Apathy-Related Symptoms Appear Early in Parkinson's Disease.

Liang Ni,Madeleine E. Hackney,Allison A. Bay,Emmie Cohen

doi:10.3390/healthcare10010091

Abstract

Background: Apathy, often-unrecognized in Parkinson’s Disease (PD), adversely impacts quality-of-life (QOL) and may increase with disease severity. Identifying apathy early can aid treatment and enhance prognoses. Whether feelings related to apathy (e.g., loss of pleasure) are present in mild PD and how apathy and related feelings increase with disease severity is unknown. Methods: 120 individuals (M age: 69.0 ± 8.2 y) with mild (stages 1–2, n = 71) and moderate (stages 2.5–4; n = 49) PD were assessed for apathy and apathy-related constructs including loss of pleasure, energy, interest in people or activities, and sex. Correlations were used to determine the association of apathy with apathy-related constructs. Regression models, adjusted for age, cognitive status, and transportation, compared groups for prevalence of apathy and apathy-related feelings. Results: Apathy-related constructs and apathy were significantly correlated. Apathy was present in one in five participants with mild PD and doubled in participants with moderate PD. Except for loss of energy, apathy-related constructs were observed in mild PD at a prevalence of 41% or greater. Strong associations were noted between all apathy-related constructs and greater disease severity. After adjustment for transportation status serving as a proxy for independence, stage of disease remained significant only for loss of pleasure and loss of energy. Conclusion: People with mild PD showed signs of apathy and apathy-related feelings. Loss of pleasure and energy are apathy-related feelings impacted by disease severity. Clinicians should consider evaluating for feelings related to apathy to enhance early diagnosis in individuals who might otherwise not exhibit psychopathology.

Highlights

Parkinson’s Disease (PD), the second most common neurodegenerative disease in the United States, involves dopamine depletion in the substantia nigra and ventral tegmental areas [1]
The moderate Hoehn and Yahr Scale (HY) group was older, and more at risk for loss of function, had PD longer, had higher Beck Depression Inventory-II (BDI-II) scores, had lower Montreal Cognitive Assessment (MoCA) scores, were slightly more likely to live in senior living, were less likely to transport themselves, left their house less frequently, took more prescribed medications and were more likely to use an assistive device than the mild group
Independence levels, age, and cognitive status may account for apathy more than the disease stage itself

Summary

Introduction

Parkinson’s Disease (PD), the second most common neurodegenerative disease in the United States, involves dopamine depletion in the substantia nigra and ventral tegmental areas [1]. Whether feelings related to apathy (e.g., loss of pleasure) are present in mild PD and how apathy and related feelings increase with disease severity is unknown. Methods: 120 individuals (M age: 69.0 ± 8.2 y) with mild (stages 1–2, n = 71) and moderate (stages 2.5–4; n = 49) PD were assessed for apathy and apathy-related constructs including loss of pleasure, energy, interest in people or activities, and sex. Except for loss of energy, apathy-related constructs were observed in mild PD at a prevalence of 41% or greater. Strong associations were noted between all apathy-related constructs and greater disease severity. Loss of pleasure and energy are apathy-related feelings impacted by disease severity. Clinicians should consider evaluating for feelings related to apathy to enhance early diagnosis in individuals who might otherwise not exhibit psychopathology

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