Assessment Of Apathy Research Articles

Diagnostic Criteria of Apathy (DCA) and Neuropsychiatric Inventory-Clinician Scale (NPI-C) for the Assessment of Apathy in Clinical Practice: A Comparison Study

Diagnostic Criteria of Apathy (DCA) and Neuropsychiatric Inventory-Clinician Scale (NPI-C) for the Assessment of Apathy in Clinical Practice: A Comparison Study

Assessment of depression, anxiety and apathy in prodromal and early huntington disease.

The Functional Rating Scale Taskforce for pre-Huntington Disease (FuRST-pHD) is a multinational, multidisciplinary initiative with the goal of developing a data-driven, comprehensive, psychometrically sound, rating scale for assessing symptoms and functional ability in prodromal and early Huntington disease (HD) gene expansion carriers. The process involves input from numerous sources to identify relevant symptom domains, including HD individuals, caregivers, and experts from a variety of fields, as well as knowledge gained from the analysis of data from ongoing large-scale studies in HD using existing clinical scales. This is an iterative process in which an ongoing series of field tests in prodromal (prHD) and early HD individuals provides the team with data on which to make decisions regarding which questions should undergo further development or testing and which should be excluded. We report here the development and assessment of the first iteration of interview questions aimed to assess Depression, Anxiety and Apathy in prHD and early HD individuals.

Apathy assessment using 7-days ambulatory actigraphy in Alzheimer's disease

Apathy assessment using 7-days ambulatory actigraphy in Alzheimer's disease

Early detection of patients at risk for anxiety, depression and apathy after stroke

Background and purpose The aim of this study was to identify clinical factors in the acute stage that can predict anxiety, depression and apathy at 4 months after stroke. Methods One hundred four consecutive stroke patients in a stroke unit were assessed within the first 2 weeks and after 4 months. Assessments included anxiety and depression symptoms on the Hospital Anxiety and Depression Scale (HADS) [HADS Anxiety subscale (HADS-A) ≥8 and HADS Depression subscale (HADS-D) ≥8], physical impairment, functional disability, somatic comorbidity upon admission, assessment of apathy (score ≥34 on the Apathy Evaluation Scale) and a psychiatric Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of anxiety disorder (anxiety) or depression (depression) on follow-up. Logistic regression analysis was used to identify factors associated with anxiety, depression and apathy. Results Anxiety and depression at 4 months were significantly associated with HADS-A scores of ≥8 upon admission [odds ratio (OR)=4.4; 95% confidence interval (95% CI)=1.7–11.9; P=.003 and OR=2.9; 95% CI=1.0–7.9; P=.043, respectively]. Apathy at 4 months was significantly associated with somatic comorbidity upon admission (OR=3.0; 95% CI=1.0–8.3; P=.036) and had a borderline association with HADS-D scores of ≥8 (OR=8.4; 95% CI=1.0–72.0; P=.051) upon admission. Conclusion Assessment with HADS within the first 2 weeks of stroke can contribute to the detection of patients at risk for clinically significant anxiety, depression and apathy at 4 months after stroke.

Apathy and Functioning in First-Episode Psychosis

Apathy and Functioning in First-Episode Psychosis

Motor Function and Human Immunodeficiency Virus–Associated Cognitive Impairment in a Highly Active Antiretroviral Therapy–Era Cohort

Cognitive impairment has long been recognized as a manifestation of human immunodeficiency virus (HIV) infection. However, highly active antiretroviral therapy (HAART) has altered the neurologic manifestations of HIV. To develop a measure to quantify the motor abnormalities included in the original descriptions of HIV-associated dementia (HAD); to determine whether motor, affective, and behavioral dysfunction predict cognitive impairment; and to determine whether quantitative motor testing is a helpful adjunct in the diagnosis of HAD in a complex population from the HAART era. Neurologic and neuropsychological data were collected from the Manhattan HIV Brain Bank, a longitudinal cohort study of patients with advanced HIV. The HIV-Dementia Motor Scale (HDMS) was developed and validated and cognitive and affective or behavioral function was quantified using global neuropsychological T scores, the Beck Depression Inventory (BDI), and an independent assessment of apathy. Relationships among cognitive, motor, affective, and behavioral performance were examined using correlation, linear regression, and analyses of variance. An urban AIDS research center. A total of 260 HIV-positive, predominantly minority patients. The HDMS scores and global neuropsychological T scores. The HDMS and BDI scores were independent predictors of cognitive impairment. Significant cognitive impairment was found in patients with motor dysfunction. Patients diagnosed as having HAD had a greater degree of motor impairment than those with other neurocognitive diagnoses. Motor, affective, and behavioral abnormalities predict cognitive impairment in HIV-positive patients in this HAART-era cohort. The HDMS may be useful in the assignment of HIV-associated neurocognitive impairment in HIV populations in which normative data or neuropsychological test design is not optimal.

