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Calamia M, Markon K, Tranel D. The structure of apathy symptoms. J Clin Exp Neuropsychol 2023; 45:377-388. [PMID: 37572079 DOI: 10.1080/13803395.2023.2245605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Apathy is common in many neurological, psychiatric, and medical disorders and is related to a number of important clinical outcomes. Nonetheless, research on apathy is hindered by different ways of defining and measuring it, which has led to heterogeneity in research findings. METHOD The current study aimed to investigate the factor structure of apathy symptoms using a novel item pool. We examined whether the use of this item pool has incremental validity above and beyond a widely used measure in predicting cognition and everyday functioning. Participants included 249 informants who reported on an individual with (n = 210) or without (n = 39) a neurological or psychiatric condition. RESULTS Results showed the best fitting model of apathy symptoms was a bifactor model with apathy as a general dimension and three specific symptom factors including reduced interest and initiative, reduced emotional and verbal expression, and reduced social engagement. Incremental validity in predicting cognition was demonstrated for this more robust assessment of apathy symptoms. CONCLUSIONS Results are most aligned with one set of proposed diagnostic criteria for apathy which differs from other criteria in that it does not distinguish between cognitive and behavioral symptoms and includes a separate social dimension. Future research could aim to replicate this model in additional clinical samples and explore the incremental validity of the newly developed Apathy Symptom Inventory (ASI) in comparison to other recently developed measures.
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Affiliation(s)
- Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Kristian Markon
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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2
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The Apathy Evaluation Scale (AES-C): Psychometric Properties and Invariance of Italian Version in Mild Cognitive Impairment and Alzheimer's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189597. [PMID: 34574524 PMCID: PMC8467636 DOI: 10.3390/ijerph18189597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022]
Abstract
Apathy is a neuropsychiatric symptom observed in different neurological and psychiatric disorders. Although apathy is considered a symptom, it has been recently reconsidered as a syndrome characterised by three dimensions: cognitive symptoms, affective symptoms and behavioural symptoms. Recent studies have shown that apathy can be considered as a prodromal symptom of Alzheimer's disease (AD), but also an indicator of the transition from mild cognitive impairment to AD. According to this scenario, an early detection of apathy in subjects with Mild Cognitive Impairment (MCI) and Mild AD can be a valid psychometric strategy to improve an early diagnosis and promote a prompt intervention. The Apathy Evaluation Scale is a validated tool composed of 18 items that assess and quantify emotional, behavioural and cognitive aspects of apathy. The aim of this study is to assess the specific reliability and validity of the Italian version of the Apathy Evaluation Scale-Clinician Version (AES-C) to detect apathy both in amnestic MCI and mild AD patients. In the present paper, we therefore examined the psychometric properties and the invariance of the Italian Version of the AES-C conducted on a sample composed of an experimental group of amnestic MCI and AD patients (N = 107) and a control group (N = 107) constituted by Age- and Sex-matched healthy controls. Results confirm the goodness of the scale. Confirmatory factory analysis confirmed that the AES-C Italian Version presents the same stability of one second-order factor and three first-order factors identified in the original version, and all items are predicted by a single general factor. Moreover, the scale was found to be invariant across both populations. Moreover, reliability and discriminant analysis showed good values. We found in the experimental group a negative correlation between the AES-C and Frontal Assessment Battery (FAB) (rs = -0.21, p < 0.001) and Mini Mental State Examination (MMSE) (rs = -0.04, p < 0.001), while a positive correlation was found between the AES-C and Hamilton psychiatric Rating scale for Depression (HAM-D) scores (rs = 0.58, p < 0.001) Overall, our data demonstrated the validity of the Italian version of the AES-C for the assessment of apathy both in MCI and in AD patients.
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3
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Pimontel MA, Solomonov N, Oberlin L, Kanellopoulos T, Bress JN, Hoptman MJ, Alexopoulos GS, Gunning FM. Cortical Thickness of the Salience Network and Change in Apathy Following Antidepressant Treatment for Late-Life Depression. Am J Geriatr Psychiatry 2021; 29:241-248. [PMID: 32680763 PMCID: PMC7738363 DOI: 10.1016/j.jagp.2020.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Apathy is common in late-life depression and is associated with poor response to antidepressant drugs. In depressed older adults, apathy may be characterized by neuroanatomical abnormalities of the salience network. The current study examined whether cortical thickness of select salience network structures predicted change in apathy following a 12-week treatment with escitalopram. METHODS A sample of 46 older adults with major depressive disorder received 12 weeks of escitalopram treatment at a daily target dose of 20 mg. All participants underwent a structural brain MRI scan at baseline, and cortical thickness was estimated in key cortical nodes of the salience network: the caudal anterior cingulate cortex and the insula. We measured baseline and post-treatment symptoms using the Apathy Evaluation Scale and the Hamilton Depression Rating Scale. RESULTS A thicker insula at baseline predicted reduction in apathy symptoms following 12 weeks of treatment with escitalopram, even when controlling for age, baseline depression severity and change in depressive symptoms. CONCLUSION Reduced insular thickness predicted residual apathetic symptoms following escitalopram treatment. These results converge with our previous findings of abnormal functional connectivity of the insular cortex in older depressed individuals with apathy. Older depressed adults with apathy may benefit from alternative treatment approaches or augmentative interventions that target abnormalities of the salience network.
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Affiliation(s)
- Monique A Pimontel
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Lauren Oberlin
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Theodora Kanellopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Jennifer N Bress
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Matthew J Hoptman
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY; New York University School of Medicine, New York, NY
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Faith M Gunning
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY.
