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.
Highlights
Many studies show that apathy is the most common and relevant behavioral symptom in patients with Amyotrophic Lateral Sclerosis (ALS) [1], and it’s estimated to be present in 31–56% of patients [2,3,4,5]
This symptom is measured using tests that do not take into consideration the physical impairment of patients, such as the Frontal Systems Behavior Scale (FrSBe) [7], or it is assessed globally as part of other behavioral and psychiatric disorders as is the case of the Cambridge Behavioral Inventory revised (CBIR) [8], the ALS Frontotemporal Dementia Questionnaire (ALSFTD-Q) [9], or, lastly, the Motor Neuron Disease Behavioral Instrument (MiND-B) [10]
ALS patients were significantly older than controls
Summary
Many studies show that apathy is the most common and relevant behavioral symptom in patients with Amyotrophic Lateral Sclerosis (ALS) [1], and it’s estimated to be present in 31–56% of patients [2,3,4,5]. Apathy has been linked to cognitive impairment, as well as to worse prognosis in ALS patients [6]. This symptom is measured using tests that do not take into consideration the physical impairment of patients, such as the Frontal Systems Behavior Scale (FrSBe) [7], or it is assessed globally as part of other behavioral and psychiatric disorders as is the case of the Cambridge Behavioral Inventory revised (CBIR) [8], the ALS Frontotemporal Dementia Questionnaire (ALSFTD-Q) [9], or, lastly, the Motor Neuron Disease Behavioral Instrument (MiND-B) [10]. The Dimensional Apathy Scale (DAS) [13] was developed to measure different subtypes of apathy, accounting for physical disability. Far the DAS has been validated in Italian, French, and Japanese [19,20,21], with no Spanish translation available
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