When you lack the will to do things...

Its such a pleasure to find one's work quoted years later. This article below in Curejoy cites our 2002 paper published in Movement Disorders Volume 17, Issue September/October 2002 Pages 1052–1057

Abulia: A Delphi survey of British neurologists and psychiatrists. Lavanya Vijayaraghavan MD, Ennapadam S. Krishnamoorthy MD, Richard G. Brown PhD, Michael R. Trimble MD, FRCP, FRCPsych

If you're feeling bored or disinterested in life, do you have abulia? Probably not. There is still a lot that we don't know about abulia, and differences of opinion about its definition are rife in the medical community. But a survey of British neurologists and psychiatrists published in 2002 attempted to reach a consensus on abulia. According to this survey, experts mostly agree that abulia is predominantly seen with brain lesions, specifically of the basal ganglia and the frontal lobes and not the cerebellum or brainstem.

The following features are also considered typical of abulia:

• Lack of motivation
• Inability to initiate or sustain actions
• Lack of spontaneous movements
• Delayed responses to questions
• Limited spontaneous speech
• Passivity
• Limited emotional responses
• Lack of spontaneity
• Limited social equations
• Lack of interest in usual pastimes.3

So think of the old man who stays in bed all day, who seems unable to summon up the will to get up; the retired 70-year old who has to be coaxed to eat and doesn't seem to be able to swallow his food even though he is not suffering from a motor disability; the grandmother who doesn't show any interest in the birth of her first grandchild and looks away or stares vacantly when you attempt to have a conversation with her. They probably have abulia.

You'd have noticed something common in all these examples: the people affected are all elderly. Although abulia is not caused by aging, it has been observed in a number of conditions associated with aging - for instance, Alzheimer's disease, vascular dementia, stroke, Lewy body dementia, Parkinson's disease, and frontotemporal dementia. It is also associated with schizophrenia, Huntington's disease, and brain injury. So the child who was in a car accident and sustained a brain injury can suffer from abulia too.4

Abulia also manifests at times in milder forms.

Abulia And Depression

Many studies have found abulia to be associated with depression. However, there are definite differences between them. People with abulia don't report any sadness or negative thoughts - rather, they seem to be indifferent and show a lack of concern for themselves and the people around them. In fact, patients with abulic symptoms may respond poorly to some antidepressants, and serotonergic agents which relieve depression may increase apathy. Also, if you look at the brain, depression is reported to be more common with anterior and left-sided lesions in the brain whereas abulia is more common with right-sided lesions.5

Abulia And Dopamine

The dopaminergic system is a system of neural pathways that transmit dopamine from one part of the brain to another. In animals, dopaminergic circuits have been found to be important factors in impulses related to reward and motivation, and their damage is associated with apathy.6

It has been hypothesized that a healthy dopaminergic system in the brain is what allows us to turn our impulses into actions. Therefore, drugs that impact the dopaminergic system are being considered as possible treatments for abulia.

Read the Curejoy post