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4
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Oudega ML, Siddiqui A, Wattjes MP, Barkhof F, Kate MT, Muller M, Bouckaert F, Vandenbulcke M, De Winter FL, Sienaert P, Stek ML, Comijs HC, Korten NCM, Emsell L, Eikelenboom P, Rhebergen D, van Exel E, Dols A. Are Apathy and Depressive Symptoms Related to Vascular White Matter Hyperintensities in Severe Late Life Depression? J Geriatr Psychiatry Neurol 2021; 34:21-28. [PMID: 32036772 DOI: 10.1177/0891988720901783] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Apathy symptoms are defined as a lack of interest and motivation. Patients with late-life depression (LLD) also suffer from lack of interest and motivation and previous studies have linked apathy to vascular white matter hyperintensities (WMH) of the brain in depressed and nondepressed patients. The aim of this study was to investigate the relationship between apathy symptoms, depressive symptoms, and WMH in LLD. We hypothesize that late-onset depression (LOD; first episode of depression after 55 years of age) is associated with WMH and apathy symptoms. METHODS Apathy scores were collected for 87 inpatients diagnosed with LLD. Eighty patients underwent brain magnetic resonance imaging. Associations between depressive and apathy symptoms and WMH were analyzed using linear regression. RESULTS All 3 subdomains of the 10-item Montgomery-Åsberg Depression Rating Scale correlated significantly with the apathy scale score (all P < .05). In the total sample, apathy nor depressive symptoms were related to specific WMH. In LOD only, periventricular WMH were associated with depression severity (β = 5.21, P = .04), while WMH in the left infratentorial region were associated with apathy symptoms (β coefficient = 5.89, P = .03). CONCLUSION Apathy and depressive symptoms are highly overlapping in the current cohort of older patients with severe LLD, leading to the hypothesis that apathy symptoms are part of depressive symptoms in the symptom profile of older patients with severe LLD. Neither apathy nor depressive symptoms were related to WMH, suggesting that radiological markers of cerebrovascular disease, such as WMH, may not be useful in predicting these symptoms in severe LLD.
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Affiliation(s)
- Mardien Leoniek Oudega
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Neuroscience, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Amna Siddiqui
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Mike P Wattjes
- Psychiatry, Amsterdam Neuroscience, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Frederik Barkhof
- Psychiatry, Amsterdam Neuroscience, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.,Institute of Neurology and Healthcare Engineering, UCL, London, United Kingdom
| | - Mara Ten Kate
- Department of Radiology and Nuclear Medicine, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine, 522567Amsterdam UMC, Amsterdam, the Netherlands
| | - Filip Bouckaert
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | | | | | - Pascal Sienaert
- ECT Department, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Max L Stek
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Hannie C Comijs
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Nicole C M Korten
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Louise Emsell
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Piet Eikelenboom
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Didi Rhebergen
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Eric van Exel
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Neuroscience, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Annemieke Dols
- 159194GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Neuroscience, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, 522567Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
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5
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Parrotta I, Maltais M, Rolland Y, Spampinato DA, Robert P, de Souto Barreto P, Vellas B. The association between apathy and frailty in older adults: a new investigation using data from the Mapt study. Aging Ment Health 2020; 24:1985-1989. [PMID: 31411039 DOI: 10.1080/13607863.2019.1650890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Apathy is a behavioral syndrome that has been suggested to share similar neuro-physiological pathways with frailty. OBJECTIVE To investigate the cross-sectional association between apathy and frailty using original data from dementia-free, community-dwelling older adults. METHOD A cross-sectional analysis was performed to test the association between frailty (according to Fried's frailty phenotype) and apathy (defined by three items from Geriatric Depression Scale) using data from MAPT, a 3-year, randomized, multicenter, placebo-controlled trial among community-dwelling, dementia-free participants (1.679 individuals with mean age of 75 years). RESULTS The ordinal logistic regression showed that apathetic individuals had a two-fold more probability to be rated as frail (OR 2.20, 95% CI 1.7-2.9), when adjusting for confounders. Apathetic individuals display a two-fold more likelihood to be rated as pre-frail (RRR 2.1; 95% CI 1.5-2.8) and a three-fold higher probability to be rated as frail (RRR 3.5, 95% CI 1.8-6.9) compared to robust participants. CONCLUSION Although data on the associations between apathy and frailty are scarce, these conditions potentially shares physiological mechanisms and were found to be closely associated. Temporal association between frailty and apathy deserve to be further investigated.
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Affiliation(s)
- Ilaria Parrotta
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,Faculty of Medicine and Dentistry, La Sapienza Università di Roma, Roma, Italy
| | - Mathieu Maltais
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR, INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Danny A Spampinato
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London
| | | | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR, INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR, INSERM, 1027 University of Toulouse III, Toulouse, France
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6
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Pimontel MA, Kanellopoulos D, Gunning FM. Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review. J Geriatr Psychiatry Neurol 2020; 33:289-303. [PMID: 31635522 DOI: 10.1177/0891988719882100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. METHOD Systematic literature review. RESULTS The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. CONCLUSIONS Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.
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Affiliation(s)
- Monique A Pimontel
- Graduate Center, City University of New York, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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7
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Wouts L, van Kessel M, Beekman AT, Marijnissen RM, Oude Voshaar RC. Empirical support for the vascular apathy hypothesis: A structured review. Int J Geriatr Psychiatry 2020; 35:3-11. [PMID: 31617249 PMCID: PMC6916153 DOI: 10.1002/gps.5217] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/15/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES A systematic review of the relationship between subclinical small vessel disease (SSVD) in the general population and apathy to examine the hypothesis that apathy has a vascular basis. METHODS We searched for studies on associations between apathy and SSVD, operationalized as white matter hyperintensities (WMH) or white matter diffusivity changes, lacunar infarcts, cerebral microbleeds, decreasing cortical thickness, and perivascular spaces, while also peripheral proxies for SSVD were considered, operationalized as ankle brachial pressure index (ABI), intima media thickness, arterial stiffness, cardio-femoral pulse wave velocity, hypertension, or cardiovascular disease. Only eligible retrospective and prospective observational studies conducted in the general population were included. RESULTS The 14 studies eligible for review examined the associations between apathy and hypertension (3), ABI (1), arterial stiffness (1), cardiovascular disease (2), WMH (3), white matter diffusivity (2), cerebral microbleeds (1), or cortical thickness (3). Arterial stiffness and white matter diffusivity were not related to apathy, while the associations with cortical thickness were contradictory. Cross-sectional studies in the general population did find evidence of apathy being associated with WMH, CM, cardiovascular disease, hypertension, and ABI, and cardiovascular disease was prospectively associated with apathy. The methodologies of the studies reviewed were too heterogeneous to perform meta-analyses. CONCLUSIONS Although more prospective evidence is needed and vascular depression needs to be controlled for, cardiovascular disease, hypertension, and ABI as proxies for SSVD, and WMH and cerebral microbleeds as direct measures of SSVD have been found to be associated with apathy in the general population, supporting the hypothesis of vascular apathy.
