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Lafond-Brina G, Pham BT, Bonnefond A. Specific mechanisms underlying executive and emotional apathy: A phenotyping study. J Psychiatr Res 2024; 172:35-46. [PMID: 38359616 DOI: 10.1016/j.jpsychires.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/11/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
Apathy is a behavioral symptom prevalent both in neuropsychiatric pathologies and in the healthy population. However, the knowledge of the cognitive and neural mechanisms underlying apathy is still very limited, even if clinical and fMRI data support the existence of three forms of apathy (executive, emotional, initiative). These forms could be explained by the alteration of specific mechanisms. This present study's aim is to specify the cognitive and neuronal mechanisms of executive and emotional apathy. We used an EEG study conducted on 68 subjects comprising two groups of young people with specific executive or emotional phenotypes of apathy and one group with no apathy. Despite having symptom of apathy, participants were free of any neurological, metabolic, or psychiatric diagnoses and with high education. Two tasks were used: the DPX for cognitive control and the MID for motivation. Our results showed that distinct mechanisms underlie these two forms of apathy, and, for the first time, we specified these mechanisms. A deficit of the proactive control mode, reflected by a reduced probe-N2 amplitude in AY trials, underlies the executive form of apathy (p < .03), whereas liking motivational blunting, highlighted by a reduced LPP amplitude for financial loss, characterizes the emotional form (p < .04). The main limit of the results is that generalizability to the general population may be reduced since the apathetic samples were chosen for having a specific form of apathy. To conclude, better knowledge of these mechanisms informs new, more targeted treatments, both pharmacological and non-pharmacological, necessary for reducing the debilitating consequences of apathy.
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Affiliation(s)
| | | | - Anne Bonnefond
- INSERM, Unité 1114, Strasbourg, France; University of Strasbourg, France
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Yi HJ, Tan CH, Hong WP, Yu RL. Development and validation of the geriatric apathy scale: Examining multi-dimensional apathy profiles in a neurodegenerative population with cultural considerations. Asian J Psychiatr 2024; 93:103924. [PMID: 38232445 DOI: 10.1016/j.ajp.2024.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Apathy is a common motivational deficit in neurodegenerative diseases, but lacks a culturally sensitive tool accounting for ethnic Chinese culture's impact on motivation initiation. This study developed and validated the Geriatric Apathy Scale (GAS), comprehensively incorporating cultural nuances, setting diagnostic cutoffs, and examining apathy's multi-dimensional aspects in a neurodegenerative cohort. METHODS The 16-item GAS was developed by considering ethnic Chinese cultural characteristics and conducting a literature review. The study involved 296 participants, comprising 113 with Parkinson's disease (PD), 66 with Alzheimer's disease (AD), and 117 healthy controls (HC). All participants completed the GAS, Apathy Evaluation Scale (AES), Geriatric Depression Scale (GDS-15), Mini-Mental State Examination, and Activities of Daily Living (ADLs). RESULTS The GAS showed good internal consistency (r = 0.862) and test-retest reliability (r = 0.767). It correlated moderately with the AES (r = 0.639, p < .001), weakly with GDS-15 (r = 0.166, p < .01), and negatively with ADLs (r = -1.19, p < .05). Clinical diagnosis cutoff scores were identified at 15.5 for PD (sensitivity: 0.789; specificity: 0.693) and 12.5 for AD (sensitivity: 0.821; specificity: 0.632). Noteworthy disparities were observed in the Cognition and Social Motivation dimension, with elevated severity in both PD and AD compared to HC (p < .01). Interestingly, within-group comparisons revealed greater apathy severity in the Cognition and Social Motivation dimension for PD (p < .001) and AD (p = .001) versus Emotional Response and Expression and Spontaneous Behavioral Activation. CONCLUSIONS The GAS, a psychometrically validated scale, assesses apathy in neurodegenerative populations, accounting for ethnic Chinese culture's influence. It establishes clinical cutoff points and explores the multi-dimensional nature of apathy.
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Affiliation(s)
- Hsin-Jou Yi
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsiang Tan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Pin Hong
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Rwei-Ling Yu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Office of Strategic Planning, National Cheng Kung University, Tainan, Taiwan.
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Espiritu AI, Hara T, Tolledo JK, Blair M, Burhan AM. Repetitive transcranial magnetic stimulation for apathy in patients with neurodegenerative conditions, cognitive impairment, stroke, and traumatic brain injury: a systematic review. Front Psychiatry 2023; 14:1259481. [PMID: 38034914 PMCID: PMC10684725 DOI: 10.3389/fpsyt.2023.1259481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background We aimed to determine the effects and tolerability of repetitive transcranial magnetic stimulation (rTMS) on apathy in patients with neurodegenerative conditions, mild cognitive impairment (MCI), stroke, and traumatic brain injury (TBI) via systematic review. Methods We conducted a systematic search in major electronic health databases, including PubMed, Scopus, and PsycINFO, covering the period from inception to June 2023. Comparative clinical trials and cohort studies, and studies with before-after designs were considered for inclusion. We used the Cochrane Risk of Bias and the National Institutes of Health (NIH) tools to assess methodological quality. Results Out of 258 records identified, 14 studies met our eligibility criteria (11 randomized controlled trials (RCT) and 3 studies utilized before-and-after designs) with a total of 418 patients (overall female-to-male ratio 1:1.17) included in the review. The overall methodological quality of the included studies was assessed to be fair to good. The stimulation parameters used varied considerably across the studies. The summary findings of our review indicate the following observations on the effects of rTMS on apathy: (1) the results of all included studies in Alzheimer's disease investigating the effects of rTMS on apathy have consistently shown a positive impact on apathy; (2) the majority of studies conducted in Parkinson's disease have not found statistically significant results; (3) a single study (RCT) on patients with primary progressive aphasia demonstrated significant beneficial effects of rTMS on apathy; (4) the trials conducted on individuals with MCI yielded varying conclusions; (5) one study (RCT) in chronic stroke suggested that rTMS might have the potential to improve apathy; (6) one study conducted on individuals with mild TBI did not find a significant favorable association on apathy; and (7) the use of different rTMS protocols on the populations described is generally safe. Conclusion The feasibility of utilizing rTMS as a treatment for apathy has been suggested in this review. Overall, limited evidence suggests that rTMS intervention may have the potential to modify apathy among patients with AD, PPA, MCI and chronic stroke, but less so in PD and mild TBI. These findings require confirmation by larger, well-designed clinical trials.
