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Johansson M, Stomrud E, Johansson PM, Svenningsson A, Palmqvist S, Janelidze S, van Westen D, Mattsson-Carlgren N, Hansson O. Development of Apathy, Anxiety, and Depression in Cognitively Unimpaired Older Adults: Effects of Alzheimer's Disease Pathology and Cognitive Decline. Biol Psychiatry 2022; 92:34-43. [PMID: 35346458 DOI: 10.1016/j.biopsych.2022.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The impact of Alzheimer's disease (AD) pathology and cognitive deficits on longitudinal neuropsychiatric symptoms is unclear, especially in early disease stages. METHODS Cognitively unimpaired older adults (N = 356) enrolled in the prospective Swedish BioFINDER study were examined. Neuropsychiatric assessments encompassed the Apathy Evaluation Scale and the Hospital Anxiety and Depression Scale, performed biennially (together with tests of global cognition) for up to 8 years. Biomarkers were measured in cerebrospinal fluid or plasma at baseline. Magnetic resonance imaging quantified white matter lesions. We used linear mixed-effect models to test associations between baseline AD biomarkers (for amyloid-β [Aβ], tau, and neurodegeneration) and white matter lesions with longitudinal neuropsychiatric symptoms (apathy, anxiety, and depressive symptoms). We also tested associations between changes in cognition and changes in neuropsychiatric symptoms. Finally, we tested if change in cognition mediated the effects of different brain pathologies on neuropsychiatric symptoms. RESULTS Aβ pathology at baseline was associated with increasing levels of apathy (β = -0.284, p = .005) and anxiety (β = -0.060, p = .011) longitudinally. More rapid decline of cognition over time was related to increasing levels of apathy. The effects of baseline Aβ pathology on longitudinal apathy were partly mediated by changes in cognitive performance (proportion mediated 23%). CONCLUSIONS Aβ pathology may drive the development of both apathy and anxiety in very early stages of AD, largely independent of cognitive change. The effect of Aβ on apathy is only partially conveyed by worse cognition. Together, these findings highlight certain neuropsychiatric symptoms as early manifestations of AD.
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Affiliation(s)
- Maurits Johansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Helsingborg, Sweden; Clinical Department of Psychiatry, Helsingborg Hospital, Helsingborg, Sweden.
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Per Mårten Johansson
- Division of Clinical Sciences Helsingborg, Department of Clinical Sciences Lund, Lund University, Helsingborg, Sweden; Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Anna Svenningsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Image and Function, Skåne University Hospital Lund, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital Lund, Lund, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden.
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Burgon C, Goldberg SE, van der Wardt V, Brewin C, Harwood RH. Apathy Measures in Older Adults and People with Dementia: A Systematic Review of Measurement Properties Using the COSMIN Methodology. Dement Geriatr Cogn Disord 2021; 50:111-123. [PMID: 33975314 DOI: 10.1159/000515678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Apathy is highly prevalent in dementia and is also seen in mild cognitive impairment and the general population. Apathy contributes to failure to undertake daily activities and can lead to health problems or crises. It is therefore important to assess apathy. However, there is currently no gold standard measure of apathy. A comprehensive systematic review of the measurement properties of apathy scales is required. METHODS A systematic review was registered with PROSPERO (ID: CRD42018094390). MEDLINE, Embase, PsycINFO, and CINAHL were searched for studies that aimed to develop or assess the validity or reliability of an apathy scale in participants over 65 years, living in the community. A systematic review was conducted in line with the COnsensus-based Standards for the selection of health Measurement INstruments procedure for reviewing patient-reported outcome measures. The studies' risk of bias was assessed, and all relevant measurement properties were assessed for quality. Results were pooled and rated using a modified Grading of Recommendations Assessment, Development, and Evaluation procedure. RESULTS Fifty-seven publications regarding 18 measures and 39 variations met the eligibility criteria. The methodological quality of individual studies ranged from inadequate to very good and measurement properties ranged from insufficient to sufficient. Similarly, the overall evidence for measurement properties ranged from very low to high quality. The Apathy Evaluation Scale (AES) and Lille Apathy Rating Scale (LARS) had sufficient content validity, reliability, construct validity, and where applicable, structural validity and internal consistency. CONCLUSION Numerous scales are available to assess apathy, with varying psychometric properties. The AES and LARS are recommended for measuring apathy in older adults and people living with dementia. The apathy dimension of the commonly used Neuropsychiatric Inventory should be limited to screening for apathy.