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Affiliation(s)
- Lonneke Wouts
- Pro PersonaMental Health InstituteThe Netherlands,Department of PsychiatryUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | | | - Aartjan T.F. Beekman
- GGZinGeestMental Health InstituteAmsterdamThe Netherlands,Department of PsychiatryAmsterdam University Medical CentreAmsterdamThe Netherlands
| | - Radboud M. Marijnissen
- Pro PersonaMental Health InstituteThe Netherlands,Department of PsychiatryUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
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8
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Carlier A, van Exel E, Dols A, Bouckaert F, Sienaert P, Ten Kate M, Wattjes MP, Vandenbulcke M, Stek ML, Rhebergen D. The course of apathy in late-life depression treated with electroconvulsive therapy; a prospective cohort study. Int J Geriatr Psychiatry 2018; 33:1253-1259. [PMID: 29851173 DOI: 10.1002/gps.4917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Apathy, a lack of motivation, is frequently seen in older individuals, with and without depression, with substantial impact on quality of life. This prospective cohort study of patients with severe late-life depression treated with electroconvulsive therapy (ECT) aims to study the course of apathy and the predictive value of vascular burden and in particular white matter hyperintensities on apathy course. METHODS Information on apathy (defined by a score of >13 on the Apathy Scale), depression severity, vascular burden, and other putative confounders was collected in at 2 psychiatric hospitals on patients with late-life depression (aged 55 to 87 years, N = 73). MRI data on white matter hyperintensities were available in 52 patients. Possible risk factors for apathy post-ECT were determined using regression analyses. RESULTS After treatment with ECT, 52.0% (26/50) of the depression remitters still suffered from clinically relevant apathy symptoms. In the entire cohort, more patients remained apathetic (58.9%) than depressed (31.5%). Presence of apathy post-ECT was not associated with higher age, use of benzodiazepines, or severity of apathy and depression at baseline. Less response in depressive symptomatology after ECT predicted post-treatment apathy. The presence of vascular disease, diabetes mellitus and smoking, and white matter hyperintensities in the brain was not associated with post-treatment apathy. CONCLUSIONS Apathy may perpetuate in individual patients, despite remission of depressive symptoms. In this cohort of patients with late-life depression, post-ECT apathy is not associated with white matter hyperintensities.
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Affiliation(s)
- A Carlier
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - E van Exel
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A Dols
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - F Bouckaert
- Old-age Psychiatry, KU Leuven, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
- Academic Center for ECT and Neuromodulation, KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation, KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - M Ten Kate
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M P Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M Vandenbulcke
- Old-age Psychiatry, KU Leuven, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - M L Stek
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - D Rhebergen
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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9
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Apathy in early and late-life depression. J Affect Disord 2017; 223:76-81. [PMID: 28734148 DOI: 10.1016/j.jad.2017.07.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/19/2017] [Accepted: 07/08/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Late-life depression is thought to differ in clinical presentation from early-life depression. Particularly, late-life depression is considered to be more characterized by apathy than is early-life depression. Lacking convincing evidence, this study examines the presence and associated socio-demographic/clinical characteristics of apathy in older compared to younger depressed persons. METHODS This cross-sectional study used data from two naturalistic cohort studies, i.e. the Netherlands Study of Depression in Older Persons (NESDO) and the Netherlands Study of Depression and Anxiety (NESDA). These studies included 605 persons (aged 18-93 years) with a major depressive disorder, divided into 217 early-life (< 60 years) and 388 late-life (≥ 60 years) depressed persons. Apathy was considered present if a score of ≥14 on the Apathy Scale. RESULTS Apathy was strongly associated with age: it was more frequently present in persons with late-life depression (74.5%) than in those with early-life depression (53.5%). Independent of age, the following characteristics were associated with the presence of apathy: male gender, low education, use of benzodiazepines, chronic diseases, and more severe depression. Of all potential risk factors, only former and current smoking was associated with the presence of apathy in older depressed persons but not in younger depressed persons (p-value for age interaction = 0.01). LIMITATIONS No causal relationships can be drawn due to the cross-sectional design of the study. CONCLUSIONS In depressed individuals, clinically relevant apathy was more frequently present in older compared to younger persons. Both age groups showed largely the same associated risk factors. Apathy was independently associated with older age, male gender and more severe depression.
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Quality of Life, Integrative Community Therapy, Family Support, and Satisfaction with Health Services Among Elderly Adults with and without Symptoms of Depression. Psychiatr Q 2017; 88:359-369. [PMID: 27377928 DOI: 10.1007/s11126-016-9453-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this cross-sectional study was to analyse quality of life, socio-demographic characteristics, family support, satisfaction with health services, and effect of integrative community therapy among non-institutionalised elderly adults with and without symptoms of depression in the state of Rio Grande do Norte, Brazil. Data from elderly adults with (n = 59) and without (n = 61) depressive symptoms were compared. The instruments used were the Mini-Mental State Examination, the short version of the Geriatric Depression Scale, a clinical socio-demographic questionnaire, the abbreviated version of the World Health Organisation Quality of Life questionnaire, the Family Assessment Device, and the Patient Satisfaction with Mental Health Services Rating Scale. Elderly adults with depressive symptoms had lower quality of life in the social relations domain than did those without depressive symptoms (p = 0.003). In addition, compared with those without depression, fewer elderly adults with depressive symptoms attended integrative community therapy (p = 0.04); they also reported a low degree of family involvement in problem solving (p = 0.04) and showed apathy regarding their satisfaction with health services (p = 0.007). These results have important implications in the decision-making process with regard to strategies for improving the health status of elderly adults with depressive symptoms.
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Groeneweg-Koolhoven I, Comijs HC, Naarding P, de Waal MWM, van der Mast RC. Apathy in Older Persons With Depression: Course and Predictors: The NESDO Study. J Geriatr Psychiatry Neurol 2016; 29:178-86. [PMID: 26917555 DOI: 10.1177/0891988716632914] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Apathy is a common behavioral syndrome, influencing different areas of daily functioning and often seen in depression. Little is known about the course of apathy in depression. In this study, we examine the course and predicting factors of apathy in older persons with depression. METHOD Data of 266 older persons with depression participating in the Netherlands Study of Depression in Older Persons, all aged at least 60 years with complete Apathy Scale scores at baseline and 2-year follow-up, were included in this study. Associations between several baseline variables and severity, incidence, and persistence of apathy were examined using regression analyses. RESULTS At 2-year follow-up, the severity of apathy was predicted by the severity of apathy at baseline, and incidence rate of apathy was 36%, with a lower baseline Mini-Mental State Examination score being an independent predictor. Older persons with incident apathy did not differ in remission rate of depression compared to those without apathy at follow-up. Persistence rate of apathy was 80% and was independently predicted by a higher baseline Apathy Scale score and, surprisingly, by less use of benzodiazepines. Persons with persistent apathy were less likely to recover from depression than those who remitted from apathy. CONCLUSION Severity of apathy at baseline, but not depression, predicted apathy at follow-up. Incident apathy was predicted by poorer cognitive function, whereas severe apathy at baseline predicted its persistence. Remarkably, new apathy was not associated with worse outcome of depression whereas persistent apathy was.
