title: Neural correlates of apathy revealed by lesion mapping in participants with traumatic brain injuries.
abstract: Apathy, common in neurological disorders, is defined as disinterest and loss of motivation, with a reduction in self-initiated activity. Research in diseased populations has shown that apathy is associated with variations in the volume of brain regions such as the anterior cingulate and the frontal lobes. The goal of this study was to determine the neural signatures of apathy in people with penetrating traumatic brain injuries (pTBIs), as to our knowledge, these have not been studied in this sample. We studied 176 male Vietnam War veterans with pTBIs using voxel-based lesion-symptom mapping (VLSM) and apathy scores from the UCLA Neuropsychiatric Inventory (NPI), a structured inventory of symptoms completed by a caregiver. Our results revealed that increased apathy symptoms were associated with brain damage in limbic and cortical areas of the left hemisphere including the anterior cingulate, inferior, middle, and superior frontal regions, insula, and supplementary motor area. Our results are consistent with the literature, and extend them to people with focal pTBI. Apathy is a significant symptom since it can reduce participation of the patient in family and other social interactions, and diminish affective decision-making.
authors: Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
authors: Kristine M
authors: KM
authors: Knutson
authors: Olga
authors: O
authors: Dal Monte
authors: Vanessa
authors: V
authors: Raymont
authors: Eric M
authors: EM
authors: Wassermann
authors: Frank
authors: F
authors: Krueger
authors: Jordan
authors: J
authors: Grafman
mesh_terms: D057565:Apathy / Q000502:physiology*; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D001931:Brain Mapping / Q000295:instrumentation / Q000379:methods*; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D007839:Functional Laterality / Q000502:physiology; D020197:Head Injuries, Penetrating / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008032:Limbic System / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012042:Registries; D014481:United States; D014728:Veterans / Q000523:psychology
keywords: apathy; cingulate cortex; fatigue; insula; traumatic brain injury; voxel-based lesion-symptom mapping
references: Brain Inj. 1990 Jul-Sep;4(3):215-22
references: 2390647
references: Neuroimage. 2002 Apr;15(4):870-8
references: 11906227
references: Neurology. 2008 Sep 2;71(10):736-42
references: 18765649
references: Nat Rev Neurosci. 2009 Jan;10(1):59-70
references: 19096369
references: Am J Psychiatry. 1990 Jan;147(1):22-30
references: 2403472
references: Aging Clin Exp Res. 2012 Aug;24(4):305-16
references: 22102508
references: Dement Geriatr Cogn Disord. 2009;27(1):96-104
references: 19158440
references: Behav Res Methods Instrum Comput. 2002 Feb;34(1):6-18
references: 12060992
references: Mov Disord. 2010 Oct 30;25(14):2318-25
references: 20669264
references: Am J Psychiatry. 2001 Jun;158(6):872-7
references: 11384893
references: Int J Geriatr Psychiatry. 2011 Jul;26(7):741-8
references: 20872914
references: J Neurol Neurosurg Psychiatry. 1987 Feb;50(2):183-93
references: 3572433
references: J Neurol Sci. 1981 Aug;51(2):289-300
references: 7276980
references: J Psychiatr Res. 1975 Nov;12(3):189-98
references: 1202204
references: Int J Geriatr Psychiatry. 2002 Dec;17(12):1099-105
references: 12461757
references: Neuroimage. 2001 May;13(5):896-902
references: 11304085
references: Neuron. 2009 Mar 12;61(5):681-91
references: 19285465
references: J Head Trauma Rehabil. 2011 Mar-Apr;26(2):116-26
