Anterior cingulate dysfunction — MRCPsych Paper A MCQ

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EasyNeuroanatomyAnterior cingulate dysfunctionMRCPsych Paper A

A 35-year-old woman develops a focal cerebral infarct following treatment for a subarachnoid haemorrhage. She is apathetic, initiates few activities spontaneously and has difficulty sustaining goal-directed behaviour. Limb power is preserved. Dysfunction of which brain structure best explains this presentation?

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Correct answer: A — Anterior cingulate cortex

The correct answer is **A, the anterior cingulate cortex**. The anterior cingulate, particularly its dorsal component and connected frontostriatal circuitry, contributes to motivation, spontaneous initiation, effort allocation and persistence with goal-directed behaviour. Dysfunction can therefore produce apathy or abulia despite preserved basic motor power. The dentate nucleus is principally involved in cerebellar coordination and motor planning; its dysfunction causes ataxic features rather than a primary motivational syndrome. The inferior colliculus and primary auditory cortex participate in auditory processing. The lateral geniculate nucleus is a thalamic relay in the visual pathway. None of these distractors explains the combination of reduced motivation and impaired self-initiation.

Reference: Le Heron C, Apps MAJ, Husain M. The anatomy of apathy: A neurocognitive framework for amotivated behaviour. Neuropsychologia. 2018;118:54–67. https://pubmed.ncbi.nlm.nih.gov/28689673/