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Affiliation(s)
- Isis Groeneweg-Koolhoven
- Old-Age Psychiatry, Hospital Parnassia Group, Rotterdam, the Netherlands Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands VU University Medical Center and GGZ inGeest, Amsterdam, the Netherlands
| | - Paul Naarding
- Department of Old-Age Psychiatry, GGNet Mental Health, Apeldoorn, the Netherlands Department of Psychiatry, University Medical Center St Radboud, Nijmegen, the Netherlands
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands Department of Psychiatry, CAPRI, University of Antwerp, Antwerp, Belgium
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Apathy in late-life depression: common, persistent, and disabling. Am J Geriatr Psychiatry 2015; 23:488-94. [PMID: 25047306 PMCID: PMC4277500 DOI: 10.1016/j.jagp.2014.06.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aims of this study were to examine: (1) the relationship between apathy and disability in late-life depression, and (2) the functional significance of improvement in apathy following escitalopram treatment in terms of its relationship to disability. METHODS Subjects were 71 non-demented elderly with non-psychotic major depression. After a 2-week single-blind placebo period, subjects who had Hamilton Depression Rating Scale (HDRS) ≥ 18 received escitalopram 10 mg daily for 12 weeks. Apathy and disability were assessed with the Apathy Evaluation Scale (AES) and the World Health Organization Disability Assessment Scale II (WHODAS), respectively. These measures and the HDRS were administered at baseline and again following 12 weeks of treatment. RESULTS At baseline, 38% of depressed subjects had significant apathy (AES ≥ 36.5). Severity of apathy at baseline significantly correlated with severity of disability. In a multivariate regression model, baseline severity of apathy, but not the overall depressive syndrome (HDRS), significantly correlated with baseline disability. Following escitalopram treatment, improvement in apathy significantly correlated with improvement in disability measures, while change in the rest of the depressive syndrome did not. The overall change in apathy and disability in response to escitalopram treatment was significant but small. CONCLUSION Apathy is common in late-life depression and is associated with disability above and beyond the influence of other depressive symptoms. Given the strong relationship between apathy and disability, understanding the neurobiology of apathy and developing treatments for apathy may improve the functional outcomes of late-life depression.
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McGovern AR, Alexopoulos GS, Yuen GS, Morimoto SS, Gunning FM. Reward-related decision making in older adults: relationship to clinical presentation of depression. Int J Geriatr Psychiatry 2014; 29:1125-31. [PMID: 25306937 PMCID: PMC4353615 DOI: 10.1002/gps.4200] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Impairment in reward processes has been found in individuals with depression and in the aging population. The purpose of this study was twofold: (1) to use an affective neuroscience probe to identify abnormalities in reward-related decision making in late-life depression; and (2) to examine the relationship of reward-related decision making abnormalities in depressed, older adults to the clinical expression of apathy in depression. We hypothesized that relative to older, healthy subjects, depressed, older patients would exhibit impaired decision making and that apathetic, depressed patients would show greater impairment in decision making than non-apathetic, depressed patients. METHODS We used the Iowa Gambling Task to examine reward-related decision making in 60 non-demented, older patients with non-psychotic major depression and 36 older, psychiatrically healthy participants. Apathy was quantified using the Apathy Evaluation Scale. Of those with major depression, 18 individuals reported clinically significant apathy, whereas 42 participants did not have apathy. RESULTS Older adults with depression and healthy comparison participants did not differ in their performance on the Iowa Gambling Task. However, apathetic, depressed older adults adopted an advantageous strategy and selected cards from the conservative decks compared with non-apathetic, depressed older adults. Non-apathetic, depressed patients showed a failure to adopt a conservative strategy and persisted in making risky decisions throughout the task. CONCLUSIONS This study indicates that apathy in older, depressed adults is associated with a conservative response style on a behavioral probe of the systems involved in reward-related decision making. This conservative response style may be the result of reduced sensitivity to rewards in apathetic individuals.
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Affiliation(s)
- Amanda R. McGovern
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - George S. Alexopoulos
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Genevieve S. Yuen
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Sarah Shizuko Morimoto
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Faith M. Gunning
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
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Yuen GS, Gunning FM, Hoptman MJ, AbdelMalak B, McGovern AR, Seirup JK, Alexopoulos GS. The salience network in the apathy of late-life depression. Int J Geriatr Psychiatry 2014; 29:1116-24. [PMID: 24990625 PMCID: PMC4197060 DOI: 10.1002/gps.4171] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/16/2014] [Accepted: 05/29/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Apathy is prevalent in late-life depression and predicts poor response to antidepressants, chronicity of depression, disability, and greater burden to caregivers. However, little is known about its neurobiology. Salience processing provides motivational context to stimuli. The aim of this study was to examine the salience network (SN) resting-state functional connectivity (rsFC) pattern in elderly depressed subjects with and without apathy. METHODS Resting-state functional MRI data were collected from 16 non-demented, non-MCI, elderly depressed subjects and 10 normal elderly subjects who were psychotropic-free for at least 2 weeks. The depressed group included 7 elderly, depressed subjects with high comorbid apathy and 9 with low apathy. We analyzed the rsFC patterns of the right anterior insular cortex (rAI), a primary node of the SN. RESULTS Relative to non-apathetic depressed elderly, depressed elderly subjects with high apathy had decreased rsFC of the rAI to dorsal anterior cingulate and to subcortical/limbic components of the SN. Depressed elderly subjects with high apathy also exhibited increased rsFC of the rAI to right dorsolateral prefrontal cortex and right posterior cingulate cortex when compared to non-apathetic depressed elderly. CONCLUSIONS Elderly depressed subjects with high apathy display decreased intrinsic rsFC of the SN and an altered pattern of SN rsFC to the right DLPFC node of the central executive network when compared to elderly non-apathetic depressed and normal, elderly subjects. These results suggest a unique biological signature of the apathy of late-life depression and may implicate a role for the rAI and SN in motivated behavior.
