Global Hypoactivity and Apathy
Olivier Godefroy, Melanie Barbay, Daniela Andriuta, Melissa Tir, and Martine Roussel
Abstract Global hypoactivity contrasting with apparently unaffected cognitive abilities was initially reported in cases of frontal damage and is now recognized as a leading behavioral feature of many cerebral diseases. Of the various terms used to refer to this behavioral change, “apathy” is now the most widely used.
Global hypoactivity with apathy is easy to diagnose in patients without other obvious neuropsychiatric impairments. In other clinical contexts, the diagnosis of global hypoactivity with apathy requires the physician to first establish that hypoac- tivity and loss of motivation cannot be more readily explained by sensorimotor impairments (e.g., as observed in patients with stroke or Parkinson’s disease) or cognitive impairments (e.g., as observed in patients with Alzheimer’s disease). Many criteria and behavioral scales have been used to diagnose hypoactivity with apathy. The main differential diagnosis is depression and depressive symptoms, and distinguishing between these conditions and apathy may be particularly challenging. The mechanisms of hypoactivity with apathy remain uncertain and probably involve several dysfunctions, including the inability to attach motivational values to stimuli. We reviewed the frequency, characteristics, and determinants of hypoactivity with apathy in Alzheimer’s disease, frontotemporal lobar degeneration, Parkinson’s disease, and stroke, across the different stages of cognitive compromise. The diagnosis of this condition is an important step in identifying the source of difficulties in patients’ activities of daily living.
Keywords Dementia • Mild cognitive impairment • Executive disorders • Stroke • Alzheimer’s disease • Parkinson’s disease • Depression
O. Godefroy (*) • M. Barbay • D. Andriuta • M. Tir • M. Roussel Department of Neurology, Laboratory of Functional Neurosciences,
University Hospital of Amiens, Avenue Rene Laennec, CHU, 80054 Amiens cedex, France e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ; This email address is being protected from spam bots, you need Javascript enabled to view it ;
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© Springer International Publishing Switzerland 2017 71
A. Verdelho, M. Gonfalves-Pereira (eds.), Neuropsychiatric Symptoms of Cognitive Impairment and Dementia, Neuropsychiatric Symptoms of Neurological Disease, DOI 10.1007/978-3-319-39138-0_5
Introduction
Behavioral modification characterized by global reduction of activities contrasting with apparently unaffected cognitive abilities has been initially reported in patients with frontal damage [1,2]. It is now recognized as a leading behavioral feature of many neuropsychiatric diseases. The diagnosis of global hypoactivity with apathy is very important, since it may be the first clinical sign of a brain disease or a complication in a patient with a previously known disease (e.g., secondary hydrocephalus as a complication of previous subarachnoid hemorrhage). Furthermore, the presence of global hypoactivity is a major component of behavioral dysexecutive syndrome, which is an independent factor in loss of personal autonomy [3].
