Post-Stroke Apathy and Anxiety

Lee, Dong Young

Abstract

This paper reviews the frequency, clinical and neurobiological correlates, and treatments of apathy and anxiety following stroke. Apathy is defined as diminished motivation not attributable to decreased level of consciousness, cognitive impairment, or emotional distress. Apathy is a common neuropsychiatric manifestation following stroke, affecting up to 22.5-50% of patients. Post-stroke apathy frequently coexists with depression and is positively correlated with advancing aging. It was reported that poor ADL and cognitive function was related with apathy, while even greater impairment was associated with the presence of both apathy and depression. It has been suggested that apathy in stroke patients may be mediated by posterior limb of internal capsule, frontal subcortical pathway, or corticolimbic-reticular subsystem. Recently the possibility of pharmacological treatment of apathy following apathy has been raised, although there was no controlled trials addressing the issue. Generalized anxiety disorder (GAD), the most common form of anxiety after stroke, occurs in up to 26.9-28% of stroke patients. Many patients with GAD also have depression. It was reported that GAD following stroke had usually chronic course and negative impact to the physical and social recovery of patient. Post-stroke anxiety cannot be explained only by the psychological reaction to stroke and its possible physical complication, but is likely to be significantly associated with the pathophysiological mechanism caused by brain injury. Lorazepam, buspirone and some antidepressants, such as SSRI, SNRI, and nonsedating TCA, can be tried, although there was no controlled trials addressing the treatment of anxiety following stroke. In conclusion, apathy and anxiety are very common neuropsychiatric manifestation following stroke and seem to have negative influences to the functional recovery of patients. Therefore, it is needed to apply active treatments, especially including pharmacological approaches, to them.