The Lille Apathy Rating Scale: Validation of a caregiver‐based version

Apathy is reported in 16.5% to 70% of Parkinson's disease (PD) patients. Our recently developed Lille Apathy Rating Scale (LARS) has been specifically validated for patient-based assessment of apathy in PD. The aim of the present study was to validate a caregiver-based version of the LARS. Sixty consecutive PD patients and their respective caregivers participated in the study. An informant-based version of the LARS (LARS-i) was developed to rate apathy via a caregiver-based structured interview. Apathy was also assessed in a patient-based interview using the LARS and the informant- and clinician-rated versions of the Apathy Evaluation Scale (AES). Cronbach's alpha and standardized alpha coefficients were 0.872 and 0.877, respectively, and the split-half reliability was 0.901 (revealing good internal consistency). The test-retest and inter-rater reliability values were 0.960 and 0.996, respectively. Criterion-related validity (according to an independent, expert diagnosis) was good. Scores on the LARS and the LARS-i were highly correlated. However, apathy was rated significantly more severely by the caregiver than by the patient. This difference was significantly higher for demented than nondemented PD patients. The LARS-i was seen to have excellent psychometric properties and appears to be valid for use in PD with respect to the patient-based LARS and the informant- and clinician-rated versions of the AES.

Digest

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Selective serotonin reuptake inhibitor use associates with apathy among depressed elderly: a case-control study

BackgroundIt has been reported for over the past decade that the use of selective serotonin reuptake inhibitors (SSRI's) may associate with the emergence of apathy. The authors hypothesized that depressed patients treated with SSRI's would show more signs of apathy than patients treated with non-SSRI antidepressants. This case control study was conducted to investigate the possibility of the association between SSRI use and the occurrence of apathy.MethodsBaycrest Centre for Geriatric Care's Day Hospital Database of elderly depressed patients who received antidepressants was divided into 2 groups depending on antidepressant use at discharge: SSRI user group-SUG, and non-SSRI user group-NSUG. Apathy scales developed by the authors were selected from the Geriatric depression Scale (GDS) and the Hamilton Rating Scale for Depression (HAMD), and were titled as GDS-apathy subscale (GAS) and HAMD-apathy subscale (HAS). Demographic data, baseline apathy, underlying medical conditions and medication use were studied. Proportion, analysis of variances, Chi-square test, odds ratio with 95% confidence interval were reported.ResultsAmong 384 patients (160 SUG and 224 NSUG), mean GDS and HAM-D at discharge were 12.46 and 10.61 in SUG, and were 11.37 and 9.30 in NSUG, respectively. Using GAS for apathy assessment, 83.7% of patients in SUG and 73.4% in NSUG stayed apathetic at discharge. As evaluated by HAS, 44.2% of patients in SUG and 36.5% in NSUG stayed apathetic. SSRI use was not a predictor of apathy at admission, while it was at discharge, p = 0.029. The SUG showed more patients with apathy than that found in NSUG (adjusted OR = 1.90 (1.14–3.17). Age 70–75 years tended to be a predictor for the apathy (p = 0.058). Using HAS, age 70–75 years and living situation were associated with apathy at discharge, p = 0.032 and 0.038 respectively.ConclusionEven though depression was improved in elderly patients receiving antidepressants, apathy appeared to be greater in patients who were treated with SSRI than that found in patients who were not. Frontal lobe dysfunction due to alteration of serotonin is considered to be one of the possibilities.