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Affiliation(s)
- Adrian I. Espiritu
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry and Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Takatoshi Hara
- Department of Rehabilitation Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Mervin Blair
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Lawson Research Institute, London, ON, Canada
| | - Amer M. Burhan
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Abrahams S. Neuropsychological impairment in amyotrophic lateral sclerosis-frontotemporal spectrum disorder. Nat Rev Neurol 2023; 19:655-667. [PMID: 37828358 DOI: 10.1038/s41582-023-00878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/14/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a rapid course, characterized by motor neuron dysfunction, leading to progressive disability and death. This Review, which is aimed at neurologists, psychologists and other health professionals who follow evidence-based practice relating to ALS and frontotemporal dementia (FTD), examines the neuropsychological evidence that has driven the reconceptualization of ALS as a spectrum disorder ranging from a pure motor phenotype to ALS-FTD. It focuses on changes in cognition and behaviour, which vary in severity across the spectrum: around 50% individuals with ALS are within the normal range, 15% meet the criteria for ALS-FTD, and the remaining 35% are in the mid-spectrum range with milder and more focal impairments. The cognitive impairments include deficits in verbal fluency, executive functions, social cognition and language, and apathy is the most prevalent behavioural change. The pattern and severity of cognitive and behavioural change predicts underlying regional cerebral dysfunction from brain imaging and post-mortem pathology. Our increased recognition of cognition and behaviour as part of the ALS phenotype has led to the development and standardization of assessment tools, which have been incorporated into research and clinical care. Measuring change over the course of the disease is vital for clinical trials, and neuropsychology is proving to be a biomarker for the earliest preclinical changes.
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Affiliation(s)
- Sharon Abrahams
- Human Cognitive Neuroscience, Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK.
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK.
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Horne KS, Ceslis A, Mosley P, Adam R, Robinson GA. The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration. Cogn Behav Neurol 2023; 36:178-193. [PMID: 37378480 DOI: 10.1097/wnn.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/23/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases. OBJECTIVE To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response). METHOD We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks. RESULTS The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task's construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring. CONCLUSION Our work presents a novel experimental task for measuring spontaneous action initiation-a key symptom of apathy-and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.
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Affiliation(s)
- Kristina S Horne
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
| | - Amelia Ceslis
- School of Psychology, The University of Queensland, Queensland, Australia
| | - Philip Mosley
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Biomedical Informatics Group, Commonwealth Scientific and Industrial Research Organisation, Queensland, Australia
| | - Robert Adam
- University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Gail A Robinson
- Queensland Brain Institute, The University of Queensland, Queensland, Australia
- School of Psychology, The University of Queensland, Queensland, Australia
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Dolphin H, Dyer AH, McHale C, O'Dowd S, Kennelly SP. An Update on Apathy in Alzheimer's Disease. Geriatrics (Basel) 2023; 8:75. [PMID: 37489323 PMCID: PMC10366907 DOI: 10.3390/geriatrics8040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Apathy is a complex multi-dimensional syndrome that affects up to 70% of individuals with Alzheimer's disease (AD). Whilst many frameworks to define apathy in AD exist, most include loss of motivation or goal-directed behaviour as the central feature. Apathy is associated with significant impact on persons living with AD and their caregivers and is also associated with accelerated cognitive decline across the AD spectrum. Neuroimaging studies have highlighted a key role of fronto-striatial circuitry including the anterior cingulate cortex (ACC), orbito-frontal cortex (OFC) and associated subcortical structures. Importantly, the presence and severity of apathy strongly correlates with AD stage and neuropathological biomarkers of amyloid and tau pathology. Following from neurochemistry studies demonstrating a central role of biogenic amine neurotransmission in apathy syndrome in AD, recent clinical trial data suggest that apathy symptoms may improve following treatment with agents such as methylphenidate-which may have an important role alongside emerging non-pharmacological treatment strategies. Here, we review the diagnostic criteria, rating scales, prevalence, and risk factors for apathy in AD. The underlying neurobiology, neuropsychology and associated neuroimaging findings are reviewed in detail. Finally, we discuss current treatment approaches and strategies aimed at targeting apathy syndrome in AD, highlighting areas for future research and clinical trials in patient cohorts.
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Affiliation(s)
- Helena Dolphin
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
| | - Adam H Dyer
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
| | - Cathy McHale
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
| | - Sean O'Dowd
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Neurology, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Academic Unit of Neurology, Trinity College Dublin, D02R590 Dublin, Ireland
| | - Sean P Kennelly
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24NR0A Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08W9RT Dublin, Ireland
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Maggi G, Vitale C, Delle Curti A, Amboni M, Santangelo G. Unawareness of Apathy in Parkinson's Disease: The Role of Executive Dysfunction on Symptom Recognition. Brain Sci 2023; 13:964. [PMID: 37371442 DOI: 10.3390/brainsci13060964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Altered self-awareness or anosognosia may impact patients' everyday life by interfering with their safe and independent functioning. Symptom awareness has been linked to executive dysfunctions caused by damage to frontal regions. Apathy is a frequent neuropsychiatric manifestation of Parkinson's disease (PD) and is considered a consequence of altered functioning of cortico-subcortical circuitries connecting the prefrontal cortex (PFC) with the basal ganglia. Thus, apathetic PD patients may be not be fully aware of their condition due to shared neuropathophysiological mechanisms. The present study aimed to explore the awareness of apathy in PD patients by comparing the self-reported evaluations with their caregivers' ratings. Moreover, we explored the clinical predictors of possible discrepancies and their consequences on patients' self-reported evaluation of quality of life (QoL). We found a fair agreement between patients' self-reports and caregivers' ratings on apathy scores, with patients reporting less severe apathetic symptoms, especially those related to executive and auto-activation processing, compared to their caregivers' reports. Executive functioning was found to mediate the relationship between disease stage and awareness of the apathetic state. Awareness of executive apathy impacted patients' self-reported QoL. Therefore, PD patients might be unaware of their apathetic symptoms, especially those with worse executive functioning, which plays a key role in metacognitive processes such as self-monitoring and error detection. Anosognosia for apathy in PD patients may affect their QoL perception and leads to misleading self-report evaluations that delay diagnosis and treatment.
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Affiliation(s)
- Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
| | - Carmine Vitale
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, 80131 Naples, Italy
- Department of Motor Sciences and Wellness, University "Parthenope", 80133 Naples, Italy
| | - Alessia Delle Curti
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
| | - Marianna Amboni
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, 80131 Naples, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
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Mehak SF, Shivakumar AB, Saraf V, Johansson M, Gangadharan G. Apathy in Alzheimer's disease: A neurocircuitry based perspective. Ageing Res Rev 2023; 87:101891. [PMID: 36871779 DOI: 10.1016/j.arr.2023.101891] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
In addition to memory deficits and other cognitive disturbances, patients with Alzheimer's disease (AD) experience neuropsychiatric symptoms, notably apathy, which is a state of impaired motivation observed by deficits in goal directed behavior. Apathy is a multifaceted neuropsychiatric condition and appears to be a prognostic indicator, correlating with the progression of AD. Strikingly, recent studies point out that the neurodegenerative pathology of AD may drive apathy independent of cognitive decline. These studies also highlight that neuropsychiatric symptoms, in particular apathy, might manifest early in AD. Here, we review the current understanding of the neurobiological underpinnings of apathy as a neuropsychiatric symptom of AD. Specifically, we highlight the neural circuits and brain regions recognized to be correlated with the apathetic symptomatology. We also discuss the current evidence that supports the notion that apathy and cognitive deficits may develop as independent but concurrent phenomena driven by AD pathology, suggesting its efficacy as an additional outcome measure in Alzheimer's disease clinical trials. The current and prospective therapeutic interventions for apathy in AD from a neurocircuitry based perspective are also reviewed.
