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Babicz MA, Matchanova A, Woods SP. Apathy Among Persons Living With HIV Is Associated With Lower Self-efficacy for Health Care Provider Interactions. J Assoc Nurses AIDS Care 2023; 34:389-397. [PMID: 37141172 DOI: 10.1097/jnc.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
ABSTRACT Apathy is common in persons with HIV (PWH) and has been associated with a variety of health outcomes. We examined the association between apathy and self-efficacy for health care provider interactions in 142 PWH. A composite score comprised of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation scale of the Profile of Mood States was used to measure apathy. Self-efficacy for health care provider interactions was measured using the Beliefs Related to Medication Adherence - Dealing with Health Professional subscale. Higher levels of apathy were associated with lower self-efficacy for health care provider interactions at a medium effect size, independent of mood disorders, health literacy, and neurocognition. Findings suggest that apathy plays a unique role in self-efficacy for health care provider interactions and support the importance of assessment and management of apathy to maximize health outcomes among PWH.
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Affiliation(s)
- Michelle A Babicz
- Michelle A. Babicz, PhD, is a Neuropsychology Resident, Mental Health and Behavioral Services, James A. Haley Veteran's Hospital, Tampa, Florida, USA, and is a formerly Graduate Student, Department of Psychology, University of Houston, Houston, Texas, USA. Anastasia Matchanova, MA, is a Graduate Student, Department of Psychology, University of Houston, Houston, Texas, USA. Steven Paul Woods, PsyD, is a Professor, Department of Psychology, University of Houston, Houston, Texas, USA
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Raya-Ruiz MA, Rodríguez-Bailón M, Castaño-Monsalve B, Vidaña-Moya L, Fernández-Solano AJ, Merchán-Baeza JA. Study protocol for a non-randomised controlled trial: Community-based occupational therapy intervention on mental health for people with acquired brain injury (COT-MHABI). PLoS One 2022; 17:e0274193. [PMID: 36206208 PMCID: PMC9543977 DOI: 10.1371/journal.pone.0274193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The sequelae of moderate-severe acquired brain injury (ABI) encompass motor, cognitive, sensory, emotional and behavioural areas that affect meaningful occupational participation and quality of life, with a high prevalence of associated mental disorders. When the patient returns to community life after discharge from the hospital, specialised care is generally insufficient due to the lack of consideration of the dual condition of mental disorder and ABI. Since there is a negative impact on competence and thus on occupational participation, occupational therapy represents a convenient way of intervention. On these assumptions, a community-based occupational therapy protocol on mental health for people with moderate/severe acquired brain injury (COT-MHABI) is presented. It is focused on meaningful occupational participation and looks for improvement in the quality of life. METHODS AND ANALYSIS This study aims: (i) to design a protocol to evaluate the effectiveness of a community occupational therapy intervention based on MOHO for patients with a dual (mental health/ABI) for improving quality of life and self-perceived occupational performance; (ii) to analyse the outcomes of occupational and social variables (occupational balance, participation level, satisfaction with occupation and performed roles and community integration) after the COT-MHABI process; (iii) to analyse the impact of quality of life on satisfaction with occupations performed by this population. A non-randomised controlled clinical trial will be performed. Patients assigned to the experimental group will receive over one year of on-site and telematic occupational therapy sessions, 16 sessions on average. Variables such as quality of life, community integration or satisfaction with occupational performance will be collected at baseline, 6, and 12 months. DISCUSSION The needs for the dual mental/ABI population in their reintegration into the community are related to the associated deficits and to the absence of specialised services for the complexity of this patient profile. Few studies consider the coexistence of mental health and ABI issues. The COT-MHABI protocol is proposed to provide continuity to the community needs of this population, conceptualised from occupational participation, person-centred and focused on meaningful activities. CLINICAL TRIAL REGISTRATION Trial identifier and registry name ClinicalTrials.gov ID: NCT04586842 https://clinicaltrials.gov/ct2/show/NCT04586842?term=252136&draw=2&rank=1; Pre-results; Community-based Occupational Therapy Intervention on Mental Health for People With Acquired Brain Injury (COT-MHABI).
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Affiliation(s)
- Marco Antonio Raya-Ruiz
- Faculty of Health Science and Welfare, Social Sciences and Community Health Department, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- Specialised Support and Assessment Team (EASE), Institut Guttmann, Badalona, Spain
| | | | | | - Laura Vidaña-Moya
- Research Group GrEUIT., Escola Universitària d’Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Spain
| | | | - José Antonio Merchán-Baeza
- Faculty of Health Science and Welfare, Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- * E-mail:
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Funayama M, Nakagawa Y, Nakajima A, Kawashima H, Matsukawa I, Takata T, Kurose S. Apathy Level, Disinhibition, and Psychiatric Conditions Are Related to the Employment Status of People With Traumatic Brain Injury. Am J Occup Ther 2022; 76:23217. [PMID: 35226063 DOI: 10.5014/ajot.2022.047456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE An understanding of the potential prognostic factors as they relate to the employment status of people with traumatic brain injury (TBI) is necessary so that occupational therapy practitioners can provide the most effective treatment. OBJECTIVE To examine the impact of apathy, disinhibition, and psychiatric conditions on employment status after TBI. DESIGN An observational study conducted from March 2015 to March 2020. SETTING Cognitive dysfunction clinics associated with two general hospitals in Japan. PARTICIPANTS Japanese people of working age (N = 110, ages 18-65 yr) with TBI. Outcomes and Measures: As an outcome indicator, each participant's employment status was rated on a 3-point scale (i.e., 3 = regular employment, 2 = welfare employment [employed as a person with disabilities or undergoing vocational training in the Japanese welfare employment system, for which a worker is paid under either system], 1 = unemployment). Psychiatric, neuropsychological, and physical assessments were measured as explanatory variables. The impact of various factors on employment status was investigated using linear discriminant regression analysis. RESULTS The level of apathy, disinhibition, and incidence of psychiatric conditions after TBI, as well as age and years postinjury, were related to employment status. Conclusion and Relevance: Although this is a cross-sectional study, interventions for apathy and disinhibition, as well as management of psychiatric conditions, are recommended to help improve employment status among people with TBI. What This Article Adds: The employment status of people with TBI is related more to apathy, disinhibition, and psychiatric conditions than to intelligence, memory function, or executive function.
