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Association between altered neurochemical metabolites and apathy in patients with Alzheimer’s disease.

Association between altered neurochemical metabolites and apathy in patients with Alzheimer’s disease.
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Yeh YC, Li CW, Kuo YT, Huang MF, Liu TL, Jaw TS, Yang YH, Kuo KC, Chen CS,


Yeh YC, Li CW, Kuo YT, Huang MF, Liu TL, Jaw TS, Yang YH, Kuo KC, Chen CS, (click to view)

Yeh YC, Li CW, Kuo YT, Huang MF, Liu TL, Jaw TS, Yang YH, Kuo KC, Chen CS,

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International psychogeriatrics 2017 11 16() 1-8 doi 10.1017/S1041610217002381
Abstract
BACKGROUND
Apathy is a condition characterized by a lack of motivation that manifests in emotional, behavioral, and cognitive domains. Although previous studies have indicated that apathy is associated with frontal lesions, few studies have focused on the different subdomains of apathy, and no in vivo human biochemical data have been obtained to examine the neurochemical changes related to apathy in patients with Alzheimer’s disease (AD). Thus, we investigated the frontal neurochemical alterations related to apathy among patients with AD using proton magnetic resonance spectroscopy (1H MRS).

METHODS
Apathy was assessed through the Apathy Evaluation Scale (AES). 1H MRS was performed to measure neurochemical metabolite levels in the anterior cingulate region and right orbitofrontal region. Associations between neurochemical metabolites and the total score and subscores of each domain of the AES were analyzed.

RESULTS
Altogether, 36 patients completed the study. Patients with lower N-acetylaspartate/creatine ratios (NAA/Cr) in the anterior cingulate region demonstrated higher total apathy scores (β = -0.56, p = 0.003) with adjustments for age, gender, educational level, dementia severity, and depression severity. In a further analysis, a lower NAA/Cr in the anterior cingulate region was associated with all subdomains of apathy, including cognition (β = -0.43, p = 0.028), behavior (β = -0.55, p = 0.002), and emotion (β = -0.50, p = 0.005). No statistically significant associations were discovered in the right orbitofrontal region.

CONCLUSIONS
Our results suggest that apathy, in each of its cognitive, behavioral, or emotional subdomains is associated with brain neurochemical alterations in the anterior cingulate region. Abnormal neuronal integrity over the anterior cingulate cortex may exhibit a central role in causing all aspects of apathy in patients with AD.

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