Pluck, Graham Christopher; (2001) Neuropsychological aspects of apathy in Parkinson's disease. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Patients with Parkinson's disease (PD) are often described as failing to show a normal range of goal directed behaviours. Among explanations that have been proposed for this apathy are effects of personality, depression and disability. This thesis investigated the phenomena from a neuropsychological perspective. It was found that PD patients are significantly more apathetic than equally disabled osteoarthritis patients, indicating that their apathy is a primary symptom of the disease. No evidence was found relating apathy in PD to personality, depression, anxiety or anhedonia. It was found that the PD patients with high levels of apathy were impaired on cognitive tests, but only those that required executive control. Using visual-search tasks it was shown that this association could not be accounted for by a reduction in effort applied. It was also shown that attention to novelty or curiosity arousing stimuli were not reduced in PD patients with apathy. However, it was shown that they persevered on task for longer than patients with low apathy in conditions in which there was no prompt to stop. This may be due to a willed action deficit that retards actions in situations that lack formal guidance. To test this hypothesis further, a task was developed to record response times for stimuli and will driven actions and was validated in a single case study of an akinetic patient. Although PD patients with high apathy appeared to show a willed action deficit, it was also found that other executive impairments might confound interpretation. It is concluded that apathy in PD may be an expression of executive impairment, but further research is needed to assess the relative contributions of cognitive and motivational dysfunction. There are significant implications to the findings, including the conceptualisation of apathy as a symptom and the potential for therapeutic interventions with apathetic patients.

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