Beyond language impairment: Profiles of apathy in primary progressive aphasia

Quang, Halle; Wong, Stephanie; Piguet, Olivier; Hodges, John R.; Irish, Muireann; Kumfor, Fiona

doi:10.1016/j.cortex.2021.02.028

Cited by 17 publications

(11 citation statements)

References 85 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings accord with previous observations in Parkinson’s disease, dementia, and cerebrovascular disease (Huey et al, 2017; Muhammed et al, 2021; Saleh et al, 2021), and for the first time uncover the impact of reduced extrinsic reward sensitivity on apathy after TBI. The consistent findings between previous studies in other brain disorders and this study in TBI suggest a universal effect whereby impaired ability to evaluate external rewards against effort costs influences motivated decision-making (Bonnelle et al, 2015), although specific brain mechanisms in distinct neurological conditions may differ (Huey et al, 2017; Le Heron et al, 2019; Quang et al, 2021).…”

Section: Discussionsupporting

confidence: 90%

Contributions of intrinsic and extrinsic reward sensitivity to apathy: Evidence from traumatic brain injury.

Quang¹,

Kumfor²,

Balleine³

et al. 2022

Neuropsychology

Self Cite

View full text Add to dashboard Cite

Objective: Apathy is a key feature of traumatic brain injury (TBI). However, mechanisms underlying apathy are poorly understood. Evidence suggests that changes in reward may be a crucial factor. Rewards can come from two important sources: extrinsic reward (e.g., money) and intrinsic reward (e.g., enjoyment). Here, we used an experimental paradigm to examine the contributions of intrinsic–extrinsic reward sensitivity to apathy post-TBI and neurocognitive processes associated with these reward processing components. Method: Fifty-seven patients with TBI (TBI with clinical/severe apathy [TBI+sA], TBI with subclinical/moderate apathy [TBI+mA] and TBI without apathy [TBI-A] groups), and 30 healthy individuals completed the “birthday-gift task.” In the “intrinsic reward” condition, participants chose to “go” to collect the gift or “wait” for the same gift to be delivered. In the “extrinsic reward” condition, the task was identical, however, participants received monetary incentives when choosing “going” instead of “waiting.” The Montreal Cognitive Assessment was utilized for cognitive examination. Results: A smaller proportion of people in the TBI+sA group had high sensitivity to both intrinsic and extrinsic rewards than the TBI+mA, TBI-A and healthy comparison groups. The TBI+sA group also perceived the “go” option on the intrinsic reward condition as more effortful and made fewer “go” decisions on the extrinsic condition. Attention was the only predictor of intrinsic reward sensitivity, whereas executive functioning, attention and group predicted extrinsic reward. Conclusion: This study demonstrates the relationship between intrinsic–extrinsic reward hyposensitivity and apathy post-TBI. These results may be integrated into future trials to improve apathy in clinical practice.

show abstract

Section: Discussionsupporting

confidence: 90%

Contributions of intrinsic and extrinsic reward sensitivity to apathy: Evidence from traumatic brain injury.

Quang¹,

Kumfor²,

Balleine³

et al. 2022

Neuropsychology

Self Cite

View full text Add to dashboard Cite

show abstract

“…In fact, during the acute post-stroke phase, aphasia correlates with apathy severity and PWA are also less likely to show resolution of such motivation deficits[ 121 ]. Apathy is usually proxy-assessed through the SAS[ 40 ], the Apathy Evaluation Scale[ 123 ], the Apathy Inventory-Clinical Scale[ 122 ] or the Dimensional Apathy Scale[ 124 ] in addition to the NPI[ 24 ]. Actigraphy records from an unaffected arm may serve to measure poststroke apathy in PWA, but should not be used alone[ 125 ].…”

Section: Resultsmentioning

confidence: 99%

Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia

Edelkraut¹,

López-Barroso²,

Torres‐Prioris³

et al. 2022

WJP

View full text Add to dashboard Cite

BACKGROUND Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders. AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia. METHODS Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416). RESULTS The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety. CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.

show abstract

“…Lastly, the sv‐PPA group displayed prominent motivational disturbance at initial presentation and throughout the disease course. Apathy and amotivated behaviour in sv‐PPA has received increased attention in the literature, with recent findings suggesting this clinical feature extends to emotional blunting and indifference towards others (Modirrousta et al, 2013; Quang et al, 2021; Shaw et al, 2021; Wong et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal changes in behaviour, mood and functional capacity in the primary progressive aphasia variants

Foxe

Irish

Ramanan

et al. 2021

Eur J of Neuroscience

Self Cite

View full text Add to dashboard Cite

Primary progressive aphasia (PPA) is a neurodegenerative clinical syndrome characterised by a progressive decline in speech and language functions. Deficits in behaviour, mood and functional capacity are reported in PPA but are less well understood. This study examined the PPA variants' profiles on these domains at initial presentation and over time and evaluated their relations to overall cognitive ability. Behaviour, mood and functional capacity were measured annually (over $6 years) in 145 individuals diagnosed with PPA (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA] and 60 semantic variants [sv-PPA]) using the Cambridge Behavioural Inventory-Revised (CBI-R) carer questionnaire. Overall cognition was assessed annually with the Addenbrooke's Cognitive Examination-III. Distinct profiles were observed across PPA syndromes. Notably, sv-PPA carers reported greater behavioural,eating and motivational disturbances than the other PPA variants throughout the disease course. Reported memory problems were also greater in sv-PPA and lv-PPA than in nfv-PPA across all time points. These disturbances occurred in the context of the sv-PPA group demonstrating a slower rate of cognitive decline than the lv-PPA group and a parallel rate to that found in the nfv-PPA group. Associations between overall cognition and the CBI-R domains were trivial at baseline assessment; however, distinct profiles emerged when mapping each syndrome's overall cognitive decline with their behavioural, mood and functional trajectories. Our findings demonstrate that the evolving behaviour, mood and functional capacity profiles of the PPA variants are distinct and extend beyond the primary disorder of language. These findings have important implications for clinical management and caregiver education in PPA.

show abstract

Beyond language impairment: Profiles of apathy in primary progressive aphasia

Cited by 17 publications

References 85 publications

Contributions of intrinsic and extrinsic reward sensitivity to apathy: Evidence from traumatic brain injury.

Contributions of intrinsic and extrinsic reward sensitivity to apathy: Evidence from traumatic brain injury.

Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia

Longitudinal changes in behaviour, mood and functional capacity in the primary progressive aphasia variants

Contact Info

Product

Resources

About