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Affiliation(s)
- Michitaka Funayama
- Michitaka Funayama, PhD, MD, is Doctor, Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan;
| | - Yoshitaka Nakagawa
- Yoshitaka Nakagawa, MS, is Speech-Language Pathologist, Department of Rehabilitation, Edogawa Hospital, Higashikoiwa, Edogawa-Ward, Tokyo, Japan
| | - Asuka Nakajima
- Asuka Nakajima is Speech-Language Pathologist, Department of Rehabilitation, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| | - Hiroaki Kawashima
- Hiroaki Kawashima is Speech-Language Pathologist, Department of Rehabilitation, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| | - Isamu Matsukawa
- Isamu Matsukawa, OTR/L, is Occupational Therapist, Department of Rehabilitation, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| | - Taketo Takata
- Taketo Takata, MD, is Doctor, Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
| | - Shin Kurose
- Shin Kurose, MD, is Doctor, Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Yobe, Ashikaga-City, Japan
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Barrash J, Bruss J, Anderson SW, Kuceyeski A, Manzel K, Tranel D, Boes AD. Lesions in different prefrontal sectors are associated with different types of acquired personality disturbances. Cortex 2022; 147:169-184. [PMID: 35051710 PMCID: PMC8816872 DOI: 10.1016/j.cortex.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/13/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
"Frontal lobe syndrome" is a term often used to describe a diverse array of personality disturbances following frontal lobe damage. This study's guiding premise was that greater neuroanatomical specificity could be achieved by evaluating specific types of personality disturbances following acquired frontal lobe lesions. We hypothesized that three acquired personality disturbances would be associated with lesion involvement of distinct sectors of the prefrontal cortex (PFC): 1) emotional-social disturbance and ventromedial PFC, 2) hypoemotional disturbance and dorsomedial PFC, and 3) dysexecutive and dorsolateral PFC. In addition, we hypothesized that distressed personality disturbance would not be associated with focal PFC lesions in any sector. Each hypothesis was pre-registered and tested in 182 participants with adult-onset, chronic, focal brain lesions studied with an observational, cross-sectional design. Pre- and postmorbid personality was assessed by informant-rating with the Iowa Scales of Personality Change, completed by a spouse or family member. Two complementary analytic approaches were employed: 1) a hypothesis-driven region-of-interest (ROI) regression analysis examining the associations of lesions in specific PFC sectors with acquired personality disturbances; 2) a data-driven multivariate lesion-behavior mapping analysis, which was not limited to pre-specified regions. Each hypothesis received some support: (i) Emotional/social personality disturbance was most strongly associated with ventromedial PFC lesions in both statistical approaches. (ii) Hypoemotional disturbance was associated with dorsomedial PFC lesions in the ROI analyses, without any significant lesion-symptom mapping associations. (iii) Dysexecutive personality disturbance was associated with bilateral dorsolateral PFC lesions and ventromedial PFC lesions; lesion-symptom mapping showed maximal association of executive dysfunction with damage of the right middle frontal gyrus within the dorsolateral PFC. (iv) Distressed personality disturbance was not associated with lesions in any PFC sector. Altogether, the findings can be interpreted to indicate that damage to different prefrontal sectors may disrupt different anatomical-functional systems and result in distinct personality disturbances.
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Affiliation(s)
- Joseph Barrash
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States.
| | - Joel Bruss
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States
| | - Steven W Anderson
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States; Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Kenneth Manzel
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States
| | - Daniel Tranel
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Aaron D Boes
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States; Department of Psychiatry, Carver College of Medicine, Iowa City, IA, United States; Department of Pediatrics, Carver College of Medicine, Iowa City, IA, United States
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Villar F, Chacur K, Celdrán M, Serrat R. Managing apathy among people with dementia living in institutional settings: Staff's perceived gap between common and best practices. Geriatr Nurs 2021; 42:613-620. [PMID: 33823418 DOI: 10.1016/j.gerinurse.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study is to explore how staff manage apathy involving a person living with dementia (PLWD). Forty-two staff members working in four Spanish long-term care facilities were interviewed; 21 were nursing assistants and 21 technical staff. They read a vignette about a PLWD presenting apathy. Participants were asked (1) how a situation like that is commonly managed, and (2) how it should be managed. Responses were content-analyzed. Most participants (88.1%) mentioned having experienced a situation similar to the one described in the vignette. Behavior-focused strategies and person-centered strategies were the most frequently mentioned. As for best practices, person-centered strategies emerged as the preferred alternative, and technical staff mentioned them more frequently than assistant carers. Our findings stress the importance of organizational guidelines and staff development in the management of apathy in PLWD.
