What is Abulia?
Abulia, as defined by the Dictionary of Neurological Signs, is a condition that results in a decreased functionality. It’s recognized by a lack of initiative or drive, spontaneity, apathy, slow thinking, and reduced emotional reactions or responses to external things. In simpler words, abulia means not having the intent or determination to act, speak, or think.
The term ‘abulia’ comes from the Greek word ‘aboulia’, which means ‘non-will’. It’s crucial to note that abulia is different from an inability to carry out a task due to cognitive or physical disabilities. The condition of abulia has been documented since 1838. Other terms that are often used to refer to abulia include apathy, psychic akinesia, loss of psychic self-activation, and athymia.
What Causes Abulia?
There are several potential reasons behind certain health issues:
* Some conditions can cause damage to the lower part of the brain, such as trauma, a stroke that affects the front part of the brain, or a ruptured brain blood vessel.
* A closed head injury, which is a type of traumatic brain injury, can also cause damage.
* Parkinson’s disease, which is a brain disorder affecting movement.
* Other health issues affecting the front part of the brain, like a tumor, an infection forming a pocket of pus, or a type of brain surgery called a frontal lobotomy.
* Certain changes in your body’s normal biochemical processes, like low oxygen levels, low blood sugar, or a brain condition that happens when the liver doesn’t remove toxins from the blood properly.
Risk Factors and Frequency for Abulia
Abulia, a condition that makes it difficult for people to make decisions or take action, is considered a common issue. However, there’s no data available on how often it occurs nationally or worldwide.
Signs and Symptoms of Abulia
Abulia is a psychological condition that comes in two forms – Minor and Major.
Abulia Minor, also known as Apathy, is characterized by the person’s lack of motivation or drive to initiate tasks independently. People affected by this condition might follow instructions from others and participate in group activities, but find it hard to start their own projects. They might also have few spontaneous conversations but will respond briefly when others engage with them. Interestingly, these patients sometimes talk extensively about their plans but never really act on them.
Abulia Major or Akinetic Mutism, on the other hand, is a severe form where patients don’t initiate anything at all, even basic activities such as speaking or eating. Akinetic Mutism is a state where individuals respond very minimally to their environment, without any physical limitation or coma. These patients could make short movements and their eyes are usually open and able to track objects. They might also react to negative stimuli by showing agitation. In case they have damages in specific parts of their brain (anteromedial lobes), they might speak. If asked questions, their responses are typically short and simple.
Interestingly, there is also the “Miller Fisher’s telephone effect” associated with individuals with Abulia. These patients may surprisingly hold a fluent and lively conversation over the phone, contrary to their usual communication habits.
Testing for Abulia
Diagnosis of the condition called abulia mainly occurs by observing a patient’s behavior. Abulia is usually diagnosed when a patient shows less initiative, takes longer to respond, and struggles to stay focused on tasks. One method of diagnosis includes something known as Fisher’s “telephone test”. With this test, if a person is able to respond during a phone conversation but not in person, they may have abulia minor.
Treatment Options for Abulia
The main method for treating abulia, a condition characterized by a lack of will or initiative, involves addressing the root cause, if it can be identified. If not, the treatment typically lies in drugs that boost the level of dopamine, the chemical in the brain that carries signals related to mood and reward.
Popular medications for this purpose include:
- Carbidopa/Levodopa: These are often used together to help control symptoms of Parkinson’s disease, which include stiffness, tremors, spasms, and poor muscle control.
- Amantadine: More commonly recognized as an antiviral medicine, it’s also used to manage Parkinson’s-related tremors and stiffness.
- Bupropion: Often used in cases of depression or for quitting smoking, it works by stopping the uptake of dopamine and norepinephrine in the brain.
- Bromocriptine: This drug is a dopamine agonist, meaning it stimulates dopamine receptors directly.
- Nefiracetam: It’s a relatively new compound that’s shown potential in enhancing neurotransmission, the process by which nerve signals are sent across chemical junctions.
- Olanzapine: Typically used for managing symptoms of psychotic conditions such as schizophrenia.
- Agomelatine: Often used to help treat major depressive disorders.
It’s important to note that treatment should be tailored to the individual based on their unique medical history, symptoms, available treatments and the known risks and benefits.
What else can Abulia be?
There are several other conditions that doctors need to consider when diagnosing abulia, these include:
- Post-Stroke Depression: This is a mood disorder where patients feel persistently sad and have negative thoughts. People with this disorder may have a previous history of depression.
- Aphasia: This is a language disorder that makes communication difficult. Patients with aphasia appear to be fine and their mood and behavior are normal. Even though they try to communicate, it’s a struggle. They are, however, still able to socialize correctly.
- Parkinson’s Disease: This is a disorder that affects movement. Patients exhibit stiffness, shaking, slow movements, and difficulty in walking. Cognitive issues and behavioral problems typically emerge in the later stages of the disease.
Abulia might be mistaken for the slow-motion related to depression, which sometimes might be wrongly labeled as “pseudo-depression.” However, it’s crucial to differentiate abulia from depression because antidepressants do not work for abulia.
Mild catatonia can also be confusing when diagnosing abulia because the symptoms are quite similar.
What to expect with Abulia
The outcome really depends on the root cause of abulia, which is a condition that affects motivation.
Possible Complications When Diagnosed with Abulia
People suffering from abulia, a condition where they lack initiative, could face several health problems such as:
- Malnutrition
- Dehydration
- Electrolyte imbalance
- Bedsores
- Deep vein thrombosis
Preventing Abulia
Patients who suffer from abulia, a condition that results in lack of motivation, can be challenging to encourage. However, the combined effort of a neuroscience nurse, a rehabilitation doctor, a neurologist, and a psychiatrist can significantly improve the patient’s situation. By actively participating in the treatment process, these medical professionals can contribute to effective results.
