Service de neurologie, hôpital Saint-Antoine, Assistance Publique-hôpitaux de Paris, Paris cedex, France.
Rev Neurol (Paris). 2012 Aug-Sep;168(8-9):585-97. doi: 10.1016/j.neurol.2012.05.003. Epub 2012 Aug 24.
We propose to defined apathy as a quantitative reduction of goal-directed behaviour. As such, the neural bases of apathy rely on lesions or dysfunctions of the brain structures that generate and control goal-directed behaviour: the frontal lobes, the basal ganglia and the frontal-basal ganglia circuits. Lesions or dysfunctions of the limbic territories of the frontal lobes (the orbital-mesial prefrontal cortex) and the basal ganglia (e.g., the ventral striatum) lead to apathy through difficulties to provide the affective value of a given behavioural context. We also suggest that lesions or dysfunctions of the associative ("cognitive") territories of the frontal lobes (the dorsal prefrontal cortex) and the basal ganglia (e.g., the dorsal caudate) contribute to apathy via a "cognitive inertia" - an inability to generate or activate strategies required to successfully complete a given program of actions. The most severe forms of apathy ("auto-activation deficit" syndrome), due to bilateral lesions in the prefrontal-basal ganglia circuits can be explained either by the addition of lesions in the cognitive and limbic territories or by a more general and elementary impairment that mirrored the presumed normal functions of the prefrontal-basal ganglia circuits, that is to selectively amplified the behaviour that one considers as the most adapted to one's personal needs or environmental demands. These lesions may limit the selective amplification of the signal that represents relevant thoughts and actions, leading to difficulties to disambiguate decision-making at the level of the prefrontal cortex.
我们提出将冷漠定义为目标导向行为的定量减少。因此，冷漠的神经基础依赖于产生和控制目标导向行为的大脑结构的损伤或功能障碍：额叶、基底节和额-基底节回路。额叶的边缘区域（眶额-内侧前额叶皮质）和基底节（例如腹侧纹状体）的损伤或功能障碍导致冷漠，因为它们难以提供给定行为背景的情感价值。我们还建议，额叶的联合（“认知”）区域（背侧前额叶皮质）和基底节（例如背侧尾状核）的损伤或功能障碍通过“认知惯性”导致冷漠——无法产生或激活成功完成给定行动计划所需的策略。由于额-基底节回路的双侧损伤，最严重的冷漠形式（“自动激活缺陷”综合征）可以通过在认知和边缘区域增加损伤来解释，或者通过更普遍和基本的损伤来解释，这种损伤反映了额-基底节回路的假定正常功能，即选择性地放大被认为最适合个人需求或环境要求的行为。这些损伤可能限制了代表相关思想和行为的信号的选择性放大，导致在前额叶皮层水平上进行决策变得困难。
