Abulia is an illness that usually occurs after an injury to an area or areas of the brain. It’s associated with brain lesions.
While abulia can exist on its own, it’s often found in conjunction with other disorders. These disorders can either be neurological or psychiatric in nature.
Abulia is a widely underdiagnosed condition and is classified by strong apathy. This can result in a lack of motivation, and many with abulia struggle with issues of will, volition, or drive.
Those with abulia experience less motivation despite normal mood, consciousness, and cognition. Someone with abulia has desires, but may struggle to do what’s necessary to accomplish the goals they wish.
Abulia is common but is often confused with other brain-related issues. There are possible treatment options, but it’s important that this condition is diagnosed appropriately in order to receive treatment.
Despite the importance of diagnosis, this condition has been rarely acknowledged. However, in recent years, discussion and research around abulia diagnosis has increased.
A person with abulia exhibits symptoms that include emotional and behavioral changes. This condition isn’t due to reduced levels of consciousness, attention, or language capacity.
Symptoms can include:
- loss of productivity, effort, and initiative
- emotional indifference
- lack of plans and goals
- less or absence of speech or action
- lack of emotional responses to important life events
- less goal-oriented thoughts
- diminished social interest
- poor attention
- being easily distracted
Those with abulia can usually describe goals, interests, or plans that they have. However, they usually do so in a less extensive way and for a shorter time, showing initial signs of apathy.
Mild cases of abulia are more common than severe ones. It’s often more common in older people with mood disorders, neurological issues, and other conditions. Abulia is often seen as a symptom within a complicated clinical situation.
More research is needed regarding the diagnosis and management of abulia in older adults. This is important because it appears in conjunction with many diseases and disorders related to aging.
Abulia is most often caused by an injury to the brain. These injuries are seen mostly in the form of brain lesions.
Motivation is triggered by environmental factors that release neuron signals. When areas of the brain are damaged, these neuron signals don’t function properly. This results in the brain’s inability to register reward. An apathetic response follows.
The common affected areas of the brain include:
Despite that there’s likely more than one neurotransmitter involved, most studies have focused on the role of dopamine in cases of abulia.
One animal study found that the damage to dopaminergic circuits related to apathy. Researchers think these pathways are what enables us to turn impulse to action.
There are also social, environmental, and biological factors that can affect drive. These factors can induce apathy. They’re not to be confused with the presence of abulia.
Abulia may be more common than once thought, as it tends to be a widely underdiagnosed condition, often confused with other diseases or disorders. This can result in individuals going untreated for longer periods of time.
This condition is often confused with:
It’s important in the process of diagnosis to rule out conditions that may present apathy as a symptom. As a result, doctors frequently perform thorough neurological and psychosocial exams when apathy is involved to provide a differential diagnosis.
In a survey of British doctors on the subject of apathy in older adults, less than 50 percent believed abulia was different from depression.
Abulia is indeed a separate diagnosis from depression. Sadness or negative thoughts aren’t attributed to abulia.
Your doctor may order a resting state fcMRI. This test involves undergoing an MRI without being asked to perform specific tasks while the brain is mapped. Other forms of brain imaging such as CT scans can also help diagnose conditions linked with abulia.
A doctor needs to identify abulia early so that they can help you identify the best treatment options for you.
Treatment options currently include bromocriptine, which has been proven to be effective in lowering apathy.
This treatment is often given in low doses with small increases in dosage over time. You should be monitored by your doctor while taking bromocriptine, due to potential negative side effects, including:
- lowered blood pressure
- an increase in compulsive behaviors
In a small number of case studies, L-dopa was tested as a potential treatment option. This study found that the L-dopa successfully treated severe cases of abulia, but the effects of this medication were not long-lasting.
Dopamine medicine could prove helpful, but due to lack of evidence, it’s not generally used. These medications also have a list of side effects that include potential psychotic relapse in people who have experienced episodes of psychosis in the past.
Amphetamines have been shown to increase stimulation-seeking behavior in rats. Human studies for using this drug in cases of abulia still need to be researched.
Abulia has been observed in association with:
Abulia is a condition that can affect your quality of life. Fixing underlying issues that may be linked with abulia is important. This will help your doctor to better identify the best treatment plan for you.
It’s important to seek the help of a medical professional if you or a loved one is experiencing apathy or other symptoms listed above. If you’re concerned about abulia, make sure to mention it to your doctor, as some may not be familiar with the diagnosis.