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Affiliation(s)
- Feliciano Villar
- Departament of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain.
| | - Karima Chacur
- Departament of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Montserrat Celdrán
- Departament of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Rodrigo Serrat
- Departament of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
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Gual N, Pérez LM, Castellano-Tejedor C, Lusilla-Palacios P, Castro J, Soto-Bagaria L, Coll-Planas L, Roqué M, Vena AB, Fontecha B, Santiago JM, Lexell EM, Chiatti C, Iwarsson S, Inzitari M. IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors. BMC Geriatr 2020; 20:321. [PMID: 32887564 PMCID: PMC7472581 DOI: 10.1186/s12877-020-01694-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants' experiences and functional status at 3 months. METHODS We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´ goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis. DISCUSSION Final results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person's health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors. TRIAL REGISTRATION ClinicalTrials.gov: NCT03434938 , registered on January 2018.
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Affiliation(s)
- Neus Gual
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Laura Mónica Pérez
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Carmina Castellano-Tejedor
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain. .,Autonomous University of Barcelona, Bellaterra, Spain.
| | | | - Judith Castro
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Luís Soto-Bagaria
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Laura Coll-Planas
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Universitat Autònoma de Barcelona, Barcelona, Spain.,Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Universitat Autònoma de Barcelona, Barcelona, Spain.,Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | | | - Benito Fontecha
- Hospital General de l'Hospitalet (Consorci Sanitari Integral), Hospitalet de Llobregat, Spain
| | - Jose M Santiago
- Hospital General de l'Hospitalet (Consorci Sanitari Integral), Hospitalet de Llobregat, Spain
| | - Eva Månsson Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Carlos Chiatti
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Susanne Iwarsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Marco Inzitari
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain.,Autonomous University of Barcelona, Bellaterra, Spain
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McDonald S, Wilson E, Wearne T, Darke L, Cassel A, Rosenberg H. The complex audio visual emotion assessment task (CAVEAT): development of a shorter version for clinical use. Disabil Rehabil 2020; 44:1498-1507. [PMID: 32787689 DOI: 10.1080/09638288.2020.1803425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The Complex Audio Visual Emotion Assessment Task (CAVEAT) is a measure of emotion recognition using dynamic, naturalistic videos to assess recognition of 22 different emotional states (11 positive, 11 negative). It has established construct validity and demonstrated sensitivity to emotion perception impairments in those with moderate-severe traumatic brain injury (TBI). Despite this, its lengthy administration has limited its use in clinical practice and rehabilitation. The current paper aimed to develop shortened versions of the CAVEAT and examine their psychometric properties. METHODS The CAVEAT-S A and CAVEAT-S B (22 items each) and the CAVEAT-S AB (44 items) were developed using the original data. Comparability, reliability, construct and predictive validity were examined in the original sample (Study 1: 32 people with TBI and 32 demographically matched control participants) and a replication sample (Study 2: 18 adults with TBI and 21 demographically matched controls). RESULTS All short forms produced comparable accuracy ratings to the full measure, as well as discriminating between people with or without a TBI. Shortened forms all correlated with other measures of emotion perception and social cognition and also predicted psychosocial outcomes in terms of self-reported interpersonal relationships. Internal reliability of the short forms was low relative to the longer forms, especially for the two very short measures. CONCLUSIONS The new shortened forms of the CAVEAT are promising tools that are sensitive and valid for assessing emotion perception in people with TBI for clinical purposes. Their application in other clinical disorders is yet to be examined.Implications for rehabilitationEmotion perception deficits are present in many clinical populations and an important target for rehabilitation.CAVEAT Short provides ecologically valid emotional stimuli. Such stimuli are important for assessing real world function and to set rehabilitation targets.By having parallel versions of CAVEAT, there is the opportunity to test pre and post intervention while minimising practice effects.Alternatively, one version of CAVEAT-S can be used for assessment, while the other is used for training purposes during remediation.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily Wilson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Travis Wearne
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Lillian Darke
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Anneli Cassel
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Hannah Rosenberg
- School of Psychology, University of New South Wales, Sydney, Australia
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Cai Y, Li L, Xu C, Wang Z. The Effectiveness of Non-Pharmacological Interventions on Apathy in Patients With Dementia: A Systematic Review of Systematic Reviews. Worldviews Evid Based Nurs 2020; 17:311-318. [PMID: 32767834 DOI: 10.1111/wvn.12459] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Apathy is one of the behavioral and psychological symptoms of dementia (BPSD), which is the most frequent and can accelerate the progress of dementia. AIMS To systematically review the evidence of effectiveness of non-pharmacological interventions on apathy in patients with dementia. METHODS Databases including the Cochrane Library, Joanna Briggs Institute (JBI) Library, PubMed, EMBASE, CINAHL, PsycINFO, Psychology and Behavioral Sciences Collection, CNKI, and Wan Fang Data were searched for systematic reviews of the effectiveness of non-pharmacological interventions on apathy in patients with dementia. AMSTAR 2 was applied to assess the methodological quality of reviews. RESULTS Nine systematic reviews were included. The average level of overall confidence for included systematic reviews was low. Among all the non-pharmacological interventions involved in this review, the effectiveness of multisensory stimulation, music therapy, cognitive stimulation, and pet therapy was relatively robust. The effects of reminiscence therapy, therapeutic conversation, progressive muscle relaxation, art therapy, exercise therapy, occupational therapy, dementia special care units, nursing staff education, and comprehensive interventions need to be validated further. Meanwhile, the current evidence failed to support the effects of psychomotor therapy and validation therapy on apathy. LINKING EVIDENCE TO ACTION Non-pharmacological interventions for apathy in patients with dementia are acceptable. In spite of requirements for adequate and high-quality original studies and quantitative systematic reviews to validate the efficacy of non-pharmacological interventions, multisensory stimulation, music therapy, cognitive stimulation, and pet therapy are deemed the most helpful according to evidences available.
