Apathy was assessed using the Apathy Evaluation Scale developed specifically to identify apathy and also to differentiate this from depression. Discussion: Apathy, a common behavioral problem, is often mistaken for depression; however, apathy differs from depression in symptomatology, clinical presentation, and treatment options.
SSRIs, a common treatment for depression, are Tge to cause or increase apathy. Deficits in the dopamine receptor system are involved in the etiology of apathy; modafinil's increased dopaminergic transmission is thought to help alleviate apathy. At admission, Mr A presented as an obese man with agitation, irritability, grandiosity, pressured speech, and impaired insight.
Mr A was not intoxicated and had a negative urine drug screen. There was no known history of bipolar illness or other psychiatric disorder in his family. He was taking no other medications or over-the-counter supplements and had no other known medical illnesses. Provigil In The Elderly computed tomography, chest radiography, and blood chemistry results were all within normal limits.
Given the lack of prior history of mood disorder and the temporal Elrerly between the manic symptoms and the introduction of modafinil, the treatment team discontinued modafinil and took a wait-and-see Elderpy, deciding not to use an antipsychotic or a mood stabilizer. After 2 days, Mr A began to show improvement in his thought process, his speech became less pressured, and his sleep improved.
For the next 3 days, Mr A was no longer grandiose or agitated and gained some insight in recognizing his recent reckless spending. Mr A stayed on our unit for 9 days and improved steadily. Mr A was discharged from Proviigl hospital for follow-up care with a community psychiatrist and given the diagnosis of modafinil-induced bipolar disorder Proovigil Six months post discharge, the patient continued to be free of manic symptoms.
This activity has been associated in vivo with increased extracellular dopamine levels in some brain regions of animals. The mechanism of action for induction of mania in patients taking modafinil is currently unknown. Currently, there are no guidelines for the treatment of modafinil-induced mania.
In our case, Provigil In The Elderly of the culprit drug was sufficient treatment for symptom resolution. New-onset mania is a possible complication of modafinil use. Patients should be carefully monitored for the onset of manic symptoms when taking modafinil. Ballon JS, Feifel D. A systematic review of modafinil: potential clinical uses and mechanisms of action.
J Clin Psychiatry. The top-down process influences patterns of recognition, thereby favoring dynamic improving or updating of the sensorial information flow. Thus, the process favors the orientation of selective attention to relevant stimuli, thereby favoring a filtering activity that prevents WM overload Gazzaley et al.
As for the modafinil-driven effects on the frontal cortex, several studies have indicated that the MFG and the neighboring inferior frontal cortex IFC act to filter out noise and irrelevant stimuli, thereby re-directing attention to achieve accurate task performance Hopfinger et al.
These functions work to complement what described for the V1, thereby suggesting an overall scenario in which modafinil may act to improve interference control.
Modafinil therapy for apathy in an elderly patient
Our Provitil results also indicate a major effect exerted by modafinil on E,derly cerebellum resting activity. The cerebellum is emerging as a crucial modulator of cognition as evidence indicates that cerebellar projections target multiple associative areas in the parietal and prefrontal cortex Stoodley and Schmahmann, These areas are involved in modulating attention and spatial processing as well as WM encoding and maintenance E et al.
Of note, despite the large evidence in preclinical and clinical Proigil showing modafinil-driven FC effects on the thalamus, our EC analysis failed to report a great drug-related enhanced centrality for this region Urbano et al.
Given that most of the studies have shown drug-related effects in young subjects, we can only speculate that the lack of major thalamic involvement that we found in our elderly sample may indicate lower sensitivity to modafinil of this subcortical region upon aging.
The net behavioral correlates of modafinil-driven modulation of network activities are largely unknown and likely to be complex. Preclinical evidence suggests potential Prkvigil effects. In theory, modafinil-driven FC changes may lead to enhanced experience-dependent synaptic plasticity and neurogenesis as well as behavioral and cognitive benefits Minzenberg and Carter, The notion is supported by preclinical evidence showing that modafinil, through increased dopaminergic and noradrenergic transmission, promotes adult neurogenesis, especially within the hippocampus Brandt Provigil In The Elderly al.
Modafinil Treatment for Sleep/Wake Disturbances in Older Adults
Furthermore, in preclinical models, modafinil has been shown to improve spatial learning and fear conditioning, inhibitory control, WM functioning, and sustained attention Morgan et al.
Our studies provide some FC evidence that corroborates the hypothesis that modafinil may interfere with some of these cognitive domains.
Upon brain aging, cognitive deficiency can result from failure of inhibitory processes and the dysfunctional interplay between the WM and the attentional systems Luis et al.
This dysfunction can result in an overall reduced activity of filtering relevant information while increasing the production of noise overflow Luis et al. A similar deficit in cognitive control has been found to occur in mild cognitive impairment MCI or early-stage dementia patients. Thus, on a speculative note, the modafinil-driven FC effects we are reporting to occur in areas that are controlling attention and inhibitory control may help to counteract deficits of the aging brain as well Provigil In The Elderly in the brain of MCI or AD patients.
Interestingly, recent data indicate that AD-related neurodegeneration is present, beyond the cortex, also in the Crus I and II cerebellar regions Guo et al. In that respect, it is conceivable that the modafinil FC effects we have found in these cerebellar areas may be of some help and exert a compensatory role.
There are some limitations of the present study. One limitation relates to the acute nature of our pharmacological intervention as chronic administration of modafinil may produce different activation patterns.
An additional limit of the study concerns the lack of investigation of behavioral effects evoked by the acute administration of modafinil. Furthermore, in the age of precision medicine, further information is warranted on CED and modafinil activity in relation to factors such as genetic background, psychosocial features, as well as baseline levels of performance, a set of critical elements that can very differently shape drug responses in each individual.
All subjects gave written informed consent in accordance with the Declaration of Helsinki. Provigil In The Elderly conceived and designed the current Provigil In The Elderly, supervised the data acquisition and analysis, and wrote the manuscript.
MP supervised the data analysis and wrote the manuscript. TG performed fMRI data analysis and wrote the draft of the manuscript. All authors read and approved the final manuscript.
Modafinil therapy for apathy in an elderly patient
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Aron, A. Inhibition and the right inferior frontal cortex. Trends Cogn. Badre, D. Frontal lobe mechanisms that resolve proactive interference. Cortex 15, — Battleday, R. Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: a systematic review.
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Modafinil (Oral Route) Before Using - Mayo Clinic
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Due to its relative lack of drug interactions, modafinil is a good alternative for elderly patients, who often receive multiple medications. Apathy improved. Brief Summary: Modafinil, trade named Provigil, is a medication approved by the Food and Drug Administration for the treatment of narcolepsy, obstructive sleep.