No abstract available.
Apathy ; Carotid Arteries ; Stroke

Apathy is a common problem observed in many neuropsychiatric disorders. In the past, apathy was a conventional term that designated an absence of feeling and a flattening of affective responses. But recent research has produced the concept that the core feature of apathy is a lack of motivation and manifests as diminished goal-directed behavior, cognition, and emotion, including initiation and responsiveness deficiency. Now, apathy tends to be considered as a distinct clinical symptom and syndrome, but it is still conceptually ill-defined and there is no definite consensus on diagnostic criteria. Several rating scales such as the Apathy Evaluation Scale (AES) and Apathy Scale (AS) have been developed that assist in making a diagnosis of apathy and a measurment of severity. Neuroimaging studies have indicated that apathy is primarily a dysfunction of the frontal-subcortical system, which is called the motivational circuit, and can be divided into auto-activation, cognitive, emotional subtypes by various frontal-subcortical circuits which have been damaged. Dopamine (DA) and acetylcholine (Ach) have important roles in this area. Many studies have focused on the relationship between apathy and depression. The core feature of apathy is distinguished from depression, but they share too many incidental aspects to be divided off completely. It is because the diagnostic criteria of depression had developed before the new concept of apathy was proposed, so symptoms of apathy were included in the diagnostic criteria of depression. There is a need for consensus of definition and diagnostic criteria of apathy to facilitate future research, which may be able to get at the root of other neuropsychiatric disorders such as depression.
Acetylcholine ; Apathy ; Cognition ; Consensus ; Depression ; Dopamine ; Motivation ; Neuroimaging ; Weights and Measures

BACKGROUND: The evaluation of behavioral and psychological symptoms (BPSD) is important for the diagnosis and management of Alzheimer's disease (AD). Previous studies have reported the prevalence and severity of BPSD changes. However, these studies have mainly focused on the AD patients with mild to moderate severity. Our study investigated the BPSD in AD patients with more advanced stages and looked at the prevalence and severity of BPSD with the progression of disease. METHODS: One hundred thirty six patients with probable AD received the Korean version of the neuropsychiatric inventory along with the expanded version of the Korean Clinical Dementia Rating Scale (CDR) and the Korean version of the Mini-Mental State Examination (K-MMSE). RESULTS: The mean K-MMSE, CDR and NPI scores were 10.1 (SD=7.1), 2.0 (SD=1.5) and 32.7 (SD=26.2), respectively. CDR and K-MMSE scores did not correlate with the total NPI score but did correlate with some of the subscale NPI scores. Apathy had the highest relationship to CDR (r=0.39, p<0.01). Aberrant motor was most correlated with the total score of NPI (r=0.65, p<0.01). The mean number of positive NPI items was 4.3, which ranged from 2.1 (CDR 5 group) to 5.4 (CDR 2 group). The most frequent symptom was apathy and the least was euphoria. The severity of BPSD increased as the dementia severity increased to CDR 2 except apathy. Night-time behavior and anxiety were frequent in the early stages whereas apathy and aberrant motor were frequent symptoms in later stages. CONCLUSIONS: These observations suggest that BPSD is relatively independent of cognitive functions. The prevalence and severity of BPSD with the exclusion of apathy, increased as the dementia severity increased from CDR 0.5 to CDR 2 and then declined declined except apathy.
Alzheimer Disease* ; Anxiety ; Apathy ; Dementia ; Diagnosis ; Euphoria ; Humans ; Prevalence

