Krista Lanctot - Apathy: Clinical and Neuroscientific Perspectives from Neurology and Psychiatry

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Library of Congress Control Number: 2021932602

ISBN 9780198841807

eISBN 9780192578891

DOI: 10.1093/med/9780198841807.001.0001

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Apathy, or a significant reduction of goal-directed activity, is a common and clinically relevant problem for many patients with a neurological or psychiatric condition. It is a prominent and severely debilitating aspect of many such disorders, including among others schizophrenia, depression, traumatic brain injury, stroke, and neurodegenerative diseases (e.g. Alzheimers disease and Parkinsons disease). Patients with apathy show reduced initiative, indolence, and general passivity of thought and action. Apathy involves changes in affect, behaviour, and cognition. No wonder it impacts the lives of patients and their loved ones, especially affecting patients independence and quality of life.

In recent years, there has been an increasing interest in studying apathy in its own right, given the prognostic value of apathy and its impact on daily functioning. Indeed, apathy can manifest itself independently from other neurological and psychiatric conditions and therefore deserves focused investigation. The advent of reliable measures and investigations of underlying mechanisms will also aid the development of novel treatment strategies.

The purpose of this book is to bring together current knowledge regarding apathy, ranging from conceptual insights to measurement, neurobiology, and treatment. For example, conceptual topics include the definition of apathy and the classification of dimensions pertaining to behaviour, cognition, and emotion. In addition, clinical observations suggest that a distinction can be made between different types of apathy. Measurement includes questionnaire and interview approaches, involving information obtained from self-report, informant (relative or close other), or clinician. Different brain circuits may be involved, such as frontoparietal, frontolimbic, and frontostriatal circuits. The neural structures subserving motivation and reward are highly relevant. Treatment has focused on diverse pharmacological approaches, and also psychosocial approaches such as behavioural activation therapy. More recently, neurostimulation has been introduced as a way of increasing brain activation of relevant circuits. Leading experts in the field have been asked to contribute a chapter on a diversity of topics, comprehensively covering different areas of apathy research. Despite the widespread presence of apathy across neurological and psychiatric disorders, much of the research has been done in artificial silos dictated by diseases. It is our hope that bringing together knowledge from across these disciplines will expand progress through cross-fertilization.

The book will be of interest to a wide range of professionals, including clinicians (psychiatrists, neurologists, psychologists, and psychiatric nurses) and researchers in the fields of neurology, psychiatry, and clinical psychology. We also trust that it will benefit students of psychiatry, neurology, clinical psychology, neuropsychology, and related disciplines.

We would like to take this opportunity to thank our colleagues for contributing to this book by accepting our invitation and for their scholarly, informative, and interesting chapters. We are very happy with the contribution of so many leading experts. We also want to thank Danielle Vieira (Sunnybrook Research Institute, Toronto) for her indispensable help in getting the chapters reviewed and sent to the publisher. Finally, we extend our gratitude to Oxford University Press and editor Lauren Tiley for their enthusiasm and help with this book.

Philippe Robert and Valeria Manera

Moyra Mortby, Bria Mele, Zahinoor Ismail, and David Miller

Danielle Vieira, Celina Liu, and Krista L. Lanctt

Gabriella Santangelo

Zahinoor Ismail, Bria Mele, Zahra Goodarzi, Jayna Holroyd-Leduc, and Moyra Mortby

Sergio Starkstein and Bradleigh Hayhow

Ann Faerden and Andr Aleman

Eliyas Jeffay, Kyrsten M. Grimes, and Konstantine K. Zakzanis

Richard Levy

Ingrid Agartz and Lynn Mrch-Johnsen

Stefan Kaiser and Florian Schlagenhauf

Andr Aleman

Lisa Nobis and Masud Husain

Marcel Riehle, Zuzana Kasanova, and Tania M. Lincoln

Andr Aleman, Jozarni J. Dlabac-De Lange, and Prasad Padala