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Affiliation(s)
- Genevieve S. Yuen
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - Faith M. Gunning
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - Matthew J. Hoptman
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY,New York University School of Medicine, New York, NY
| | - Bassem AbdelMalak
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - Amanda R. McGovern
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - Joanna K. Seirup
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - George S. Alexopoulos
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
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Hülür G, Hertzog C, Pearman A, Ram N, Gerstorf D. Longitudinal associations of subjective memory with memory performance and depressive symptoms: between-person and within-person perspectives. Psychol Aging 2014; 29:814-27. [PMID: 25244464 DOI: 10.1037/a0037619] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinical diagnostic criteria for memory loss in adults typically assume that subjective memory ratings accurately reflect compromised memory functioning. Research has documented small positive between-person associations between subjective memory and memory performance in older adults. Less is known, however, about whether within-person fluctuations in subjective memory covary with within-person variance in memory performance and depressive symptoms. The present study applied multilevel models of change to 9 waves of data from 27,395 participants of the Health and Retirement Study (HRS; mean age at baseline = 63.78; SD = 10.30; 58% women) to examine whether subjective memory is associated with both between-person differences and within-person variability in memory performance and depressive symptoms and explored the moderating role of known correlates (age, gender, education, and functional limitations). Results revealed that across persons, level of subjective memory indeed covaried with level of memory performance and depressive symptoms, with small-to-moderate between-person standardized effect sizes (0.19 for memory performance and -0.21 for depressive symptoms). Within individuals, occasions when participants scored higher than usual on a test of episodic memory or reported fewer-than-average depressive symptoms generated above-average subjective memory. At the within-person level, subjective memory ratings became more sensitive to within-person alterations in memory performance over time and those suffering from functional limitations were more sensitive to within-person alterations in memory performance and depressive symptoms. We take our results to suggest that within-person changes in subjective memory in part reflect monitoring flux in one's own memory functioning, but are also influenced by flux in depressive symptoms.
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Affiliation(s)
- Gizem Hülür
- Institute of Psychology, Humboldt University
| | | | - Ann Pearman
- School of Psychology, Georgia Institute of Technology
| | - Nilam Ram
- Human Development and Family Studies, Pennsylvania State University
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Yuen GS, Gunning FM, Woods E, Klimstra SA, Hoptman MJ, Alexopoulos GS. Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response. J Affect Disord 2014; 166:179-86. [PMID: 25012429 PMCID: PMC4096713 DOI: 10.1016/j.jad.2014.05.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 05/06/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Apathy is a prominent feature of geriatric depression that predicts poor clinical outcomes and hinders depression treatment. Yet little is known about the neurobiology and treatment of apathy in late-life depression. This study examined apathy prevalence in a clinical sample of depressed elderly, response of apathy to selective serotonin reuptake inhibitor (SSRI) treatment, and neuroanatomical correlates that distinguished responders from non-responders and healthy controls. METHODS Participants included 45 non-demented, elderly with major depression and 43 elderly comparison individuals. After a 2-week single-blind placebo period, depressed participants received escitalopram 10mg daily for 12 weeks. The Apathy Evaluation Scale (AES) and 24-item Hamilton Depression Rating Scale (HDRS) were administered at baseline and 12 weeks. MRI scans were acquired at baseline for concurrent structural and diffusion tensor imaging of anterior cingulate gray matter and associated white matter tracts. RESULTS 35.5% of depressed patients suffered from apathy. This declined to 15.6% (p<0.1) following treatment, but 43% of initial sufferers continued to report significant apathy. Improvement of apathy with SSRI was independent of change in depression but correlated with larger left posterior subgenual cingulate volumes and greater fractional anisotropy of left uncinate fasciculi. LIMITATIONS Modest sample size, no placebo control, post-hoc secondary analysis, use of 1.5T MRI scanner CONCLUSIONS While prevalent in geriatric depression, apathy is separable from depression with regards to medication response. Structural abnormalities of the posterior subgenual cingulate and uncinate fasciculus may perpetuate apathetic states by interfering with prefrontal cortical recruitment of limbic activity essential to motivated behavior.
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Affiliation(s)
- Genevieve S. Yuen
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - Faith M. Gunning
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - Eric Woods
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - Sibel A. Klimstra
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
| | - Matthew J. Hoptman
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY,New York University School of Medicine, New York, NY
| | - George S. Alexopoulos
- Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, NY
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Abstract
BACKGROUND Late-life depression is a heterogeneous disorder, whereby cognitive impairments are often observed. This study examines which clinical characteristics and symptom dimensions of late-life depression are especially impacting on specific cognitive domains. METHODS Cross-sectional data of 378 depressed and 132 non-depressed older adults between 60-93 years, from the Netherlands Study of Depression in Older adults (NESDO) were used. Depressed older adults were recruited from both inpatient and outpatient mental healthcare institutes and general practices, and diagnosed according to DSM-IV-TR criteria. Multivariable associations were examined with depression characteristics (severity, onset, comorbidity, psychotropic medication) and symptom dimensions as independent variables and cognitive domains (episodic memory, processing speed, interference control, working memory) as dependent variables. RESULTS Late-life depression was associated with poorer cognitive functioning. Within depressed participants, higher severity of psychopathology and having a first depressive episode was associated with poorer cognitive functioning. The use of tricyclic antidepressants, serotonergic and noradrenergic working antidepressants, and benzodiazepines was associated with worse cognitive functioning. Higher scores on the mood dimension were associated with poorer working memory and processing speed, whereas higher scores on a motivational and apathy dimension were associated with poorer episodic memory and processing speed. CONCLUSIONS Heterogeneity in late-life depression may lead to differences in cognitive functioning. Higher severity and having a first depressive episode was associated with worse cognitive performance. Additionally, different domains of cognitive functioning were associated with specific symptom dimensions. Our findings on the use of psychotropic medication suggest that close monitoring on cognitive side effects is needed.
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Alexopoulos GS, Arean P. A model for streamlining psychotherapy in the RDoC era: the example of 'Engage'. Mol Psychiatry 2014; 19:14-9. [PMID: 24280983 PMCID: PMC4337206 DOI: 10.1038/mp.2013.150] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/30/2013] [Accepted: 09/24/2013] [Indexed: 12/19/2022]
Abstract
A critical task for psychotherapy research is to create treatments that can be used by community clinicians. Streamlining of psychotherapies is a necessary first step for this purpose. We suggest that neurobiological knowledge has reached the point of providing biologically meaningful behavioral targets, thus guiding the development of effective, simplified psychotherapies. This view is supported by the Research Domain Criteria (RDoC) Project, which reflects the field's consensus and recognizes the readiness of neurobiology to guide research in treatment development. 'Engage' is an example of such a streamlined therapy. It targets behavioral domains of late-life depression grounded on RDoC constructs using efficacious behavioral strategies selected for their simplicity. 'Reward exposure' targeting the behavioral expression of positive valence systems' dysfunction is the principal therapeutic vehicle of 'Engage'. Its first three sessions consist of direct 'reward exposure', but the therapists search for barriers in three behavioral domains, that is, 'negativity bias' (negative valence), 'apathy' (arousal) and 'emotional dysregulation' (cognitive control), and add strategies targeting these domains when needed. The end result is a structured, stepped approach using neurobiological constructs as targets and as a guide to personalization. We argue that the 'reduction' process needed in order to arrive to simplified effective therapies can be achieved in three steps: (1) identify RDoC constructs driving the syndrome's psychopathology; (2) create a structured intervention utilizing behavioral and ecosystem modification techniques targeting behaviors related to these constructs; (3) examine whether the efficacy of the new intervention is mediated by change in behaviors related to the targeted RDoC constructs.
