Apathy in patients with Parkinson disease without dementia or depression: a PET study.
OBJECTIVE
We sought to identify apathy metabolic bases in Parkinson disease (PD).


METHODS
A total of 45 patients with PD who were not clinically depressed (Montgomery-Åsberg Depression Rating Scale [MADRS] <21) and had no dementia (Mattis Dementia Rating Scale [MDRS] >130) were assessed with the Apathy Evaluation Scale (AES) and underwent a resting-state F-18 fluorodeoxyglucose PET (FDG-PET) scan. A motor assessment comprising the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) was conducted and total levodopa equivalent daily dose (LEDD) was calculated. Imaging data were analyzed with statistical parametric mapping. Age, LEDD, and MDRS scores were introduced as covariates.


RESULTS
Positive correlations were observed between the AES score and cerebral metabolism in the right inferior frontal gyrus (Brodmann area [BA] 47), right middle frontal gyrus (BA 10), right cuneus (BA 18), and right anterior insula (BA 13). Negative correlations were observed between the AES score and cerebellar metabolism in the semilunar lobules bilaterally, within the posterior lobe. Using an AES score equal to or above 42 to define clinical apathy, prevalence in our patient group was 17.8%. The AES score was negatively correlated with the MDRS score and positively correlated with the "retardation" subscore of the MADRS. It was not correlated with either UPDRS III or LEDD.


CONCLUSIONS
Results indicate that the frontal, temporal, and cerebellar areas known to be involved in reward, emotion, and cognition are also implicated in apathy in patients with PD without dementia or depression. Their roles in the etiopathology of apathy are discussed.
Academic Psychiatry Department, Guillaume Régnier Hospital, EA 4712 Basal Ganglia and Behaviour team, University of Rennes I, Rennes, France.
Gabriel
G
Robert
Florence
F
Le Jeune
Clément
C
Lozachmeur
Sophie
S
Drapier
Thibault
T
Dondaine
Julie
J
Péron
David
D
Travers
Paul
P
Sauleau
Bruno
B
Millet
Marc
M
Vérin
Dominique
D
Drapier
D000368:Aged; D057565:Apathy / Q000502:physiology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000378:metabolism*; D003704:Dementia / Q000000981:diagnostic imaging / Q000378:metabolism / Q000523:psychology; D003863:Depression / Q000000981:diagnostic imaging / Q000378:metabolism / Q000523:psychology; D003866:Depressive Disorder / Q000000981:diagnostic imaging / Q000378:metabolism / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000378:metabolism / Q000523:psychology*; D011877:Radionuclide Imaging