Apathy and neurocognitive correlates: review from the perspective of 'precision psychiatry'

Prevalence, treatment, and neural correlates of apathy in different forms of dementia: a narrative review

OBJECTIVES

The aim of this review is to provide an overview on prevalence and clinical tools for the diagnosis of apathy, as well as on neurophysiological and neuroimaging findings obtained from studies in patients with apathy in different forms of dementia, including Alzheimer's disease (AD), vascular (VaD) and mixed dementia, frontotemporal dementia (FTD), and Parkinson's disease dementia (PDD).

METHODS

Randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series from four databases (WebOfScience, Scopus, Pubmed, and PsycINFO) addressing apathy in adults or older people aged over 65 years of age affected by dementia were included.

RESULTS

The prevalence of apathy was 26-82% for AD, 28.6-91.7 for VaD, 29-97.5% in PDD, and 54.8-88.0 in FTD. The assessment of apathy was not consistent in the reviewed studies. Methylphenidate was the most successful pharmacological treatment for apathy. Neurobiological studies highlighted the relationship between both structural and functional brain areas and the presence or severity of apathy.

CONCLUSION

Apathy is a very common disorder in all types of dementia, although it is often underdiagnosed and undertreated. Further studies are needed to investigate its diagnosis and management. A consensus on the different evaluation scales should be achieved.

Palliative care in Parkinson disease and related disorders

Although neuropalliative care is a relatively new field, there is increasing evidence for its use among the degenerative parkinsonian syndromes, including idiopathic Parkinson disease, progressive supranuclear palsy, multiple system atrophy, dementia with Lewy bodies, and corticobasal syndrome. This chapter outlines the current state of evidence for palliative care among individuals with the degenerative parkinsonian syndromes with discussion surrounding: (1) disease burden and needs across the conditions; (2) utility, timing, and methods for advance care planning; (3) novel care models for the provision of palliative care; and 4) end-of-life care issues. We also discuss currently unmet needs and unanswered questions in the field, proposing priorities for research and the assessment of implemented care models.

Frailty and senile apathy in the everyday clinical practice in the conditions of COVID-19

The article covers the pathogenesis, clinical manifestations, and diagnostic criteria of frailty and senile apathy in the elderly. Special attention is paid to sarcopenia: the phenotypic classification and modern approaches to the treatment are discussed. The knowledge and understanding of the main pathogenetic links of sarcopenia, frailty and senile apathy, as well as the development of a single therapeutic line for these pathological conditions can significantly improve the life quality and expectancy of the elderly.

Apathetic symptoms and white matter integrity after traumatic brain injury

PRIMARY OBJECTIVE

The aim of the study was twofold. First, to study the relationship among apathy in the long term, initial clinical measures, and standard outcome scores after traumatic brain injury (TBI). Second, to describe white matter integrity correlates of apathy symptoms.

RESEARCH DESIGN

Correlational study. Methods and Procedures: Correlation and Bayesian networks analyses were performed in a sample of 40 patients with moderate to severe TBI in order to identify the relationship among clinical variables, functionality, and apathy. A diffusion tensor imaging study was developed in 25 participants to describe correlations between fractional anisotropy (FA) measures and apathetic symptoms.

MAIN OUTCOMES AND RESULTS

Correlation analysis revealed associations between pairs of variables as apathy in the long term and functional score at discharge from hospital. Bayesian network illustrated the relevant role of axonal injury mediating the relationship between apathy and initial clinical variables. FA in the superior longitudinal fasciculus, the inferior longitudinal fasciculus, and the internal capsule were negatively correlated with apathy measures. Widespread brain areas showed positive correlations between FA and apathy.

CONCLUSIONS

These results highlight the relevance of white matter integrity measures in initial assessment after TBI and its relationship with apathetic manifestations in the chronic phase.

Is Depression or Apathy Playing a Key Role in Predicting Financial Capacity in Parkinson's Disease with Dementia and Frontotemporal Dementia?

(1) Background: Depression and apathy both affect cognitive abilities, such as thinking, concentration and making decisions in young and old individuals. Although apathy is claimed to be a “core” feature of Parkinson’s disease (PD) and frontotemporal dementia (FTD), it may occur in the absence of depression and vice versa. Thus, the aim of this study is to explore whether depression or apathy better predict financial capacity performance in PD and FTD as well as in nondemented participants. (2) Methods: Eighty-eight participants divided into three groups (PD, FTD and non-demented participants) were examined with the Mini-Mental State Examination (MMSE) and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS)—Full and short form. The Geriatric Depression Scale informant version (GDS-15) and the Irritability-Apathy Scale (IAS) we completed by caregivers. (3) Results: The results indicated that both PD and FTD patients’ general cognitive functioning and financial capacity performance is negatively influenced by apathy and not by depression. (4) Conclusions: Differences in financial capacity performance indicate that apathy should not be disregarded in clinical assessments. Further studies on larger PD and FTD populations are necessary in order to investigate the decisive role of mood factors on financial capacity impairment.

Anhedonia as a Potential Risk Factor of Alzheimer's Disease in a Community-Dwelling Elderly Sample: Results from the ZARADEMP Project

(1) Introduction: Dementia is a major public health problem, and Alzheimer's disease (AD) is the most frequent subtype. Clarifying the potential risk factors is necessary in order to improve dementia-prevention strategies and quality of life. Here, our purpose was to investigate the role of the absence of hedonic tone; anhedonia, understood as the reduction on previous enjoyable daily activities, which occasionally is underdetected and underdiagnosed; and the risk of developing AD in a cognitively unimpaired and non-depressed population sample. (2) Method: We used data from the Zaragoza Dementia and Depression (ZARADEMP) project, a longitudinal epidemiological study on dementia and depression. After excluding subjects with dementia, a sample of 2830 dwellers aged ≥65 years was followed for 4.5 years. The geriatric mental state examination was used to identify cases of anhedonia. AD was diagnosed by a panel of research psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. A multivariate survival analysis and Cox proportional hazards regression model were performed, and the analysis was controlled by an analysis for the presence of clinically significant depression. (3) Results: We found a significant association between anhedonia cases and AD risk in the univariate analysis (hazard ratio (HR): 2.37; 95% CI: 1.04-5.40). This association persisted more strongly in the fully adjusted model. (4) Conclusions: Identifying cognitively intact individuals with anhedonia is a priority to implement preventive strategies that could delay the progression of cognitive and functional impairment in subjects at risk of AD.