Abulia

What Causes Abulia?

Abulia results from damage to parts of the brain associated with motivation and drive. This damage can arise from many different types of injuries or brain disorders, and the underlying cause may also be a psychological disorder.

Brain-related problems associated with abulia include:

• Alzheimer’s disease
• Frontotemporal dementia
• Lewy body dementia
• Huntington’s disease
• Parkinson’s disease
• Stroke
• Traumatic brain injury
• Schizophrenia

Abulia is also likely linked to the levels or functioning of the brain chemical dopamine. Dopamine is part of the brain’s pleasure-reward system and plays a critical role in motivation. It is also associated with some brain disorders, such as Parkinson’s disease, which might explain why abulia is sometimes associated with these disorders.

Is Abulia Hereditary?

It’s unclear whether abulia itself has an inherited component. Still, some brain disorders of which abulia is a symptom, including Alzheimer’s and schizophrenia, seem to be linked to genetic traits.

There is a consensus among scientists that genetics play a significant role in the development of schizophrenia. Several studies have estimated that between 50% and 80% of the risk of developing the disorder comes from inherited genetic traits. A broader study in 2017 put the heritability rate at the top end of that range, suggesting that about 80% of the risk comes from an individual’s genes.

How Is Abulia Detected?

Abulia can be confused with other neurological and psychiatric disorders, so it is important for doctors to follow a thorough diagnostic process to differentiate it from similar problems. For example, abulia sometimes resembles aphasia, a neurological disorder that causes problems with speech.

Abulia may also be confused with depression, which frequently causes decreased motivation. However, people with abulia don’t usually exhibit the feelings of sadness or hopelessness typically associated with depression.

How Is Abulia Diagnosed?

Diagnosis of abulia typically begins with a physical and neurological assessment, and it may also include a psychological evaluation. First, doctors will usually try to rule out medical conditions that could be causing the physical and mental symptoms. After these potential physical conditions have been ruled out, the diagnostic process moves on to possible psychological causes.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Neurological exams. These exams will test the function of the patient’s brain and nervous system.
• Blood and laboratory tests. These tests will look at the patient’s blood chemistry for issues such as thyroid function that could be causing the symptoms of abulia.
• Imaging exams. Exams such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans may be used to look for evidence of brain damage associated with abulia. 
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

How Is Abulia Treated?

There is no cure for abulia, but several medications and therapies may be used to treat and manage the disease’s symptoms. The first line of treatment is typically focused on the underlying disorder or condition causing the abulia.

Medications

Most of the medications used to treat abulia manage, in one way or another, the level of dopamine in the brain. Drugs commonly used include:

• Carbidopa-levodopa works by converting naturally to dopamine in the brain.
• Dopamine agonists such as bromocriptine. These medications work by simulating the effects of dopamine in the brain.
• Bupropion, which inhibits the reabsorption of dopamine by nerve cells
• Nefiracetam
• Olanzapine
• Agomelatine

Other Therapies

Physical therapy may be helpful for some people with abulia. Family therapy may help the patient and their loved ones cope with the complications of the disorder.

How Does Abulia Progress?

The long-term outlook for people with abulia varies depending on the underlying disorder and the severity of symptoms. Potential complications of abulia include:

• Malnutrition
• Dehydration
• Bedsores
• Blood clots

How Is Abulia Prevented?

There is no known way to prevent abulia.

Abulia Caregiver Tips

Caregivers for someone with abulia should consider these tips to help the person affected, and themselves deal with the disorder:

• Learn as much as possible about the disorder.
• Don’t expect the affected loved one to get better on their own.
• Seek appropriate professional treatment for the affected person.
• Do everything possible to support the affected person in the pursuit of treatment.
• Be supportive of the affected person and acknowledge any improvements.
• Find a support group for caregivers.
• Take time away from the affected person when possible.

Some people with abulia also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with abulia:

• Alzheimer’s disease
• Anxiety
• Depression
• Frontotemporal dementia
• Lewy body dementia
• Huntington’s disease
• Parkinson’s disease
• Schizophrenia

Abulia Brain Science

Scientists believe that abulia results from damage to the brain’s centro-medial core, a region extending from the frontal lobes to the brain stem. Activity in other parts of the brain can also be affected because of complex interconnections between the damaged areas and more remote areas.

Commonly affected areas include:

• Basal ganglia
• Frontal lobes
• Cingulate gyrus
• Caudate nucleus
• Globus pallidus

Damage to these parts of the brain likely causes problems with the function of dopamine, resulting in dysfunction in motivation. Issues with other brain chemicals are probably involved as well.

