurons.
J Neurosci, 28 (2008), pp. 7837-7846
[20.]
M. Watanabe.
Motivational control of learning in the prefrontal cortex.
Brain Nerve, 60 (2008), pp. 815-824
[21.]
D.J. Zgaljardic, J.C. Borod, N.S. Foldi, M. Rocco, P.J. Mattis, M.F. Gordon, et al.
Relationship between self-reported apathy and executive dysfunction in nondemented patients with Parkinson disease.
Cogn Behav Neurol, 20 (2007), pp. 184-192
[22.]
G. Zamboni, E.D. Huey, F. Krueger, P.F. Nichelli, J. Grafman.
Apathy and disinhibition in frontotemporal dementia: Insights into their neural correlates.
Neurology, 71 (2008), pp. 736-742
[23.]
R. Levy, B. Dubois.
Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits.
Cereb Cortex, 16 (2006), pp. 916-928
[24.]
L. Schmidt, B.F. d’Arc, G. Lafargue, D. Galanaud, V. Czernecki, D. Grabli, et al.
Disconnecting force from money: effects of basal ganglia damage on incentive motivation.
Brain, 131 (2008), pp. 1303-1310
[25.]
R. Levy, B. Dubois.
Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits.
Cereb Cortex, 16 (2006), pp. 916-928
[26.]
C.E. Feierstein, M.C. Quirk, N. Uchida, D.L. Sosulski, Z.F. Mainen.
Representation of spatial goals in rat orbitofrontal cortex.
Neuron, 51 (2006), pp. 495-507
[27.]
M. Habib.
Athymhormia and disorders of motivation in Basal Ganglia disease.
J Neuropsychiatry Clin Neurosci, 16 (2004), pp. 509-524
[28.]
J. Bogousslavsky.
William Feinberg lecture 2002: Emotions, mood, and behavior after stroke.
Stroke, 34 (2003), pp. 1046-1050
[29.]
R. Djaldetti, T.A. Treves, I. Ziv, E. Melamed, M. Lorberboym.
123IFPCIT SPECT imaging of dopamine transporters in patients with recurrent sudden falls: are such falls a distinct entity?.
J Nucl Med Technol, 35 (2007), pp. 232-236
[30.]
J. Yelnik.
Functional anatomy of the basal ganglia.
Mov Disord, 17 (2004), pp. 15-21
[31.]
M. Kimura, N. Matsumoto, K. Okahashi, Y. Ueda, T. Satoh, T. Minamimoto, et al.
Goal-directed, serial and synchronous activation of neurons in the primate striatum.
Neuroreport, 14 (2003), pp. 799-802
[32.]
I.H. Richard.
Apathy does not equal depression in Parkinson disease.
Neurology, 67 (2006), pp. 10-11
[33.]
R.S. Marin, S. Firinciogullari, R.C. Biedrzycki.
The sources of. convergence between measures of apathy and depression.
J Affect Disord, 28 (1993), pp. 117-124
[34.]
W. Poewe.
Non-motor symptoms in Parkinson's disease.
Eur J Neurol, 15 (2008), pp. 14-20
[35.]
L. Kirsch-Darrow, H.H. Fernandez, M. Marsiske, M.S. Okun, D. Bowers.
Dissociating apathy and depression in Parkinson disease.
Neurology, 67 (2006), pp. 33-38
[36.]
S.E. Starkstein, L. Ingram, M.L. Garau, R. Mizrahi.
On the overlap between apathy and depression in dementia.
J Neurol Neurosurg Psychiatry, 76 (2005), pp. 1070-1074
[37.]
V. Czernecki, B. Pillon, J.L. Houeto, J.B. Pochon, R. Levy, B. Dubois.
Motivation, reward, and Parkinson's disease: influence of dopatherapy.
Neuropsychologia, 40 (2002), pp. 2257-2267
[38.]
G. Kuzis, L. Sabe, C. Tiberti, F. Dorrego, S.E. Starkstein.
Neuropsychological correlates of apathy and depression in patients with dementia.
Neurology, 52 (1999), pp. 1403-1407
[39.]
D. Aarsland, K. Brønnick, U. Ehrt, P.P. De Deyn, S. Tekin, M. Emre, et al.
Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress.
J Neurol Neurosurg Psychiatry, 78 (2007), pp. 36-42
[40.]
S.E. Starkstein, R. Jorge, R. Mizrahi, R.G. Robinson.
A prospective longitudinal study of apathy in Alzheimer's disease.
J Neurol Neurosurg Psychiatry, 77 (2006), pp. 8-11
[41.]
P. Remy, M. Doder, A. Lees, N. Turjanski, D. Brooks.
Depression in Parkinson's disease: loss of dopamine and noradrenaline innervation in the limbic system.
Brain, 128 (2005), pp. 1314-1322
[42.]
G. Levy, D.M. Jacobs, M.X. Tang, L.J. Côté, E.D. Louis, B. Alfaro, et al.
Memory and executive function impairment predict dementia in Parkinson's disease.
Mov Disord, 17 (2002), pp. 1221-1226
[43.]
B.W. Balleine, M.R. Delgado, O. Hikosaka.
The role of the dorsal striatum in reward and decision-making.
J Neurosci, 27 (2007), pp. 8161-8165
[44.]
C.D. Fiorillo, P.N. Tobler, W. Schultz.
