The detrimental effects of apathy on cognition, frailty and quality of life

Abstract

AbstractBackgroundApathy is defined as the lack of motivation and has been found to be associated with incident dementia in western populations (Dalen, 2018). Little is known about the impact of apathy in Asians. Apathy is a prevalent behavioural symptom of pre dementia and current literature shows that apathy increases the risk of dementia (Bock, 2020). Apathy is also linked to an increased risk of frailty(Ayers, 2018) and found to impair executive function and processing speed(Lohner, 2017). We aim to evaluate the association of apathy with cognitive function, frailty and lifestyle factors in a pre‐dementia community population in Singapore.MethodWe recruited 534 participants from the community who completed a detailed neuropsychological assessment. Apathy was measured using the mild behavioural impairment checklist (MBI‐C). To test for the association of apathy with the different variables, we performed a multiple generalized linear model controlling for covariates age, sex and education.ResultThe study population included 186 participants with subjective cognitive decline and 348 mild cognitive impairment participants from Dementia Research Centre (Singapore). Mean age of the cohort was 62.55, SD = 9.55, mean education years was 13.97, SD = 3.45 and majority were women (57.1%). The prevalence of apathy among our cohort was 23.5%. Compared to participants without apathy, those with apathy had poorer cognitive scores in processing speed (test of coding) (β = ‐4.60, p<0.001), executive function (colour trails 2) (β = 9.71, p = 0.020), episodic memory on the RAVLT Delayed (β = ‐0.738, p = 0.026), RCFT Delayed (β = ‐1.941, p = 0.009) and FCSRT delayed (β = ‐0.616, p = 0.030). Participants with apathy were also more frail (β = 0.316, p<0.001) on the Fried Phenotype frailty assessment test and had poorer quality of life (β = ‐12.49, p<0.001), had lower levels of physical activity (β = 0.163, p = 0.017), and had poorer sleep (β = 2.25, p<0.001).ConclusionApathy is associated with worse cognitive performance, higher frailty, lower physical performance and poorer sleep in an Asian pre‐dementia community cohort. Screening for apathy and appropriate early intervention could reduce incidence of dementia and frailty.