Pain and apathy

Bahia, Valéria Santoro

doi:10.1590/S1980-57642009DN20400023

Abstract

In this case report we discuss the lack of emotional reactivity and evasive motor motivation to nociceptive stimuli presented by a patient with frontotemporal degenerative disease and apathy as a predominant behavioral symptom.

Key words:
pain; apathy; frontotemporal; dementia; anterior cingulate cortex

Resumo

Neste relato de caso, nós discutimos a falta de reatividade emocional e motora frente a um forte estímulo doloroso apresentada por uma paciente com doença degenerativa fronto-temporal cujo principal sintoma era a apatia.

Palavras-chave:
dor; apatia; fronto-temporal; demência; córtex cingulado anterior

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Full text available only in PDF format.

References

¹
Schnitzler A, Ploner M. Neurophysiology and functional neuroanatomy of pain perception. J Clin Neurophysiol 2000;17:591-603.
²
Cohen-Mansfield J. Pain assessment in non-communicative elderly persons - PAINE. Clin J Pain 2006;22:569-575.
³
Gloth FM, Scheve AA, Stober CV, et al. The functional pain scale: reliability, validity, and responsiveness in an elderly population. J Am Med Dir Assoc 2001;2:110-114.
⁴
Villanueva MR, Smith TL, Erickson JS, et al. Pain assessment for the dementing elderly (PADE): reliability and validity of a new measure. J Am Med Dir Assoc 2003;4:1-8.
⁵
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced Alzheimer patients (PAINED) scale. J Am Med Dir Assoc 2003; 4:9-15.
⁶
Proctor WR, Hirdes JP. Pain and cognitive status among nursing home residents in Canada. Pain Res Manag 2001;6:119-25.
⁷
Cohen-Mansfield J. The relationship between different pain assessments in dementia. Alzheimer Dis Assoc Disord 2008; 22:86-93.
⁸
Cohen-Mansfield J, Biling N. Agitated behaviors in the elderly. I. A conceptual review. J Am Geriatr Soc 1986;34:711-21.
⁹
Fuchs-Lacelle S, Hadjistavropoulos T, Lix L. Pain Assessment as intervention. A study of older adults with severe dementia. Clin J Pain 2008;24:697-707.
¹⁰
Scherder EJA, Sergeant JA, Swaab DF. Pain processing in dementia and its relation to neuropathology. Lancet Neurol 2003;2:677-686.
¹¹
Cole LJ, Farrell MJ, Duff EP, et al. Pain sensitivity and fMRI pain-related brain activity in Alzheimer's disease. Brain 2006; 129:2957-2965.
¹²
Pfeffer RI, Kusosaki TT, Harrah Jr CH, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
¹³
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹⁴
Brucki SM, Malheiros SM, Okamoto IH, Bertolucci PH. Normative data on the verbal fluency test in the animal category in our milieu. Arq Neuropsiquiatr 1997;55:56-61.
¹⁵
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52(4):457-65.
¹⁶
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36
¹⁷
Ratnavalli E, Brayne C, Dawson K, Hodges JR. The prevalence of frontotemporal dementia. Neurology 2002;58:1615-21.
¹⁸
Johnson JK, Dichl J, Mendez MF, et al. Frontotemporal lobar degeneration. Demographic characteristics of 353 patients. Arch Neurol 2005;62:925-30.
¹⁹
Harvey RJ, Skelton-Robinson M, Rossor MN.The prevalence and causes of dementia in people under the age of 65 years.J Neurol Neurosurg Psychiatry 2003;74:1206-9.
²⁰
Rosso SM, Kaat LD, Baks T, et al. Frontotemporal dementia in The Netherlands: patient characteristics and prevalence estimates from a population-based study. Brain 2003;126:2016-22.
²¹
Neary D, Snowden JS, Mann D. Frontotemporal Dementia. Lancet Neurol 2005;4(11):771-80.
²²
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51:1546-54.
²³
Kertesz A, Blair M, McMonagle P, Munoz DG. The Diagnosis and Course of Frontotemporal Dementia. Alzheimer Dis Assoc Disord 2007;21(2):155-63.
²⁴
Melzack R, Casey K. Sensory, motivational and central control determinants of pain. In: Kenshalo D, Thomas CC, editors. The skin senses. Illinois: Springfields; 1968:423-43.
²⁵
Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. IASP press, Seattle 1994:210.
²⁶
Almeida TF, Roizenblatt S, Tufik S. Afferent pain pathways: a neuroanatomical review. Brain Res 2004;1000:40-56.
²⁷
Sewards TV, Sewards MA. The medial pain system: neural representations of the motivational aspect of pain. Brain Res Bull 2002;59: 2-31.
²⁸
Willis WD, Westlund KN. Neuroanatomy of the pain system and the pathways that modulate pain. J Clin Neurophysiol 1997;14:2-31.
²⁹
Millan MJ. The induction of pain: an integrative review. Prog Neurobiol 1999;57:1-164.
³⁰
Leone M, Proietti Cecchini A, Mea E, Tullo V, Curone M, Bussone G. Neuroimaging and pain: a window on the autonomic nervous system. Neurol Sci 2006;27(Suppl.2):S134-137.
³¹
Yen CP, Kung SS, Su YF, Lin WC, Howng SL, Kwan AL. Stereotactic bilateral anterior cingulotomy for intractable pain. J Clin Neurosci 2005;12:886-890.
³²
Cohen RA, Kaplan RF, Zuffante P, et al. Alteration of intention and self-initiated action associated with bilateral anterior cingulotomy. J Neuropsychiatry Clin Neurosci 1999;11: 444-453.
³³
Cohen RA, Paul R, Zawacki TM. Emotional and personality changes following cingulotomy. Emotion 2001;1:38-50.
³⁴
Vogt BA, Sikes RW. The medial pain system, cingulated cortex, and parallel processing of nociceptive information. Prog Brain Res 2000;122:223-225.
³⁵
Morrinson I, Peelen MV, Downing PE. The sight of other's pain modulates motor processing in human cingulated cortex. Cerebr Cortex 2007;17:2214-2222.
³⁶
Snowden JS, Bathgate D, Varma A, Blackshaw A, Gibbons ZC, Neary D. Distinct behavioural profiles in frontotemporal dementia and semantic dementia. J Neurol Neurosurg Psychiatry 2001;70:323-332.
³⁷
Zamboni G, Huey ED, Krueger F, Nichelli PF, Grafman J. Apathy and disinhibition in frontotemporal dementia: insights into their neural correlates. Neurology 2008;71:736-742.
³⁸
Schereckenberger M, Siessmeier T, Viertmann A, et al. The unpleasantness of tonic pain is encoded by the insular cortex. Neurology 2005;64:1175-1183.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
28 Oct 2008
Accepted
20 Nov 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Schnitzler A, Ploner M. Neurophysiology and functional neuroanatomy of pain perception. J Clin Neurophysiol 2000;17:591-603.

