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Invited Commentary: The Vascular Apathy Hypothesis and Its Meaning for Clinicians

Published:October 22, 2022DOI:https://doi.org/10.1016/j.jagp.2022.10.004
      For geriatric psychiatrists, apathy is one of the most challenging syndromes to diagnose and treat. Although it is a common syndrome characterized by a lack of motivation,
      • Robert P
      • Onyike CU
      • Leentjens AF
      • et al.
      Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders.
      it is striking to observe how frequently apathy is missed or misdiagnosed in clinical settings. It often underlies treatment resistance, which can leave patients, caregivers, and clinicians feeling frustrated with a perceived lack of progress. Apathy is the most common neuropsychiatric symptom of dementia, but it is also seen in numerous neurological diseases including stroke and Parkinson's disease, and it may co-occur with depression.
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      Linked Article

      • Strengths and Weaknesses of the Vascular Apathy Hypothesis: A Narrative Review
        The American Journal of Geriatric Psychiatry
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          As a clinical syndrome, apathy is characterized by diminished motivation, leading to a reduction in emotions, thoughts, and initiative to perform activities.1 Cerebral small vessel disease (CSVD), an atherosclerotic disease of the brain causing ischemic changes in the surrounding brain tissue, is suspected to be a cause of this frequent and disabling syndrome.2,3 Neuroimaging markers of CSVD include white matter hyperintensities (WMH), cerebral microbleeds, lacunar infarcts, and visible perivascular spaces.
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