Treatment of Apathy With Methylphenidate

Treatment of Apathy With Methylphenidate

Apathy in Dementia: An Examination of the Psychometric Properties of the Apathy Evaluation Scale

Apathy in Dementia: An Examination of the Psychometric Properties of the Apathy Evaluation Scale

Pathological gambling in Parkinson's disease improves on chronic subthalamic nucleus stimulation

Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 +/- 9 years; levodopa equivalent dose, 1,390 +/- 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0-48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, off period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS-associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment.

A Comparison of Self-Report and Caregiver Assessment of Depression, Apathy, and Irritability in Huntington's Disease

The natural history of psychiatric syndromes associated with Huntington’s disease (HD) remains unclear, and longitudinal studies of symptoms such as depression, apathy, and irritability are required to better understand the progression and role of these syndromes and their effect on disability. Self-administered scales such as the Beck Depression Inventory (BDI) may be useful to document changes in symptoms over time, but the validity of self-report may be questionable with the inevitable progression of cognitive deficits. An alternative to the patient’s self-report would be assessments by the caregiver. The authors assessed interrater agreement between patient self-assessment and caregiver assessment of patients status for the presence of depressed mood using the BDI and apathy and irritability using an apathy and irritability scale. Agreement between these scales across strata of cognitive status was also examined. Interrater agreement varied from moderate to good for the BDI, depending on patient cognitive status. Agreement for the apathy scores was low for patients with poor cognition and fair in patients with better cognition. Irritability scale agreement was fair at best and was the worst in patients with the most intact cognition. Caregiver assessment of patients’ moods and apathy may be an acceptable alternative to patient self-report as patients’ cognitive status worsens.

A Comparison of Self-Report and Caregiver Assessment of Depression, Apathy, and Irritability in Huntington’s Disease

The natural history of psychiatric syndromes associated with Huntington's disease (HD) remains unclear, and longitudinal studies of symptoms such as depression, apathy, and irritability are required to better understand the progression and role of these syndromes and their effect on disability. Self-administered scales such as the Beck Depression Inventory (BDI) may be useful to document changes in symptoms over time, but the validity of self-report may be questionable with the inevitable progression of cognitive deficits. An alternative to the patient's self-report would be assessments by the caregiver. The authors assessed interrater agreement between patient self-assessment and caregiver assessment of patients status for the presence of depressed mood using the BDI and apathy and irritability using an apathy and irritability scale. Agreement between these scales across strata of cognitive status was also examined. Interrater agreement varied from moderate to good for the BDI, depending on patient cognitive status. Agreement for the apathy scores was low for patients with poor cognition and fair in patients with better cognition. Irritability scale agreement was fair at best and was the worst in patients with the most intact cognition. Caregiver assessment of patients' moods and apathy may be an acceptable alternative to patient self-report as patients' cognitive status worsens.

The apathy inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment.

This study was designed to establish the validity and reliability of the apathy inventory (IA), a rating scale for global assessment of apathy and separate assessment of emotional blunting, lack of initiative, and lack of interest. Information for the IA can be obtained from the patient or from a caregiver. We evaluated 115 subjects using the IA, consisting of 19 healthy elderly subjects, 24 patients with Mild Cognitive Impairment (MCI), 12 subjects with Parkinson's disease (PD) and 60 subjects with Alzheimer's disease (AD). Internal consistency, item reliability, and between-rater reliability were high. A test-retest reliability study demonstrated that caregiver responses to IA questions were stable over short intervals. A concurrent validity study showed that the IA assesses apathy as effectively as the Neuro Psychiatric Inventory apathy domain. In the caregiver-based evaluation, AD subjects had significantly higher scores than controls, both for global apathy score and for the lack of interest dimension. When the AD patients were subdivided according to diagnostic criteria for apathy, apathetic patients had significantly higher scores than non apathetic patients. With the patient-based evaluations, no differences were found among the AD, MCI and control groups. The scores in the patient-based evaluations were only higher for the PD group versus the control subjects. The results also indicated that AD patients had poor awareness of their emotional blunting and lack of initiative. The IA is a reliable method for assessing in demented and non-demented elderly subjects several dimensions of the apathetic syndrome, and also the subject's awareness of these symptoms.

Apathy in Alzheimer's disease.