[2] ²
Cohen-Mansfield J. Pain assessment in non-communicative elderly persons - PAINE. Clin J Pain 2006;22:569-575.

[3] ³
Gloth FM, Scheve AA, Stober CV, et al. The functional pain scale: reliability, validity, and responsiveness in an elderly population. J Am Med Dir Assoc 2001;2:110-114.

[4] ⁴
Villanueva MR, Smith TL, Erickson JS, et al. Pain assessment for the dementing elderly (PADE): reliability and validity of a new measure. J Am Med Dir Assoc 2003;4:1-8.

[5] ⁵
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced Alzheimer patients (PAINED) scale. J Am Med Dir Assoc 2003; 4:9-15.

[6] ⁶
Proctor WR, Hirdes JP. Pain and cognitive status among nursing home residents in Canada. Pain Res Manag 2001;6:119-25.

[7] ⁷
Cohen-Mansfield J. The relationship between different pain assessments in dementia. Alzheimer Dis Assoc Disord 2008; 22:86-93.

[8] ⁸
Cohen-Mansfield J, Biling N. Agitated behaviors in the elderly. I. A conceptual review. J Am Geriatr Soc 1986;34:711-21.

[9] ⁹
Fuchs-Lacelle S, Hadjistavropoulos T, Lix L. Pain Assessment as intervention. A study of older adults with severe dementia. Clin J Pain 2008;24:697-707.

[10] ¹⁰
Scherder EJA, Sergeant JA, Swaab DF. Pain processing in dementia and its relation to neuropathology. Lancet Neurol 2003;2:677-686.

[11] ¹¹
Cole LJ, Farrell MJ, Duff EP, et al. Pain sensitivity and fMRI pain-related brain activity in Alzheimer's disease. Brain 2006; 129:2957-2965.