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Affiliation(s)
- Yan Cai
- School of Nursing, Peking University, Beijing, China.,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Liyu Li
- School of Nursing, Peking University, Beijing, China
| | - Chang Xu
- School of Nursing, Peking University, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, Malec JF, Bergquist TF, Kingsley K, Nagele D, Trexler L, Fraas M, Bogdanova Y, Harley JP. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Arch Phys Med Rehabil 2019; 100:1515-1533. [DOI: 10.1016/j.apmr.2019.02.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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Ter Mors B, Backx A, Spauwen P, Ponds R, Van Harten P, Van Heugten C. Efficacy of amantadine on behavioural problems due to acquired brain injury: A systematic review. Brain Inj 2019; 33:1137-1150. [DOI: 10.1080/02699052.2019.1631482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- B.J. Ter Mors
- GGZ Oost-Brabant, Brain Injury Department Huize Padua, Boekel, The Netherlands
| | - A.P.M. Backx
- Adelante Rehabilitation Centre, Hoensbroek, The Netherlands
| | - P. Spauwen
- GGZ Oost-Brabant, Brain Injury Department Huize Padua, Boekel, The Netherlands
| | - R.W.H.M. Ponds
- Adelante Rehabilitation Centre, Hoensbroek, The Netherlands
- Limburg Brain Injury Center, Maastricht, The Netherlands
| | - P.N. Van Harten
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- GGz Centraal, Amersfoort, The Netherlands
| | - C.M. Van Heugten
- Limburg Brain Injury Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
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Henstra MJ, Houbolt CM, Seppala LJ, de Rooij SE, Rhebergen D, Stek ML, van der Velde N. Age modifies the association between apathy and recurrent falling in Dutch ambulant older persons with a high fall risk: Recurrent falling in Dutch outpatients, does apathy play a role? Exp Gerontol 2018; 112:54-62. [PMID: 30217662 DOI: 10.1016/j.exger.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
Abstract
Apathy, a common and disabling behavioural syndrome in older persons, has been associated with impaired physical performance and executive dysfunction. Both are fall risk factors and they share pathophysiological pathway. We cross-sectionally examined the association between apathy and recurrent falling (≥2 falls in the past 12 months) and number of falls in the past 12 months in 243 outpatients aged ≥65 years with ≥3 fall risk-factors visiting a fall-clinic after a fall. We calculated Odds Ratio's (ORs), Incidence Rate Ratio's (IRRs) and their 95% Confidential Intervals (CI95) using multivariable regression and negative binomial regression analyses. We adjusted for cognitive functioning, depression, the use of fall risk increasing drugs, visual impairment, urine incontinence, comorbidity, smoking, use of alcohol, body mass index (BMI), and the number of months between assessment of fall risk and of apathy. We assessed effect modification by age and gender. In our study, apathy was independently associated with recurrent falling in patients aged 65-75 years: OR 2.8 (CI95 1.0-7.7). Overall, patients with apathy experienced 1.46 times as many falls in the past 12 months compared to patients without apathy (IRR 1.46 (CI95 1.0-2.1). To conclude, in high fall-risk older outpatients, apathy was cross-sectionally associated with recurrent falling in patients aged 65-75 years and the number of falls. Apathy appeared to be especially relevant in relation to falling in this age group. Whether apathy predicts recurrent falling is yet to be determined.
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Affiliation(s)
- M J Henstra
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - C M Houbolt
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - L J Seppala
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - S E de Rooij
- UMCG Department of Internal Medicine, Geriatrics, University Medical Centre Groningen, Groningen, the Netherlands; AMC Department of Internal Medicine, Geriatrics, Academic Medical Center, University of Amsterdam, the Netherlands
| | - D Rhebergen
- Department of Psychiatry, GGZ inGeest, Amsterdam, the Netherlands; EMGO+ Institute for Health and Care Research VU Medical Center, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - M L Stek
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; GGZ inGeest/Department of Psychiatry, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, the Netherlands
| | - N van der Velde
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Azuar C, Levy R. Behavioral disorders: The ‘blind spot’ of neurology and psychiatry. Rev Neurol (Paris) 2018; 174:182-189. [DOI: 10.1016/j.neurol.2018.02.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/25/2022]
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Theleritis C, Siarkos K, Politis AA, Katirtzoglou E, Politis A. A systematic review of non-pharmacological treatments for apathy in dementia. Int J Geriatr Psychiatry 2018; 33:e177-e192. [PMID: 28960446 DOI: 10.1002/gps.4783] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/24/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Apathy is one of the most frequent neuropsychiatric symptoms encountered in dementia. Early diagnosis and timely treatment of apathy in dementia are crucial because apathy has been associated with poor disease outcome, reduced daily functioning, and caregiver distress. DESIGN Extensive electronic search from the databases included in the National Library of Medicine as well as PsychInfo and Google Scholar for studies which have investigated the effect of non-pharmacological treatments of apathy in dementia. Quality of the studies was appraised. RESULTS A total of 1303 records were identified and 120 full-texts assessed. Forty-three unique studies were reviewed. A variety of interventions were found to be effective in reducing apathy in demented patients, particularly when provided in a multidisciplinary manner. However, quantification of the effect was limited by the marked methodological heterogeneity of the studies and the small number of studies where apathy was the primary outcome measure. CONCLUSIONS Treatment of apathy in dementia is a complex and underexplored field. Certain studies suggest promise for a variety of non-pharmacological interventions. Standardized and systematic efforts primarily focusing on apathy may establish a benefit from individualized treatments for specific disease groups.
