Apathy and its therapeutic approaches in rehabilitation facilities

Abstract

Apathy is defined as a deficiency in overt behavioral, emotional and/or cognitive components of goa-by Marin and as the quantitative reduction of voluntary, goal-directed behaviors by Levy and Dubois. The underlying mechanisms responsible for apathy can be divided into three subtypes: emotional-affective processing, cognitive processing and auto-activation processing. Apathy is diagnosed based on clinical signs and symptoms, and the Yaruki Score, the Japanese version of the Apathy Scale developed by Starkstein, the Neuropsychiatric Inventory and the Clinical Assessment for Spontaneity, if necessary, should be used to evaluate the features and severity of this condition. Furthermore, the brain lesions responsible for apathy should be identified using magnetic resonance imaging and/or brain receptor scintigraphy. Pharmacological treatments for apathy include the administration of dopaminergic and noradrenergic agents in patients with stroke, traumatic brain injury or Parkinsonʼs disease and cholinesterase inhibitors in those with dementia. Non-pharmacological treatments consist of external cueing, the use of checklists, cognitive training, interviewing and external compensation, as well as music therapy, although the efficacy of these treatments has not yet been established. Further studies on the effects of training in patients with apathy should be performed taking into consideration the causes, underlying brain lesions, types, severity and progression of apathy.