There are some days where you just don’t want to get out of bed. Days when summoning up the will to step out of the house seems like a Herculean task. Now imagine a foggy world where that’s every day. Abulia is a condition in which you are weighed down by a lack of motivation or will. It is predominantly seen with lesions in the brain and can make people indifferent to life. People who suffer from it often find it difficult to do ordinary things like holding a conversation or feeding themselves.
There are some days where you just don’t want to get out of bed. Days when summoning up the energy to step out of the house seems like a herculean task. Now imagine a foggy world where that’s every day. Abulia is a condition in which you are weighed down by a lack of motivation or will. In fact, the literal meaning of the word “abulia” is “without will.” The Gale Encyclopedia of Neurological Disorders defines it as a “state in which an individual seems to have lost will or motivation.”1 It’s considered a form of apathy in which there’s very little or no spontaneous thinking and acting.2
Symptoms Of Abulia
If you’re feeling bored or disinterested in life, do you have abulia? Probably not. There is still a lot that we don’t know about abulia, and differences of opinion about its definition are rife in the medical community. But a survey of British neurologists and psychiatrists published in 2002 attempted to reach a consensus on abulia. According to this survey, experts mostly agree that abulia is predominantly seen with brain lesions, specifically of the basal ganglia and the frontal lobes and not the cerebellum or brainstem. The following features are also considered typical of abulia:
Lack of motivation
Inability to initiate or sustain actions
Lack of spontaneous movements
Delayed responses to questions
Limited spontaneous speech
Limited emotional responses
Lack of spontaneity
Limited social equations
Lack of interest in usual pastimes.
So think of the old man who stays in bed all day, who seems unable to summon up the will to get up; the retired 70-year old who has to be coaxed to eat and doesn’t seem to be able to swallow his food even though he is not suffering from a motor disability; the grandmother who doesn’t show any interest in the birth of her first grandchild and looks away or stares vacantly when you attempt to have a conversation with her. They probably have abulia.
You’d have noticed something common in all these examples: the people affected are all elderly. Although abulia is not caused by aging, it has been observed in a number of conditions associated with aging – for instance, Alzheimer’s disease, vascular dementia, stroke, Lewy body dementia, Parkinson’s disease, and frontotemporal dementia. It is also associated with schizophrenia, Huntington’s disease, and brain injury. So the child who was in a car accident and sustained a brain injury can suffer from abulia too. Abulia also manifests at times in milder forms.
Many studies have found abulia to be associated with depression. However, there are definite differences between them. People with abulia don’t report any sadness or negative thoughts – rather, they seem to be indifferent and show a lack of concern for themselves and the people around them. In fact, patients with abulic symptoms may respond poorly to some antidepressants, and serotonergic agents which relieve depression may increase apathy. Also, if you look at the brain, depression is reported to be more common with anterior and left-sided lesions in the brain whereas abulia is more common with right-sided lesions.
Abulia And Dopamine
The dopaminergic system is a system of neural pathways that transmit dopamine from one part of the brain to another. In animals, dopaminergic circuits have been found to be important factors in impulses related to reward and motivation, and their damage is associated with apathy.6 It has been hypothesized that a healthy dopaminergic system in the brain is what allows us to turn our impulses into actions. Therefore, drugs that impact the dopaminergic system are being considered as possible treatments for abulia.[ref]Drubach, Daniel A., Gabriel Zeilig, Julio Perez, Ligia Peralta, and Michael Makley. “Treatment of abulia with carbidopa/levodopa.” Neurorehabilitation and Neural Repair .