Cross‐Validation of a Novel Apathy Measurement Model in a Diverse Ambulatory Cohort of Older Adults with Memory Complaints

Abstract

AbstractBackgroundApathy is a psychological syndrome characterized by a loss of motivation, goal‐directed activity, and diminished emotion (Marin, 1990), which may mediate the relationship between depression and cognitive impairment (Funes et al., 2018) and be an early risk factor for dementia that precedes predementia syndromes including non‐amnestic mild cognitive impairment (NA‐MCI) and motoric cognitive risk syndrome (MCR) (Ceïde et al., 2020). While there is no gold standard measure of apathy, assessment tools vary from subscales of depression instruments to apathy specific questionnaires. Our group conducted a confirmatory factor analysis (CFA) of the Geriatric Depression Scale (GDS) in a pooled cohort of community and memory clinic older adults which identified a novel 2‐factor model that distinguishes apathy from depression. The goal of this study was to cross‐validate this novel apathy measurement model in a bilingual urban primary care clinical cohort.MethodWe conducted a CFA in the primary care cohort that was composed of participants from the 5‐Cog Battery for Detecting Cognitive Impairment and Dementia clinical trial. We compared the reliability measures and model fit indices of both the previous 2‐factor model and this novel model. Cohort characteristics were compared as well.ResultThe primary care clinical cohort was significantly different from the community and memory clinic cohorts in all baseline characteristics. The CFA of the primary care cohort yielded depression and apathy factors with good reliability (α = .78 and .63, respectively). Despite the fact that the primary care cohort included Spanish speakers, it performed similarly to the reliability of the depression and apathy factors in the community dwelling and memory clinic pooled cohort (α = .75 and .63, respectively). Both the primary care and memory clinic cohorts had higher depression and apathy scale scores compared to the community dwelling cohort, with the primary care cohort scoring in between the community and memory clinic cohorts in both depression and apathy scale measurements.ConclusionOur 2‐factor measurement model demonstrated similar reliability and fit across 3 distinct cohorts (community dwelling, memory clinic and primary care clinic) and 2 languages (English and Spanish), indicating its appropriateness as an apathy measurement model in further clinical trials.