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Affiliation(s)
- Sonam Fathima Mehak
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Apoorva Bettagere Shivakumar
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Vikyath Saraf
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Maurits Johansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, SUS, Sweden; Division of Clinical Sciences, Helsingborg, Department of Clinical Sciences Lund, Lund University, Sweden; Department of Psychiatry, Helsingborg Hospital, Sweden.
| | - Gireesh Gangadharan
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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De Paepe AE, Garcia-Gorro C, Martinez-Horta S, Perez JP, Kulisevsky J, Rodriguez-Dechicha N, Vaquer I, Subira S, Calopa M, Santacruz P, Muñoz E, Mareca C, Ruiz-Idiago J, de Diego-Balaguer R, Camara E. Delineating apathy profiles in Huntington's disease with the short-Lille Apathy Rating Scale. Parkinsonism Relat Disord 2022; 105:83-89. [PMID: 36395542 DOI: 10.1016/j.parkreldis.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Apathy, a prevalent feature in neurological disorders including Huntington's disease (HD), is characterized by a reduction in goal-directed behavior across cognitive, auto-activation (i.e., self-activating thoughts/behavior), and emotional domains. Nonetheless, current diagnostic criteria are incapable of distinguishing multidimensional apathy profiles. Meanwhile, the short-Lille Apathy Rating Scale (LARS-s) bears potential as an operative diagnostic tool to disentangle apathy dimensions in clinical practice. The present study thereby examines the psychometric properties and factor structure of the LARS-s to tap into apathy profiles and their underlying neural correlates in HD. METHODS Forty HD individuals were scanned and evaluated for apathy using the LARS-s, assessed for reliability and validity in HD, and the short-Problem Behavior Assessment (PBA-s). To study the dimensional structure of apathy, principal component analysis (PCA) of the LARS-s was implemented. Resulting factors were associated with gray matter volume through whole-brain voxel-based morphometry. RESULTS The LARS-s demonstrated satisfactory psychometric properties, sharing convergent validity with PBA-s apathy and discriminant validity against depression. PCA resulted in three factors representative of apathy profiles across cognitive, auto-activation, and emotional domains. Anatomically, global apathy was significantly related with large-scale motor, cognitive, and limbic networks. Exploratory analyses of apathy profiles revealed correspondence between each factor and distinct cortical and subcortical nodes. CONCLUSION The LARS-s is capable of capturing the multidimensional spectrum of apathy. At the same time, apathy profiles in HD are underpinned by functionally diverse neural networks. Such findings promote the continued study of apathy domains to pinpoint personalized therapeutic targets in neurologic disorders in addition to HD.
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Affiliation(s)
- Audrey E De Paepe
- Cognition and Brain Plasticity Unit Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Education Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Clara Garcia-Gorro
- Cognition and Brain Plasticity Unit Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Education Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Saül Martinez-Horta
- European Huntington's Disease Network; Movement Disorders Unit, Dept of Neurology, Biomedical Research Institute Sant Pau IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autonoma de Barcelona (U.A.B.), Medicine Department, Barcelona, Spain
| | - Jesus Perez Perez
- European Huntington's Disease Network; Movement Disorders Unit, Dept of Neurology, Biomedical Research Institute Sant Pau IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autonoma de Barcelona (U.A.B.), Medicine Department, Barcelona, Spain
| | - Jaime Kulisevsky
- European Huntington's Disease Network; Movement Disorders Unit, Dept of Neurology, Biomedical Research Institute Sant Pau IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; CIBERNED Center for Networked Biomedical Research on Neurodegenerative Diseases, Carlos III Institute, Madrid, Spain; Universitat Autonoma de Barcelona (U.A.B.), Medicine Department, Barcelona, Spain
| | | | - Irene Vaquer
- Hestia Duran i Reynals. Hospital Duran i Reynals, Hospitalet de Llobregat Barcelona, Spain
| | - Susana Subira
- Hestia Duran i Reynals. Hospital Duran i Reynals, Hospitalet de Llobregat Barcelona, Spain; Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matilde Calopa
- Movement Disorders Unit, Neurology Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Pilar Santacruz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Esteban Muñoz
- Movement Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain; IDIBAPS Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Facultat de Medicina, University of Barcelona, Barcelona, Spain
| | - Celia Mareca
- Hospital Mare de Deu de la Mercè, Barcelona, Spain
| | - Jesus Ruiz-Idiago
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain; Hospital Mare de Deu de la Mercè, Barcelona, Spain; FIDMAG Research Foundation, Barcelona, Spain
| | - Ruth de Diego-Balaguer
- Cognition and Brain Plasticity Unit Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Education Psychology, Universitat de Barcelona, Barcelona, Spain; Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain; ICREA Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Estela Camara
- Cognition and Brain Plasticity Unit Bellvitge Biomedical Research Institute - IDIBELL, 08097 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Education Psychology, Universitat de Barcelona, Barcelona, Spain.
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Altered reward processing underpins emotional apathy in dementia. COGNITIVE, AFFECTIVE, & BEHAVIORAL NEUROSCIENCE 2022; 23:354-370. [PMID: 36417157 PMCID: PMC10049956 DOI: 10.3758/s13415-022-01048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Introduction
While apathy is broadly defined as a loss of motivation, it is increasingly recognised as a multidimensional syndrome spanning executive, emotional, and initiation domains. Emotional apathy is purportedly driven by deficits in using socioemotional rewards to guide behaviour, yet the link between these symptoms and reward processing, and their common neural correlates, has not been directly examined.
Methods
Sixty-four patients (33 behavioural-variant frontotemporal dementia, 14 Alzheimer’s disease, 8 semantic dementia, 6 progressive nonfluent aphasia, 3 logopenic progressive aphasia) were classified into high (HEA; n = 36) and low (LEA; n = 28) emotional apathy groups based on emotional apathy subscale scores on the Dimensional Apathy Scale. Patients and age-matched healthy controls (n = 27) performed an instrumental reward learning task where they learned to associate cues with either social or monetary outcomes.
Results
HEA patients showed impaired learning on both the social and monetary reward conditions, relative to LEA patients (p = 0.016) and controls (p = 0.005). Conversely, the LEA group did not differ from controls (p = 0.925). Importantly, multiple regression analyses indicated that social reward learning significantly predicted emotional apathy. Voxel-based morphometry analyses revealed that emotional apathy and social reward learning were both associated with orbitofrontal cortex, ventral striatum, and insula atrophy.
Discussion
Our results demonstrate a unique link between impaired social reward learning and emotional apathy in dementia and reveal a shared neurobiological basis. Greater understanding of these neurocognitive mechanisms of reward processing will help improve the identification of emotional apathy in dementia and inform the development of novel interventions to address these symptoms.
