DOCSLIB.ORG

Disorders of Motivation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Disorders of Motivation Disorders of Motivation Prof. Sanjay Manohar Nuffield Department of Clinical Neurosciences Department of Psychology University of Oxford Disorders of motivation Too much, too little, ° Impulsivity ° Apathy ° Akinetic mutism ° Fatigue ° Alien limb ° Split brain ° Dyskinesias ° Utilisation behaviour ° Functional disorders Impulse control disorders Abnormal urge or impulse, interfering with normal life ° Pathological Gambling ° Compulsive Shopping ° Sexual Compulsion ° Dopamine Dysregulation Disorder ° Punding ° Kleptomania, pyromania, trichotillomania, Impulse control disorders Common and disabling ° 14% of PD patients on D2 agonists ° May be subtle, not always picked up ° Proposed Mechanisms • Increased reward sensitivity • Reduced sensitivity to risk / uncertainty • Novelty-seeking • Steeper temporal discounting / cost of time • Disinhibition • Less ‘reflection’ or desire for information Impulse control disorders ° How often do they select the more probable colour? Abnormal gambling task behaviour ° How much do they then bet? Amount increases or decreases during the response period Cools et al. Neuropsychologia 2003; Clark et al. Brain 2008 Are ICDs a consequence of disinhibition? Stop signal Stroop Haylings ° ON minus OFF RT for DBS ° Patients with PD have to STN vs ventral impaired suppression of intermediate thalamus prepotent responses in Stop ° Choice RT and SSRT much signal, Stroop and Haylings prolonged A/B Van den Wildenberg et al. JoCN 2006 Impulsivity is related to time Time is more costly? ° Steeper temporal discounting rate in PD with ICDs Voon et al Psychopharmacology 2012 Reflection impulsivity PD ICD and substance abusers desire less information before choice ° Blue or green beads drawn from an urn ° Guess the majority colour Djamshidian et al. Mov Dis 2012 Clinical Apathy Amotivation ° Diagnostic criteria Diminished motivation in comparison to previous level of function, which is not consistent with age or culture. PLUS one of: diminished • goal-directed behaviour • goal-directed cognitive activity • emotion Clinically significant impairment (personal, social, occupational) Not explained by physical / motor disabilities or direct physiological effects of a drug Robert et al. (2009) European Psychiatry Apathy and Depression Distinct but overlapping syndromes Emotional symptoms Apathetic symptoms Overlap of depression Pagonabarraga et al Lancet Neurol 2015 Clinical Apathy Mechanisms only studied recently ° Neuroeconomic approaches ° Postulated mechanisms • Higher effort cost • Lower reward sensitivity •Inability to generate options • Failure of internally-guided movement Pagonabarraga et al Lancet Neurol 2015 Rodents: Effort costs increased by Ventral striatal dopamine depletion Medial frontal lesions Pre-lesion Post-lesion Salamone 1994/2012 Walton 2002/2006 Motivation and mesolimbic dopamine insula Wanting (Instrumental) Liking (Hedonic) cingulate OFC accumbens VTA Kringelbach & Berridge 2012 Role of dopamine release Tonic Phasic Dorsal Striatum Willingness to exert effort Reward prediction error Chunking action Motor invigoration Cue value learning Habit formation Stress response Aversive / penalty Working memory Perceptual salience Zweifel et al. PNAS 2009 mesolimbic DA serves as a bridge that “ enables animals to traverse the psychological distance that separates them from goal objects or events ” Salamone & Correa 2012 a general property of a specific function? neural processing? • Goal-directed OR • Energisation • Localised • Chemical Dopamine vs. Noradrenaline in Reward- effort task Decision time: DA = Reward – Effort NA = Reward Action time: NA = Effort Varazzanni…Bouret et al. 2015 Many diseases cause apathy A final common pathway? • Depression AD • Schizophrenia PD •TBI Stroke% • Vascular Dementia 0204060 •FTD, HD, CBD, PSP Apathy Both Depression Neuro- Kirsch-Darrow et al. Neurology 2006 degenerative Benoigt et al. J Alz D 2012 Acquired brain injury Psychiatric 16 Kos et al. 2016 (Neurosci Biobeh Rev) AD Healthy MCI Mild AD Mod-Sev AD 2% 39% 51% 72% Holthoff Biol Psych 2005 Apostolova et al.,2007 Devos et al (2013) JNNP 101 cases screened 31 cases eligible * * * * But not in AD Sepehry et al. 2017 Management of Apathy Holistic, multi-faceted approach •Quantify • Psychosocial and biological contributors • Sleep, mood, drugs, pain. Patient Information. • Neuropsychology • Concurrent depression • Dopamine agonists •Cholinesterase inhibitors Reduced reward sensitivity in post-stroke apathy In a monetary incentive delay task ° Apathetic patients with lesions to basal ganglia show reduced effects of monetary incentive Reward probability Rochat et al. Neurology 2013 Apathy in healthy people Measured by questionnaires and effort-sensitivity tasks Higher effort costs in apathy Reduced willingness to squeeze a gripper for money Lower anterior cingulum bundle integrity in apathy (Fractional anisotropy correlates negatively with apathy score) 21 Bonnelle et al (2015) Cerebral Cortex Akinetic mutism “Autoactivation deficit” ° Bilateral medial frontal damage ° SMA, preSMA, cingulate callosum / cingulate white matter Nemeth et al 1988 Assorted terms for Amotivation Not always considered distinct Akrasia Apathy Akinetic mutism Abulia Autoactivation deficit Anergia Athymhormia Anhedonia Dimensions of apathy “behavioural apathy” autoactivation deficit “cognitive apathy” “emotional apathy” Marin 1991 Robert…Starkstein 2009 Fatigue A feeling of low energy levels ° Heightened sense of effort ‰ High effort cost ° Very common after stroke, inflammation, infection, and in all chronic diseases ° “Ego depletion” account ° State vs trait fatigue – fatiguability Kuppuswamy, Brain 2017 ° What is Chronic Fatigue Syndrome (previously Myalgic Encephalomyelitis)? • Does it exist? • Is it organic (i.e. have a biological rather than psychological cause)? • Attention to somatic feedback; Bias in interpreting information •“Illness behaviour” Alien Limb Syndrome Limb “has a mind of its own” ° Anarchic hand vs asomatognosia ° Penfield: complex movements elicited from frontal cortex • Stimulation of PMC – “my hand just moved” • Stimulation of SMA – “I felt the urge to move” ° TMS – similar effects Alien limb is modulated by context Moro, Pernigo, Scandola, Aglioti Neuropsychologia 2015 Split brain Right hemisphere can’t combine meanings of sequential words Gazzaniga Split brain Visual word match: right hemisphere. Picture match: left hemisphere Levy and Trevarthen, Brain 1977 Split brain Confabulation – what motivated behaviour? Dyskinesia Abnormal involuntary movements ° Chorea – complex, dance-like • Huntington’s Chorea, Sydenham’s Chorea • Degeneration of striatal GABAergic neurons ° Hemiballismus • Unilateral flinging twisting movements • Lesions to subthalamic nucleus (inhibitory area in basal ganglia) ° Dystonia • Stiffness and abnormal posture Akathisia A sense of inner restlessness ° Very unpleasant, disabling ° A few weeks after dopamine D2 agonist withdrawal in PD ° Drug side effect of D2 blockade in Schizophrenia ° Patients have to rock, march on the spot, fidget, pace about ° Restless legs syndrome – akathisia localised to legs? Altered agency Movements may arise through many non-volitional routes ° Obsessions vs compulsions ° OCD – anxiety; neurosis ° Compulsion: experience as “desire causes action” ° Stereotypies ° Hypnotic suggestibility ° cf. Cognitive dissonance / “Choice blindness” e.g. Wilson & Nisbett 1978 ° Made acts, delusions, depersonalisation, derealisation (Schizophrenia) Tourette syndrome Urges and habits ° Tics • Stereotyped voluntary movements • Preceded by an urge • Result in satisfaction / quench the urge ° Coprolalia Utilisation behaviour A profound form of disinhibition? ° Bilateral medial frontal lesions ° Unaware and unable to apply context-governed control ° Affordance-driven behaviour ° Use objects in an ‘overlearned’ manner, rather than following task instructions Utilisation behaviour More than just competition from affordances ° Cup on left or right ° “Reach with nearest hand” ° Interference when handle conflicted. ° “Reach with hand nearest handle”, target central ° Distractors captured action irrespective of compatibility Humphreys and Riddoch EBR 2000 Functional Neurological Disorders Borderline between neurology and psychiatry ° Hysterical / Psychogenic / Conversion disorder • Neurological symptoms with normal neural function • Fluctuate, distractible, • Not “faked” • Triggered by emotional stress, anxiety • Often history of (repressed) major mental trauma eg. in childhood • Can be paralysis, abnormal movement or seizures, speech disturbance, or sensations •Hard to treat ° Opposite: Munchausen syndrome •Patient fully aware • Secondary gain Carson et al. http://www.neurosymptoms.org/ Feedback https://oxfordxpsy.az1.qualtrics.com/jfe/form/SV_b9QzLybTpzOb165.
