Figure 1.

The Networks Involved in Akinetic Mutism Include the Reward Pathway and the Motivation-to-Movement Pathway, Otherwise Known as the Parallel Cortico-Striato-Thalamo-Cortical (CSTC Loops). Disruptions in the neurotransmitter flow or direct injury to key sites in these pathways will directly affect motivation and movement. Here we provide examples of locations where COVID-19 and associated systemic and local effects through various mechanisms may affect motivational circuity and produce the phenotype of AM. DA = dopamine; GABA = gamma aminobutyric acid; GP = globus pallidus; Glu = glutamate; MFB = medial forebrain bundle; NAc = nucleus accumbens; PFC = prefrontal cortex; Thal = thalamus; VTA = ventral tegmental area.