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Poletti B, Solca F, Maffi S, Torre S, Carelli L, Aiello EN, Ferrucci R, Priori A, Monti A, Verde F, Ticozzi N, Migliore S, Scaricamazza E, Casella M, Squitieri F, Ciammola A, Silani V. Semiology and determinants of apathy across neurodegenerative motor disorders: A comparison between amyotrophic lateral sclerosis, Parkinson’s and Huntington’s disease. Front Aging Neurosci 2022; 14:1031908. [PMID: 36408105 PMCID: PMC9667083 DOI: 10.3389/fnagi.2022.1031908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background The semiology and determinants of apathy are largely unknown across amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD), and Huntington’s disease (HD), due to both motor and non-motor confounders. This study thus aimed at (1) profiling apathy in ALS, PD, and HD and (2) exploring its clinical determinants. Materials Consecutive ALS (N = 99), PD (N = 73), and HD (N = 25) patients underwent a motor-free assessment of apathy (Dimensional Apathy Scale, DAS), global cognition, anxiety and depression. Function was assessed through disease-specific scales. The DAS was also completed by N = 101 healthy controls (HCs). Between-group comparisons on DAS scores were implemented by covarying for all applicable confounders. Predictive models on DAS scores were built through multiple, stepwise regressions. Results Parkinson’s disease and HD, but not ALS, patients were more apathetic than HCs—with HD patients also selectively showing lower initiation and poorer goal-directed planning than HCs. Higher apathetic features were detected in PD and HD as compared to ALS. Education was a protective factor against apathy in ALS. Anxiety was a risk factor for global apathy in ALS, HD, and to a lesser extent, in PD, whereas, protective only toward affective disintegration in PD and ALS. Cognitive inefficiency was a risk factor toward apathy in both PD and ALS. Depression was a risk factor for executive-related apathy in PD. Discussion This study provides unprecedented insights into the heterogeneous semiology and determinants of apathy across ALS, PD, and HD via the DAS, in turn informing clinical practice and research.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- *Correspondence: Barbara Poletti, ; orcid.org/0000-0003-4398-2051
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Sabrina Maffi
- Huntington and Rare Diseases Unit, CSS-Mendel Institute, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Ph.D Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Roberta Ferrucci
- Department of Health Sciences, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center,” Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center,” Università degli Studi di Milano, Milan, Italy
| | - Simone Migliore
- Huntington and Rare Diseases Unit, CSS-Mendel Institute, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Eugenia Scaricamazza
- Huntington and Rare Diseases Unit, CSS-Mendel Institute, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Melissa Casella
- Italian League for Research on Huntington Foundation, Rome, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, CSS-Mendel Institute, Fondazione IRCCS Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center,” Università degli Studi di Milano, Milan, Italy
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12
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Dickson SS, Husain M. Are there distinct dimensions of apathy? The argument for reappraisal. Cortex 2022; 149:246-256. [PMID: 35181121 PMCID: PMC9021925 DOI: 10.1016/j.cortex.2022.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/17/2021] [Accepted: 01/05/2022] [Indexed: 01/05/2023]
Abstract
Apathy is widely accepted to be a multidimensional syndrome. Assessment scales typically probe one or more dimensions but there is no consensus on the precise nature of these domains. Existing major theoretical frameworks include cognitive, behavioural, and emotional dimensions of apathy. While a social domain has also been suggested, it is far less well studied. Here we argue that although most assessment scales have been developed with these theoretical frameworks in mind, few findings actually support the existence of some of the dimensions that have been proposed, with the evidence for separation of cognitive and behavioural dimensions particularly lacking. In our opinion, although there is evidence for behavioural and emotional domains of apathy, the contention that there might be a separate dimension of cognitive or executive apathy is far less robust. Further, while there is some evidence for a social dimension of apathy, this has not been investigated sufficiently to make any definitive conclusion. We argue that there is a pressing need to reconsider different domains of apathy using robust analyses of proposed theoretical dimensions.
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Affiliation(s)
- Shannon S Dickson
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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13
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Giulia LB, Anne B. The stability of multidimensional subclinical apathy during a pandemic and its relations to psycho-behavioral factors. Sci Rep 2022; 12:2931. [PMID: 35190558 PMCID: PMC8860996 DOI: 10.1038/s41598-022-06777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Abstract
Apathy is a clinical symptom prevalent in many neuropsychiatric pathologies. Subclinical apathy is found in 35% of the general population. Despite high prevalence and negative consequences, underlying mechanisms are poorly understood, perhaps because the concept of apathy is one-dimensional. The current investigation aims to address the incidence of multidimensional apathetic trait in three distinct forms in a student population, to specify its determinants and to evaluate its stability during a global pandemic. Two online surveys, conducted 1 year apart on two separate cohorts of university students, with qualitative measures and validated scales. The final analysis included, respectively, 2789 and 1678 students. The three forms of apathetic trait were present, with the same debilitating consequences as apathetic symptom but independent determinants. Executive apathy was predicted by depressive symptoms, emotional apathy by motivational deficit and initiative apathy comprised a mixed executive-emotional form and a pure deficit of action initiation. The three forms of subclinical apathy remained similar in the context of increased depressive symptoms due to a global pandemic. This study confirmed the presence and independence of three forms of subclinical apathy in healthy students, which remained similar even in the light of increased depressive scores. These results shed light on cognitive and neuronal mechanisms underlying multidimensional apathy, allowing new, targeted treatments.
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14
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Myhre P, Radakovic R, Ford C. Validation of the self-rated Dimensional Apathy Scale in community stroke survivors. J Neurol Sci 2021; 434:120103. [PMID: 34999366 DOI: 10.1016/j.jns.2021.120103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/15/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
Apathy, a disorder of motivation observed in up to 40% of stroke survivors, is negatively associated with stroke rehabilitation outcomes. Different apathy subtypes have been identified in other conditions, but there is currently no validated multidimensional measure of post-stroke apathy (PSAp). The Dimensional Apathy Scale (DAS) assesses apathy across three subtypes: Executive, Emotional and Initiation apathy. We aimed to determine if the DAS is a reliable and valid tool to detect and characterise apathy in stroke. Fifty-three stroke survivors, (45.3% males, median age 54), and 71 people without stroke (26.8% males, median age 45) completed measures of apathy (DAS, Apathy Evaluation Scale, AES), depression (Patient Hospital Questionnaire, PHQ-9) and anxiety (Generalised Anxiety Disorder scale, GAD-7) as part of an online survey. The DAS showed high internal consistency and convergent validity with the current gold standard unidimensional assessment for apathy (AES) and divergent validity with depression (PHQ-9) and anxiety (GAD-7). Stroke survivors scored significantly higher on the total score of the DAS and all subscales, compared with controls. There were however no significant differences on depression and anxiety scores between the two groups. Our results suggest the DAS is a reliable and valid screening tool to detect and characterise PSAp.
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Affiliation(s)
- Pernille Myhre
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Ratko Radakovic
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom; School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom; Norfolk and Norwich University Hospital, Norwich, United Kingdom; The Euan MacDonald Centre for Motor Neurone Disease, University of Edinburgh, Edinburgh, United Kingdom; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Catherine Ford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom.