Load more

Recommended publications
  • Post-Stroke Apathy: Screening and Functional Impact
    Post-Stroke Apathy: Screening and Functional Impact Pernille Spillum Myhre Date of submission: 7 April 2020 Word count: 27467 (excluding appendices) This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with the author and that use of any information derived therefrom must be in accordance with current UK Copyright Law. In addition, any quotation or extract must include full attribution. Doctorate in Clinical Psychology University of East Anglia POST-STROKE APATHY 2 Acknowledgements Firstly, I would like to thank all the individuals who participated in this research. They generously gave their time, and without them, this project would not have been possible. I would also like to thank the various organisations and individuals for their invaluable assistance in sharing the details of this study, as well as supporting the online advertisement and recruitment aspects. I wish to express my sincere appreciation to my two supervisors, Dr Catherine Ford and Dr Ratko Radakovic. They have both been extremely supportive throughout this entire process and have contributed many hours of supervision and guidance. Thanks to their continuous support, the success of this project has been achievable. I would also like to thank my advisors Prof Niall Broomfield and Prof Siân Coker, and Dr Fergus Gracey as well as all my clinical supervisors who provided support through my ClinPsyD training. I would also like to thank my fellow Trainee, Hannah Wakeley for helping with the screening for the systematic review. I extend a warm thank you to Dr Joanne Hodgekins for her contribution on ethical and methodological input and to Prof David Peck for his involvement and support on statistical analyses.
    [Show full text]
  • Developing a New Apathy Measurement Scale
    Edinburgh Research Explorer Developing a new apathy measurement scale Citation for published version: Radakovic, R & Abrahams, S 2014, 'Developing a new apathy measurement scale: Dimensional apathy scale', Psychiatry Research, vol. 219, no. 3, pp. 658-663. https://doi.org/10.1016/j.psychres.2014.06.010 Digital Object Identifier (DOI): 10.1016/j.psychres.2014.06.010 Link: Link to publication record in Edinburgh Research Explorer Document Version: Peer reviewed version Published In: Psychiatry Research General rights Copyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s) and / or other copyright owners and it is a condition of accessing these publications that users recognise and abide by the legal requirements associated with these rights. Take down policy The University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorer content complies with UK legislation. If you believe that the public display of this file breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 28. Sep. 2021 Developing a new apathy measurement scale: dimensional apathy scale * a, b, c, d a, c, d Ratko Radakovic and Sharon Abrahams a Human Cognitive Neuroscience-Psychology, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, UK b Alzheimer Scotland Dementia Research Centre, University of Edinburgh, UK c Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, UK d Euan MacDonald Centre for MND Research, University of Edinburgh, UK Abstract Apathy is both a symptom and syndrome prevalent in neurodegenerative disease, including motor system disorders, that affects motivation to display goal directed functions.
    [Show full text]
  • Neuropsychological Aspects of Apathy in Parkinson's Disease
    Neuropsychological Aspects of Apathy in Parkinson's Disease Graham Christopher Pluck Thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy The Institute of Neurology University College London ProQuest Number: U643345 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest U643345 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract Patients with Parkinson's disease (PD) are often described as failing to show a normal range of goal directed behaviours. Among explanations that have been proposed for this apathy are effects of personality, depression and disability. This thesis investigated the phenomena from a neuropsychological perspective. It was found that PD patients are significantly more apathetic than equally disabled osteoarthritis patients, indicating that their apathy is a primary symptom of the disease. No evidence was found relating apathy in PD to personality, depression, anxiety or anhedonia. It was found that the PD patients with high levels of apathy were impaired on cognitive tests, but only those that required executive control. Using visual-search tasks it was shown that this association could not be accounted for by a reduction in effort applied.
