Abstract
BackgroundThe present study represents an initial attempt to assess the role of apathy in motivated decision making on the Iowa Gambling Task. Clinical descriptions of patients with apathy highlight deficits in the cognitive, emotional and behavioural aspects of goal directed activity, yet standard neurocognitive tests of these measures fail to demonstrate reliable sensitivity to the disorder. Available research suggests the Iowa Gambling Task is a robust test of complex emotional socio-executive processes involved in motivational decision making, which can analogue real-world goal-directed behaviour.MethodsWe ask whether performance on the Iowa Gambling Task can distinguish brain damaged patients with apathy symptoms from 1) brain damaged patients without apathy and 2) neurologically intact controls. Overall, 22 healthy adults and 29 brain damaged patients took part in this study.ResultsBrain damaged patients with apathy were distinctively impaired on the Iowa Gambling Task compared to both non-apathetic brain damaged patients and neurologically intact healthy controls. On the other hand, standard measures for the cognitive control of behaviour failed to show this sensitivity.ConclusionsOur results demonstrated that the Iowa Gambling Task is sensitive to the presence of apathy symptoms. We discuss these findings in terms of neurocognition deficits in apathy and the related implications for rehabilitation and clinical intervention.
Highlights
The present study represents an initial attempt to assess the role of apathy in motivated decision making on the Iowa Gambling Task
Rehabilitation outcome studies on chronic patients going beyond 2 years post brain injury show that the majority of cases experience persisting apathy symptoms with related psychosocial problems characterised by lack of motivation, attenuated emotionality, decreased social contact and leisure activity, unemployment, marital problems and family breakdowns [3]
Apathy is often conceptualised as a dysexecutive syndrome [12], studies have shown inconsistent results on the relationship between apathy and executive deficits assessed through standard executive function (EF) tests
Summary
Clinical descriptions of patients with apathy highlight deficits in the cognitive, emotional and behavioural aspects of goal directed activity, yet standard neurocognitive tests of these measures fail to demonstrate reliable sensitivity to the disorder. Available research suggests the Iowa Gambling Task is a robust test of complex emotional socio-executive processes involved in motivational decision making, which can analogue real-world goal-directed behaviour. Neurological models suggest apathy follows dysfunction in frontal-subcortical brain circuits crucial for motivation-related executive processing [5,6]. The classic case of Phineas Gage provides the earliest documented case of such dysfunction Despite his preserved capacities on basic cognition after his brain injury, Gage had significant socio-executive deficits including personality change and apparent apathy to his symptoms [7]. A review by van Reekum and associates [15] found a near middle split in the number of studies that reported a significant relationship between apathy levels and executive deficits (8 studies) and those that did not (7 studies)
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