Abulia

Definition

Abulia is a state in which an individual seems to have lost will or motivation.

Description

Abulia is not a separate condition; rather, it is a symptom associated with various forms of brain injury. It may occur in association with a variety of conditions, including stroke, brain tumor, traumatic brain damage, bleeding into the brain, and exposure to toxic substances.

Causes and symptoms

Some research suggests that abulia occurs due to malfunction of the brain's dopamine-dependent circuitry. Injuries to the frontal lobe (the area of the brain responsible for higher thinking) and/or the basal ganglia (the area of the brain responsible for movement) can interfere with an individual's ability to initiate speech, movement, and social interaction. Abulia has been noted in patients who have suffered brain injuries due to stroke, bleeding into the brain from a ruptured aneurysm, trauma, brain tumor, neurological disease (such as Parkinson's disease), psychiatric condition (such as severe depression or schizophrenia), and exposure to toxic substances (such as cyclosporin-A).

An individual with abulia may not appear to have much will or motivation to pursue activities or initiate conversation. Such an individual may appear apathetic, disinterested, asocial, quiet or mute, physically slowed or still (hypokinetic), and emotionally remote.

Diagnosis

Abulia is not an individual diagnosis; it is a symptom that usually occurs as part of a constellation of symptoms accompanying a specific disorder. Diagnosis of the underlying disorder depends on the kinds of symptoms that co-exist with abulia. Psychiatric interview, magnetic resonance imaging (MRI), ultrasound, or computed tomography (CT) imaging of the brain, EEG, blood tests, and neurological testing may all be used to diagnose an underlying condition.

Treatment team

Treatment of abulia is usually part of a program of general rehabilitation for the symptoms accompanying the underlying condition. A neurologist or psychiatrist may lead a treatment team. Other professionals that may be involved include physical therapists, occupational therapists, recreational therapists, and speech and language therapists.

Treatment

There are no specific treatments for abulia. The underlying condition should be treated such as administering antidepressants or electroconvulsive therapy to depressed patients or antipsychotic medications to schizophrenic patients. Patients who have suffered brain injury due to stroke, bleeding, or trauma will benefit from rehabilitation programs that provide stimulation and attempt to re-teach skills.

Research has looked at the possibility of treating abulia with medications that boost the activity of dopamine throughout the brain, but this is far from becoming a standard treatment.

Prognosis

The prognosis of abulia depends on the prognosis of the underlying condition.

BOOKS

Friedman, Joseph H. "Mood, Emotion, and Thought." In Textbook of Clinical Neurology, edited by Christopher G. Goetz. Philadelphia: W. B. Saunders Company, 2003.

PERIODICALS

Al-Adawi, Samir. "Abulia: The Pathology of 'Will' and Dopaminergic Dysfunction in Brain-Injured Patients." Medical Sciences 1 (1999): 27–40.

Nishie, M. "Posterior Encephalopathy Subsequent to Cyclosporin A Presenting as Irreversible Abulia." Internal Medicine 42, no. 8 (1 August 2003): 750–755.

Pantoni, L. "Abulia and Cognitive Impairment in Two Patients with Capsular Genu Infarct." Acta Neurologica Scandinavia 104, no. 3 (1 September 2001): 185–190.

Vijayaraghavan. "Abulia: A Delphi Survey of British Neurologists and Psychiatrists." Movement Disorders 17, no. 5 (September 2002): 1052–1057.

Rosalyn Carson-Dewitt, MD