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15
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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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16
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Barek LM, Mercy G, Gautier C, Noquet M, Legros-Lafarge E, Fiegl L, Fiard D, Allain P. The use of the French Dimensional Apathy Scale (f-DAS) to assess apathy in schizophrenia: Properties and profiles. J Affect Disord 2021; 294:181-188. [PMID: 34298224 DOI: 10.1016/j.jad.2021.06.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Apathy can be defined as a quantitative reduction of self-generated voluntary and purposeful (or goal-directed) behaviour. The literature underlines the triadic dimensional nature of apathy, but in schizophrenia there are inconsistencies due to difficulty in assessment. The Dimensional Apathy Scale (DAS) and its validation into French (f-DAS) provide measurement of three neurobehavioral apathy subtypes: Executive, Emotional and Initiation, but these subtypes have never been explored in schizophrenia. OBJECTIVE The aims of this study are to assess apathy in schizophrenia with a tri-dimensional tool (the f-DAS), to examine its psychometric properties in schizophrenia and the apathetic profiles of patients with schizophrenia. METHODS One hundred and ten subjects were recruited. Forty-five belonged to the patients' group and fifty-five to the control group. They all completed the Mini-International Neuropsychiatric Interview (M.I.N.I), the French National Reading Test (f-NART), the French Dimensional Apathy Scale (f-DAS), the Lille Apathy Rating Scale (LARS) and the Beck Depression Inventory (BDI II). RESULTS Regarding the total score of the f-DAS and the subscores for each dimension, patients appeared significantly more apathetic than healthy controls. Consistency, validity, concurrent and divergent validity were good. In the patient group, several profiles of apathy were identified. CONCLUSIONS The f-DAS has good psychometric properties and provides reliable and valid dimensional assessment of apathy in schizophrenia. From a dimensional point of view, using the f-DAS we demonstrated that prevalence of apathy could be underestimated in schizophrenia. Patients with schizophrenia are more impaired on the Executive and Initiative dimensions of apathy.
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Affiliation(s)
- Lise M' Barek
- Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, Nantes Université, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers Cedex 01; Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France.
| | | | - Caroline Gautier
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Malika Noquet
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Emilie Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), Centre Hospitalier Esquirol, Limoges, France
| | - Lucia Fiegl
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), Centre Hospitalier Esquirol, Limoges, France
| | - Dominique Fiard
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Philippe Allain
- Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, Nantes Université, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers Cedex 01; Département de Neurologie, Centre Hospitalier Universitaire d'Angers, Angers, France
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17
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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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18
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Radakovic R, Colville S, Cranley D, Starr JM, Pal S, Abrahams S. Multidimensional Apathy in Behavioral Variant Frontotemporal Dementia, Primary Progressive Aphasia, and Alzheimer Disease. J Geriatr Psychiatry Neurol 2021; 34:349-356. [PMID: 32410488 PMCID: PMC8326892 DOI: 10.1177/0891988720924716] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Apathy is prevalent in dementia, such as behavioral variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD). As a multidimensional construct, it can be assessed and subsumed under a Dimensional Apathy Framework. A consistent apathy profile in bvFTD and PPA has yet to be established. The aim was to explore apathy profiles and awareness in bvFTD, PPA, and AD. A total of 12 patients with bvFTD, 12 patients with PPA, 28 patients with AD, and 20 matched controls, as well as their informants/carers, were recruited. All participants completed the Dimensional Apathy Scale (DAS), assessing executive, emotional, and initiation apathy subtypes, a 1-dimensional apathy measure, depression measure, and functional and cognitive screens. Apathy subtype awareness was determined through DAS informant/carer and self-rating discrepancy. Apathy profile comparison showed patients with bvFTD had significantly higher emotional apathy than patients with AD (P < .01) and significantly higher apathy over all subtypes than patients with PPA (Ps < .05). Additionally, patients with bvFTD had significantly lower awareness for emotional apathy (P < .01) when compared to patients with AD and PPA. All patient groups had significant global apathy over all subtypes compared to controls. The emergent apathy profile for bvFTD seems to be emotional apathy (indifference or emotional/affective neutrality), with lower self-awareness in this subtype. Further, lower self-awareness for executive apathy (lack of motivation for planning, organization, or attention) differentiates bvFTD from PPA. Future research should investigate the cognitive and neural correlates as well as the practical impact of apathy subtypes.
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Affiliation(s)
- Ratko Radakovic
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom,Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, United Kingdom,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,Ratko Radakovic, University of East Anglia Faculty of Medicine and Health Sciences, Norwich Research Park, Norwich NR4 7TJ, United Kingdom. Emails: ;
| | - Shuna Colville
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom,Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Denise Cranley
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom,Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, United Kingdom
| | - John M. Starr
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,Deceased
| | - Suvankar Pal
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom,Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, United Kingdom,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sharon Abrahams
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom,Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, United Kingdom,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
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19
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Chan NK, Gerretsen P, Chakravarty MM, Blumberger DM, Caravaggio F, Brown E, Graff-Guerrero A. Structural Brain Differences Between Cognitively Impaired Patients With and Without Apathy. Am J Geriatr Psychiatry 2021; 29:319-332. [PMID: 33423870 DOI: 10.1016/j.jagp.2020.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 11/21/2020] [Accepted: 12/06/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Since apathy increases in prevalence with severity of dementia pathology, we sought to distinguish concomitant neurodegenerative processes from brain differences associated with apathy in persons with mild cognitive impairment (MCI) and Alzheimer's Disease (AD). We examined relative structural brain differences between case-control matched cognitively impaired patients with and without apathy. DESIGN Cross-sectional case-control study. SETTING Fifty-eight clinical sites in phase 2 of the AD Neuroimaging Initiative across the United States and Canada. PARTICIPANTS The ≥ 55 years of age with MCI or AD dementia and no major neurological disorders aside from suspected incipient AD dementia. Participants with apathy (n=69) were age-, sex-, apolipoprotein E ε4 allele carrier status-, Mini-Mental State Exam score-, and MCI or AD dementia diagnosis-matched to participants without apathy (n=149). INTERVENTIONS The 3-tesla T1-weighted MRI scan and neurocognitive assessments. Using the Neuropsychiatric Inventory apathy domain scores, participants were dichotomized into a with-apathy group (score ≥ 1) and a without-apathy group (score = 0). MEASUREMENTS Cortical thicknesses from 24 a priori regions of interest involved in frontostriatal circuits and frontotemporal association areas. RESULTS False-discovery rate adjusted within-group comparisons between participants with apathy and participants without apathy showed thinner right medial orbitofrontal (mOFC; meandifference(MD)±standarderrorofMD(SE)=-0.0879±0.0257mm; standardizedMD(d)=-0.4456) and left rostral anterior cingulate (rACC; MD±SE=-0.0905±0.0325mm; d=-0.3574) cortices and thicker left middle temporal cortices (MTC; MD±SE=0.0688±0.0239mm; d=0.3311) in those with apathy. CONCLUSION Atrophy of the right mOFC and left rACC and sparing of atrophy in the left MTC are associated with apathy in cognitively impaired persons.