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Affiliation(s)
- Christos Theleritis
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Siarkos
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios A Politis
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Everina Katirtzoglou
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Politis
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.,Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, MD, USA
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Nijsten JMH, Leontjevas R, Pat-El R, Smalbrugge M, Koopmans RTCM, Gerritsen DL. Apathy: Risk Factor for Mortality in Nursing Home Patients. J Am Geriatr Soc 2017; 65:2182-2189. [DOI: 10.1111/jgs.15007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Johanna M. H. Nijsten
- Archipel Landrijt; Knowledge Center for Specialized Care; Eindhoven the Netherlands
- Department of Primary and Community Care; Radboudumc Alzheimer Center, Radboud University Medical Center; Nijmegen the Netherlands
| | - Ruslan Leontjevas
- Department of Primary and Community Care; Radboudumc Alzheimer Center, Radboud University Medical Center; Nijmegen the Netherlands
- Faculty of Psychology and Educational Sciences; Open University of the Netherlands; Heerlen the Netherlands
| | - Ron Pat-El
- Faculty of Psychology and Educational Sciences; Open University of the Netherlands; Heerlen the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine; Amsterdam Public Health research institute, VU University Medical Center; Amsterdam the Netherlands
| | - Raymond T. C. M. Koopmans
- Department of Primary and Community Care; Radboudumc Alzheimer Center, Radboud University Medical Center; Nijmegen the Netherlands
- Joachim en Anna; Center for Specialized Geriatric Care; Nijmegen the Netherlands
| | - Debby L. Gerritsen
- Department of Primary and Community Care; Radboudumc Alzheimer Center, Radboud University Medical Center; Nijmegen the Netherlands
- Joachim en Anna; Center for Specialized Geriatric Care; Nijmegen the Netherlands
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15
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Theleritis C, Siarkos K, Katirtzoglou E, Politis A. Pharmacological and Nonpharmacological Treatment for Apathy in Alzheimer Disease : A systematic review across modalities. J Geriatr Psychiatry Neurol 2017; 30:26-49. [PMID: 28248559 DOI: 10.1177/0891988716678684] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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 one of the most frequent neuropsychiatric symptoms encountered in Alzheimer disease (AD). Early diagnosis and timely treatment of apathy in AD seem to be of great importance, since apathy has been associated with poor disease outcome, reduced daily functioning, and caregiver distress. DESIGN Within this context, we conducted an extensive electronic search from the databases included in the National Library of Medicine as well as PsychInfo and Google Scholar for studies that have investigated the effect of pharmacological and nonpharmacological treatments of apathy in AD. RESULTS Acetylcholinesterase inhibitors, gingko biloba, methylphenidate, and a variety of nonpharmacological interventions were found to be successful in reducing apathy in patients with AD. Methodological heterogeneity of the studies and the small amount of studies where apathy was a primary outcome measure are limiting factors to evaluate for group effects. CONCLUSION Treatment of apathy in AD is a complicated and an underexplored field. Standardized and systematic efforts primarily focused on the study of apathy in AD may establish a benefit from individualized treatment for specific disease groups that would stem from a combination of both pharmacological and nonpharmacological interventions.
