The role of dopamine in the pathophysiology and treatment of apathy

T. T.- J Chong*, M. Husain

*Corresponding author for this work

    Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

    41 Citations (Scopus)

    Abstract

    Disorders of diminished motivation, such as apathy, are common and prevalent across a wide range of medical conditions, including Parkinson's disease, Alzheimer's dementia, stroke, depression, and schizophrenia. Such disorders have a significant impact on morbidity and quality of life, yet their management lacks consensus and remains unsatisfactory. Here, we review laboratory and clinical evidence for the use of dopaminergic therapies in the treatment of apathy. Dopamine is a key neurotransmitter that regulates motivated decision making in humans and other species. A large corpus of evidence suggests that it plays an important role in promoting approach behavior by attributing incentive salience to reward stimuli, and facilitating the overcoming of effort costs. Furthermore, dopaminergic neurons innervate several frontostriatal structures that mediate reward-guided behavior. Based on these findings, there are a priori reasons for considering dopamine in the treatment of disorders of diminished motivation. We highlight key studies that have attempted to use dopamine to manage patients with apathy, and that collectively offer cautious evidence in favor of its efficacy. However, many of these studies are small, unblinded, and uncontrolled, and utilize subjective, questionnaire-based measures of apathy. Given the development of novel paradigms which are able to objectively dissect motivational dysfunction, we are now well positioned to quantify the effect of specific classes of dopaminergic medication on reward- and effort-based decision making in apathy. We anticipate that such paradigms will lay the foundation for future studies to evaluate new and existing treatments for disorders of motivation, using sensitive measures of apathy as primary quantifiable end points.

    Original languageEnglish
    Title of host publicationMotivation
    Subtitle of host publicationtheory, neurobiology and applications
    EditorsBettina Studer, Stefan Knecht
    Place of PublicationAmsterdam
    PublisherElsevier
    Pages389-426
    Number of pages38
    ISBN (Print)9780444637017
    DOIs
    Publication statusPublished - 2016

    Publication series

    NameProgress in Brain Research
    Volume229
    ISSN (Print)0079-6123
    ISSN (Electronic)1875-7855

    Keywords

    • apathy
    • decision making
    • disorders of motivation
    • dopamine
    • effort
    • motivation
    • reward

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