Structural correlates of apathy in Alzheimer's disease: a multimodal MRI study

Luis Aguera-Ortiz*, Juan A. Hernandez-Tamames, Pablo Martinez-Martin, Isabel Cruz-Orduna, Gonzalo Pajares, Jorge Lopez-Alvarez, Ricardo S. Osorio, Marta Sanz, Javier Olazaran

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

26 Citations (Scopus)


ObjectiveApathy is one of the most frequent symptoms of dementia, whose underlying neurobiology is not well understood. The objective was to analyze the correlations of apathy and its dimensions with gray and white matter damage in the brain of patients with advanced Alzheimer's disease (AD).MethodsThe setting of the study was at the Alzheimer Center Reina Sofia Foundation Research Unit. Participants include 37 nursing home patients with moderate to severe AD, 78.4% were women, and mean Standard Deviation (SD) age is 82.7 (5.8). Several measurements were taken: severe mini-mental state examination and Global Deterioration Scale for cognitive and functional status, Neuropsychiatric Inventory for behavioral problems, and Apathy In Dementia-Nursing Home Version Scale for apathy, including total score and subscores of emotional blunting, deficit of thinking, and cognitive inertia. 3T magnetic resonance imaging measures (voxel-based morphometry, fluid-attenuated inversion recovery, and diffusion tensor imaging) were also conducted.ResultsModerate levels of apathy (mean Apathy In Dementia-Nursing Home Version Scale: 31.118.5) were found. Bilateral damage to the corpus callosum and internal capsule was associated with apathy severity (cluster size 2435, p<0.0005, family-wise error [FWE]-corrected). A smaller and more anteriorly located region of the right internal capsule and corpus callosum was associated with higher emotional blunting (cluster size 334, p<0.0005, FWE-corrected). Ischemic damage in the right periventricular frontal region was associated with higher deficit of thinking (cluster size 3805, p<0.005, FWE-corrected).ConclusionsBrain damage related to apathy may have different features in the advanced stages of AD and differs between the three apathy dimensions. Besides atrophy, brain connectivity and vascular lesions are relevant in the study of apathy, especially in the more severe stages of dementia. Further magnetic resonance imaging studies should include multimodal techniques. Copyright (c) 2016 John Wiley & Sons, Ltd.
Original languageEnglish
Pages (from-to)922-930
Number of pages9
JournalInternational Journal of Geriatric Psychiatry
Issue number8
Early online date18 Jul 2016
Publication statusPublished - Aug 2017

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  • EMC NIHES-03-30-03


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