Apathy, or loss of motivation, is arguably the most common change in behavior in Alzheimer's disease (AD) but is underrecognized. Apathy represents a form of executive cognitive dysfunction. Patients with apathy suffer from decreased daily function and specific cognitive deficits and rely on families to provide more care, which results in increased stress for families. Apathy is one of the primary syndromes associated with frontal and subcortical pathology, and apathy in AD appears to have multiple neuroanatomical correlates that implicate components of frontal subcortical networks. Despite the profound effects of this common syndrome, only a few instruments have been designed to specifically assess apathy, and these instruments have not been directly compared. Assessment of apathy in AD requires clinicians to distinguish loss of motivation from loss of ability due to cognitive decline. Although apathy may be misdiagnosed as depression because of an overlap in symptoms, current research has shown apathy to be a discrete syndrome. Distinguishing apathy from depression has important treatment implications, because these disorders respond to different interventions. Further research is required to clarify the specific neuroanatomical and neuropsychological correlates of apathy and to determine how correct diagnosis and treatment of apathy may improve patient functioning and ease caregiver burden.

Apathy in Neuropsychiatric Disorders

AbstractApathy is a common neurobehavioral feature in a variety of neuropsychiatric disorders. Apathy is often interpreted as a sign of depression or as a nonspecific symptom of other medical conditions. However, recent research indicates that the essential meaning of apathy is lack of motivation. This article presents a framework for the classification and differential diagnosis of apathy and addresses issues related to the assessment and treatment of apathy in neuropsychiatric patients.

Apathy: Concept, Syndrome, Neural Mechanisms, and Treatment.

The essential meaning of apathy is lack of motivation. Criteria for diagnosing the syndrome of apathy and for distinguishing symptomatic and syndromal apathetic states are based on this definition, whereas assessment of apathy as a continuous variable is operationalized in the Apathy Evaluation Scale, which provides reliable and valid measures of diminished motivation in diverse clinical populations. The clinical utility of this formulation is shown by describing the causes, differential diagnosis, and treatment of apathy. The neural mechanisms of apathy are postulated to involve the brainstem and forebrain circuits that mediate goal-directed behavior. The functions of these circuits provide a model for understanding a provisional classification of apathy syndromes into cognitive, sensory, motor, and affective subtypes. This classification and its postulated neural basis has heuristic value for increasing our understanding of the disorders in which apathy is prominent.

Clinical assessment of mental decline in elderly people: a proposal for a new quantitative index.

Despite the many instruments available for assessing elderly people, there is a need for additional methods to measure mental decline that would also be applicable in cross sectional and longitudinal studies. With this purpose in mind, our group developed and checked a new instrument, the Index of Mental Decline (IMD), which consists of five clusters of items intended for the assessment of cognition, personal interrelationships, affective disorders, apathy and somatic complaints. To improve its consistency, all clusters and items were evaluated individually, according to their clinical impact. Three levels of symptom importance were determined: absent to very mild, mild to moderate, severe to very severe. Inter-rater reliability and test-retest reliability were demonstrated in a sample of 59 subjects, and proved to be satisfactory. The validity of the IMD was tested in a group of 203 patients, in whom a clinical diagnosis of probable dementia (DSM III-R criteria) had been formulated. The results suggest the effectiveness of the IMD both in quantifying mental decline and monitoring clinical symptoms. The IMD cannot be the first step of diagnostic procedure, but it can be useful for evaluating mental decline in elderly subjects with cognitive disorders. In longitudinal studies, the presence of the same caregiver or informant is compulsory.

Apathy: a neuropsychiatric syndrome

Traditionally, apathy has been viewed as a symptom indicating loss of interest or emotions. This paper evaluates evidence that neuropsychiatric disorders also produce a syndrome of apathy. Both the symptom and the syndrome of apathy are of conceptual interest because they signify loss of motivation. An apathy syndrome is defined as a syndrome of primary motivational loss, that is, loss of motivation not attributable to emotional distress, intellectual impairment, or diminished level of consciousness. Loss of motivation due to disturbance of intellect, emotion, or level of consciousness defines the symptom of apathy. Neuropsychiatric literature dealing with apathy is reviewed within the framework of three approaches to defining the concept of a syndrome. Clinical and investigative approaches for evaluating apathy when it occurs in association with other syndromes are described.