[12] ¹²
Pfeffer RI, Kusosaki TT, Harrah Jr CH, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[13] ¹³
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[14] ¹⁴
Brucki SM, Malheiros SM, Okamoto IH, Bertolucci PH. Normative data on the verbal fluency test in the animal category in our milieu. Arq Neuropsiquiatr 1997;55:56-61.

[15] ¹⁵
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52(4):457-65.

[16] ¹⁶
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36

[17] ¹⁷
Ratnavalli E, Brayne C, Dawson K, Hodges JR. The prevalence of frontotemporal dementia. Neurology 2002;58:1615-21.

[18] ¹⁸
Johnson JK, Dichl J, Mendez MF, et al. Frontotemporal lobar degeneration. Demographic characteristics of 353 patients. Arch Neurol 2005;62:925-30.

[19] ¹⁹
Harvey RJ, Skelton-Robinson M, Rossor MN.The prevalence and causes of dementia in people under the age of 65 years.J Neurol Neurosurg Psychiatry 2003;74:1206-9.

[20] ²⁰
Rosso SM, Kaat LD, Baks T, et al. Frontotemporal dementia in The Netherlands: patient characteristics and prevalence estimates from a population-based study. Brain 2003;126:2016-22.

[21] ²¹
Neary D, Snowden JS, Mann D. Frontotemporal Dementia. Lancet Neurol 2005;4(11):771-80.

[22] ²²
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51:1546-54.

[23] ²³
Kertesz A, Blair M, McMonagle P, Munoz DG. The Diagnosis and Course of Frontotemporal Dementia. Alzheimer Dis Assoc Disord 2007;21(2):155-63.

[24] ²⁴
Melzack R, Casey K. Sensory, motivational and central control determinants of pain. In: Kenshalo D, Thomas CC, editors. The skin senses. Illinois: Springfields; 1968:423-43.

[25] ²⁵
Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. IASP press, Seattle 1994:210.

[26] ²⁶
Almeida TF, Roizenblatt S, Tufik S. Afferent pain pathways: a neuroanatomical review. Brain Res 2004;1000:40-56.

[27] ²⁷
Sewards TV, Sewards MA. The medial pain system: neural representations of the motivational aspect of pain. Brain Res Bull 2002;59: 2-31.

[28] ²⁸
Willis WD, Westlund KN. Neuroanatomy of the pain system and the pathways that modulate pain. J Clin Neurophysiol 1997;14:2-31.

[29] ²⁹
Millan MJ. The induction of pain: an integrative review. Prog Neurobiol 1999;57:1-164.

[30] ³⁰
Leone M, Proietti Cecchini A, Mea E, Tullo V, Curone M, Bussone G. Neuroimaging and pain: a window on the autonomic nervous system. Neurol Sci 2006;27(Suppl.2):S134-137.

[31] ³¹
Yen CP, Kung SS, Su YF, Lin WC, Howng SL, Kwan AL. Stereotactic bilateral anterior cingulotomy for intractable pain. J Clin Neurosci 2005;12:886-890.

[32] ³²
Cohen RA, Kaplan RF, Zuffante P, et al. Alteration of intention and self-initiated action associated with bilateral anterior cingulotomy. J Neuropsychiatry Clin Neurosci 1999;11: 444-453.

[33] ³³
Cohen RA, Paul R, Zawacki TM. Emotional and personality changes following cingulotomy. Emotion 2001;1:38-50.

[34] ³⁴
Vogt BA, Sikes RW. The medial pain system, cingulated cortex, and parallel processing of nociceptive information. Prog Brain Res 2000;122:223-225.

[35] ³⁵
Morrinson I, Peelen MV, Downing PE. The sight of other's pain modulates motor processing in human cingulated cortex. Cerebr Cortex 2007;17:2214-2222.

[36] ³⁶
Snowden JS, Bathgate D, Varma A, Blackshaw A, Gibbons ZC, Neary D. Distinct behavioural profiles in frontotemporal dementia and semantic dementia. J Neurol Neurosurg Psychiatry 2001;70:323-332.

[37] ³⁷
Zamboni G, Huey ED, Krueger F, Nichelli PF, Grafman J. Apathy and disinhibition in frontotemporal dementia: insights into their neural correlates. Neurology 2008;71:736-742.

[38] ³⁸
Schereckenberger M, Siessmeier T, Viertmann A, et al. The unpleasantness of tonic pain is encoded by the insular cortex. Neurology 2005;64:1175-1183.

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