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Affiliation(s)
- Nathan K Chan
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - M Mallar Chakravarty
- Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | | | - Eric Brown
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada.
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20
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Beyond language impairment: Profiles of apathy in primary progressive aphasia. Cortex 2021; 139:73-85. [PMID: 33836304 DOI: 10.1016/j.cortex.2021.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/28/2020] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
Primary progressive aphasia (PPA) is characterised by predominant language and communication impairment. However, behavioural changes, such as apathy, are increasingly recognised. Apathy is defined as a reduction in motivation and goal-directed behaviour. Recent theoretical models have suggested that apathy can be delineated into multiple dimensions: executive apathy (i.e., deficits in maintaining goals and organisation), emotional apathy (i.e., emotional blunting and indifference) and initiation apathy (i.e., reduced self-initiation). Whether the nature of apathy differs between clinical variants of PPA, and across early and late disease stages, remains to be established. Here, carers/informants of 20 semantic variant PPA (svPPA), 15 non-fluent variant PPA (nfvPPA), 16 logopenic variant PPA (lvPPA) and 25 healthy older controls completed the Dimensional Apathy Scale to quantify executive, emotional and initiation apathy. Voxel-based morphometry was used to identify associations between dimensions of apathy and regions of grey matter intensity decrease. Our behavioural results showed greater executive and initiation apathy in late svPPA than in late nfvPPA patients, while late svPPA had greater emotional apathy than both late nfvPPA and late lvPPA groups. Executive and initiation apathy were significantly higher than premorbid levels in all PPA subtypes, while elevated emotional apathy was only seen in early and late svPPA. Distinct neural correlates were identified across apathy dimensions. Executive apathy correlated with grey matter intensity of the left dorsolateral prefrontal and inferior parietal cortices; emotional apathy with the left medial prefrontal, insular and cerebellar regions; and initiation apathy with right parietal areas. Our findings are the first to reveal evidence of the dimensional nature of apathy in PPA, with different clinical signatures observed for each subtype. From a clinical standpoint, these results will inform the development of targeted interventions for specific aspects of apathy which emerge in PPA.
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21
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Atkins KJ, Andrews SC, Chong TTJ, Stout JC. Multidimensional Apathy: The Utility of the Dimensional Apathy Scale in Huntington's Disease. Mov Disord Clin Pract 2021; 8:361-370. [PMID: 33816664 DOI: 10.1002/mdc3.13147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/09/2022] Open
Abstract
Background Apathy is a disorder of motivation common to Huntington's disease (HD). Recent conceptual frameworks suggest that apathy is not unitary but consists of discrete subtypes ("dimensions"). Which of the proposed dimensions are preferentially affected in HD, and how these dimensions evolve with disease progression is unknown. Objectives The Dimensional Apathy Scale (DAS) separates apathy into Executive, Initiation and Emotional subscales. Using the DAS, we aimed to: 1) Determine the apathy subtypes prevalent in HD; 2) Compare the DAS against a unitary measure of apathy (Apathy Evaluation Scale, AES); 3) Assess the reliability of self- and observer-ratings; and 4) Determine the relationship between the DAS, and disease burden, total functional capacity (TFC) and the AES. Method Fifty pre-manifest, 51 manifest-HD, 87 controls, and 50 HD-observers completed the DAS, AES, and TFC. Results Manifest-HD participants had the highest levels of apathy across all dimensions (30.4% on Executive subscale, 34.8% on Initiation subscale, and 15.2% on Emotional subscale), relative to pre-manifest and control participants. Self- and observer-ratings on the DAS did not differ. Hierarchical regressions across the entire gene-expanded sample showed that scores on the Initiation subscale correlated with AES scores; higher Executive subscale scores were related to higher disease burden; and Emotional subscale scores with lower total functional capacity. Conclusions In this first study of the DAS in HD, manifest-HD participants were more apathetic than pre-manifest and control participants across all apathy subtypes. The DAS may be a useful tool for measuring different aspects of apathy in people with HD.
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Affiliation(s)
- Kelly J Atkins
- School of Psychological Sciences, Turner Institute for Brain and Mental Health Monash University Melbourne Victoria Australia
| | - Sophie C Andrews
- School of Psychological Sciences, Turner Institute for Brain and Mental Health Monash University Melbourne Victoria Australia.,Neuroscience Research Australia Sydney New South Wales Australia.,School of Psychiatry University of New South Wales Sydney New South Wales Australia
| | - Trevor T-J Chong
- School of Psychological Sciences, Turner Institute for Brain and Mental Health Monash University Melbourne Victoria Australia.,Department of Neurology Alfred Health Melbourne Victoria Australia.,Department of Clinical Neurosciences St Vincent's Hospital Melbourne Victoria Australia
| | - Julie C Stout
- School of Psychological Sciences, Turner Institute for Brain and Mental Health Monash University Melbourne Victoria Australia
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Radakovic R, Gray D, Dudley K, Mioshi E, Dick D, Melchiorre G, Gordon H, Newton J, Colville S, Pal S, Chandran S, Abrahams S. Reliability and validity of the brief dimensional apathy scale. Arch Clin Neuropsychol 2020; 35:539-544. [PMID: 32045001 DOI: 10.1093/arclin/acaa002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Apathy is composed of different demotivational subtypes measurable by the dimensional apathy scale (DAS) and can be quickly assessed using the brief DAS (b-DAS). The aim was to determine the reliability and validity of the b-DAS. METHODS 53 amyotrophic lateral sclerosis (ALS) patients and 53 of their informants were recruited. Informants completed the b-DAS, the original informant/carer-rated DAS and behavioral interview about the patients (i.e., presence of behaviors such as apathy/inertia, loss of sympathy/empathy). Patients completed measures of depression, anxiety, emotional lability, cognitive functioning, and functional disability measures. RESULTS The b-DAS showed good internal consistency, excellent test-retest reliability, significant positive correlation with the original DAS, and no significant correlations with depression, anxiety, emotional lability, cognitive functioning or functional disability measures. Semi-structured behavior interview showed patients with apathy/inertia had significantly higher b-DAS subscale scores and patients with loss of sympathy/empathy had significantly higher emotional apathy scores only. CONCLUSIONS The b-DAS is a fast, reliable, and valid instrument for screening apathy subtypes independent of physical disability.