Discrete coding of reward probability and uncertainty by dopamine neurons.
Science, 299 (2003), pp. 1898-1902
[45.]
P.N. Tobler, C.D. Fiorillo, W. Schultz.
Adaptive coding of reward value by dopamine neurons.
Science, 307 (2005), pp. 1642-1645
[46.]
V. Isella, P. Melzi, M. Grimaldi, S. Iurlaro, R. Piolti, C. Ferrarese, et al.
Clinical, neuropsychological, and morphometric correlates of apathy in Parkinson's disease.
Mov Disord, 17 (2002), pp. 366-371
[47.]
M. Sarazin, A. Michon, B. Pillon, Y. Samson, A. Canuto, G. Gold, et al.
Metabolic correlates of behavioral and affective disturbances in frontal lobe pathologies.
J Neurol, 250 (2003), pp. 827-833
[48.]
G.C. Pluck, R.G. Brown.
Apathy in Parkinson's disease.
J Neurol Neurosurg Psychiatry, 73 (2002), pp. 636-642
[49.]
M. Filion, L. Tremblay.
Abnormal spontaneous activity of globus pallidus neurons in monkeys with MPTP-induced parkinsonism.
Brain Res, 547 (1991), pp. 142-151
[50.]
E.T. Rolls, S.J. Thorpe, M. Boytim, I. Szabo, D.I. Perrett.
Responses of striatal neurons in the behaving monkey. 3. Effects of iontophoretically applied dopamine on normal responsiveness.
Neuroscience, 12 (1984), pp. 1201-1212
[51.]
M. Samuel, A.O. Ceballos-Baumann, H. Boecker, D.J. Brooks.
Motor imagery in normal subjects and Parkinson's disease patients: an H215O PET study.
Neuroreport, 12 (2001), pp. 821-828
[52.]
D.J. Zgaljardic, N.S. Foldi, J.C. Borod.
Cognitive and behavioral dysfunction in Parkinson's disease: neurochemical and clinicopathological contributions.
J Neural Transm, 111 (2004), pp. 1287-1301
[53.]
J.L. Cummings, C. Back.
The cholinergic hypothesis of neuropsychiatric symptoms in Alzheimer's disease.
Am J Geriatr Psychiatry, 6 (1998), pp. 64-78
[54.]
J.L. Cummings.
Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations.
Am J Geriatr Psychiatry, 11 (2003), pp. 131-145
[55.]
S.E. Starkstein, H.S. Mayberg, T.J. Preziosi, P. Andrezejewski, R. Leiguarda, R.G. Robinson.
Reliability, validity, and clinical correlates of apathy in Parkinson's disease.
J Neuropsychiatry Clin Neurosci, 4 (1992), pp. 134-139
[56.]
D. Aarsland, J.P. Larsen, N.G. Lim, C. Janvin, K. Karlsen, E. Tandberg, et al.
Range of neuropsychiatric disturbances in patients with Parkinson's disease.
J Neurol Neurosurg Psychiatry, 67 (1999), pp. 492-496
[57.]
K. Dujardin.
Apathy and neurodegenerative diseases: pathophysiology, diagnostic evaluation, and treatment.
Rev Neurol (Paris), 163 (2007), pp. 513-521
[58.]
K.F. Pedersen, J.P. Larsen, G. Alves, D. Aarsland.
Prevalence and clinical correlates of apathy in Parkinson's disease: A community- based study.
Parkinsonism Relat Disord, 14 (2008), pp. 183-186
[59.]
J. Kulisevsky, J. Pagonabarraga, B. Pascual-Sedano, C. García- Sánchez, A. Gironell, Trapecio Group Study.
Prevalence and correlates of neuropsychiatric symptoms in Parkinson's disease without dementia.
Mov Disord, 23 (2008), pp. 1889-1896
[60.]
A.F. Leentjens, K. Dujardin, L. Marsh, P. Martinez-Martin, I.H. Richard, S.E. Starkstein, et al.
Apathy and anhedonia rating scales in Parkinson's disease: Critique and recommendations.
Mov Disord, 23 (2008), pp. 2004-2014
[61.]
S.E. Starkstein, J.P. Fedoroff, T.R. Price, R. Leiguarda, R.G. Robinson.
Apathy following cerebrovascular lesions.
Stroke, 24 (1993), pp. 1625-1630
[62.]
J.L. Cummings, M. Mega, K. Gray, S. Rosenberg-Thompson, D.A. Carusi, J. Gornbein.
The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.
Neurology, 44 (1994), pp. 2308-2314
[63.]
G. Kuzis, L. Sabe, C. Tiberti, F. Dorrego, S.E. Starkstein.
Neuropsychological correlates of apathy and depression in patients with dementia.
Neurology, 52 (1999), pp. 1403-1407
[64.]
P.H. Robert, S. Clairet, M. Benoit, J. Koutaich, C. Bertogliati, O. Tible, et al.
The apathy inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment.
Int J Geriatr Psychiatry, 17 (2002), pp. 1099-1105
[65.]
K.F. Pedersen, J.P. Larsen, D. Aarsland.
Validation of the Unified Parkinson's Disease Rating Scale (UPDRS) section I as a screening and diagnostic instrument for apathy in patients with Parkinson's disease.
Parkinsonism Relat Disord, 14 (2008), pp. 183-186
Copyright © 2010. Sociedad Española de Neurología