    [Show full text]
  • A Dictionary of Neurological Signs.Pdf
    A DICTIONARY OF NEUROLOGICAL SIGNS THIRD EDITION A DICTIONARY OF NEUROLOGICAL SIGNS THIRD EDITION A.J. LARNER MA, MD, MRCP (UK), DHMSA Consultant Neurologist Walton Centre for Neurology and Neurosurgery, Liverpool Honorary Lecturer in Neuroscience, University of Liverpool Society of Apothecaries’ Honorary Lecturer in the History of Medicine, University of Liverpool Liverpool, U.K. 123 Andrew J. Larner MA MD MRCP (UK) DHMSA Walton Centre for Neurology & Neurosurgery Lower Lane L9 7LJ Liverpool, UK ISBN 978-1-4419-7094-7 e-ISBN 978-1-4419-7095-4 DOI 10.1007/978-1-4419-7095-4 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2010937226 © Springer Science+Business Media, LLC 2001, 2006, 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.
    [Show full text]
  • Neuropsychological Neurology the Neurocognitive Impairments of Neurological Disorders Second Edition
    more information - www.cambridge.org/9781107607606 Neuropsychological Neurology The Neurocognitive Impairments of Neurological Disorders Second Edition Neuropsychological Neurology The Neurocognitive Impairments of Neurological Disorders Second Edition A. J. Larner Consultant Neurologist Cognitive Function Clinic Walton Centre for Neurology and Neurosurgery Liverpool, UK cambridge university press Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao˜ Paulo, Delhi, Mexico City Cambridge University Press The Edinburgh Building, Cambridge CB28RU,UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9781107607606 Second edition c A. J. Larner 2013 First edition c A. J. Larner 2008 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. Second edition first published 2013 First edition first published 2008 Printed and bound in the United Kingdom by the MPG Books Group A catalogue record for this publication is available from the British Library Library of Congress Cataloguing in Publication data Larner, A. J. Neuropsychological neurology : the neurocognitive impairments of neurological disorders / A.J. Larner. – 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-107-60760-6 (pbk.) I. Title. [DNLM: 1. Nervous System Diseases – complications. 2. Cognition Disorders – physiopathology. 3. Neuropsychology – methods. WL 140] RC553.C64 616.8 – dc23 2013006091 ISBN 978-1-107-60760-6 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.
    [Show full text]
  • Dveloping a New Apathy Measurement Scale
    Developing a New Apathy Measurement Scale Exam Number: B020190 MSc Human Cognitive Neuropsychology School of Philosophy, Psychology & Language Sciences The University of Edinburgh 2012 Abstract Apathy is both a symptom and syndrome prevalent in many pathological populations that affects motivation to display goal directed functions. Apathy has been established as having a triadic substructure by various researchers but has never been directly detected in normative and non- normative populations. Levy and Dubois (2006) proposed three apathetic subtypes, Cognitive, Emotional- Affective and Auto Activation, all with particular neural correlates and functional impairments. The aim of this study was to create and begin the validation process of a new apathy measure called the Dimensional Apathy Scale (DAS), which assesses the three previously mentioned apathetic subtypes. There were 311 participants (mean = 37.4, SD = 15.0) ranging from 18 to 70 years old .Upon performing an Horn’s parallel analysis of principal factors and Exploratory Factor Analysis, 4 factors (labelled Executive, Emotional, Cognitive Initiation and Behavioural Initiation) were extracted accounting for 28.9% of the total variance. The factors and their meanings fitted Levy and Dubois’ definitions of the three apathetic subtypes with the exception of the Auto Activation apathy. Upon closer examination thematically the Auto Activation apathy subtype definition accounted for Behavioural Initiation and Cognitive Initiation factors. These were found to be thematically intertwined and therefore were labelled as Behavioural/Cognitive Initiation. The 24 item DAS contained 3 subscales – Executive, Emotional and Behavioural/Cognitive Initiation, each composed of 8 items. The DAS items for each subscale showed good reliability and validity against depression based on a normally ageing population.
