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Apathy in Lewy Body Disorders: A Position Paper
Jaime Kulisevsky1,2,3,4, Lidia Bojtos1,2,3,4, Milica G Kramberger5
1Universitat Autònoma de Barcelona, Medicine Department, Barcelona, Spain.
Summary
Apathy is a common, disabling symptom in Lewy body disorders (LBDs) like Parkinson's disease. Current treatments are not definitively effective, highlighting the urgent need for better research and clinical trials for this underrecognized condition.
Area of Science:
- Neurology
- Neuroscience
- Psychiatry
Background:
- Apathy is a prevalent and disabling non-motor symptom in Lewy body disorders (LBDs), impacting quality of life and functional outcomes.
- Despite its prevalence, apathy in LBDs remains underrecognized and undertreated, posing significant challenges for patients and caregivers.
Purpose of the Study:
- To synthesize current evidence on the clinical features, neurobiology, assessment, and management of apathy in LBDs.
- To define priorities for future research and clinical trials to address apathy in LBDs.
Main Methods:
- A comprehensive literature review was conducted by a Working Group of the International Parkinson and Movement Disorder Society's Non-Motor Symptoms Study Group.
- Expert discussion and critical appraisal of available data informed the development of a position paper.
Main Results:
- Apathy in LBDs is a multidimensional syndrome involving reward insensitivity, negative affect, executive dysfunction, and auto-activation deficits.
- Evidence implicates dysfunction in frontal-striatal-limbic networks and multiple neurotransmitter systems.
- Few randomized controlled trials have targeted apathy, and no treatment is currently considered definitively efficacious due to methodological limitations.
Conclusions:
- Apathy should be prioritized in clinical practice and research for LBDs.
- Future research requires adequately powered, mechanistically informed trials with standardized criteria and validated outcome measures to advance treatment development.
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