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Alexopoulos GS, Hoptman MJ, Yuen G, Kanellopoulos D, Seirup J, Lim KO, Gunning FM. Functional connectivity in apathy of late-life depression: a preliminary study. J Affect Disord 2013; 149:398-405. [PMID: 23261142 PMCID: PMC3636174 DOI: 10.1016/j.jad.2012.11.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/06/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Apathy is common in late-life depression and is associated with disability and poor antidepressant response. This study examined whether resting functional connectivity (FC) of the nucleus accumbens (NAcc) and the dorsal anterior cingulate (dACC) with other structures can distinguish apathetic depressed older patients from non-apathetic depressed patients and normal subjects. METHODS Twenty-six non-demented, non-MCI older adults were studied. Of these, 16 had major depression (7 also had apathy) and 10 had no psychopathology. Resting state fMRI was performed prior to treatment in subjects who were psychotropic-free for at least two weeks. FC was determined by placing seeds in the NAcc and the dACC bilaterally. RESULTS Apathetic depressed patients had lower FC of the NAcc with the amygdala, caudate, putamen, globus pallidus, and thalamus and increased FC with the dorsomedial prefrontal cortex, the superior frontal cortex, and the insula than non-apathetic patients. Further, apathetic patients had lower FC of the dACC with dorsolateral and ventrolateral prefrontal cortices and higher FC with the insula and the orbitofrontal cortex than non-apathetic patients. LIMITATIONS Small number of subjects, lack of random sampling, use of a 1.5T MRI scanner. CONCLUSIONS This preliminary study suggests that FC between the NAcc and the dACC and structures related to reward and related behavioral responses constitute the functional topography of abnormalities characterizing apathy of late life depression. However, replication is needed.
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Affiliation(s)
- George S. Alexopoulos
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry,Corresponding author: Tel. (914) 997-5767; Fax (914) 997-5926;
| | - Matthew J. Hoptman
- Nathan S. Kline Institute for Psychiatric Research, Department of Psychiatry, New York University School of Medicine
| | - Genevieve Yuen
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | | | - Joanna Seirup
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | | | - Faith M. Gunning
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
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Lavretsky H, Zheng L, Weiner MW, Mungas D, Reed B, Kramer JH, Jagust W, Chui H, Mack WJ. Association of depressed mood and mortality in older adults with and without cognitive impairment in a prospective naturalistic study. Am J Psychiatry 2010; 167:589-97. [PMID: 20160005 PMCID: PMC2864365 DOI: 10.1176/appi.ajp.2009.09020280] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined predictors of mortality in individuals age 50 or older with or without cognitive impairment in a 12-year prospective naturalistic study of subcortical ischemic vascular disease focusing on symptoms of depressed mood, apathy, anhedonia, or anergia. METHOD A total of 498 participants were recruited from the community and from memory clinics into a multicenter longitudinal study of subcortical ischemic vascular disease. For baseline cognitive status, 36% of participants were assessed as cognitively intact, 31% as cognitively impaired, and 33% as demented. All participants underwent a research protocol MRI, and 41% were classified as having subcortical lacunes. Depressed mood, anhedonia, anergia, and apathy were assessed at baseline using a structured behavioral assessment. Cox regression models were used to investigate the associations between neuropsychiatric symptoms and mortality, controlling for age, gender, race, education level, cognitive status, presence of vascular lacunes, and vascular risk factors. RESULTS Of 498 participants, 175 (35%) died over the follow-up period, with a median survival time of 5.6 years. In the multivariate analyses, cognitive impairment, age, male gender, depressed mood, and the presence of lacunes predicted higher mortality. Participants with both lacunes and depressed mood had the shortest survival among all cognitive groups. The mortality hazard ratio for participants with depressed mood was 2.2 (95% CI=1.5-3.2) after adjustment for cognitive status, age, gender, education level, race, lacunes, and all vascular conditions. CONCLUSIONS These findings suggest the importance of detecting depressed mood in individuals with cerebrovascular disease and of developing more aggressive treatment and preventive interventions for this vulnerable population.
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Affiliation(s)
- Helen Lavretsky
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Abstract
BACKGROUND The aim of this study was to determine levels, rates and progression of apathy in healthy older persons and to investigate factors associated with its progression. METHODS Seventy-six healthy elderly subjects, aged 58-85 years (mean 69.9), who were recruited by general advertisement and through local community groups, participated as a control group for a longitudinal study of stroke patients. Data were collected on demographic, psychological, neuropsychological and neuroimaging (MRI) variables and apathy was rated by informants on the Apathy Evaluation Scale (AES). RESULTS Apathy scores and rates increased over 5 years, especially in men. Change of apathy was associated with informant ratings of cognitive decline in the years prior to baseline assessment but not to subsequent neuropsychological, neuroimaging or functional changes. CONCLUSIONS Apathy increases with age in otherwise healthy community-dwelling individuals, particularly in men.
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Bour A, Rasquin S, Aben I, Strik J, Boreas A, Crijns H, Limburg M, Verhey F. The symptomatology of post-stroke depression: comparison of stroke and myocardial infarction patients. Int J Geriatr Psychiatry 2009; 24:1134-42. [PMID: 19418490 DOI: 10.1002/gps.2236] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression is a frequent problem in stroke patients but, all too often, the problem goes unrecognized. How depression-like symptoms in post-stroke depression (PSD) should be interpreted is still subject to debate. If PSD has a distinct symptom profile of depression accompanying other chronic vascular somatic conditions then this could imply that PSD is a specific disease entity. OBJECTIVE To study whether depressed stroke patients exhibit other signs and symptoms than patients suffering from depression after myocardial infarction (MI). METHODS Depressive signs and symptoms were measured using the Hospital Anxiety and Depression Scale and the 17-item Hamilton Depression Rating Scale. The results of 190 stroke patients were compared with the results of 198 MI patients every 3 months during the first year after the event. RESULTS Depressed stroke patients exhibited more loss of interest, psychomotor retardation, and gastro-intestinal complaints as compared to depressed MI patients. However, in multivariate analyses including both depressed and non-depressed stroke and MI patients, no specific symptom profile was found to differentiate between the two depressive syndromes by looking at the modifying effect of stroke vs MI on the occurrence of specific symptoms in depression. CONCLUSION Although in their clinical presentation, depressed stroke patients exhibit a symptom profile different from depressed MI patients, this is not due to differences in the depressive syndrome in these two patient groups but it reflects differences between stroke and MI patients in general.