    [Show full text]
  • Acute Stroke Treatment, Second Edition
    Acute Stroke Treatment Acute Stroke Treatment Second Edition Edited by Julien Bogousslavsky Professor of Neurology and Cerebrovascular Diseases Chairman, University Hospital of Neurology Centre Hospitalier Universitaire Vaudois Lausanne Switzerland LONDON AND NEW YORK © 1997, 2003 Martin Dunitz, an imprint of the Taylor & Francis Group plc First published in the United Kingdom in 1997 by Martin Dunitz, an imprint of the Taylor & Francis Group plc, 11 New Fetter Lane, London EC4P 4EE Tel: +44 (0)20 7583 9855 Fax: +44 (0)20 7842 2298 E-mail: [email protected] Website: http://www.dunitz.co.uk This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Second edition 2003 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P OLP. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. A CIP record for this book is available from the British Library.
    [Show full text]
  • Give-Up-Itis’ Revisited: Neuropathology of Extremis T John Leach
    Medical Hypotheses 120 (2018) 14–21 Contents lists available at ScienceDirect Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy ‘Give-up-itis’ revisited: Neuropathology of extremis T John Leach Extreme Environmental Medicine & Science Group, Extreme Environments Laboratory, University of Portsmouth, Portsmouth PO1 2ER, England, United Kingdom ARTICLE INFO ABSTRACT Keywords: The term ‘give-up-itis’ describes people who respond to traumatic stress by developing extreme apathy, give up Death and dying hope, relinquish the will to live and die, despite no obvious organic cause. This paper discusses the nature of Psychological stress give-up-itis, with progressive demotivation and executive dysfunction that have clinical analogues suggesting Psychopathology frontal-subcortical circuit dysfunction particularly within the dorsolateral prefrontal and anterior cingulate Neuropsychology circuits. It is hypothesised that progressive give-up-itis is consequent upon dopamine disequilibrium in these circuits, and a general theory for the cause and progression of give-up-itis is presented in which it is proposed that give-up-itis is the clinical expression of mental defeat; in particular, it is a pathology of a normal, passive coping response. Introduction of desire to live [5]. Elie Cohen [6] reports that, ‘At Ebensee I found a few times one or two men lying dead by my side in the morning. The The term ‘give-up-itis’ (GUI) was originally applied during the evening before I had observed nothing in these people to show that Korean war (1950–1953) to prisoners-of-war (PoW) who following se- their end was near’. Mary Lindell (in Ravensbrük camp) found that one vere trauma developed extreme apathy, gave up hope, relinquished the of her friends, ‘…had given up and died, even though she had no or- will to live and died, despite no obvious organic cause.
    [Show full text]
  • A Multidimensional Approach to Apathy After Traumatic Brain Injury
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by RERO DOC Digital Library Neuropsychol Rev (2013) 23:210–233 DOI 10.1007/s11065-013-9236-3 REVIEW A Multidimensional Approach to Apathy after Traumatic Brain Injury Annabelle Arnould & Lucien Rochat & Philippe Azouvi & Martial Van der Linden Received: 1 July 2013 /Accepted: 26 July 2013 /Published online: 7 August 2013 # Springer Science+Business Media New York 2013 Abstract Apathy is commonly described following traumatic variables (e.g., anticipatory pleasure) and aspects related to brain injury (TBI) and is associated with serious conse- personal identity (e.g., self-esteem). Future investigations that quences, notably for patients’ participation in rehabilitation, consider these various factors will help improve the under- family life and later social reintegration. There is strong evi- standing of apathy. This theoretical framework opens up rel- dence in the literature of the multidimensional nature of apa- evant prospects for better clinical assessment and rehabilita- thy (behavioural, cognitive and emotional), but the processes tion of these frequently described motivational disorders in underlying each dimension are still unclear. The purpose of patients with brain injury. this article is first, to provide a critical review of the current definitions and instruments used to measure apathy in neuro- Keywords Apathy . Traumatic brain injury . Motivation . logical and psychiatric disorders, and second, to review the Depression . Executive functions
    [Show full text]
  • Apathy in Parkinson's Disease: a Behavioral Intervention Study London Butterfield University of South Florida, [email protected]