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Affiliation(s)
- Ratko Radakovic
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, Royal Infirmary of Edinburgh, Edinburgh, UK.,Norfolk and Norwich University Hospital, Norwich, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Debbie Gray
- Euan MacDonald Centre for Motor Neurone Disease Research, Royal Infirmary of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Kaitlin Dudley
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.,Norfolk and Norwich University Hospital, Norwich, UK
| | - Eneida Mioshi
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - David Dick
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Giulia Melchiorre
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Harry Gordon
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Judith Newton
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Euan MacDonald Centre for Motor Neurone Disease Research, Royal Infirmary of Edinburgh, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
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23
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Salas T, Radakovic R, Rodriguez-Castillo V, Marín S, Chaverri D, Rodriguez-Santos F. Spanish Adaptation of the Dimensional Apathy Scale (DAS) in Amyotrophic Lateral Sclerosis. Front Neurol 2020; 11:562837. [PMID: 33123076 PMCID: PMC7573163 DOI: 10.3389/fneur.2020.562837] [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: 05/16/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: To adapt, translate, and utilize the Dimensional Apathy Scale (DAS) in Amyotrophic Lateral Sclerosis (ALS) to the Spanish population. Method: We recruited 104 ALS patients (67 of their caregivers) and 49 controls. Participants completed the Spanish-translated DAS, Geriatric Depression Scale- Short form. Patients were also administered the ALS Functional Rating Scale-Revised (ALSFRS-R). Caregivers additionally completed the informant/caregiver-rated Spanish-translated DAS. The DAS was translated to Spanish using a back-translation method. Test-retest and internal consistency reliability were examined. Divergent validity was assessed by comparing the DAS with the depression scale (GDS-15). Principal Component Analysis (PCA) was applied to explore the substructure of the Spanish DAS. Results: The internal consistency reliability of self-rated Spanish DAS was 0.72 and of the informant/caregiver-rated Spanish DAS was 0.84. Correlations between self-rated DAS subscales and GDS-15 were not statistically significant, with a good test-retest reliability. PCA analysis showed a similar substructure to the original DAS. ALS patients had significantly higher Initiation apathy than controls. Additionally, ALS patient informant/caregiver-rated DAS Emotional apathy was significantly higher than the self-rated, with no significant differences observed in the Executive and Initiation subscales. No association was found between DAS and functional impairment using the ALS Functional Rating Scale (ALSFRS-R). Conclusion: The Spanish translation of the DAS is valid and reliable for use in assessing multidimensional apathy in the Spanish population. Availability of the Spanish DAS will allow for future research to explore different apathy subtypes and their impact in ALS and other conditions.
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Affiliation(s)
- Teresa Salas
- Neurology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Ratko Radakovic
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom.,Norfolk and Norwich University Hospital, Norwich, United Kingdom.,The Euan MacDonald Centre for Motor Neurone Disease, University of Edinburgh, Edinburgh, United Kingdom.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Saúl Marín
- Neurology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Delia Chaverri
- Neurology Service, Hospital Universitario La Paz, Madrid, Spain
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24
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A Comparison of the Greek ACE-III, M-ACE, ACE-R, MMSE, and ECAS in the Assessment and Identification of Alzheimer's Disease. J Int Neuropsychol Soc 2020; 26:825-834. [PMID: 32312343 DOI: 10.1017/s1355617720000314] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to adapt the Addenbrooke's Cognitive Examination-III (ACE-III) and Mini-Addenbrooke's Cognitive Examination (M-ACE) into Greek and then to examine the convergent validity against their predecessors Addenbrooke's Cognitive Examination-Revised (ACE-R) and Mini-Mental State Examination (MMSE) in a Greek population. Moreover, a primary aim was to appraise the utility of each screen by conducting a comparison of the psychometric properties of ACE-III, M-ACE, ACE-R, MMSE, and the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS) in detecting Alzheimer's disease (AD). METHODS Forty patients with AD were recruited and matched with 38 controls. Bayesian Pearson's correlation analysis was conducted to examine the convergent validity. Receiver operating characteristic curve analysis was implemented to appraise the sensitivity and specificity of the tests in detecting AD. RESULTS The ACE-III, M-ACE, and the ECAS scores robustly correlated with ACE-R and MMSE. The ACE-III and the ECAS-ALS Non-Specific score were the most sensitive and specific tools in detecting AD, closely followed by ECAS Total score and M-ACE. Only ECAS Total score correlated with the duration of disease. The ECAS scores were more resilient to ceiling effects than the other screens. M-ACE produced fewer ceiling effects than MMSE. CONCLUSION The Greek ACE-III and M-ACE were successfully adapted and showed good convergent validity against their predecessors. They showed very good psychometric properties in detecting AD and may be considered in hectic clinical settings. ECAS Total score and ECAS-ALS Non-Specific showed comparable psychometric properties in the detection of AD and may be considered in polypathological clinics where motor impairments are common.
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25
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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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26
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Maier F, Spottke A, Bach JP, Bartels C, Buerger K, Dodel R, Fellgiebel A, Fliessbach K, Frölich L, Hausner L, Hellmich M, Klöppel S, Klostermann A, Kornhuber J, Laske C, Peters O, Priller J, Richter-Schmidinger T, Schneider A, Shah-Hosseini K, Teipel S, von Arnim CAF, Wiltfang J, Jessen F. Bupropion for the Treatment of Apathy in Alzheimer Disease: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e206027. [PMID: 32463470 PMCID: PMC7256670 DOI: 10.1001/jamanetworkopen.2020.6027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Apathy is a frequent neuropsychiatric symptom in dementia of Alzheimer type and negatively affects the disease course and patients' and caregivers' quality of life. Effective treatment options are needed. OBJECTIVE To examine the efficacy and safety of the dopamine and noradrenaline reuptake inhibitor bupropion in the treatment of apathy in patients with dementia of Alzheimer type. DESIGN, SETTING, AND PARTICIPANTS This 12-week, multicenter, double-blind, placebo-controlled, randomized clinical trial was conducted in a psychiatric and neurological outpatient setting between July 2010 and July 2014 in Germany. Patients with mild-to-moderate dementia of Alzheimer type and clinically relevant apathy were included. Patients with additional clinically relevant depressed mood were excluded. Data analyses were performed between August 2018 and August 2019. INTERVENTIONS Patients received either bupropion or placebo (150 mg for 4 weeks plus 300 mg for 8 weeks). In case of intolerability of 300 mg, patients continued to receive 150 mg throughout the study. MAIN OUTCOMES AND MEASURES Change on the Apathy Evaluation Scale-Clinician Version (AES-C) (score range, 18-72 points) between baseline and week 12 was the primary outcome parameter. Secondary outcome parameters included measures of neuropsychiatric symptoms, cognition, activities of daily living, and quality of life. Outcome measures were assessed at baseline and at 4, 8, and 12 weeks. RESULTS A total of 108 patients (mean [SD] age, 74.8 [5.9] years; 67 men [62%]) were included in the intention-to-treat analysis, with 54 randomized to receive bupropion and 54 randomized to receive placebo. The baseline AES-C score was comparable between the bupropion group and the placebo group (mean [SD], 52.2 [8.7] vs 50.4 [8.2]). After controlling for the baseline AES-C score, site, and comedication with donepezil or galantamine, the mean change in the AES-C score between the bupropion and placebo groups was not statistically significant (mean change, 2.22; 95% CI, -0.47 to 4.91; P = .11). Results on secondary outcomes showed statistically significant differences between bupropion and placebo in terms of total neuropsychiatric symptoms (mean change, 5.52; 95% CI, 2.00 to 9.04; P = .003) and health-related quality of life (uncorrected for multiple comparisons; mean change, -1.66; 95% CI, -3.01 to -0.31; P = .02) with greater improvement in the placebo group. No statistically significant changes between groups were found for activities of daily living (mean change, -2.92; 95% CI, -5.89 to 0.06; P = .05) and cognition (mean change, -0.27; 95% CI, -3.26 to 2.73; P = .86). The numbers of adverse events (bupropion group, 39 patients [72.2%]; placebo group, 33 patients [61.1%]) and serious adverse events (bupropion group, 5 patients [9.3%]; placebo group, 2 patients [3.7%]) were comparable between groups. CONCLUSIONS AND RELEVANCE Although it is safe, bupropion was not superior to placebo for the treatment of apathy in patients with dementia of Alzheimer type in the absence of clinically relevant depressed mood. TRIAL REGISTRATION EU Clinical Trials Register Identifier: 2007-005352-17.