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Affiliation(s)
- A Bour
- Department of Neurology, Maastricht University Hospital, Maastricht, The Netherlands
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Asakawa Y, Usuda S, Mizukami M, Imura S. Moderator and Mediator Effects of Personal Factors in Patients with Stroke. J Phys Ther Sci 2009. [DOI: 10.1589/jpts.21.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yasutsugu Asakawa
- Gunma University Graduate School of Health Sciences
- Department of Physical Therapy, Nippon Engineering College
| | | | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences
| | - Shigeyuki Imura
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences
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Corruble E, Gorwood P, Falissard B. Association between age of onset and symptom profiles of late-life depression. Acta Psychiatr Scand 2008; 118:389-94. [PMID: 18759804 DOI: 10.1111/j.1600-0447.2008.01239.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The recognition of later late-onset (LLO) major depression (MD) is a matter of concern. METHOD Cross-sectional study assessed MD with the MINI structured interview and the MADRS in a referred sample of 13 377 non-demented adult out-patients visiting their physicians. Among 6850 patients with a first episode of MD, 370 LLO (75 years of age and older) MD were compared with 814 late-onset (LO) (60-74 years old) MD and 5666 early-onset (EO) (18-59 years old) MD. RESULTS There are many similarities between the symptom patterns of EO, LO and LLO MDs. However, the symptom pattern of LLO MD includes more retardation/agitation, lassitude, reduced appetite and apparent sadness, and less sleep disturbances, guilt feelings, pessimism and inner tension than LO and EO MD. CONCLUSION The differences in symptom profiles are very modest and between-group differences may not be meaningful on an individual level.
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Affiliation(s)
- E Corruble
- Department of Psychiatry, Bicêtre University Hospital, INSERM U 669, Paris XI University, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
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Lavretsky H, Zheng L, Weiner MW, Mungas D, Reed B, Kramer JH, Jagust W, Chui H, Mack WJ. The MRI brain correlates of depressed mood, anhedonia, apathy, and anergia in older adults with and without cognitive impairment or dementia. Int J Geriatr Psychiatry 2008; 23:1040-50. [PMID: 18412291 PMCID: PMC2575050 DOI: 10.1002/gps.2030] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We examined the magnetic resonance imaging (MRI) correlates of depressed mood, apathy, anhedonia, and anergia in older adults with and without cognitive impairment or dementia. METHODS This analysis included 270 community-dwelling older adults (59% male; 79% Caucasian; mean age 74.4 years) who were recruited into a multi-center longitudinal observational study of subcortical ischemic vascular disease (SIVD).The distribution of cognitive status included: cognitively intact (38%), cognitively impaired (27%), or demented (35%). All subjects underwent MRI and 41% were classified as having subcortical lacunes. MRI measures included cortical gray and white matter volumes, lacunar volumes in subcortical white and gray matter structures, volume of white matter hyperintensities, and total hippocampal volume. Depressed mood, anhedonia, anergia, and apathy apparent at the time of assessment were assessed using a behavioral assessment Associations between neuropsychiatric symptoms and MRI variables were evaluated using logistic regression. RESULTS Subjects with neuropsychiatric symptoms were more likely to be cognitively impaired or demented than those without neuropsychiatric symptoms. In multivariate models controlling for cognitive status, age, gender, and education, higher lacunar volume in white matter was independently associated with the presence of all four neuropsychiatric symptoms. CONCLUSIONS We report an association between the lacunar volumes in the white matter and depressed mood, anhedonia, apathy, and anergia, thus supporting the role of subcortical ischemic vascular disease in the pathogenesis of late-life neuropsychiatric disorders.
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Affiliation(s)
- Helen Lavretsky
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
| | - Ling Zheng
- Department of Neurology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Michael W. Weiner
- Veterans Administration Northern California Health Care System,Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA,Department of and Radiology, School of Medicine, University of California, San Francisco, CA, USA
| | - Dan Mungas
- Department of Neurology School of Medicine University of California, Los Angeles, CA, USA
| | - Bruce Reed
- Department of Neurology School of Medicine University of California, Los Angeles, CA, USA
| | - Joel H. Kramer
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
| | - William Jagust
- Department of Neurology School of Medicine University of California, Los Angeles, CA, USA
| | - Helena Chui
- Department of Neurology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Wendy J. Mack
- Department of Preventive Medicine Keck School of Medicine, University of Southern California Los Angeles, CA, USA
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McDougall F, Brayne C. Systematic review of the depressive symptoms associated with vascular conditions. J Affect Disord 2007; 104:25-35. [PMID: 17449107 DOI: 10.1016/j.jad.2007.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 03/05/2007] [Accepted: 03/06/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Numerous studies report a positive association between the presence of vascular conditions and depression; however, it is unclear whether this presents a distinct subtype of depression. METHOD A comprehensive literature search of Medline was conducted in order to identify studies that have compared symptoms of those with depression in the presence and absence of vascular factors. AIMS To provide a systematic review of studies that have attempted to characterise the depressive symptomatology associated with vascular factors. To establish whether the evidence for a subtype is sufficient to be of use in clinical settings. RESULTS Thirteen publications were identified as relevant to the investigation. Study design and definition of vascular factors varied greatly between studies. Depression in the presence of vascular conditions was associated with poor motivation, lack of energy and psychomotor change in some studies, though these findings were inconsistent. Many other possible distinctive features were reported in individual publications but were not consistent enough to be used confidently as a diagnostic feature. CONCLUSION At present, there does not appear to be sufficient evidence to support a clinically-recognisable subtype of vascular depression.
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Affiliation(s)
- Fiona McDougall
- Department of Public Health and Primary Care, University of Cambridge, UK.
