Aboulia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [3]

Overview

Aboulia or Abulia (from the Greek "αβουλία", meaning "non-will"), in neurology, refers to a lack of will or initiative. The patient is unable to act or make decisions independently. It may range in severity from subtle to overwhelming.

Pathophysiology

Abulia may result from a variety of brain injuries which cause personality change, such as dementing illnesses, trauma, or intracerebral hemorrhage (stroke), especially stroke causing diffuse injury to the right hemisphere. Abulia has also been associated with amphetamine withdrawal.^[1]It may complicate rehabilitation when a stroke patient is uninterested in performing tasks like walking despite being capable of doing so. It should be differentiated from apraxia, when a brain injured patient has impairment in comprehending the movements necessary to perform a motor task despite not having any paralysis that prevents performing the task; that condition can also result in lack of initiation of activity.

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. Caregivers can use sweet or salty flavored foods later in meals to provide interest and increase oral intake, but must always clear the mouth of food after each meal.

Causes

Common Causes

Causes by Organ System

Cardiovascular	Huntington's disease, amphetamine withdrawal, Parkinson's disease, traumatic brain injury
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Amphetamine withdrawal
Ear Nose Throat	traumatic brain injury
Endocrine	Huntington's disease
Environmental	No underlying causes
Gastroenterologic	Hydrocephalus, intracerebral hemorrhage, traumatic brain injury, multiple sclerosis, progressive supranuclear palsy, Parkinson's disease
Genetic	Huntington's disease
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	Traumatic brain injury, multiple sclerosis, Huntington's disease, Parkinson's disease, progressive supranuclear palsy, intracerebral hemorrhage
Neurologic	Acute caudate vascular lesions, alzheimer's disease, amphetamine withdrawal, anterior cingulate circuit damage, capsular genu, infarction, CNS lupus, damage to the basal ganglia, dementia, huntington's disease, hydrocephalus, intracerebral hemorrhage, multiple sclerosis, Parkinson's disease, progressive supranuclear palsy, Traumatic brain injury
Nutritional / Metabolic	Huntington's disease
Oncologic	No underlying causes
Opthalmologic	Multiple sclerosis, hydrocephalus, intracerebral hemorrhage, traumatic brain injury, Parkinson's disease, progressive supranuclear palsy
Overdose / Toxicity	No underlying causes
Psychiatric	Depression, schizophrenia, Alzheimer's disease, dementia, Huntington's disease, Parkinson's disease, progressive supranuclear palsy, amphetamine withdrawal, hydrocephalus, traumatic brain injury
Pulmonary	Multiple sclerosis, Huntington's disease, traumatic brain injury
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Multiple sclerosis
Trauma	No underlying causes
Urologic	Hydrocephalus, multiple sclerosis, Parkinson's disease, progressive supranuclear palsy
Miscellaneous	No underlying causes