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In their article proposing a "‘Vascular Depression' Hypothesis," Alexopoulos et al¹ distinguish a very significant group of patients with features of depression, related to underlying vascular disease and neurological lesions. Though they acknowledge that their concept is broad and encompasses many pathogenetic processes, I would contend that many of the patients they consider as having vascular depression may be more appropriately classified as having an apathy syndrome instead.²

As a disorder of motivation rather than mood, apathy is distinct from depression, with different clinical features, psychopathology, treatment, and prognostic implications.³ Patients with apathy show a marked diminution of goal-directed activity or thought and lack goal-related emotional responses. More profound states of apathy include abulia or akinetic mutism in the extreme. Similar to depression, apathy can be considered a symptom of another syndrome, or as a syndrome. Etiologically, it is linked to various neuropsychiatric conditions including vascular, traumatic, and degenerative brain . . . [Full Text of this Article]

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Methylphenidate May Treat Apathy Independent of Depression
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