Abulia: A Delphi survey of British neurologists and psychiatrists

Abstract

Abulia is the relatively uncommon yet debilitating lack of spontaneous, goal-directed behaviour that is seen predominantly with lesions of the basal ganglia and the frontal lobes. We sought to confirm the existence of abulia as an entity recognized by clinicians, to generate a set of items characteristic of the condition, and to see how clinicians differentiate between overlapping disorders. The Delphi technique was used to survey consultant neurologists and psychiatrists at three hospitals in London. The study consisted of two phases: semi- structured interviews of a small group of neurologists and psychiatrists, followed by a survey of a larger group of consultants using postal questionnaires. Both neurologists and psychiatrists recognized abulia to be a distinct clinical entity but its status as a syndrome was unclear. Features such as difficulty in initiating and sustaining spontaneous movements and reduction in emotional responsiveness, spontaneous speech, and social interaction were identified as being characteristic of abulia. The information generated by this study may help to develop a working classification for disorders of diminished drive and motivation, and instruments for clinical assessment and decision making.

The circuitry of abulia: Insights from functional connectivity MRI

“…Abulia is most commonly associated with lesions of the anterior cingulate cortex (ACC), but also has been described in association with a variety of subcortical lesions (Vijayaraghavan et al, 2002; Ghoshal et al, 2011; Jorge et al, 2010). These observations raise the question of whether common circuitry is disrupted by both types of lesion.…”

“…This association is consistent with neuroimaging evidence linking the ACC to the initiation of goal-directed behavior (Carter et al, 1999). However, abulia or some degree of apathy is also caused by subcortical lesions of the anterior thalamus, caudate nucleus, globus pallidus, and internal capsule (for a review of abulia see Vijayaraghavan et al, 2002; Ghoshal et al, 2011; Jorge et al, 2010). It is therefore likely that a more accurate functional localization of abulia, and related deficits of willed behavior, involves a network-level dysfunction.…”

Psychiatric aspects of Parkinson?s disease

“…Diagnostic difficulty in the diagnosis of depression arises not only in its differentiation from parkinsonian features (e. g. masked facies, poverty of movement, sexual and sleep disturbances and lack of appetite), but also from apathy, another recognized psychiatric phenomenon in PD, and the related phenomenon of abulia [94]. In contrast to depression, apathy and abulia are not characterized by anhedonia, hopelessness or low mood, but isolated lack of motivation and initiative.…”

The nosological position of apathy in clinical practice

“…In a study that focused on behavioural changes after basal ganglia lesions, Giroud et al defined abulia as “the loss of mental and motor initiative and drive…inducing apathy and blunting of responses” 40. Vijayaraghavan et al assessed the concept of abulia in a group of psychiatric and neurological experts 41. The final consensus was that the following eight features should be considered typical of abulia: (1) difficulty to initiate and sustain purposeful movements; (2) poverty of spontaneous movements; (3) reduced spontaneous speech; (4) increased response time to queries; (5) passivity; (6) reduced emotional responsiveness and spontaneity; (7) reduced social interaction; and (8) reduced interest in usual pastimes.…”