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Abstract
Objective: We sought to identify apathy metabolic bases in Parkinson disease (PD).
Methods: A total of 45 patients with PD who were not clinically depressed (Montgomery-Åsberg Depression Rating Scale [MADRS] <21) and had no dementia (Mattis Dementia Rating Scale [MDRS] >130) were assessed with the Apathy Evaluation Scale (AES) and underwent a resting-state F-18 fluorodeoxyglucose PET (FDG-PET) scan. A motor assessment comprising the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) was conducted and total levodopa equivalent daily dose (LEDD) was calculated. Imaging data were analyzed with statistical parametric mapping. Age, LEDD, and MDRS scores were introduced as covariates.
Results: Positive correlations were observed between the AES score and cerebral metabolism in the right inferior frontal gyrus (Brodmann area [BA] 47), right middle frontal gyrus (BA 10), right cuneus (BA 18), and right anterior insula (BA 13). Negative correlations were observed between the AES score and cerebellar metabolism in the semilunar lobules bilaterally, within the posterior lobe. Using an AES score equal to or above 42 to define clinical apathy, prevalence in our patient group was 17.8%. The AES score was negatively correlated with the MDRS score and positively correlated with the “retardation” subscore of the MADRS. It was not correlated with either UPDRS III or LEDD.
Conclusions: Results indicate that the frontal, temporal, and cerebellar areas known to be involved in reward, emotion, and cognition are also implicated in apathy in patients with PD without dementia or depression. Their roles in the etiopathology of apathy are discussed.
GLOSSARY
- ACA=
- anterior cerebral artery;
- ACC=
- anterior cingulate cortex;
- AES=
- Apathy Evaluation Scale;
- AES-C=
- clinician version of the Apathy Evaluation Scale;
- BA=
- Brodmann area;
- BOLD=
- blood oxygen level-dependent;
- DSM-IV=
- Diagnostic and Statistical Manual of Mental Disorders, 4th edition;
- FDG-PET=
- F-18 fluorodeoxyglucose PET;
- LARS=
- Lille Apathy Rating Scale;
- LEDD=
- levodopa equivalent daily dose;
- MADRS=
- Montgomery-Åsberg Depression Rating Scale;
- MDRS=
- Mattis Dementia Rating Scale;
- MINI=
- Mini-International Neuropsychiatric Interview;
- OFC=
- orbitofrontal cortex;
- PD=
- Parkinson disease;
- PFC=
- prefrontal cortex;
- STN-DBS=
- subthalamic nucleus deep brain stimulation;
- TMT=
- Trail Making Test;
- UPDRS-III=
- Unified Parkinson's Disease Rating Scale Part III;
- VBM=
- voxel-based morphometry;
- WCST=
- Wisconsin Card Sorting Test
Footnotes
Editorial, page 1082
Supplemental data at www.neurology.org
- Received October 19, 2011.
- Accepted March 21, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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