Apathy meaning
To understand the concept of apathy We refer to the definition proposed by Robert Marin. These conceptualize it as a “loss of motivation not attributable to a compromise of the state of consciousness, to a cognitive impairment or to an emotional distress”. However, an agreement must be found on defining what is meant by “motivation”.
We could define the motivation as a guide to the behavior necessary to be able to implement a conduct aimed at achieving a purpose. Being motivated to start an action can be considered the link between an idea and a behavior.
It can be strange, but not always the apathetic subjects They are without motivation.
There are situations of terrible apathy in which we even witness very intense motivation levels, while unable to start moving. Clinicians know well the expressions of many patients: “I would love … .. but I can’t”.
The motivational levels are adequate but unfortunately the steps to be implemented necessary to achieve an end are lacking. Many cases of apathy The process that should lead to the achievement of the purpose stops immediately after the creative phase.
Apathy and depression
The different degree of this fracture determines the different levels of gravity of apathy (a diametrically opposite process we observe it in the impulsiveness in which thought and action appear merged).
A confusion that is often made by clinics, and not, concerns the association between apathy and depressive state. Apatia is not necessarily connected to a depressive disorder: many times the apathetic subjects do not burst with happiness but they are not particularly sad.
Certainly it is possible to observe apathetic traits In depressed subjects but in general they are accompanied to other elements: the absence of feeling pleasure in things (anedonia) and the consequent sense of shame or fault for such difficulty often prevails.
In apathetic subjects, sometimes a component of poor empathy prevails or poor awareness of self that hardly leads them to experience feelings of guilt.
It is of fundamental importance keep depressive disorders from the paintings of apathy distinctnot only from a conceptual point of view. In fact, many antidepressant pharmacological treatments, which bring excellent results in the first case, can even make the latter get worse.
Biological bases of apathy
Apatia would also see the involvement of different neuroanatomical structures compared to those involved in depressive disorder. Sometimes it derives from brain, traumatic or vascular lesions, which are manifested at the level of the frontal lobes or ganglia of the base. Other times it can be the clinical signal of the debut of a demented framework that manifests itself even before the mnesic deficit or executive functions.
From a neurophysiological point of view apathy could be the result of three different processes:
- a compromise of the connection of emotion to the action;
- a cognitive inertia;
- A deficit of the “self-activation”.
In other words, theapathy It can be the result of impairment at any level of the process through which we formulate ideas. As well as we manage to attribute an emotional value to the objective to be achieved and we place ideas to the behavioral implementation.
Neuroimaging studies
From neuroimaging studies and brain lesions due to different causes, it is observed that the prefrontal twenty-media and orbitofrontal cortex turns out to be a fundamental structure in associating emotions to carrying out a task.
This brain area is older, evolutionary speaking, compared to surface and lateral cortical alter regions (such as the back-lateral prefrontal areas). This does not surprise us since the prefrontal cortex is anatomically near the limbic areas (amygdala and hippocampus) that regulate appetitive drivs.
Cognitive inertia
In the defined situation of cognitive inertia it is not the disconnection between emotion and action that generates it state of apathy but the elaboration of the objective in itself. Being able to formulate thoughts and articula them in an articulated sequence that leads to the complete execution of a task is a high -order cognitive ability, recent from an evolutionary point of view.
A lesion at the level of the frontocortical regions or other parts connected to it in a circuit (such as eg the thalamus) can lead to large difficulties even in operations considered simple. For example, dressing, precisely because of the difficulty in representing the cognitive sequence necessary to correctly perform the given task.
These paintings can observe themselves following strokes or vascular dementia or front -time.
Auto activation deficits
The situation of a apathetic picture derived from a self-activation deficit. The stimuli that determine a human conduct can derive from both the internal and external environment.
In subjects with focal lesions at the level of the nuclei of the base, although not observing deficit of the motor function, a complete inability to carry out any action can be observed. They can remain motionless in the same position or even not to utter a word for long periods. This is considered the more serious form of apathy, called Abulia.
Nonetheless, these subjects can respond correctly when requests are formulated or when they are guided in carrying out activities. It is believed that in these situations it lacks the inner ability to formulate a correct internal guide to the task, which does not happen when it comes from the outside.
The role of the base ganglia
The ganglia of the base would be the structures responsible for integrating, organizing and filtering the information from inside or outside adequately. Focal lesions at the level of the base ganglia – such as the pale globe or the thalamus – can determine the arrival of a series of information disorganized to the prefrontal cortex that prevent the implementation of any conduct independently.
Neuroimmagine studies in apathetic subjects with basal ganglia lesions detect a marked reduction in the activity of the prefrontal cortex, even if the latter is intact from a structural point of view. The neurotransmitter systems that would be compromised in the various forms of apathy they would primarily concern dopaminergic paths. It is no coincidence that it is precisely on Dopamino-agonist drugs which is concentrating research to improve apathy as a symptom.
Unfortunately, for the care of the causes upstream still it takes time. We have so far spoken of the forms of apathy derived from organic problems.
Different is the conceptualization of paintings in which apathetic aspects can derive from personality structures that can benefit from a cognitive behavioral intervention and for which we will dedicate further study.
