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

Abstract

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.

Neuropsychiatric symptoms after moderate-to-severe traumatic brain injury in Vietnam: Assessment, prevalence, and impact on caregivers

“…Furthermore, it is still unclear how cultural factors such as spiritual and religious beliefs modulate the presentation and impact of NPS after TBI in Vietnam. While neural and cognitive mechanisms are still an important aspect to explore (Quang, Kumfor et al, 2022), cross-cultural differences at the individual level, such as family roles and expectations, and religious beliefs, can contribute to different representations of NPS. For example, based on our clinical observations, when a Vietnamese individual shows hallucination symptoms, they have a tendency to seek religious explanations rather than scientific evidence.…”

A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI)

“…Detachment within the established HiTOP model is considered a separate dimension from the internalizing spectrum, with links to psychoticism. 69 There may be a multitude of reasons why individuals with moderate-severe TBI report high levels of detachment, including impaired reward processing and apathy, 70 social cognition deficits (e.g., reduced theory of mind), 71 loss of self-confidence, 1 and fewer available sources of pleasure (e.g., hobbies, friends) as a consequence of disability and social isolation.…”

A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI)

“…Detachment within the established HiTOP model is considered a separate dimension from the internalizing spectrum, with links to psychoticism (Kotov et al, 2020). There may be a multitude of reasons why individuals with moderate-severe TBI report high levels of detachment, including impaired reward processing and apathy (Quang et al, 2022), social cognition deficits (e.g., reduced theory of mind; McDonald, 2013), loss of self-confidence (Hibbard et al, 2000), and fewer available sources of pleasure (e.g., hobbies, friends) as a consequence of disability and social isolation.…”