references: 20485191
references: J Neurosci. 2007 Sep 12;27(37):9984-8
references: 17855612
references: Brain. 2008 Sep;131(Pt 9):2455-63
references: 18669506
references: Amyotroph Lateral Scler. 2011 Jan;12(1):52-8
references: 21271791
references: Arch Neurol. 1996 Nov;53(11):1116-20
references: 8912484
references: Brain. 1986 Feb;109 ( Pt 1):55-80
references: 3942857
references: Psychol Med. 1999 Mar;29(2):447-56
references: 10218936
references: Age Ageing. 1982 May;11(2):121-6
references: 7102472
references: J Neuropsychiatry Clin Neurosci. 2010 Summer;22(3):313-20
references: 20686138
references: Brain. 2005 Nov;128(Pt 11):2612-25
references: 16195246
references: J Neurosci. 2010 Sep 29;30(39):13095-104
references: 20881127
references: Arch Neurol. 1989 Oct;46(10):1121-3
references: 2803071
references: Radiology. 2004 Jan;230(1):77-87
references: 14645885
references: Neuroimage. 2002 Jan;15(1):273-89
references: 11771995
references: Arch Neurol. 2007 Jul;64(7):1015-20
references: 17620493
references: Trends Cogn Sci. 2007 Apr;11(4):168-76
references: 17337237
references: Dement Geriatr Cogn Disord. 2007;24(1):65-72
references: 17565215
references: Lancet. 2004 Mar 20;363(9413):978-88
references: 15043967
references: Neurology. 2011 Apr 26;76(17):1472-7
references: 21518996
references: Lancet. 1975 Mar 1;1(7905):480-4
references: 46957
references: Neurology. 2010 Mar 2;74(9):749-54
references: 20194914
references: Arq Neuropsiquiatr. 2008 Jun;66(2B):436-43
references: 18641892
references: Dement Geriatr Cogn Disord. 2006;21(3):144-7
references: 16391476
references: J Neurol Sci. 2008 Jul 15;270(1-2):28-39
references: 18336838
references: Int J Geriatr Psychiatry. 2004 Sep;19(9):864-9
references: 15352144
references: Brain Inj. 2009 May;23(5):420-32
references: 19408165
references: Am J Geriatr Psychiatry. 2011 Jul;19(7):644-53
references: 21709610
references: J Comput Assist Tomogr. 1998 Jan-Feb;22(1):153-65
references: 9448780
references: J Nerv Ment Dis. 1999 Dec;187(12):707-12
references: 10665464
references: Biol Psychiatry. 2005 Feb 15;57(4):412-21
references: 15705358
references: Front Neurol. 2011 Mar 28;2:15
references: 21625624
references: Neuroimage. 2007 May 15;36(1):108-22
references: 17408973
references: J Am Geriatr Soc. 2001 Dec;49(12):1700-7
references: 11844006
references: Nat Neurosci. 2006 Sep;9(9):1161-8
references: 16921368
references: J Am Geriatr Soc. 1998 Feb;46(2):210-5
references: 9475452
references: Neurology. 1994 Dec;44(12):2308-14
references: 7991117
references: J Int Neuropsychol Soc. 2011 Nov;17(6):1058-66
references: 22040900
references: Dement Geriatr Cogn Disord. 2008;25(1):1-8
references: 18025783
references: Brain. 2008 Dec;131(Pt 12):3209-21
references: 18952679
references: Comput Methods Programs Biomed. 2007 Jun;86(3):245-54
references: 17408802
references: Mov Disord. 2008 Apr 30;23(6):845-9
references: 18307266
references: J Neuropsychiatry Clin Neurosci. 2009 Summer;21(3):259-65
references: 19776304
references: Brain. 1988 Feb;111 ( Pt 1):169-84
references: 3365546
references: Dement Geriatr Cogn Disord. 2007;24(2):91-7
references: 17570907
references: Eur J Neurol. 2002 Nov;9(6):615-24
references: 12453077
references: Eur J Neurol. 2006 Jul;13(7):729-35
references: 16834702
references: Dement Geriatr Cogn Disord. 1999 Nov-Dec;10(6):511-7
references: 10559568
references: Neurology. 1993 Jan;43(1):95-103
references: 8423917
references: J Neuropsychiatry Clin Neurosci. 1998 Summer;10(3):314-9
references: 9706539
references: Psychiatry Res. 2002 Jun 15;114(2):103-11
references: 12036510
references: Prog Brain Res. 2012;195:123-63
references: 22230626