TY - JOUR
T1 - Strengths and Weaknesses of the Vascular Apathy Hypothesis
T2 - A Narrative Review
AU - Wouts, Lonneke
AU - Marijnissen, Radboud M.
AU - Oude Voshaar, Richard C.
AU - Beekman, Aartjan T. F.
N1 - Publisher Copyright: © 2022 The Authors
PY - 2023/3
Y1 - 2023/3
N2 - The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
AB - The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
KW - Apathy
KW - cerebral small vessel disease
KW - white matter hyperintensities
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85140791367&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36283953
UR - http://www.scopus.com/inward/record.url?scp=85140791367&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jagp.2022.09.016
DO - https://doi.org/10.1016/j.jagp.2022.09.016
M3 - Review article
C2 - 36283953
SN - 1064-7481
VL - 31
SP - 183
EP - 194
JO - The American Journal of Geriatric Psychiatry
JF - The American Journal of Geriatric Psychiatry
IS - 3
ER -