Deans' stroke musings: Treatment of apathy in stroke patients: a systematic review

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, December 1, 2025

Treatment of apathy in stroke patients: a systematic review

Apathy is COMPLETELY YOUR DOCTOR'S FAULT! EXACT 100% RECOVERY PROTOCOLS and your patient will gladly do the millions of reps needed because they are looking forward to recovery! If you can't see that, you are incredibly blitheringly stupid!

Treatment of apathy in stroke patients: a systematic review

Maria Luisa Ruiz-Franco¹^†

Laura Amaya-Pascasio¹^*^†

Mercedes Gil-Rodríguez²

Antonio Arjona-Padillo¹

José García-Pinteño²

Antonio Jose Rodriguez-Sanchez²

Ana Sánchez-Kuhn^3,4

Pilar Flores^3,4

Patricia Martinez-Sanchez^1,4^*

¹Stroke Unit, Department of Neurology, Torrecárdenas University Hospital, Almería, Spain
²Fundation for Biosanitary Research of Eastern Adnalusia (FIBAO), Torrecárdenas University Hospital, Almería, Spain
³Department of Psychology, Faculty of Psychology, CTS-280 Clinical and Experimental Neuroscience Research Group and Research Center CiBiS, University of Almeria, Almeria, Spain
⁴Department of Nursing, Physiotherapy and Medicine, Faculty of Health Science, Health Research Center (CEINSA), University of Almería, Almeria, Spain

Introduction: Post-stroke apathy is a prevalent yet frequently underdiagnosed neuropsychiatric syndrome, reported in up to one-third of stroke survivors, and is consistently associated with poorer functional recovery and cognitive decline. We aimed to review the current evidence on available pharmacological and non-pharmacological treatments for post-stroke apathy, and to evaluate their efficacy and safety.

Methods: A systematic review was conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42022332559). We searched PubMed, Web of Science, and Scopus for randomized and non-randomized clinical trials published until November 2024. Eligible studies included adults with ischemic or hemorrhagic stroke and a defined diagnosis of apathy. Interventions included pharmacological treatments and non-pharmacological strategies, such as neuromodulation techniques. Data extraction and risk of bias assessment were independently performed by two reviewers using the RoB-2 tool.

Results: Ten clinical trials involving 2,359 patients were included. Pharmacological interventions with escitalopram and donepezil (alone or combined with intensive language action therapy) showed potential benefits. Nefiracetam yielded mixed results depending on dose and coexisting depression. Non-pharmacological approaches such as problem-solving therapy, motor relearning programs, strategy training, and complex rehabilitation programs demonstrated significant improvement in apathy scores. High-frequency repetitive transcranial magnetic stimulation also showed efficacy. However, heterogeneity in study design and apathy assessment scales limited direct comparisons.

Conclusion: Several interventions, including escitalopram, donepezil, motor relearning programs, strategy training, and rTMS, have demonstrated potential effectiveness in treating post-stroke apathy. Nevertheless, evidence remains scarce and heterogeneous, underscoring the need for larger, high-quality randomized controlled trials to establish definitive treatment guidelines.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022332559.