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Affiliation(s)
- Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Jan-Philipp Bach
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Neurodegenerative Diseases, Munich, Germany
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | | | | | - Lutz Frölich
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Arne Klostermann
- German Center for Neurodegenerative Diseases, Berlin, Germany
- Department of Psychiatry, Charité Berlin, Berlin, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases, Tübingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases, Berlin, Germany
- Department of Psychiatry, Charité Berlin, Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases, Berlin, Germany
- Department of Neuropsychiatry, Berlin Institute of Health, Charité Berlin, Berlin, Germany
| | - Tanja Richter-Schmidinger
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, University of Bonn, Bonn, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases, Rostock, Germany
- Department of Psychosomatic Medicine, University Hospital of Rostock, Rostock, Germany
| | | | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
- German Center for Neurodegenerative Diseases, Goettingen, Germany
| | - Frank Jessen
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
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Wei G, Irish M, Hodges JR, Piguet O, Kumfor F. Disease-specific profiles of apathy in Alzheimer's disease and behavioural-variant frontotemporal dementia differ across the disease course. J Neurol 2019; 267:1086-1096. [PMID: 31873787 DOI: 10.1007/s00415-019-09679-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 11/25/2022]
Abstract
Apathy is one of the most prevalent and disabling non-cognitive symptoms of dementia. This loss of motivation and pervasive decline in goal-directed behaviour represents a core diagnostic feature of behavioural-variant frontotemporal dementia (bvFTD) and is also common in Alzheimer's disease (AD). However, despite growing recognition of a multidimensional model, apathy has typically been examined as a unitary symptom. Here, we employed a cross-sectional design to characterise the multidimensional nature of apathy across syndromes and disease course. 92 participants (44 bvFTD, 20 AD, 28 controls) completed the Dimensional Apathy Scale (DAS) to quantify emotional, executive, and initiation apathy. Patients were divided into early and late stages based on time since symptom onset. All participants underwent structural MRI and voxel-based morphometry was used to identify neural correlates of apathy dimensions. In the early stage of the disease (< 5 years since onset), emotional apathy was greater in bvFTD than AD. In contrast, in the late stage (> 5 years since onset), executive apathy was greater in AD than bvFTD, although apathy was elevated across all dimensions compared to controls. Notably, apathy was observed in the absence of self-reported depression in 46.2% of patients, with no patients classified as depressed only. Neuroimaging analyses revealed both common and divergent prefrontal and subcortical neural correlates associated with apathy dimensions. Our results reveal differing profiles of apathy across the disease course, in AD and bvFTD, with distinct brain regions mediating these dimensions. These findings will inform the development of appropriate treatment targets to ameliorate the impact of apathy in dementia.
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Affiliation(s)
- Grace Wei
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Muireann Irish
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Psychology, The University of Sydney, Sydney, Australia
| | - John R Hodges
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Fiona Kumfor
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.
- School of Psychology, The University of Sydney, Sydney, Australia.
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28
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Radakovic R, McGrory S, Chandran S, Swingler R, Pal S, Stephenson L, Colville S, Newton J, Starr JM, Abrahams S. The brief Dimensional Apathy Scale: A short clinical assessment of apathy. Clin Neuropsychol 2019; 34:423-435. [PMID: 31154933 DOI: 10.1080/13854046.2019.1621382] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Apathy is a prominent syndrome across neurodegenerative diseases. The Dimensional Apathy Scale (DAS) assesses three apathy subtypes-executive, emotional, and initiation-and is sensitive and valid in amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), and Parkinson's disease. This study describes the development of the brief DAS (b-DAS), which will enable apathy to be swiftly detected in the clinic.Method: 102 ALS and 102 AD patients' previously collected data were used. Mokken analyses were performed on item-level data of each informant/carer-rated DAS subscale (executive, emotional, and initiation) for the initial scale reduction. Item-total correlational analyses against standard apathy (convergent validity criteria) and depression (divergent validity criteria) measures and qualitative examination of items aided final item selection. Receiver operating curve analysis determined optimal cutoffs for the reduced subscales.Results: Mokken analyses suggested unidimensionality of each DAS subscale. Three items were removed that failed to satisfy monotone homogeneity model requirements, three items were removed due to validity criteria not being met, and six items were removed due to a combination of lower item scalability and item-total correlations. Item-theme examination further reduced the b-DAS to nine items, three per subscale, with a supplemental awareness deficit assessment being added. Sensitivity- and specificity-based optimal cutoffs were calculated for each b-DAS subscale.Conclusions: This study presents the b-DAS, an informant/carer-based robust yet short multidimensional apathy instrument with good convergent and divergent validity, with recommended clinical cutoffs. The b-DAS is appropriate for use in the clinic and for research to quickly and comprehensively screen for apathy subtype impairments.
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Affiliation(s)
- Ratko Radakovic
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah McGrory
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Robert Swingler
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Laura Stephenson
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Judy Newton
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
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29
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Mohammad D, Ellis C, Rau A, Rosenberg PB, Mintzer J, Ruthirakuhan M, Herrmann N, Lanctôt KL. Psychometric Properties of Apathy Scales in Dementia: A Systematic Review. J Alzheimers Dis 2018; 66:1065-1082. [DOI: 10.3233/jad-180485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Dana Mohammad
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Courtney Ellis
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Allison Rau
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacobo Mintzer
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Myuri Ruthirakuhan
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Krista L. Lanctôt
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abstract
Apathy is the most common neuropsychiatric symptom in patients with Alzheimer's disease (AD). The presence of apathy has been related to greater caregiver distress, decreased quality of life, and increased morbidity. Here we review the most recent studies on this neuropsychiatric syndrome, focusing on prevalence, impact on quality of life, behavioural and neuroimaging studies, and treatment options. The results of some investigations on the behavioural and neuroanatomical profile of apathy in AD point to a role of frontostriatal circuits, specifically involving the anterior cingulate cortex. However, small and heterogeneous samples, lack of control for disease severity, and non-specific apathy scales complicate interpretation of results. Future studies might benefit from studying multiple dimensions of apathy within conceptual frameworks which allow for a deconstruction of underlying mechanisms.
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Different aspects of emotional processes in apathy: Application of the French translated dimensional apathy scale. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-017-9775-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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