Apathy and executive functions: insights from brain damage involving the anterior cingulate cortex

Patients with anterior cingulate cortex (ACC) lesions present an opportunity for understanding apathy's disputed neuropsychiatric features, as well as its associated neurocognitive phenotype. In this case report, two male patients (patient A and patient B) with lesions involving the ACC bilaterally were assessed for apathy, depressive symptoms, executive functioning, and also tested on the Iowa Gambling Task (IGT). Twenty neurologically intact controls also provided normative scores on the IGT. Patient A and patient B had high scores for apathy and low depressive symptoms scores. Patient A had relatively intact performance on standard executive function tests, but patient B had significant impairments. Both patients were significantly impaired on the IGT. Our findings suggest that executive function deficits are not crucial for the presence of apathy symptoms. These findings not only shed light on the relationship between apathy and executive function deficits, but also have important implications for patient care and rehabilitation.