Apathy Scores Research Articles

An investigation into the effects and prognostic factors of cognitive decline following subthalamic nucleus stimulation in patients with Parkinson’s disease

We retrospectively investigated the effects of subthalamic nucleus stimulation (STN-DBS) on new postoperative onset of cognitive decline and prognostic factors for advanced Parkinson’s disease (PD). We studied 39 PD patients who had received bilateral STN-DBS. Clinical symptoms, cognitive function, psychiatric function, and health-related quality of life (HRQOL) were assessed before and six months after surgery. Based on the results of neuropsychological examinations six months after the surgery, the subjects were divided into those with and those without cognitive decline. We compared pre- and post-operative assessments between the two groups. Prognostic factors were investigated using multiple logistic regression analyses. Seven patients had cognitive decline six months after the operation (17.9%); they were significantly older than those without cognitive decline. Preoperative neuropsychological examinations revealed impairments in language and executive function. No differences were found in clinical symptoms. Patients with cognitive decline had significantly worse apathy scale scores. The HRQOL revealed significant declines in the Mental Component Summary (MCS), vitality, and mental health (MH) domains. Postoperative comparisons revealed novel significant differences in activities of daily living in the “on” and “off” states and in daytime drowsiness. Preoperative differences seen in the MCS and vitality indices were no longer present. Word fluency, and apathy scale and MH scores were independent preoperative prognostic factors for cognitive decline. New postoperative onset of cognitive decline due to STN-DBS affected activities of daily living and psychiatric function. Preoperative non-motor symptoms may be prognostic factors for new onset of cognitive decline.

Apathy Mediates Cognitive Difficulties in Geriatric Depression

Cognitive impairment associated with late-life depression can persist after remission of mood symptoms. Apathy, a common symptom of late-life depression, often leads to worse clinical outcomes. We examined if severity of apathy mediates cognitive difficulties in a cohort of older adults with major depression. One hundred thirty-eight older adults with depression (54.4% female; mean [SD] age: 69.7 [7.4] years; mean [SD] education:15.6 [2.7] years) were recruited to participate in a treatment study, and only baseline data were analyzed. All participants received a comprehensive evaluation of depression, apathy, and cognition. We examined whether apathy mediated the relationship between depression and cognition, focusing our attention on memory and cognitive control. We then explored whether the mediation effects differed across women and men. Increased apathy was significantly associated with worse depression and lower performance in the cognitive control domain but not in memory. Higher depressive scores were significantly associated with worse cognitive control but not memory. Mediation analyses revealed a significant indirect effect on cognitive control by depression through increased apathy scores with the mediator accounting for 21% of the total effect. Stratifying by sex, we found that women exhibited a significant indirect effect, with the mediator accounting for 47% of the total effect, whereas there was no mediation by apathy in men. The findings imply that increased apathy mediates the relationship between cognition and depression. The identification of mediating effects may inform future treatment strategies and preventive interventions that can focus on decreasing apathy to improve cognition in late-life depression.

Lithium and It’s Association with Physical Disorders: Focus on theKidney

The aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic (“primary”) dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits.Thirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory).Almost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifférence sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences.Our data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.

Is psychotherapy for functional somatic syndromes harmful to patients? A mixed method study on negative effects

The aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic (“primary”) dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits.Thirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory).Almost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifférence sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences.Our data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.

Characterizing end-of-life decision-making in Japanese female nurses by marital status

The aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic (“primary”) dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits.Thirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory).Almost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifférence sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences.Our data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.

High- and low-dose Acceptance and Commitment group Therapy (ACT-G) versus enhanced care for patients with severe functional somatic syndromes (STreSS-4): Preliminary results from a randomizedcontrolled trial

The aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic (“primary”) dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits.Thirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory).Almost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifférence sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences.Our data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.

Predictors of pain perception and quality of life in a 1-year follow-up of patients with Chronic pelvic pain syndrome (CPPS)

The aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic (“primary”) dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits.Thirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory).Almost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifférence sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences.Our data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.

