Apathy Is Not Associated with Basal Ganglia Atrophy in Frontotemporal Dementia

doi:10.1097/JGP.0b013e3181b047ff

The American Journal of Geriatric Psychiatry

Volume 17, Issue 9, September 2009, Pages 819-821

https://doi.org/10.1097/JGP.0b013e3181b047ff Get rights and content

Objective:

To determine whether basal ganglia atrophy, known to be associated with apathy in nondementia populations, was associated with presence of apathy in patients with frontotemporal dementia (FTD).

Methods:

A cross-sectional case study was conducted at two tertiary dementia care clinics in Toronto, Ontario, Canada. Striatal and thalamic gray matter volumes and apathy measures were collected from 21 subjects with FTD, 6 of whom did not show apathy on the Neuropsychiatric Inventory.

Results:

No significant differences in gray matter volumes were found between apathetic and nonapathetic groups for the striatum or the thalamus.

Conclusions:

Our findings imply that the etiology of apathy seen in patients with FTD differs from that of patients with apathy after acquired injuries to the basal ganglia. Further study is needed to determine whether posterior thalamic atrophy correlates with apathy in FTD or functional imaging techniques might successfully find a relationship between basal ganglia dysfunction and apathy.

Section snippets

METHODS

This study and methods of obtaining consent were approved by Research Ethics Boards at Sunnybrook Health Sciences Centre and Baycrest. In a previous study, we assessed a sample of 21 subjects with FTD and 21 age- and gender-matched healthy comparison subjects for striatal and thalamic atrophy and found that subjects with FTD, especially those more impaired in activities of daily living, had atrophy in the left anterior thalamus and bilaterally in the striatum.⁴

Our sample consisted of 21

RESULTS

Of the 21 subjects with FTD, 15 had apathy and 6 did not. Given the findings reported by Levy and Dubois, we suspected that the apathetic subjects with FTD would have significantly more atrophy (smaller mean VOI) than those who did not demonstrate apathy by independent samples t-test.

There were no significant differences between VOI direct measures from apathetic versus nonapathetic groups. Although both posterior thalamic mean VOIs of apathetic subjects were smaller than those in the

CONCLUSIONS

We did not find differences in subcortical atrophy for subjects with FTD with or without apathy. The lack of positive finding may be related to small sample size (N = 21) and a resulting lack of power to detect a difference with small effect size.

These results may suggest that the apathy exhibited in patients with FTD differs in etiology from that of patients with apathy due to the acquired, nonneurodegenerative BG lesions, as reported by Levy and Dubois. The damage assessed in these articles

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Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits
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Citation Excerpt :
The first observation was however only significant at a lowered threshold (Zamboni et al., 2008) and the second was not uniquely associated with apathy (Rosen et al., 2005). In a VBM-study (Links et al., 2009), only subcortical regions of interest were investigated (bilateral striatum and thalami) and no association was found between apathy and morphometry of these specified brain areas. In summary, in FTD especially atrophy of frontal regions has been associated to apathy, more specifically within the right hemisphere.
Apathy can be described as a loss of goal-directed purposeful behavior and is common in a variety of neurological and psychiatric disorders. Although previous studies investigated associations between abnormal brain functioning and apathy, it is unclear whether the neural basis of apathy is similar across different pathological conditions. The purpose of this systematic review was to provide an extensive overview of the neuroimaging literature on apathy including studies of various patient populations, and evaluate whether the current state of affairs suggest disorder specific or shared neural correlates of apathy. Results suggest that abnormalities within fronto-striatal circuits are most consistently associated with apathy across the different pathological conditions. Of note, abnormalities within the inferior parietal cortex were also linked to apathy, a region previously not included in neuroanatomical models of apathy. The variance in brain regions implicated in apathy may suggest that different routes towards apathy are possible. Future research should investigate possible alterations in different processes underlying goal-directed behavior, ranging from intention and goal-selection to action planning and execution.
Thalamic pathology in frontotemporal dementia: Predilection for specific nuclei, phenotype-specific signatures, clinical correlates, and practical relevance
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2016, European Journal of Nuclear Medicine and Molecular Imaging
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Brief ReportApathy Is Not Associated with Basal Ganglia Atrophy in Frontotemporal Dementia

Objective:

Methods:

Results:

Conclusions:

Section snippets

METHODS

RESULTS

CONCLUSIONS

Neuroimage

Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits

Cereb Cortex

Brief Report
Apathy Is Not Associated with Basal Ganglia Atrophy in Frontotemporal Dementia