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Psychologie & NeuroPsychiatrie du vieillissement

Le concept d‘apathie : intérêt et limites Volume 2, issue 1, Mars 2004

  • Author(s): Christian Derouesné , Université Paris VI, Faculté de médecine Pitié‐Salpêtrière
  • Key words: apathy, motivation, goal‐directed behavior, evaluation, emotional blunting  
  • Page(s) : 19-28
  • Published in: 2004

In the nineties, Marin proposed to define apathy as a clinical syndrome due to a lack of motivation. The syndrome is characterized by a diminished goal‐directed overt behaviors, a lack of interest or concern for social and personal activities and a lack of responsiveness to positive and negative events. Apathy is clearly distinct from depression and can be observed in many conditions, in healthy people as well as in psychiatric disorders such as depression or schizophrenia. It is very common in patients with brain lesions involving the frontal lobes, the right hemisphere, but also in degenerative diseases such as Alzheimer‘s disease. Motivation, considered as the source of apathy by Marin, is not a simple construct. It refers to a complex set of multiple affective and cognitive processes. However, it is considered, either in an energetic acception, as a single quantitative variable, a force which impulses action but not direct behavior or, in a more specific acception, as the factor which direct behavior towards specific actions. The description of apathy by Marin and the scales designed to its assessment, are based on the first acception. The term apathy is only descriptive, such as those of dysphasia or anosognosia. They do not allow to study the mechanisms underlying the motivation disorders, essential process for the management of apathetic patients. A tentative qualitative approach to assess motivation disorders is proposed, using a semi‐structured interview. However, it should be stressed that motivation can not be directly assessed: motivation is a concept to explain some behavior disorders and an inference from the study of behavior.