Cerebral blood flow correlates of apathy in Alzheimer disease
A. H. Craig, J. L. Cummings, L. Fairbanks, L. Itti, B. L. Miller, J. Li and I. Mena
Department of Neurology, University of California, Los Angeles, USA.
BACKGROUND: Apathy is a pervasive noncognitive neuropsychiatric disturbance
in Alzheimer disease, which causes significant caregiver distress. The
neuroanatomical substrate of apathy is not well understood. OBJECTIVE: To
study the relationship between regional cerebral blood flow and the
presence and severity of the personality disturbance, apathy, in
individuals with Alzheimer disease. DESIGN: Analysis of the relationship
between regional cerebral blood flow as measured by single photon emission
computed tomography and severity of apathy as measured by the
Neuropsychiatric Inventory using an analysis of variance design. We
examined regional cerebral perfusion alterations as measured by xenon
133Xecalibrated technetium Tc 99m hexamethyl-propyleneamine-oxime single
photon emission computed tomography in relation to the presence and
severity of apathy. SETTING: The neurology clinics of the University of
California, Los Angeles, UCLA School of Medicine, and Harbor-UCLA Medical
Center. PARTICIPANTS: Thirty-one community-dwelling patients fulfilling
National Institute of Neurological and Communicative Disorders and
Stroke-Alzheimer's Disease and Related Disorders Association diagnostic
criteria for probable Alzheimer disease who had a single photon computed
tomographic scan performed within 3 months of administration of the
Neuropsychiatric Inventory. RESULTS: The presence of apathy was associated
with more severe prefrontal and anterior temporal dysfunction. These
regional cerebral perfusion relationships with apathy were independent of
cognitive decline except in the dorsolateral prefrontal cortex.
CONCLUSIONS: These results demonstrate the association of apathetic
syndromes with prefrontal and anterior temporal regional brain dysfunction
and are consistent with similar findings previously reported in other
disorders.