Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review

Abstract

Objective: Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. Method: Systematic literature review. Results: The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. Conclusions: Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.

Are Apathy and Depressive Symptoms Related to Vascular White Matter Hyperintensities in Severe Late Life Depression?

“…In particular, the odds of having white matter changes were over 4 for late compared with early-onset depression (EOD), with a first episode of depression before the age of 55 years. These results are in accordance with a recent systematic review of Pimontel et al 16 showing that apathy in LLD appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks.…”

Amygdala: Neuroanatomical and Morphophysiological Features in Terms of Neurological and Neurodegenerative Diseases

“…This could be a main reason for AD associated depression. Similar findings were noted in patients with dementia, showing that apathy was prevalent in patients with neuroanatomical disfunction of central brain structures, including the amygdala [ 84 ].…”

“…This could be a main reason for AD associated depression. Similar findings were noted in patients with dementia, showing that apathy was prevalent in patients with neuroanatomical disfunction of central brain structures, including the amygdala [84]. Lewy Body Diseases (LBDs), such as dementia with Lewy bodies and Parkinson disease (PD), develop in a certain pattern from caudal to rostral: spreading from brain stem to midbrain and limbic lobe, then reaching neocortex and finally affecting the primary, sensory and motor cortices [73].…”

“…Atrophy in the BA, the storing of Aβ plaques in the cortical transition zone, and the loss of cells in the corticomedial group may lead to AD [73]. This important brain structure has the main role in depression formation in patients with AD, because of increased functional connectivity between the orbitofrontal and medial prefrontal cortex [84]. Lesions in the BLA lead to disorders in the reward assessment system [85].…”

Resting-State Functional Connectivity Signatures of Apathy in Community-Living Older Adults

“…Neuroimaging studies of apathy have predominantly focused on individuals with brain diseases or psychiatric conditions, including stroke (Kang and Kim, 2008;Onoda et al, 2011;Rochat et al, 2013;Kumral et al, 2019), neurodegeneration (Apostolova et al, 2007;Marshall et al, 2007;Reijnders et al, 2010;Tunnard et al, 2011;Eslinger et al, 2012;Carriere et al, 2014;Jones et al, 2019), and late-life depression (Lavretsky et al, 2007;Alexopoulos et al, 2013;Yuen et al, 2014). Reviews integrating structural and functional correlates of apathy across different disorders have identified regions commonly associated with apathy, including the anterior cingulate cortex (ACC), ventral striatum (nucleus accumbens; NAcc), thalamus, orbitofrontal cortex (OFC), and insula (IC) (Kos et al, 2016;Le Heron et al, 2018;Pimontel et al, 2020). These are considered key nodes in networks responsible for decision-making, initiating effortful activities, and reward-and salience-related processing (Kos et al, 2016;Le Heron et al, 2018;Pimontel et al, 2020).…”