Abulia Research

Title: Effect of Istradefylline Treatment on Behavioral Measures of Apathy in Parkinson’s Disease

Stage: Recruiting

Study Chair: Lilia Lovera, MD

Medical University of South Carolina

Charleston, SC 

Apathy is defined as a lack of feeling, emotion, interest, or concern. Apathy also involves the reduction or loss of motivation and goal-directed behavior. Clinically significant apathy, where meaningful activities are abandoned, and quality of life is diminished, is common in people with Parkinson’s disease (PD).

Many individuals with Parkinson’s disease experience fluctuations in the severity of their movement problems and medication “off” time. “Off” time refers to periods of the day between doses of PD medication when your motor symptoms (e.g., tremor, stiffness, slowness, walking problems, etc.) are worse and interfere with your ability to complete tasks of daily living. The investigational drug, Istradefylline, is an FDA-approved medication to treat motor fluctuations and “off” time in PD.

The purpose of this study is to investigate whether people with Parkinson’s disease (PD) who are treated with istradefylline (ISD) show improvements in motivation and apathy over a 12-week period. Specifically, researchers aim to determine whether people with PD treated with ISD engage in more physical and recreational activities, such as hobbies and other interests.

Apathy is a clinical syndrome characterized by a lack of motivation, interest, engagement, and emotional reactivity for goal-directed behaviors (Starkstein et al., 2008). A common and troublesome symptom of Parkinson’s disease (PD), apathy is associated with diminished quality of life for both the patient and care partner (Van Reekum, Stuss, & Ostrander, 2005; Barone et al., 2009). To the extent that apathy reduces engagement in physical and social activities, it may also result in more rapid disease progression and cognitive decline (e.g., Crotty & Schwarzchild, 2020). Addressing apathy is therefore a crucial component of treating PD. A recent open-label study demonstrated a significant reduction in self-reported apathy with Istradefylline (ISD) in PD (Nagayama et al., 2019). This unsurprising result likely reflects contributions from known benefits of ISD with respect to daytime somnolence and improved motor functioning (Matsuura et al., 2017; Suzuki et al., 2017), as well as enhanced functioning of dopamine-mediated reward pathways. However, patients with PD advanced enough to warrant treatment with ISD may also have diminished insight and awareness, and therefore not be particularly reliable reporters (e.g., Orfei et al., 2018). It is also unknown whether, and to what extent, this is correlated with actual changes in behavior and caregiver burden.

This study aims to determine whether treatment with ISD increases engagement in physical and other meaningful activities in patients with Parkinson’s disease.

Title: Transcranial Magnetic Stimulation for Apathy in Mild Cognitive Impairment (TAMCI)

Stage: Recruiting

Principal Investigator: Prasad R. Padala, MBBS

Central Arkansas Veterans Healthcare System

Little Rock, AR 

Apathy, a profound loss of initiative and motivation, is often seen in older Veterans with memory problems. Apathy leads to serious health problems, increased dependency, and caregiver burden. If untreated, apathy hastens the progression to frank dementia. In a pilot study, the investigators found that apathy, working memory, and function can be restored using magnetic stimulation in some but not all older Veterans. The reason for this variation is unknown. The investigators propose a three-phase study on 125 older Veterans with mild memory problems. Their motivation, memory, and function will be measured periodically. Veterans with apathy that are eligible for treatment will receive either real or sham magnetic stimulation to the front part of their brain over 20 sessions. Genetic testing and biomarkers will be used to differentiate those who respond to magnetic stimulation from those who do not. The impact on function, quality of life, and rates of progression to dementia will also be studied.

Title: Use of Socially Assistive Robots for Long-Term Care Older Adults With Cognitive Impairment and Apathy

Stage: Recruiting

Contact: Nilanjan Sarkar, PhD

Vanderbilt University

Nashville, TN 

This study aims to demonstrate the impact of a socially assistive robot system on reducing apathy among cognitively impaired older adults residing in long-term care facilities. Earlier phases of this project demonstrated the feasibility and acceptability of the robotic system. First, investigators will improve the social robotic interaction architecture through additional software development, enhance its versatility, and make it easy for non-experts to run. Second, 188 participants will be randomized to either usual activity programs at the long-term care facility, or the usual activity programs plus the robotic activities. Third, researchers will examine the effect on apathy and also plan on examining underlying individual and facility factors that influence the impact of the robotic activities.