    University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School January 2013 Apathy in Parkinson's Disease: A Behavioral Intervention Study London Butterfield University of South Florida, [email protected] Follow this and additional works at: http://scholarcommons.usf.edu/etd Part of the Clinical Psychology Commons Scholar Commons Citation Butterfield, London, "Apathy in Parkinson's Disease: A Behavioral Intervention Study" (2013). Graduate Theses and Dissertations. http://scholarcommons.usf.edu/etd/4873 This Dissertation is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. Apathy in Parkinson’s Disease: A Behavioral Intervention Study by London C. Butterfield A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Psychology with a concentration in Clinical Neuropsychology College of Arts and Sciences University of South Florida Major Professor: Cynthia R. Cimino, Ph.D. William E. Haley, Ph.D. Paul Jacobsen, Ph.D. Douglas Rohrer, Ph.D. Juan Sanchez-Ramos, Ph.D., M.D. Date of Approval: November 15, 2013 Keywords: Motivation, Neurodegenerative, Movement Disorder, Treatment, Behavioral Activation Copyright © 2013, London C. Butterfield Table of Contents List of Tables iv List of Figures vi Abstract vii Introduction 1 Parkinson’s
    [Show full text]
  • Apathy in Parkinson's Disease: Clinical Features, Neural Substrates, Diagnosis, and Treatment
    Article Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment PAGONABARRAGA, Javier, et al. Reference PAGONABARRAGA, Javier, et al. Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment. The Lancet Neurology, 2015, vol. 14, no. 5, p. 518-531 DOI : 10.1016/S1474-4422(15)00019-8 PMID : 25895932 Available at: http://archive-ouverte.unige.ch/unige:95955 Disclaimer: layout of this document may differ from the published version. 1 / 1 Review Apathy in Parkinson’s disease: clinical features, neural substrates, diagnosis, and treatment Javier Pagonabarraga, Jaime Kulisevsky, Antonio P Strafella, Paul Krack Lancet Neurol 2015; 14: 518–31 Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal Movement Disorders Unit, cortex with the limbic system. Structural and functional disruption of diff erent networks within these circuits alters the Neurology Department, maintenance of spontaneous mental activity and the capacity of aff ected individuals to associate emotions with complex Sant Pau Hospital and stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours Biomedical Research Institute, Barcelona, Spain known as apathy. Apathy is highly prevalent in Parkinson’s disease (and across many neurodegenerative disorders) and (J Pagonabarraga PhD, can severely aff ect the quality of life of both patients and caregivers. Diff erentiation of apathy from depression, and Prof J Kulisevsky PhD); discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the Universitat Autònoma de treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson’s disease allows Barcelona, Barcelona, Spain (J Pagonabarraga, researchers to study a continuous range of motivational states, from apathy to impulse control disorders.
    [Show full text]
  • Diaschisis and Neurobehavior
    Diaschisis and Neurobehavior Dang Khoa Nguyen and M.I. Botez ABSTRACT: We review forms of diaschisis and their relationship with neurobehavioral and neuropsy­ chological findings. The following forms of diaschisis are discussed: (1) cortico-cerebellar diaschisis; (2) cerebello-cortical diaschisis; (3) transhemispheric diaschisis; (4) cortico-thalamic diaschisis; (5) thalamo-cortical diaschisis; and (6) basal ganglia-cortical diaschisis. For each form, the neurobehav­ ioral and neuropsychological findings are discussed. Diaschisis can be classified from the behavioral point of view as follows: (1) forms in which the metabolic effect at distance is not followed by neu­ robehavioral impairment; (2) forms in which the remote metabolic impairment could induce neurobehavioral and neuropsychological disorders; and (3) forms in which the role of the lesion itself and its remote metabolic effects on the production of neurobehavioral and neuropsychological abnor­ malities cannot be disentangled. RESUME: Diaschisis et comportement: Faire une revue concernant les diverses formes de diaschisis et leurs relations avec les donnees comportementales et neuropsychologiques. Les auteurs presentent les differentes formes de diaschisis: (1) diaschisis cortico-c6rebelleaux; (2) diaschisis cerebello-cortical; (3) diaschisis transhemispherique; (4) diaschisis cortico-thalamique; (5) diaschisis thalamo-cortical; et (6) diaschisis des ganglions de la base - cortex cerebral. On discute de la presence ou de I'absence des troubles neuropsychologiques et du comportement
    [Show full text]