Perfusion brain SPECT and statistical parametric mapping analysis indicatethat apathy is a cingulate syndrome: A study in Alzheimer's disease and nondemented patients

Apathy is the most frequent behavioral symptom in Alzheimer's disease and i s also frequently reported in other brain organic disorders occurring in th e elderly. Based on the literature, we hypothesized that apathy was related to an anterior cingulate hypofunction. Forty-one subjects were studied. Ac cording to ICD 10 diagnostic criteria, 28 patients had Alzheimer dementia ( demented: diagnostic group 1), and 13 had organic personality disorders or mild cognitive impairment not attributable to dementia (nondemented: diagno stic group 2). Apathy was evaluated by the Neuro-Psychiatric Inventory. As a result each diagnostic group was divided into two symptomatic subgroups: apathetic or nonapathetic. Brain perfusion was measured by Tc-99m-labeled b icisate (ECD) brain SPECT and the images were compared using Statistical Pa rametric Mapping (SPM96). We began by comparing apathetic vs nonapathetic p atients, whatever their diagnostic group (whole population), then analyzed them within each group, Twenty-one subjects were apathetic (14 in group 1 a nd 7 in group 2) and 20 were not (14 in group 1 and 6 in group 2). For the whole population, the Z map showed a significant decrease in ECD uptake for the apathetic patients in the anterior cingulate (P < 0.002) bilaterally. This area was also identified as hypoactive by SPM analysis in the demented (P < 0.035) and in the nondemented (P < 0.02) apathetic patient groups. Fi nally, conjunction analysis indicated that the anterior cingulate was the c ommon hypoactive structure of the two apathetic subgroups (Z = 4.35, P < 0. 0009). These results point to a close relationship between apathy and the a nterior cingulate region. (C) 2001 Academic Press.