Dados do Trabalho

Título

Acquired Apathy Without Abulia: The Interface of Emotion and Volition

Apresentação do caso

TP, a 36-year-old married federal officer, enjoyed excellent health until 2016, when he was diagnosed with colon adenocarcinoma. He was treated with chemotherapy and surgery. In 2017, following the removal of a newly discovered hepatic lesion, he became unemotional and indifferent to people, objects, and situations that until then had been a source of pleasure or pain. This state of indifference set in over a few days and did not change for several months. In June 2018, when we first saw TP, he thought of suicide “because he no longer saw meaning in life”. Although he retained the ability to discriminate subtle tastes and odors, eating and drinking were no longer accompanied by any emotional experience. The same was true for exercising, watching movies, working (a major source of pleasure to him), and intercourse (“orgasm became a mere genital sensation”). He did not mourn his mother’s death, nor did he rejoice in the birth of his first child. Despite the loss of emotional experience, he continued to meet his obligations, displaying the expected affective responses in different social contexts. His wife stated that his conduct was appropriate and that she would not know of his problems if he did not explicitly tell her. The neurological and neuropsychological exams were normal. T2-weghted MRI revealed a bilateral, symmetrical, signal increase in the medial prefrontal cortex, in the posterior cingulate-medial parietal cortices, and in the amygdala and hippocampus. 18FDG-PET showed a bilateral increase of metabolism in the orbitomedial and superior frontal gyri. A tentative diagnosis of paraneoplasic encephalitis was made. After several months, TP’s symptoms spontaneously remitted in a few days. Follow up MRI was normal, and the metabolic abnormality had improved.

Discussão

The classical literature distinguishes the loss of emotional experience (“apathy”) from the loss of the inclination to act (“abulia”). Modern authors have merged these concepts into the construct of “apathy”. We propose that apathy results from the injury of temporopolar-amygdala circuits, whereas abulia reflects the injury of anterior cingulate circuits.

Comentários finais

This case provides further evidence that apathy and abulia represent distinct clinical and phenomenological entities with dedicated neural correlates. Conflating apathy and abulia into one construct blurs clinicoanatomical differences that are critical for both clinical practice and research.

Palavras-Chave

Abulia — apathy — emotional experience

Área

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