For professionals

Abstract

Akinetic mutism (AM) is a rare neurological disorder characterized by the presence of an intact level of consciousness and sensorimotor capacity, but with a simultaneous decrease in goal-directed behavior and emotions. Patients are in an awake state of deep apathy, seemingly indifferent to pain, thirst, or hunger. It represents the end within the spectrum of disorders of reduced motivation.

In recent years, more has become known about the functional roles of neurocircuits and neurotransmitters associated with human motivational behavior. More specifically, there is an increasing body of behavioral evidence linking specific damage of the functional frontal-subcortical organization to the occurrence of marked neurological deficits. In this review, we combine evidence from lesion studies and neurophysiological evidence in animals, imaging studies in humans, and clinical research in patients with AM to form an integrative theory of its pathophysiology.

In addition, the specific pharmacological interventions used to treat AM and their motivations are assessed, providing a comprehensive overview for use in clinical practice.

Keywords
Akinetic mutism, Frontal-subcortical neurocircuits, Behavior, Impaired motivation disorders