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Affiliation(s)
- Clare Burgon
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.,Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Veronika van der Wardt
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of General Medicine, Preventative and Rehabilitative Medicine, Philipps-Universität Marburg, Marburg, Germany
| | - Catherine Brewin
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.,Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom, .,Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom,
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Ekström MP, Palmqvist S, Currow DC, Sjøgren P, Kurita GP, Jakobsen G, Kaasa S, Hjermstad M. Mild to Moderate Cognitive Impairment Does Not Affect the Ability to Self-Report Important Symptoms in Patients With Cancer: A Prospective Longitudinal Multinational Study (EPCCS). J Pain Symptom Manage 2020; 60:346-354.e2. [PMID: 32179133 DOI: 10.1016/j.jpainsymman.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 11/29/2022]
Abstract
CONTEXT Patients with advanced cancer commonly suffer from both distressing symptoms and cognitive impairment, but the effect of cognitive impairment on the reliability and validity of symptom self-report is unknown. OBJECTIVES To evaluate the reliability and validity of symptom self-report in cancer outpatients with and without mild to moderate cognitive impairment. METHODS This was an analysis of the longitudinal European Palliative Care Cancer Symptom study of adults with incurable cancer in specialized palliative care (30 centers across 12 countries). Patients who could not comply with the study because of severe cognitive impairment were excluded. Cognitive status on the Mini-Mental State Examination short version and nine symptoms (pain, tiredness, drowsiness, nausea, appetite, breathlessness, depression, anxiety, and well-being) using the revised Edmonton Symptom Assessment System were self-reported at baseline and one-month follow-up. Reliability was analyzed using intraclass correlation coefficients and validity using regression of each symptom with health-related quality of life (HrQoL) measured with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care. RESULTS A total of 1047 patients were included: mean age of 62.9 years; 54.4% women; main cancer types were of digestive organs (26.6%), breast (21.6%), and lungs (21.2%). Cognitive impairment was present in 181 (17.3%) at baseline and associated with worse self-reported tiredness, drowsiness, appetite, and depression. Reliability (intraclass correlation coefficient) and validity (associations with HrQoL) were similar between people with/without cognitive impairment across the nine symptoms, except breathlessness, which showed a weaker relation to HrQoL in patients with cognitive impairment. Findings were robust in sensitivity analyses and after controlling for potential confounders. CONCLUSION In advanced cancer, self-report of nine major symptoms was reliable and valid also in people with mild-to-moderate cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov database (NCT01362816).
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Affiliation(s)
- Magnus P Ekström
- Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Sebastian Palmqvist
- Department of Clinical Sciences in Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Geana P Kurita
- Department of Oncology, Palliative Research Group, Rigshospitalet Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Neuroanaesthesiology, Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Gunnhild Jakobsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology and Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein Kaasa
- Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU) and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Hjermstad
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway; Department of Oncology, European Palliative Care Research Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Apathy and anxiety are early markers of Alzheimer's disease. Neurobiol Aging 2020; 85:74-82. [DOI: 10.1016/j.neurobiolaging.2019.10.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 01/03/2023]
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Carrozzino D. Clinimetric approach to rating scales for the assessment of apathy in Parkinson's disease: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109641. [PMID: 31059722 DOI: 10.1016/j.pnpbp.2019.109641] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 02/09/2023]
Abstract
A number of rating scales for the assessment of apathy in Parkinson's disease (PD) were developed. Unfortunately, previous studies focused mainly on psychometric criteria rather than on clinimetric principles to develop these assessment instruments. In the clinimetric approach, the clinical validity of a rating scale, rather than its statistical significance, has the priority. The aim of the present systematic review was to capture the clinimetric properties of these rating scales and to identify the measures, which display clinical validity for the assessment of apathy in PD. The systematic search was conducted on Scopus, PsycINFO, PubMed, Web of Science, ScienceDirect, and Medline following the PRISMA guidelines. A total of 44 studies were included and analyzed in this systematic review. The apathy rating scales, which were found to be psychometrically robust and reliable, were actually clinically questionable. The apathy measures, which displayed clinimetric properties, were the Starkstein Apathy Scale (SAS), the 5-item version of the World Health Organization Well-Being Index (WHO-5), the Neurasthenia Scale and the Lille Apathy Rating Scale (LARS). The SAS was found to be clinically valid at a macro-analytic level, particularly when used either to exclude the presence of symptoms of apathy or to evaluate the side effects of medications. The WHO-5 and the Neurasthenia Scale were found to be clinically valid only at a micro-analytic level and can be used as screening measures for the assessment of the severity of symptoms of apathy. The LARS was a clinically valid instrument to be used for the diagnosis of apathy.
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Affiliation(s)
- Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini no. 31, 66100 Chieti, Italy.
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