Apathy, but not depression, is associated with executive dysfunction in cerebral small vessel disease.

Valerie Lohner,Matthew J Hollocks,Hugh S Markus,Robin G Morris,Rebecca L Brookes

doi:10.1371/journal.pone.0176943

Valerie Lohner, Matthew J Hollocks + Show 3 more

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Journal: PLOS ONE	Publication Date: May 11, 2017
Citations: 51	License type: CC BY 4.0

Affiliation: University of Cambridge, King's College London

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ObjectiveTo determine the prevalence of apathy and depression in cerebral small vessel disease (SVD), and the relationships between both apathy and depression with cognition. To examine whether apathy is specifically related to impairment in executive functioning and processing speed.Methods196 patients with a clinical lacunar stroke and an anatomically corresponding lacunar infarct on MRI were compared to 300 stroke-free controls. Apathy and depression were measured using the Geriatric Depression Scale, and cognitive functioning was assessed using an SVD cognitive screening tool, the Brief Memory and Executive Test, which measures executive functioning/processing speed and memory/orientation. Path analysis and binary logistic regression were used to assess the relation between apathy, depression and cognitive impairment.Results31 participants with SVD (15.8%) met criteria for apathy only, 23 (11.8%) for both apathy and depression, and 2 (1.0%) for depression only. In the SVD group the presence of apathy was related to global cognition, and specifically to impaired executive functioning/processing speed, but not memory/orientation. The presence of depression was not related to global cognition, impaired executive functioning/processing speed or memory/orientation.ConclusionsApathy is a common feature of SVD and is associated with impaired executive functioning/processing speed suggesting the two may share biological mechanisms. Screening for apathy should be considered in SVD, and further work is required to develop and evaluate effective apathy treatment or management in SVD.

Highlights

Cerebral Small Vessel Disease (SVD) is the most common cause of vascular cognitive impairment and vascular dementia, with up to 50% of patients with lacunar stroke having some degree of cognitive impairment [1, 2]
In the SVD group the presence of apathy was related to global cognition, and to impaired executive functioning/processing speed, but not memory/orientation
The presence of depression was not related to global cognition, impaired executive functioning/processing speed or memory/orientation

Summary

Introduction

Cerebral Small Vessel Disease (SVD) is the most common cause of vascular cognitive impairment and vascular dementia, with up to 50% of patients with lacunar stroke having some degree of cognitive impairment [1, 2]. These impairments characteristically involve cognitive flexibility, attention, and processing speed [3,4,5], with episodic memory relatively spared [6, 7]. In one recent study in patients with clinical lacunar stroke and confluent WMH, apathy, but not depression, was associated with the extent of white matter damage, estimated using diffusion tensor imaging (DTI) [11]. Following from this paper, it is important to replicate the finding that apathy is an important neuropsychiatric symptom in further SVD cohorts, and to determine whether this association is seen across patients with a wide variety of SVD severity; in this paper all cases had lacunar infarcts as well as confluent white matter hyperintensities, indicating more severe disease

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