Trends in Neurosciences
ReviewNegative symptoms: the ‘pathology’ of motivation and goal-directed behaviour
Section snippets
Phenomenology of negative symptoms and apathy
The term ‘negative symptoms’ has its origins in the writings of Hughlings-Jackson2, and his distinction between positive or ‘florid’ symptoms, and negative or ‘defect’ symptoms. Negative symptoms resulted from a true loss of function, whereas positive symptoms represented the disorganization or exaggeration of existing functions. It was in relation to schizophrenia that negative symptoms found a modern home, as a reworking of Bleuler’s original description of the disease ‘Many schizophrenics
Negative symptoms and apathy in neurological disorders
Recent case reports and series (for example 6, 7), plus group studies that used standardized instruments such as the SANS, Apathy Evaluation Scale (AES)8 and Neuropsychiatric Inventory (NPI)9 have greatly increased our appreciation of the widespread occurrence of apathy or negative symptoms in neurological disorders (Table 2).
As with negative symptoms in schizophrenia, doubts are often raised about the status of apathy as a distinct neurobehavioural phenomenon separate from other symptoms,
Neurobiological substrate of apathy and negative symptoms
Table 2 reveals a high prevalence of apathy or negative symptoms in patients with pathology involving the frontal cortex and subcortical structures, particularly those with prototypical fronto-subcortical dementia syndromes26, such as progressive supranuclear palsy (PSP) and frontal lobe dementia. There is no evidence that damage to any one structure, pathway or region is uniquely responsible for producing apathy or negative symptoms. Instead, a network of cortical and subcortical areas is
Goal-directed behaviour and motivation
Although we might appreciate the phenomenology of negative symptoms and have some idea of their possible neurobiological substrate, we lack a framework of the normal cognitive processes that are involved. One such framework is explicit in the Marin formulation of apathy; that it is a reduction in GDB owing to impaired motivation5.
Within neuroscience, the construct of GDB is increasingly being used to operationalize a broad spectrum of purposeful actions and their determinants, from the simplest
Concluding remarks
The GDB model, although complex, serves to highlight the differences between simple movement and purposeful GDB. It places cognitive, motor, emotional and motivational processes within an overall system that subserves GDB and helps to oppose the tendency to view such processes in isolation. It is obviously tempting to map the motivational, emotional, cognitive and motor components of such a model to the neuronal structures and circuits outlined in Fig. 1. For example, it is relatively easy to
References (46)
Apathy and hypersomnia are common features of myotonic dystrophy
J. Neurol. Neurosurg. Psychiatry
(1998)Networks related to the orbital and medial prefrontal cortex; a substrate for emotional behavior?
The pedunculopontine nucleus in Parkinson’s disease, progressive supranuclear palsy and Alzheimer’s disease
J. Neurol. Neurosurg. Psychiatry
(1988)- et al.
Pedunculopontine tegmental nucleus. Anatomy, functional considerations and physiopathological implications
An. Sist. Sanit. Navarra
(1999) - et al.
Schizophrenia, psychosis, and the basal ganglia
Psychiatr. Clin. North Am.
(1997) The primate basal ganglia and the voluntary control of behaviour
J. Consc. Stud.
(1999)Apathy: a treatable syndrome
J. Neuropsychiatry Clin. Neurosci.
(1995)Neuropsychiatric symptoms and cholinergic therapy for Alzheimer’s disease
Gerontology
(1999)- et al.
Motivational control of goal-directed action
Anim. Learn. Behav.
(1994) Negative symptoms in schizophrenia. Definition and reliability
Arch. Gen. Psychiatry
(1982)
Selected Writings
Dementia Paecox, or the Group of Schizophrenias
Scale for the Assessment of Negative Symptoms (SANS)
Br. J. Psychiatry
Apathy: a neuropsychiatric syndrome
J. Neuropsychiatry Clin. Neurosci.
Dementia, apathy, and thalamic infarcts
Neuropsychiatry Neuropsychol. Behav. Neurol.
The behavioural and motor consequences of focal lesions of the basal ganglia in man
Brain
Reliability and validity of the Apathy Evaluation Scale
Psychiatry Res.
The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia
Neurology
Apathy following cerebrovascular lesions
Stroke
Reliability, validity, and clinical correlates of apathy in Parkinson’s disease
J. Neuropsychiatry Clin. Neurosci.
Neuropsychological correlates of apathy and depression in patients with dementia
Neurology
Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophyiological reactivity
Psychol. Med.
Range of neuropsychiatric disturbances in patients with Parkinson’s disease
J. Neurol. Neurosurg. Psychiatry
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