Neurological Examination, clinical cases and neuropsychological ...

23/07/54
Brodmann area 24 is part of the anterior
cingulate in the human brain.
In the human this area is known as ventral anterior
cingulate area 24, and it refers to a subdivision of the
cytoarchitecturally defined cingulate cortex region of
cerebral cortex (area cingularis anterior ventralis). It
occupies most of the anterior cingulate gyrus in an arc
around the genu of corpus callosum. Its outer border
corresponds approximately to the cingulate sulcus.
Cytoarchitecturally it is bounded internally by the
pregenual area 33, externally by the dorsal anterior
cingulate area 32, and caudally by the ventral
posterior cingulate area 23 and the dorsal posterior
cingulate area 31.
Francis Crick, one of the discoverers of DNA, listed
area 24 as the seat of free will because of its
centrality in abulia and amotivational syndromes.
Brain: Brodmann area 24
Figure 1 from Experiment 2 of the original description of the Stroop
Effect (1935). 1 is the time that it takes to name the color of the dots
while 2 is the time that it takes to say the color when there is a conflict
with the written word
Aboulia or Abulia (from the Greek "αβουλία", meaning
"non‐will"), in neurology, refers to a lack of will or initiative
and is one of the Disorders of Diminished Motivation or
DDM. Aboulia falls in the middle of the spectrum of
diminished motivation, with apathy being less extreme and
akinetic mutism being more extreme than aboulia. A
patient with aboulia is unable to act or make decisions
independently. d It may range in severity from subtle bl to
overwhelming. It is also known as Blocq's disease (which
also refers to abasia and astasia‐abasia). Abulia was
originally considered to be a disorder of the will. [
Aboulia has been known to clinicians since 1838. However, in the time since its
inception, the definition of aboulia has been subjected to many different forms, some
even contradictory with previous ones. Aboulia has been described as a loss of drive,
expression, loss of behavior and speech output, slowing and prolonged speech latency,
and reduction of spontaneous thought content and initiative. The clinical features most
commonly associated with aboulia are:
1. Difficulty in initiating and sustaining purposeful movements
2. Lack of spontaneous movement
3. Reduced spontaneous movement
4. Increased response‐time to queries
5. Passivity
6. Reduced emotional responsiveness and spontaneity
7. Reduced social interactions
8. Reduced interest in usual pastimes
Especially in patients with progressive dementia, it may affect feeding. Patients may
continue to chew or hold food in their mouths for hours without swallowing it. The
behavior may be most evident after these patients have eaten part of their meals
and no longer have strong appetites.
Amotivational syndrome is a psychological condition associated
with diminished inspiration to participate in social situations and activities,
with lapses in apathy caused by an external event, situation, substance (or
lack of), relationship, or other cause.
While some have claimed that chronic use of cannabis causes amotivational
syndrome in some users, empirical studies suggest that there is no such thing
as "amotivational syndrome", per se, but that chronic cannabis intoxication
can lead to apathy and amotivation. From a World Health Organization report:
The evidence for an "amotivational syndrome" among adults consists largely
of case histories i and observational reports (e.g. Kl Kolanskyand Moore, 1971;
Millman and Sbriglio, 1986). The small number of controlled field and
laboratory studies have not found compelling evidence for such a syndrome
(Dornbush, 1974; Negrete, 1983; Hollister, 1986)... (I)t is doubtful that
cannabis use produces a well defined amotivational syndrome. It may be more
parsimonious to regard the symptoms of impaired motivation as symptoms of
chronic cannabis intoxication rather than inventing a new psychiatric
syndrome.
Apathy (also called impassivity or
perfunctoriness) is a state of
indifference, or the suppression of emotions
such as concern, excitement, motivation and
passion. An apathetic individual has an
absence of interest in or concern about
emotional, social, spiritual, philosophical or
physical life.
They may lack a sense of purpose or
meaning in their life. He or she may also
exhibit hb insensibility bl or sluggishness. The
opposite of apathy is flow. In positive
psychology, apathy is described as a result of
the individual feeling they have much more
than the level of skill required to confront a
challenge. It may also be a result of
perceiving no challenge at all (e.g. the
challenge is irrelevant to them, or conversely,
they have learned helplessness).
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