Cerebral Blood Flow Correlates of Apathy in Alzheimer Disease

doi:10.1001/archneur.1996.00550110056012

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Vol. 53 No. 11, November 1996

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Cerebral Blood Flow Correlates of Apathy in Alzheimer Disease

Ann H. Craig, MD; Jeffrey L. Cummings, MD; Lynn Fairbanks, PhD; Laurent Itti; Bruce L. Miller, MD; Jenny Li; Ismael Mena, MD

Arch Neurol. 1996;53(11):1116-1120.

Abstract

Background
Apathy is a pervasive noncognitive neuropsychiatric disturbancein 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 flowand the presence and severity of the personality disturbance,apathy, in individuals with Alzheimer disease.

Design
Analysis of the relationship between regional cerebral bloodflow as measured by single photon emission computed tomographyand severity of apathy as measured by the Neuropsychiatric Inventoryusing an analysis of variance design. We examined regional cerebralperfusion alterations as measured by xenon ¹³³Xecalibrated technetiumTc 99m hexamethyl-propy-leneamine-oxime single photon emissioncomputed tomography in relation to the presence and severityof 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 Instituteof Neurological and Communicative Disorders and Stroke-Alzheimer'sDisease and Related Disorders Association diagnostic criteriafor probable Alzheimer disease who had a single photon computedtomographic scan performed within 3 months of administrationof the Neuropsychiatric Inventory.

Results
The presence of apathy was associated with more severe prefrontaland anterior temporal dysfunction. These regional cerebral perfusionrelationships with apathy were independent of cognitive declineexcept in the dorsolateral prefrontal cortex.

Conclusions
These results demonstrate the association of apathetic syndromeswith prefrontal and anterior temporal regional brain dysfunctionand are consistent with similar findings previously reportedin other disorders.

Author Affiliations

From the Departments of Neurology (Drs Craig and Cummings) and Psychiatry and Biobehavioral Sciences (Drs Cummings and Fairbanks), University of California, Los Angeles, UCLA School of Medicine; Behavioral Neuroscience Section, Psychiatry Service, West Los Angeles Veterans Affairs Medical Center (Dr Cummings); and Departments of Neurology (Dr Miller, Ms Li, and Mr Itti) and Radiology (Dr Mena), Harbor-UCLA Medical Center.

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