Initiative apathy is the most disabling form of apathy, prevalent both in neuropsychiatric pathologies and in the healthy population. This apathy has been specifically associated with functional abnormalities of the anterior cingulate cortex, a key structure underlying Effort-based Decision-Making (EDM). The main aim of the present study was to explore, for the first time, the cognitive and neural effort mechanisms of initiative apathy, by distinguishing the steps of effort anticipation and effort expenditure and the potential modulating effect of motivation. We conducted an EEG study in 23 subjects with specific subclinical initiative apathy and 24 healthy subjects with no apathy. The subjects had to complete two effort tasks. The analysis of behavioral choices, CNV, and mPFC theta power highlighted that initiative apathy is associated with effort avoidance and impairments of effort anticipation and effort expenditure that suggest EDM deficits. Better knowledge of these impairments should aid the development of new, more targeted therapeutic interventions necessary for reducing the debilitating consequences of initiative apathy.

Initiative apathy is the most disabling form of apathy, prevalent both in neuropsychiatric pathologies and in the healthy population. This apathy has been specifically associated with functional abnormalities of the anterior cingulate cortex, a key structure underlying effort-based decision-making. The main aim of the present study was to explore, for the first time, the cognitive and neural effort mechanisms of initiative apathy, by distinguishing the steps of effort anticipation and effort expenditure and the potential modulating effect of motivation. We conducted an EEG study in 23 subjects with specific subclinical initiative apathy and 24 healthy subjects with no apathy. The subjects had to compete two effort tasks. The analysis of behavioral choices, CNV, and mPFC theta power highlighted that initiative apathy is associated with effort avoidance and impairments of effort anticipation and effort expenditure that suggest effort-based decision-making deficits. Better knowledge of these impairments should aid the development of new, more targeted therapeutic interventions necessary for reducing the debilitating consequences of initiative apathy.

Apathy is a clinical symptom prevalent in many neuropsychiatric pathologies. Subclinical apathy is found in 35% of the general population. Despite high prevalence and negative consequences, underlying mechanisms are poorly understood, perhaps because the concept of apathy is one-dimensional. The current investigation aims to address the incidence of multidimensional apathetic trait in three distinct forms in a student population, to specify its determinants and to evaluate its stability during a global pandemic. Two online surveys, conducted 1 year apart on two separate cohorts of university students, with qualitative measures and validated scales. The final analysis included, respectively, 2789 and 1678 students. The three forms of apathetic trait were present, with the same debilitating consequences as apathetic symptom but independent determinants. Executive apathy was predicted by depressive symptoms, emotional apathy by motivational deficit and initiative apathy comprised a mixed executive-emotional form and a pure deficit of action initiation. The three forms of subclinical apathy remained similar in the context of increased depressive symptoms due to a global pandemic. This study confirmed the presence and independence of three forms of subclinical apathy in healthy students, which remained similar even in the light of increased depressive scores. These results shed light on cognitive and neuronal mechanisms underlying multidimensional apathy, allowing new, targeted treatments.

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