Neurobiologic Rationale for Treatment of Apathy in Alzheimer's Disease With Methylphenidate

Christopher H. van Dyck, Amy F.T. Arnsten, Prasad R. Padala, Olga Brawman-Mintzer, Alan J. Lerner, Anton P. Porsteinsson, Roberta W. Scherer, Allan I. Levey, Nathan Herrmann, Nimra Jamil, Jacobo E. Mintzer, Krista L. Lanctôt, Paul B. Rosenberg

Research output: Contribution to journalReview articlepeer-review

Abstract

The public health burden of Alzheimer's disease (AD) is related not only to cognitive symptoms, but also to neuropsychiatric symptoms, including apathy. Apathy is defined as a quantitative reduction of goal-directed activity in comparison to a previous level of functioning and affects 30%–70% of persons with AD. Previous attempts to treat apathy in AD—both nonpharmacologically and pharmacologically—have been wanting. Catecholaminergic treatment with methylphenidate has shown encouraging results in initial trials of apathy in AD. Understanding the neuronal circuits underlying motivated behavior and their reliance on catecholamine actions helps provide a rationale for methylphenidate actions in the treatment of apathy in patients with AD. Anatomical, physiological, and behavioral studies have identified parallel, cortical-basal ganglia circuits that govern action, cognition, and emotion and play key roles in motivated behavior. Understanding the distinct contributions to motivated behavior of subregions of the prefrontal cortex—dorsolateral, orbital-ventromedial, and dorsomedial—helps to explain why degeneration of these areas in AD results in apathetic behaviors. We propose that the degeneration of the prefrontal cortex in AD produces symptoms of apathy. We further propose that methylphenidate treatment may ameliorate those symptoms by boosting norepinephrine and dopamine actions in prefrontal-striatal-thalamocortical circuits.

Original languageEnglish (US)
Pages (from-to)51-62
Number of pages12
JournalAmerican Journal of Geriatric Psychiatry
Volume29
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • Alzheimer's disease
  • apathy
  • catecholamines
  • dopamine
  • methylphenidate
  • norepinephrine
  • prefrontal cortex

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

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