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Affiliation(s)
- Christos Theleritis
- 1 First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.,2 Department of Psychosis Studies, Institute of Psychiatry, King's College, London, United Kingdom
| | - Kostas Siarkos
- 1 First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Everina Katirtzoglou
- 1 First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Politis
- 1 First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.,3 Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, MD, USA
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Sveen U, Søberg HL, Østensjø S. Biographical disruption, adjustment and reconstruction of everyday occupations and work participation after mild traumatic brain injury. A focus group study. Disabil Rehabil 2016; 38:2296-304. [DOI: 10.3109/09638288.2015.1129445] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Skidmore ER, Whyte EM, Butters MA, Terhorst L, Reynolds CF. Strategy Training During Inpatient Rehabilitation May Prevent Apathy Symptoms After Acute Stroke. PM R 2015; 7:562-70. [PMID: 25595665 PMCID: PMC4466065 DOI: 10.1016/j.pmrj.2014.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/16/2014] [Accepted: 12/25/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Apathy, or lack of motivation for goal-directed activities, contributes to reduced engagement in and benefit from rehabilitation, impeding recovery from stroke. OBJECTIVE To examine the effects of strategy training, a behavioral intervention used to augment usual inpatient rehabilitation, on apathy symptoms over the first 6 months after stroke. DESIGN Secondary analysis of randomized controlled trial. SETTING Acute inpatient rehabilitation. PARTICIPANTS Participants with acute stroke who exhibited cognitive impairments (Quick Executive Interview Scores ≥3) and were admitted for inpatient rehabilitation were randomized to receive strategy training (n = 15, 1 session per day, 5 days per week, in addition to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). METHODS Strategy training sessions focused on participant-selected goals and participant-derived strategies to address these goals, using a global strategy training method (Goal-Plan-Do-Check). Reflective listening sessions focused on participant reflections on their rehabilitation goals and experiences, facilitated by open-ended questions and active listening skills (attending, following, and responding). MAIN OUTCOME MEASURES Trained raters blinded to group assignment administered the Apathy Evaluation Scale at study admission, 3 months, and 6 months. Data were analyzed with repeated-measures fixed-effects models. RESULTS Participants in both groups had similar subsyndromal levels of apathy symptoms at study admission (strategy training, mean = 25.79, standard deviation = 7.62; reflective listening, mean = 25.18, standard deviation = 4.40). A significant group × time interaction (F2,28 = 3.61, P = .040) indicated that changes in apathy symptom levels differed between groups over time. The magnitude of group differences in change scores was large (d = -0.99, t28 = -2.64, P = .013) at month 3 and moderate to large (d = -0.70, t28 = -1.86, P = .073) at month 6. CONCLUSION Strategy training shows promise as an adjunct to usual rehabilitation for maintaining low levels of poststroke apathy.
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Affiliation(s)
- Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260; and Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA(∗).
| | - Ellen M Whyte
- Department of Physical Medicine & Rehabilitation and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA(†)
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA(‡)
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA(§)
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; and Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA(‖)
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18
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den Brok MG, van Dalen JW, van Gool WA, Moll van Charante EP, de Bie RM, Richard E. Apathy in Parkinson's disease: A systematic review and meta-analysis. Mov Disord 2015; 30:759-69. [DOI: 10.1002/mds.26208] [Citation(s) in RCA: 220] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 02/05/2015] [Accepted: 02/12/2015] [Indexed: 01/24/2023] Open
Affiliation(s)
| | | | - Willem A. van Gool
- Department of Neurology; Academic Medical Center Amsterdam; The Netherlands
| | | | - Rob M.A. de Bie
- Department of Neurology; Academic Medical Center Amsterdam; The Netherlands
| | - Edo Richard
- Department of Neurology; Radboud University Medical Center Nijmegen; The Netherlands
- Department of Neurology; Academic Medical Center Amsterdam; The Netherlands
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Gardiner JC, Horwitz JL. Neurologic Music Therapy and Group Psychotherapy for Treatment of Traumatic Brain Injury: Evaluation of a Cognitive Rehabilitation Group. ACTA ACUST UNITED AC 2015. [DOI: 10.1093/mtp/miu045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Apathy has been identified as an independent clinical syndrome. As prevalent and problematic as it is in the field of neuropsychiatry, there is no fully accepted definition of apathy. In this study, a concept analysis utilizing Rodgers' evolutionary approach was performed. CINAHL Plus with Full Text was searched, and altogether 36 publications were identified for the concept analysis. Our study shows that psychometric scales may have resulted in an inappropriate diagnosis of depression instead of apathy. As a whole, the literature showed that apathy was defined in comparison to depression as well as altered motivation, emotionality, activity, interest, and initiative. We discuss the advances in the development of apathy as an evolutionary concept. Consistent with Rodgers' evolutionary method, these findings are not an endpoint.
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Affiliation(s)
- Mélinda McCusker
- a University of Colorado, Helen and Arthur E. Johnson Depression Center , Aurora , Colorado , USA
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21
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INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part III. J Head Trauma Rehabil 2014; 29:338-52. [DOI: 10.1097/htr.0000000000000068] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Wu LM, Austin J, Valdimarsdottir H, Isola L, Rowley SD, Diefenbach MA, Cammarata M, Redd WH, Rini C. Cross-sectional study of patient-reported neurobehavioral problems following hematopoietic stem cell transplant and health-related quality of life. Psychooncology 2014; 23:1406-14. [PMID: 24846770 DOI: 10.1002/pon.3554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 03/12/2014] [Accepted: 03/25/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although hematopoietic stem cell transplant (HSCT) patients may experience neurocognitive impairment, experiences of neurobehavioral problems (including apathy and disinhibition) are understudied. These experiences reflect behavioral signs and symptoms of neurological dysfunction that can potentially reduce health-related quality of life (HRQOL). Understanding them is important because they may be confused with other diagnoses, including depression, potentially leading to inappropriate treatments. The objectives of this preliminary cross-sectional study were to describe HSCT patients' neurobehavioral functioning pre-HSCT and post-HSCT and to examine relations with HRQOL. METHODS Patients (n = 42) 9 months to 3 years post-HSCT completed measures of neurobehavioral functioning to report apathy and disinhibition pre-HSCT (retrospectively) and post-HSCT (currently). Paired t-tests and McNemar tests were used to explore differences in the incidence of patient-reported neurobehavioral problems within and across time points. Regression analyses were conducted to examine relations between neurobehavioral functioning and physical and mental HRQOL. RESULTS Elevated levels of apathy were reported by many patients post-HSCT (36%) and increased significantly from pre-HSCT to post-HSCT (p = 0.001). Hierarchical regression analysis indicated that higher levels of apathy were associated with reduced mental HRQOL (p < 0.05) even after controlling for depressed mood and fatigue. CONCLUSIONS Findings from this preliminary study highlight the importance of investigating neurobehavioral problems, particularly apathy, in HSCT patients. Because apathy is often confused with other diagnoses and may worsen HRQOL, understanding the nature of these symptoms has implications for interventions. Further research is needed in this important area.