BACKGROUND: Behavioral and psychological symptoms (BPS) following acute middle cerebral artery (MCA) infarcts are not uncommon, but these have been considered to be less important than physical disability. The purpose of this study is to evaluate the characteristics of BPS following acute MCA infarcts by using the Korean version of neuropsychiatric inventory (K-NPI). METHODS: Fifty-one patients with acute MCA infarcts were studied using the K-NPI scale. We investigated newly developed BPS after the onset of MCA infarcts by interviewing the primary caregiver of each patient. We then evaluated factors related to the BPS such as lesion laterality and various characteristics of the subjects. RESULTS: The most common BPS following acute MCA infarcts was depression. It was present in 69% of the patients, followed by anxiety (61%), agitation (39%), apathy (29%) and irritability (25%). Depression and anxiety were associated with left MCA lesion, whereas apathy was associated with right lesion. Patients with recurrent MCA infarcts more often had depression and anxiety than those without (p=0.03, p=0.04, respectively). Patients with MCA infarcts caused by cardioembolism more often had irritability and disinhibition than those with other subtypes (p=0.01, p=0.02, respectively). CONCLUSIONS: BPS is frequently observed following acute MCA infarcts. Therefore, early and adequate assessment of post stroke BPS and appropriate therapy may be important in patients with MCA infarcts.
Anxiety ; Apathy ; Caregivers ; Depression ; Dihydroergotamine ; Humans ; Middle Cerebral Artery* ; Stroke

OBJECTIVES: The purpose of this study is to determine the amount of burden placed on the caregivers of patient diagnosed as dementia and depression. The study is intended 1) to compare depression and anxiety levels of caregivers with the degree of their burden and 2) to analyze and determine the clinical factors that contributed to such levels of depression and anxiety. METHODS: 93 individuals with dementia, suspected dementia, and depression were selected between February 2001 and April 2001. In order to determine the patients decreased cognitive function and psychopathology MMSE-K and NPI were used. In addition, the burden scale recently developed from Zarit, HARS, HDRS were used on 58 caregivers. RESULTS: The MMSE-K figure form in the demented group was significantly lower than that of the non-demented group, 15.65 and 25.55 respectively. As for the NPI figures, the demented group posted higher numbers compared to the non-demented group. Among the individuals in the demented group, apathy, aberrant motor behavior, and night-time behavior showed the highest figures. On the caregiver's burden point, the demented group showed higher scores compared to the non-demented group with 76.62 and 58.30 respectively. The caregiver's burden point compared to the HDRS and HARS figures provided an evidence that there is a signigicant relationship between the groups. CONCLUSIONS: The caregiver's burden point is found to be more affected by the demented patient's progressive phase of psychopathology than conditions due totheir decreased cognitive functions. There is a probability that an increase in the caregivers burden is likely to contribute to an increase in the caregiver's depression and anxiety.
Aged* ; Anxiety ; Apathy ; Caregivers ; Dementia ; Depression ; Humans ; Psychopathology*

OBJECTIVES : To define the neuropsychiatric features of amnestic-type Mild Cognitive Impairment (aMCI) and compare them with those of mild Alzheimer's disease (AD). METHODS : The study participants included 353 aMCI and 500 mild AD patients. The Neuropsychiatric Inventory (NPI) was used to assess the neuropsychiatric symptoms in two groups. RESULTS : 65.4% of aMCI and 85.4% of mild AD patients exhibited neuropsychiatric symptoms. The most common symptoms in the aMCI group were depression (33.7%), irritability (29.5%), sleep/ night-time behavior (23.2%), apathy (21.5%), and anxiety (21.2). The most common features in the mild AD group were depression (52.4%), apathy (52%), irritability (41.6%), and anxiety (41%). There were significant differences between the aMCI and mild AD groups in 11 NPI symptoms except sleep/night-time behavior. CONCLUSION : A high prevalence of neuropsychiatric symptoms were associated with aMCI, especially mood disturbances and apathy. In contrast, psychotic symptoms were rare. The neuropsychiatric symptoms observed in aMCI were similar to those of mild AD.
Alzheimer Disease ; Anxiety ; Apathy ; Depression ; Humans ; Mild Cognitive Impairment ; Prevalence

