J Neuropsychiatry Clin Neurosci 13:56-60, February 2001
© 2001 American Psychiatric Press, Inc.
Psychiatric Symptoms Associated With Cortical-Subcortical Dysfunction in Alzheimer's Disease
Oscar L. Lopez, M.D.,
Sa a  ivkovi , M.D.,
Gwenn Smith, Ph.D.,
James T. Becker, Ph.D.,
Carolyn Cidis Meltzer, M.D. and
Steven T. DeKosky, M.D.
Received September 15, 1999; revised February 7, 2000; accepted March 24, 2000. From the Alzheimer's Disease Research Center, and Departments of Neurology, Psychiatry, and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Address correspondence to Dr. Lopez, Neuropsychology Research Program, 3501 Forbes Avenue, Suite 830, Pittsburgh, PA 15213.
Positron emission tomography was used to evaluate 3 Alzheimer's disease (AD) patients: 1 with major depression, 1 with emotional lability, and 1 with apathy. Compared with 5 non–mood-disordered AD patients, the patient with depression had diminished relative regional cerebral blood flow (rel-CBF) in the anterior cingulate and superior temporal cortices, bilaterally. This patient also showed diminished rel-CBF in the left dorsolateral prefrontal and right medial temporal and parietal cortices. The patient with emotional lability had diminished rel-CBF in the anterior cingulate and dorsolateral prefrontal cortices, bilaterally, and left basal ganglia. The patient with apathy had diminished rel-CBF in the basal ganglia and dorsolateral prefrontal cortex, bilaterally. Results are consistent with the hypothesis of a common frontal-temporal-subcortical substrate (e.g., involving aminergic nuclei) in the etiology of depression in AD. Frontal-subcortical dysfunction may also be associated with emotional lability and apathy in AD, although these may be related to a greater involvement of frontal–basal ganglia circuits.
Key Words: Alzheimer's Disease • Apathy • Depression • PET Studies
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