Post-Stroke Apathy: A Theoretical Framework and Pilot Protocol (The Disconnected Engine)

This record contains two interconnected documents extending the Dispositional Commitment (Dc) framework to post-stroke apathy (PSA): 1. The Disconnected Engine (Theoretical Paper): This paper proposes a radical shift in understanding post-stroke apathy. We argue that contemporary neurorehabilitation often conflates the cognitive structure of a plan (Prospective Memory, PM—the "map") with the dispositional readiness to execute it (Dispositional Commitment, Dc—the "engine"). By reviewing the "disconnection hypothesis" (lesions disrupting the ACC-OFC-striatal circuit), we propose that PSA is not a memory deficit, but a structural collapse of Dc. The paper introduces the Behavioral Commitment Index (BCI) as a formative composite to measure Dc. 2. The Pilot Protocol (Clinical Design): A 12-week pilot randomized controlled trial (N=40) designed to test the feasibility and preliminary effects of a Dc-targeted intervention (Implementation Intentions + Intention Maintenance) in stroke survivors. The protocol includes a detailed Table of Measures (eCAP, LSI, AES, LARS-P), an adaptive titration protocol to address fatigue, and an exploratory neuroimaging component (DTI, rs-fMRI) to assess white matter integrity and functional connectivity. Target Audience: Neurologists, neurorehabilitation specialists, clinical psychologists, and researchers in volitional disorders. Conceptual Framework: Triadic Theory of Action / PM vs Dc (Sanzhiev, 2026).