Awardee: Professor Hugh Markus, University of Cambridge

Award Type: Priority Programme Award

Research Title:

Understanding the importance of apathy, and improving its care in patients with stroke

Description of research:

Cerebral small vessel disease (SVD) describes a disorder of the small blood vessels in the brain, which is usually associated with high blood pressure. It causes 20% of all strokes (lacunar stroke) and is the main cause of cognitive changes and dementia associated with stroke. In addition, behavioural symptoms such as depression and apathy are common in patients with SVD. Apathy describes a loss of initiative, a failure to engage in normal activities and a lack of emotional reactivity. Apathy has a major effect of quality of life for a SVD sufferer; we have shown that for the patient it is more important in determining quality of life than is disability, such as weakness, from the stroke itself. It is also very distressing for the family/carer. Despite its importance it is poorly understood, and there are few treatment options which have been shown to work. We will bring together a multidisciplinary team (stroke physicians/neurologists, cognitive neuroscientists, clinical neuropsychologists, brain imagers and physiotherapists) to address this area. An additional component will be to build capacity through two multidisciplinary PhD studentships.

Components of the programme will be:

1. Determining how common apathy is and whether the presence of apathy predicts long term decline in cognition, functional status, disability and quality of life.

2. A study using MRI brain imaging to look at which areas of the brain are affected in patients who suffer apathy in SVD to help us understand the underlying mechanisms.

3. A study in stroke patients to determine whether the presence of apathy interferes with recovery from stroke, and therefore whether intervening to reduce apathy could improve response to physiotherapy.

4. A review of possible treatments used in neurology which might be applicable to apathy in SVD and pilot studies looking at some of these possible treatments.