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Affiliation(s)
- Lisa M Wu
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Njomboro P, Deb S. Distinct neuropsychological correlates of cognitive, behavioral, and affective apathy sub-domains in acquired brain injury. Front Neurol 2014; 5:73. [PMID: 24904518 PMCID: PMC4032882 DOI: 10.3389/fneur.2014.00073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/01/2014] [Indexed: 11/13/2022] Open
Abstract
Apathy has a high prevalence and a significant contribution to treatment and rehabilitation outcomes in acquired brain damage. Research on the disorder's neuropsychological correlates has produced mixed results. While the mixed picture may be due to the use of varied assessment tools on different patient populations, it is also the case that most studies treat apathy as a unitary syndrome. This is despite the evidence that apathy is a multifaceted and multidimensional syndrome. This study investigates the neuropsychological correlates of apathy in 49 patients with acquired brain damage. It further fractionates apathy symptoms into affective, cognitive, and behavioral sub-domains and investigates their individual relations with standard measures of affective, cognitive, and behavioral functioning. Global apathy scores were not related to any of these measures. Affective apathy was associated with emotion perception deficits, and cognitive apathy was associated with executive deficits on the Brixton test. These results demonstrate that treating apathy as a single entity may hide important correlates to apathy symptoms that become visible when the disorder is fractionated into its sub-domains. The study highlights the research and clinical importance of treating apathy as a multidimensional syndrome.
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Affiliation(s)
- Progress Njomboro
- Department of Psychology, University of Cape Town , Cape Town , South Africa
| | - Shoumitro Deb
- Division of Brain Sciences, Department of Medicine, Imperial College London , London , UK
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Sveen U, Ostensjo S, Laxe S, Soberg HL. Problems in functioning after a mild traumatic brain injury within the ICF framework: the patient perspective using focus groups. Disabil Rehabil 2012; 35:749-57. [DOI: 10.3109/09638288.2012.707741] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Apathy: A pathology of goal-directed behaviour. A new concept of the clinic and pathophysiology of apathy. Rev Neurol (Paris) 2012; 168:585-97. [DOI: 10.1016/j.neurol.2012.05.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 12/21/2022]
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Abstract
We describe a 76-year-old man with herpes encephalitis whose symptom of severe apathy was improved by the dopamine D2/D3 receptor agonist ropinirole. Brain magnetic resonance imaging had shown lesions in the patient's right mesial temporal cortex, right insula, and bilateral medial frontal regions. During treatment with acyclovir, he had developed severe apathy and depression. On neuropsychological assessment, he scored 21/30 points on the Mini-Mental State Examination, 30/42 on the Starkstein Apathy Scale (cutoff score =16), and 59/80 on the Zung Self-Rating Depression Scale (cutoff score=40). We then started him on ropinirole 0.25 mg/day. Over the next 10 days, his apathy and depression gradually improved. On day 10 of treatment, follow-up testing showed that his Apathy Scale score had improved to 25 points. This case suggests that a low dose of a dopamine receptor agonist may be an effective treatment for patients who develop apathy and depression after encephalitis.
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Lane-Brown AT, Tate RL. Apathy After Traumatic Brain Injury: An Overview of the Current State of Play. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.12.1.43] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractApathy is a decrease in behavioural, cognitive and emotional components of goal-directed behaviour. Clinically, it is characterised by diminished initiation, reduced concern, and decreased activity. Apathy is a common occurrence following traumatic brain injury (TBI), occurring in around 60% of people. Consequences are widespread, negatively impacting independence, social integration, rehabilitation outcome, vocational outcome, coping and caregiver burden. The current knowledge base on apathy following TBI is presented, with implications for clinical practice. This includes a review of clinical presentations, neuroanatomical and neurochemical substrates associated with apathy, and differential diagnoses. Instruments to measure apathy are presented, highlighting those with demonstrated reliability and validity for the TBI population. Current evidence for pharmacological and non-pharmacological methods of treatment is described, with a model for non-pharmacological interventions provided and discussion of challenges faced by clinicians when treating the patient with apathy. In the TBI arena, greater understanding of apathy and methods of treatment is pivotal given the frequency of occurrence and widespread negative consequences.
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Treusch Y, Page J, Niemann-Mirmehdi M, Gutzmann H, Heinz A, Rapp M. Apathy and Its Nonpharmacological Treatment in Dementia. GEROPSYCH 2011. [DOI: 10.1024/1662-9647/a000041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Apathy is the most common behavioral symptom in Alzheimer’s disease. Apathy has been defined as a state characterized by simultaneous diminution in the overt behavioral, cognitive, and emotional concomitants of goal-directed behavior. In that sense, apathy refers to impairments in motor, cognitive, and emotional functions. To date, there is little empirical foundation for how these three levels interact in patients suffering from apathy. We describe here neurobiological foundations as well as clinical correlations between the severity of apathy and impairments in motor, cognitive, and emotional functions. Furthermore, we present a literature review of the nonpharmacological treatment options of apathy in dementia. We suggest that focusing on the motor, cognitive, and emotional aspects of apathy may help to implement successful treatment strategies. Multimodal, individualized approaches, including the use of physical activation and biography-based information to motivate dementia patients, seem to be of high relevance.
