title: Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response.
abstract: BACKGROUND
  Apathy is a prominent feature of geriatric depression that predicts poor clinical outcomes and hinders depression treatment. Yet little is known about the neurobiology and treatment of apathy in late-life depression. This study examined apathy prevalence in a clinical sample of depressed elderly, response of apathy to selective serotonin reuptake inhibitor (SSRI) treatment, and neuroanatomical correlates that distinguished responders from non-responders and healthy controls.
  
  
  METHODS
  Participants included 45 non-demented, elderly with major depression and 43 elderly comparison individuals. After a 2-week single-blind placebo period, depressed participants received escitalopram 10mg daily for 12 weeks. The Apathy Evaluation Scale (AES) and 24-item Hamilton Depression Rating Scale (HDRS) were administered at baseline and 12 weeks. MRI scans were acquired at baseline for concurrent structural and diffusion tensor imaging of anterior cingulate gray matter and associated white matter tracts.
  
  
  RESULTS
  35.5% of depressed patients suffered from apathy. This declined to 15.6% (p<0.1) following treatment, but 43% of initial sufferers continued to report significant apathy. Improvement of apathy with SSRI was independent of change in depression but correlated with larger left posterior subgenual cingulate volumes and greater fractional anisotropy of left uncinate fasciculi.
  
  
  CONCLUSIONS
  Modest sample size, no placebo control, post-hoc secondary analysis, use of 1.5T MRI scanner
  
  
  CONCLUSIONS
  While prevalent in geriatric depression, apathy is separable from depression with regards to medication response. Structural abnormalities of the posterior subgenual cingulate and uncinate fasciculus may perpetuate apathetic states by interfering with prefrontal cortical recruitment of limbic activity essential to motivated behavior.
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY, USA. Electronic address: gsyuen@med.cornell.edu.
authors.forename: Genevieve S
authors.initials: GS
authors.lastname: Yuen
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY, USA.
authors.forename: Faith M
authors.initials: FM
authors.lastname: Gunning
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Woods
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY, USA.
authors.forename: Sibel A
authors.initials: SA
authors.lastname: Klimstra
authors.affiliation: Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA; New York University School of Medicine, New York, NY, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hoptman
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY, USA.
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016880:Anisotropy; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D057565:Apathy; D015283:Citalopram / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000473:pathology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000473:pathology* / Q000523:psychology; D056324:Diffusion Tensor Imaging; D005260:Female; D006179:Gyrus Cinguli / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D015995:Prevalence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016037:Single-Blind Method; D066127:White Matter / Q000473:pathology
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Apathy; Cingulate; Depression; Geriatric; SSRI; Uncinate