In neurology, abulia, or aboulia (from Ancient Greek: βουλή, meaning "will"),[1] refers to a lack of will or initiative and can be seen as a disorder of diminished motivation.
In the case of akinetic mutism, many patients describe that as soon as they "will" or attempt a movement, a "counter-will" or "resistance" rises up to meet them.
[citation needed] Both neurologists and psychiatrists recognize abulia to be a distinct clinical entity, but its status as a syndrome is unclear.
Although abulia 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'.
Only recently has the study of motivational processes been extended to integrate biological drives and emotional states in the explanation of purposeful behavior in human beings.
Considering the number of disorders attributed to a lack of will and motivation, it is essential that abulia and apathy be defined more precisely to avoid confusion.
[6] As a result of more and more evidence showing that the mesolimbic and the mesocortical dopamine system are key to motivation and responsiveness to reward, abulia may be a dopamine-related dysfunction.
[9][10] Injuries to the frontal lobe and/or the basal ganglia can interfere with an individual's ability to initiate speech, movement, and social interaction.
A case study involving two patients with acute confusional state and abulia was conducted to see if these symptoms were the result of an infarct in the capsular genu.
These tracts are part of a complex system of cortical and subcortical frontal circuits through which the flow of information from the entire cortex takes place before reaching the basal ganglia.
Most of the cases where abulia was present were when the patients had a left caudate infarct that extended into the putamen as seen through a CT or MRI scan.