OBJECTIVES : To define the neuropsychiatric features of amnestic-type Mild Cognitive Impairment (aMCI) and compare them with those of mild Alzheimer's disease (AD). METHODS : The study participants included 353 aMCI and 500 mild AD patients. The Neuropsychiatric Inventory (NPI) was used to assess the neuropsychiatric symptoms in two groups. RESULTS : 65.4% of aMCI and 85.4% of mild AD patients exhibited neuropsychiatric symptoms. The most common symptoms in the aMCI group were depression (33.7%), irritability (29.5%), sleep/ night-time behavior (23.2%), apathy (21.5%), and anxiety (21.2). The most common features in the mild AD group were depression (52.4%), apathy (52%), irritability (41.6%), and anxiety (41%). There were significant differences between the aMCI and mild AD groups in 11 NPI symptoms except sleep/night-time behavior. CONCLUSION : A high prevalence of neuropsychiatric symptoms were associated with aMCI, especially mood disturbances and apathy. In contrast, psychotic symptoms were rare. The neuropsychiatric symptoms observed in aMCI were similar to those of mild AD.
Alzheimer Disease ; Anxiety ; Apathy ; Depression ; Humans ; Mild Cognitive Impairment ; Prevalence

Secondary mania is closely linked to neurocircuitry defects. Frontal-subcortical circuits, in particular, play a major role in the affective, motor and cognitive symptoms of secondary mania. In this paper, we present the three main frontal-subcortical circuits : the dorsolateral prefrontal circuit, which mediates executive functions (i.e., the organization of information to facilitate a response) ; the anterior cingulate circuit, which is involved in motivated behavior ; the orbitofrontal circuit, which has medial (i.e., integration of visceral-amygdalar functions with the internal state of the organism) and lateral divisions (i.e., integration of limbic and emotional information into contextually appropriate behavioral responses). Impaired executive functions, apathy, disinhibition and impulsivity are hallmarks of frontal-subcortical circuit dysfunction. The various neuropsychiatric manifestations of secondary mania may result from disturbances that have a direct or indirect impact on the integrity or functioning of these loops.
Apathy ; Bipolar Disorder* ; Executive Function ; Impulsive Behavior ; Neurobehavioral Manifestations

OBJECTIVE: We performed a cross-sectional study to examine the relationship between premorbid personality and behavioral and psychological symptoms in dementia (BPSD) in Korean patients with Alzheimer's disease (AD). METHODS: We assessed 103 patients diagnosed with AD for the presence of BPSD over the disease course by using the caregiver-rated Korean version of the Neuropsychiatric Inventory (K-NPI) and for the premorbid personality by using a retrospective version of the NEO-Five Factor Inventory questionnaire completed by informants. RESULTS: Premorbid neuroticism was significantly correlated with delusion, agitation, anxiety, disinhibition, total K-NPI score (p<0.05), and sleep disturbances (p<0.01). Lower premorbid conscientiousness was significantly correlated with symptoms of hallucinations and sleep disturbances in AD patients (p<0.05). However, premorbid neuroticism and low premorbid conscientiousness did not act as independent predictors for "psychosis, hyperactivity," or "moods, apathy, frontal" factors of BPSD. CONCLUSION: Premorbid personality was associated with the K-NPI score, but was not observed to be potential predictors of BPSD.
Alzheimer Disease* ; Anxiety ; Apathy ; Cross-Sectional Studies ; Delusions ; Dementia* ; Dihydroergotamine ; Hallucinations ; Humans ; Surveys and Questionnaires ; Retrospective Studies

Disulfiram, tetraethylthiuram disulfide, has been used in the clinical treatment of alcoholism since 1948. Aside from the manifestations of a disulfiram-alcohol reaction, disulfiram causes direct toxic side effects including psychiatric, cardiovascular, hematologic and neurologic disorders. The most frequent neurologic side effects are drowsiness, apathy, headache, decreased sexual potency, neuropathy, and optic neuritis. We describe a 26-year-old man who insidiously developed a distal synunetric sensorimotor polyneuropathy after seven years of disulfiram ingestion confirmed by nerve biopsy. He showed nearly complete resolution after the disulfiram was stopped.
Adult ; Alcoholism ; Apathy ; Biopsy ; Disulfiram* ; Eating ; Headache ; Humans ; Nervous System Diseases ; Optic Neuritis ; Polyneuropathies ; Sleep Stages