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Affiliation(s)
- Y. Treusch
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité – University Medicine, Berlin, Germany
- Geriatric Psychiatry Center, Psychiatric University Hospital at St Hedwig, Charité – University Medicine, Berlin, Germany
- Institute of Occupational Therapy, School of Health Professions, Zurich University of Applied Sciences (ZHAW), Switzerland
| | - J. Page
- Institute of Occupational Therapy, School of Health Professions, Zurich University of Applied Sciences (ZHAW), Switzerland
| | - M. Niemann-Mirmehdi
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité – University Medicine, Berlin, Germany
- Geriatric Psychiatry Center, Psychiatric University Hospital at St Hedwig, Charité – University Medicine, Berlin, Germany
| | - H. Gutzmann
- Department of Psychiatry and Psychotherapy, Alexianer-Hospital Hedwigshöhe, Berlin, Germany
| | - A. Heinz
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité – University Medicine, Berlin, Germany
- Geriatric Psychiatry Center, Psychiatric University Hospital at St Hedwig, Charité – University Medicine, Berlin, Germany
| | - M. Rapp
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité – University Medicine, Berlin, Germany
- Geriatric Psychiatry Center, Psychiatric University Hospital at St Hedwig, Charité – University Medicine, Berlin, Germany
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Evaluation of an intervention for apathy after traumatic brain injury: a multiple-baseline, single-case experimental design. J Head Trauma Rehabil 2011; 25:459-69. [PMID: 20414129 DOI: 10.1097/htr.0b013e3181d98e1d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Apathy is diminished initiation, sustained activity, and concern about goal-directed behaviors. It occurs in between 46% and 71% of adults with traumatic brain injury and has widespread effects. Despite this, evidence for treatment of apathy is sparse, with no evidence for treatments aimed at sustaining activity toward goal-directed behavior. METHOD A multiple-baseline, single-case experimental design evaluated a novel treatment for apathy in a 32-year-old man with traumatic brain injury. This treatment incorporated motivational interviewing and external compensation to increase sustained activity toward cumulative goals. RESULTS A specific treatment effect was demonstrated. Reliable Change Indices indicated a significant decrease in apathy that was maintained at 1-month follow-up. CONCLUSION Treatment had a strong and specific effect on treated goal-directed activity and decreased apathy. The success of treatment was dependent on initiation as well as sustaining goal-directed activity.
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Combining neuropsychological and cognitive-behavioral approaches for treating psychological sequelae of acquired brain injury. Curr Opin Psychiatry 2011; 24:156-61. [PMID: 21206272 DOI: 10.1097/yco.0b013e328343804e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Acquired brain injury (ABI) does not only result in physical and cognitive impairments, but may also entail behavioral-emotional difficulties and mental disorders. Although neuropsychological approaches target the rehabilitation of cognitive deficits, the treatment of emotional and behavioral sequelae has received less consideration. This review argues for the integration of cognitive-behavioral approaches into the rehabilitation process and examines respective recent research. RECENT FINDINGS Cognitive-behavioral interventions have been investigated in the treatment of behavioral disturbances and mental disorders after ABI. They have also been targeted at supporting adaptive coping with chronic injury-related impairments. Problem-solving approaches of cognitive behavioral therapy may work as meta-models or framework for the rehabilitative process. Unfortunately, most studies reviewed employed methodologically weak designs, which limit convincing conclusions. Still, positive intervention effects have been demonstrated concerning specific outcome measures. Whether these changes also translate into increased psychosocial functioning or quality of life remains unclear. SUMMARY Methodologically sound evidence for cognitive-behavioral interventions after ABI is limited, but preliminary results support the effectiveness of these interventions in the treatment of behavioral disorders and emotional disturbances after ABI. Integrating neuropsychological and cognitive-behavioral approaches may therefore prove beneficial to the rehabilitation process.
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Reeves RR, Panguluri RL. Neuropsychiatric complications of traumatic brain injury. J Psychosoc Nurs Ment Health Serv 2011; 49:42-50. [PMID: 21323264 DOI: 10.3928/02793695-20110201-03] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 11/18/2010] [Indexed: 11/20/2022]
Abstract
Traumatic brain injury (TBI) may be defined as any extracranial mechanical force to the brain that results in any period of loss of consciousness, any loss of memory for events immediately before or after the event, or any alteration in mental status at the time of the event. The major causes are automobile accidents, falls, sporting injuries, and assaults. Many soldiers returning from combat in Afghanistan and Iraq have also experienced TBI. This article provides an overview of the neuropsychiatric complications of TBI, including impairment of consciousness, posttraumatic amnesia, cognitive disorders and dementia, posttraumatic epilepsy, aphasia, depression, mania, psychosis, anxiety disorders, personality changes, aggression, behavioral dyscontrol, fatigue/apathy, and increased risk of suicide. Discussion will focus primarily on issues affecting mental health clinicians. Because mental health providers are more involved in care of chronic issues related to TBI, these issues will be discussed in more detail, although acute neuropsychiatric complications of TBI will be briefly explained.
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Affiliation(s)
- Roy R Reeves
- G.V. (Sonny) Montgomery VA Medical Center, (11M), 1500 E. Woodrow Wilson Drive, Jackson, MS 29216, USA.
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