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Apathy is associated with parietal cortical-subcortical dysfunction in ALS.

Jashelle Caga1, Sicong Tu1, Thanuja Dharmadasa1

  • 1Brain & Mind Centre, University of Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia.

Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
|April 19, 2021
PubMed
Summary

Apathy is common in amyotrophic lateral sclerosis (ALS), particularly initiation and emotional subtypes. Neurodegeneration in specific brain areas underlies these apathy subtypes, impacting patient quality of life.

Keywords:
Amyotrophic lateral sclerosisApathyEmotion processingGoal-directed behaviourReward processing

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Area of Science:

  • Neuroscience
  • Neurology
  • Behavioral Science

Background:

  • Apathy is a core feature of frontotemporal dysfunction in amyotrophic lateral sclerosis (ALS).
  • Initiation and emotional apathy significantly impact ALS patients and their caregivers' quality of life.
  • Understanding the prevalence and neural underpinnings of apathy subtypes in ALS is crucial.

Purpose of the Study:

  • To investigate the prevalence of apathy and its subtypes (initiation, emotional) in amyotrophic lateral sclerosis (ALS).
  • To identify the neural correlates, specifically brain volumes, associated with apathy subtypes in ALS.
  • To explore the relationship between apathy subtypes and clinically significant apathy in ALS patients.

Main Methods:

  • Recruited 109 participants from a specialized ALS/FTD clinic.
  • Assessed apathy using the Dimensional Apathy Scale (DAS) and correlated scores with high-resolution MRI-based voxel-based morphometry.
  • Employed two-way repeated measures ANOVA and logistic regression to analyze apathy subtypes and their predictive value.

Main Results:

  • Clinically significant apathy was prevalent, ranging from 49% (patient-rated) to 64% (carer-rated).
  • Initiation (84-96%) and emotional (74-75%) apathy were the most common subtypes.
  • Initiation and emotional apathy significantly predicted clinically significant apathy and correlated with reduced grey matter in specific brain regions (superior frontal gyrus, prefrontal cortices, anterior cingulate, angular gyrus).

Conclusions:

  • Apathy is frequent and multi-dimensional in amyotrophic lateral sclerosis (ALS), with initiation and emotional subtypes being particularly significant.
  • Neurodegeneration in a distributed brain network, including areas involved in task initiation, emotion, and reward processing, underlies apathy in ALS.
  • These findings highlight the critical role of specific brain networks in the pathophysiology of apathy in ALS and its impact on patients.