The anatomy of apathy: A neurocognitive framework for amotivated behaviour.
The anatomy of apathy: A neurocognitive framework for amotivated behaviour.
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DOI：
10.1016/j.neuropsychologia.2017.07.003
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发表时间：
2018-09
期刊：
影响因子：
2.6
通讯作者：
Husain M
中科院分区：
文献类型：
--
作者：
Le Heron C;Apps MAJ;Husain M
冷漠是一种与许多神经系统疾病相关的衰弱综合征，包括几种常见的神经退行性疾病，如帕金森病和阿尔茨海默病，以及局灶性病变综合征，如中风。在这里，我们回顾了神经影像学研究，以确定冷漠的解剖学相关性，在大脑疾病。我们的分析表明，冷漠与特别是背侧前扣带皮层（dACC），腹侧纹状体（VS）和连接的大脑区域的中断密切相关。值得注意的是，这些变化在临床疾病和成像模式中是一致的。回顾神经影像学的发现，使我们能够发展一个神经认知框架，考虑潜在的冷漠机制。根据这一观点，一组相互关联的大脑区域--以dACC和VS为核心--在正常的动机行为中起着至关重要的作用。具体来说，我们认为，激励行为需要愿意工作，继续工作，并学习什么是值得工作。我们认为，这些过程中的任何一个或多个缺陷可能导致冷漠的临床综合征，并概述了测试这一假设的具体方法。对冷漠背后的机制有了更丰富的神经生物学理解，最终将有助于开发针对这种致残性疾病的有效疗法。神经系统疾病中冷漠的一致解剖学基础。影像学显示与前扣带和腹侧纹状体破坏密切相关。三个核心组成部分提供了一个与这些回路相关的动机框架：选择何时采取行动，维持行动和学习行动的价值。这种方法为冷漠的机制提供了可检验的假设。
Apathy is a debilitating syndrome associated with many neurological disorders, including several common neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease, and focal lesion syndromes such as stroke. Here, we review neuroimaging studies to identify anatomical correlates of apathy, across brain disorders. Our analysis reveals that apathy is strongly associated with disruption particularly of dorsal anterior cingulate cortex (dACC), ventral striatum (VS) and connected brain regions. Remarkably, these changes are consistent across clinical disorders and imaging modalities. Review of the neuroimaging findings allows us to develop a neurocognitive framework to consider potential mechanisms underlying apathy. According to this perspective, an interconnected group of brain regions – with dACC and VS at its core – plays a crucial role in normal motivated behaviour. Specifically we argue that motivated behaviour requires a willingness to work, to keep working, and to learn what is worth working for. We propose that deficits in any one or more of these processes can lead to the clinical syndrome of apathy, and outline specific approaches to test this hypothesis. A richer neurobiological understanding of the mechanisms underlying apathy should ultimately facilitate development of effective therapies for this disabling condition. A consistent anatomical basis for apathy across neurological disorders. Imaging reveals close ties to anterior cingulate and ventral striatum disruption. Three core components provide a framework for amotivation linked to these circuits: Choosing when to act, sustaining action and learning the value of actions. This approach provides testable hypotheses of the mechanisms underlying apathy.
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