Aboulia

Aboulia or abulia (from Greek: βουλή, meaning "will", with the prefix -a), in neurology, refers to a lack of will or initiative and can be seen as a disorder of diminished motivation (DDM). Aboulia falls in the middle of the spectrum of diminished motivation, with apathy being less extreme and akinetic mutism being more extreme than aboulia. A patient with aboulia is unable to act or make decisions independently. It may range in severity from subtle to overwhelming. It is also known as Blocq's disease (which also refers to abasia and astasia-abasia). Aboulia was originally considered to be a disorder of the will.

Aboulia has been known to clinicians since 1838. However, in the time since its inception, the definition of aboulia has been subjected to many different forms, some even contradictory with previous ones. Aboulia has been described as a loss of drive, expression, loss of behavior and speech output, slowing and prolonged speech latency, and reduction of spontaneous thought content and initiative. The clinical features most commonly associated with aboulia are:

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.

Both neurologists and psychiatrists recognize aboulia to be a distinct clinical entity, but its status as a syndrome is unclear. Although aboulia has been known to clinicians since 1838, it has been subjected to different interpretations – from 'a pure lack of will', in the absence of motor paralysis to, more recently, being considered 'a reduction in action emotion and cognition'. As a result of the changing definition of aboulia, there is currently a debate on whether or not aboulia is a sign or a symptom of another disease, or its own disease that seems to appear in the presence of other more well-researched diseases, such as Alzheimer's disease.

A survey of 2 movement disorder experts, 2 neuropsychiatrists, and 2 rehabilitation experts was conducted and the results did not seem to shed any light on the matter of differentiating aboulia from other DDMs. The experts used the terms apathy and aboulia interchangeably and even debated on whether or not aboulia was a discrete entity, or just a hazy gray area on a spectrum of more defined disorders. Four of the experts said aboulia was a sign and a symptom, but the group was split on whether or not it was a syndrome. Another survey, which consisted of true and false questions about what aboulia is distinct from, whether it is a sign, symptom, or syndrome, where lesions are present in cases of aboulia, what diseases are commonly associated with aboulia, and what current treatments are used for aboulia, was sent to 15 neurologists and 10 psychiatrists. Most experts agreed that aboulia is clinically distinct from depression, akinetic mutism, and alexithymia. However, only 32% believed aboulia was different from apathy, while 44% said they were not different, and 24% were unsure. Yet again, there was disagreement about whether or not aboulia is a sign, symptom, or syndrome.

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