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Malloy P, Correia S, Stebbins G, Laidlaw DH. Neuroimaging of white matter in aging and dementia. Clin Neuropsychol 2007; 21:73-109. [PMID: 17366279 DOI: 10.1080/13854040500263583] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Clinical neuroscientists have focused increasing attention on white matter connections in the brain and on the effects of aging and disease on these connections. Recent advances in magnetic resonance imaging (MRI) analysis have given researchers new tools for quantifying and visualizing white matter to better relate white matter structure and function. The goals of this article are (a) to acquaint the reader with both established and newer methods for imaging and quantifying white matter anatomy and pathology; and (b) to review recent findings on white matter pathology in aging and dementia. Computer-assisted quantification appears to offer better statistical power than visual rating scales for detecting these relationships. New MR modalities such as diffusion imaging can detect white matter abnormalities not shown with conventional acquisition sequences. These newer techniques hold promise for early detection of disease and for delineating functional connections between brain areas.
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Affiliation(s)
- Paul Malloy
- Brown University Medical School, Providence, RI, USA.
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Lavretsky H, Ballmaier M, Pham D, Toga A, Kumar A. Neuroanatomical characteristics of geriatric apathy and depression: a magnetic resonance imaging study. Am J Geriatr Psychiatry 2007; 15:386-94. [PMID: 17463189 PMCID: PMC3197853 DOI: 10.1097/jgp.0b013e3180325a16] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Apathy is one of the most common late-life neuropsychiatric syndromes. The objective of our study was to examine the neuroanatomical correlates of apathy in older subjects with and without geriatric major depression (MDD). METHODS Eighty-four subjects (43 patients with MDD and 41 normal comparison subjects) underwent comprehensive neuropsychiatric examination, physical examination, and high-resolution magnetic resonance imaging (MRI) brain scans on a 1.5T GE MRI scanner. Apathy was assessed using the Apathy Evaluation Scale. MRI image analyses included cortical surface extraction, tissue segmentation, and cortical parcellation methods to measure the gray and white matter volumes in two prefrontal subregions: the anterior cingulate and orbitofrontal cortex. RESULTS The depressed group had smaller orbitofrontal gray matter volumes compared to the age-matched normal comparison group. The severity of apathy was associated with the decreased gray matter volume in the right anterior cingulate gray matter volumes using partial correlation and regression analyses after controlling for age, sex, and diagnosis. CONCLUSION Apathy and depression were associated with different anatomical correlates in the prefrontal regions implicated in the regulation of cognition and emotion. Our findings offer new understanding of the neuroanatomical characteristics of apathy and depression in late life, and have broad implications for the neurobiology of behavior.
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Affiliation(s)
- Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Clarke DE, Van Reekum R, Patel J, Simard M, Gomez E, Streiner DL. An appraisal of the psychometric properties of the Clinician version of the Apathy Evaluation Scale (AES-C). Int J Methods Psychiatr Res 2007; 16:97-110. [PMID: 17623389 PMCID: PMC6878351 DOI: 10.1002/mpr.207] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This article examines the psychometric properties of the clinician version of the Apathy Evaluation Scale (AES-C) to determine its ability to characterize, quantify and differentiate apathy. Critical appraisals of the item-reduction processes, effectiveness of the administration, coding and scoring procedures, and the reliability and validity of the scale were carried out. For training, administration and rating of the AES-C, clearer guidelines, including a more standardized list of verbal and non-verbal apathetic cues, are needed. There is evidence of high internal consistency for the scale across studies. In addition, the original study reported good test-retest and inter-rater reliability coefficients. However, there is a lack of replication on these more stable and informative measures of reliability and as such they warrant further investigation. The research evidence confirms that the AES-C shows good discriminant, convergent and criterion validity. However, evidence of its predictive validity is limited. As this aspect of validity refers to the scale's ability to predict future outcomes, which is important for treatment and rehabilitation planning, further assessment of the predictive validity of the AES-C is needed. In conclusion, the AES-C is a reliable and valid measure for the characterization and quantification of apathy.
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Affiliation(s)
- Diana E Clarke
- Toronto Rehabilitation Institute and Department of Psychiatry, Baycrest Centre for Geriatric Care, Canada.
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Lenze EJ, Munin MC, Skidmore ER, Dew MA, Rogers JC, Whyte EM, Quear T, Begley A, Reynolds CF. Onset of Depression in Elderly Persons After Hip Fracture: Implications for Prevention and Early Intervention of Late-Life Depression. J Am Geriatr Soc 2007; 55:81-6. [PMID: 17233689 DOI: 10.1111/j.1532-5415.2006.01017.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify predictors of onset of major depressive disorder (MDD) and of depressive symptoms in subjects who suffered a hip fracture. DESIGN Prospective naturalistic study. SETTING University of Pittsburgh Medical Center-Shadyside, a large urban hospital in Pittsburgh, Pennsylvannia. PARTICIPANTS One hundred twenty-six elderly patients who received surgical fixation for hip fracture and who were not experiencing a major depressive episode at the time of the fracture; severely cognitively impaired persons were excluded. MEASUREMENTS Subjects were evaluated at the time of hospital discharge using a battery of clinical measures (including apathy measured using the Apathy Evaluation Scale (AES), delirium, cognitive measures, social support, and disability level). Depression was assessed at the end of the surgical stay, 2 weeks later, and then monthly for 6 months, using the Hamilton Rating Scale for Depression (Ham-D) to evaluate symptomatology and the Primary Care Evaluation of Mental Disorders to evaluate diagnosis of MDD. RESULTS Eighteen of 126 subjects (14.3%) developed MDD after hip fracture. Of these, 11 developed MDD by the end of the hospitalization, and seven developed MDD between 2 and 10 weeks later. Logistic regression showed that baseline apathy score, as measured using the AES, was the only clinical measure associated with the development of MDD (odds ratio=1.09, 95% confidence interval=1.03-1.16, P=.003); 46.2% of those with high AES scores developed MDD, versus 10.9% of those with lower scores. In contrast, cognitive variables, delirium, disability after hip fracture, and other factors related to the fracture (e.g., fracture type) were not associated with MDD. A repeated-measures analysis with Ham-D over time as a dependent variable generally confirmed these findings; depressive symptoms were highest immediately after the fracture, and apathy and delirium scores were associated with higher depressive symptom levels. CONCLUSION The onset of MDD is common after hip fracture, and the greatest period of risk is immediately after the fracture. Individuals with clinical evidence of apathy are at high risk for developing MDD, and evaluation and close follow-up of such individuals is warranted. However, further research is needed to examine other candidate variables (e.g., clinical measures or biomarkers) to model adequately the risk for MDD after hip fracture and other disabling medical events.
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Affiliation(s)
- Eric J Lenze
- Advanced Center for Interventions and Services Research and John A Hartford Center of Excellence in Geriatric Psychiatry, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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