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Structural Brain Differences Between Cognitively Impaired Patients With and Without Apathy.

Nathan K Chan1, Philip Gerretsen2, M Mallar Chakravarty3

  • 1Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.

The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry
|January 11, 2021
PubMed
Summary

Apathy in mild cognitive impairment and Alzheimer's Disease is linked to specific brain changes. Thinner right medial orbitofrontal cortex and left rostral anterior cingulate cortex, with thicker left middle temporal cortex, are associated with apathy.

Keywords:
ADNIAlzheimer's DiseaseStructural MRIapathycase-controlcognitively normalcortical thicknessdementiafrontostriatal circuitsfrontotemporal association areashealthy controlsmatchingmild cognitive impairmentmixed modelsregion of interest analysis

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Area of Science:

  • Neuroscience
  • Neurology
  • Radiology

Background:

  • Apathy is a common symptom that increases with dementia severity.
  • Distinguishing apathy-related brain changes from general neurodegeneration in MCI and AD is crucial.
  • Understanding these differences can inform targeted interventions.

Purpose of the Study:

  • To investigate structural brain differences associated with apathy in individuals with mild cognitive impairment (MCI) and Alzheimer's Disease (AD).
  • To differentiate brain changes specific to apathy from those related to the progression of neurodegenerative pathology.
  • To identify specific brain regions affected by apathy in cognitively impaired populations.

Main Methods:

  • A cross-sectional case-control study involving 58 clinical sites from the AD Neuroimaging Initiative.
  • Participants (n=218) with MCI or AD dementia were matched based on age, sex, APOE ε4 status, and cognitive scores.
  • Structural brain differences were assessed using 3-tesla T1-weighted MRI, focusing on cortical thickness in frontostriatal and frontotemporal regions.

Main Results:

  • Individuals with apathy exhibited thinner cortices in the right medial orbitofrontal (mOFC) and left rostral anterior cingulate (rACC) regions.
  • A significant difference in cortical thickness was observed in the right mOFC (MD±SE=-0.0879±0.0257mm) and left rACC (MD±SE=-0.0905±0.0325mm).
  • Conversely, participants with apathy showed thicker cortices in the left middle temporal cortex (MTC; MD±SE=0.0688±0.0239mm).

Conclusions:

  • Atrophy in the right mOFC and left rACC is associated with apathy in individuals with cognitive impairment.
  • Sparing of atrophy in the left MTC suggests a distinct pattern related to apathy.
  • These findings highlight specific neuroanatomical correlates of apathy in MCI and AD, aiding in differential diagnosis and treatment strategies.