The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration

Abstract

Background: Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases. Objective: To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response). Method: We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks. Results: The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task’s construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring. Conclusion: Our work presents a novel experimental task for measuring spontaneous action initiation—a key symptom of apathy—and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.

Verbal and nonverbal fluency in amyotrophic lateral sclerosis

“…Thus, if a primary intrinsic response generation deficit is present in ALS, reduced total output would be evident on word, design, gesture and ideational fluency tasks, across the entire duration of the task. An intrinsic response generation impairment may be related to apathy, as suggested by recent evidence in neurodegenerative disorders (Horne et al, 2023). Apathy is a reduction in self-initiated behaviour, and fluency tasks require self-initiation in order to generate responses.…”