Is there a specific psychiatric background or personality profile in functional dystonia?

ObjectiveThe aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic (“primary”) dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits. MethodsThirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory). ResultsAlmost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifférence sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences. ConclusionOur data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.

Apathy is related to reduced activation in cognitive control regions during set-shifting.

Apathy is a prominent and influential symptom in several neurological and psychiatric disorders, but it also occurs in the healthy population. It has considerable impact on daily life functioning, in clinical as well as healthy samples. Even though cognitive control is thought to be disrupted in people with apathy, the exact neural underpinnings of apathy remain unclear. Because flexible shifting between behaviors (set-shifting) is crucial for goal-directed behavior, disruptions in set-shifting may underlie apathy. In this study, the neural correlates of apathy during set-shifting were studied in 34 healthy participants with varying levels of apathy, measured by the Apathy Evaluation Scale. During functional MRI scanning participants performed a set-shifting task, distinguishing between behavioral switches (a change in response to different stimuli), cognitive switches (a change in response rule), and salience decoupling (detecting a change in relevant stimuli). Regression analysis was used to assess the relationship between apathy and brain activation. Results showed that higher apathy scores were related to reduced activation in the medial superior frontal gyrus and cerebellum (Crus I/II) during cognitive set-shifting, but not behavioral shifting and salience decoupling. No relationship between apathy and accuracy or response time was found. These results support the idea that alterations in the neural basis of cognitive control, especially cognitive set-shifting, may contribute to apathy. Hum Brain Mapp 38:2722-2733, 2017. © 2017 Wiley Periodicals, Inc.

117.3 Imaging Microglial Activation in Clinical High Risk for Psychosis and Untreated First-Episode Psychosis: A PET StudyW [18F]FEPPA

Abstract Background: A role of the immune system in the pathogenesis of schizophrenia is supported by convergence of evidence from genetic, epidemiology, and preclinical studies. Previous positron emission tomography (PET) studies using radioligands that target the translocator protein 18kDa (TSPO) in patients with schizophrenia in vivo were limited by radioligand used, resolution of scanners used, and the confounding effect of antipsychotic medications. There is a dearth of evidence on the state of early stages of the illness such as the first-episode psychosis (FEP) and clinical high risk for psychosis (CHR). Methods: Using a second-generation TSPO radioligand, [18F]FEPPA, and a high-resolution research tomograph (HRRT), we examined microglial activation in dorsolateral prefrontal cortex (DLPFC) and hippocampus of CHR and FEP. Dynamic PET data were analyzed using a 2-tissue compartment model with an arterial plasma input function to obtain [18F]FEPPA total volume of distribution (VT), as previously validated. Based on their rs6971 polymorphism, subjects were classified as high-, medium- or low-affinity [18F]FEPPA binders, and all the analyses were controlled for genotype. Results: 24 (mean age = 21.21, SD = 3.35) CHR and 19 patients with untreated FEP (mean age = 27.53, SD = 6.78), and 20 healthy volunteers (mean age =27.75, SD = 8.77) underwent PET and magnetic resonance imaging. No significant differences in [18F]FEPPA VT in DLPFC and hippocampus were found between different diagnostic groups. Explorative association analyses found a trend toward significant association between RBANS total score and [18F]FEPPA VT in hippocampus of FEP (r = .50, P = .04). In CHR, apathy score was associated with [18F]FEPPA VT in DLPFC (r = .604, P = .003) and hippocampus (r = .574, P = .005). Moreover, [18F]FEPPA VT in DLPFC was associated with state anxiety score (r = .56, P = .007). Conclusion: This is the largest study examined microglial activation in the early stages of psychosis using a standard methodology without the confound of antipsychotic medications. Our findings suggest that microglial activation is not present in early stages of psychosis (i.e., CHR and FEP).

Association between dopaminergic dysfunction and anxiety in de novo Parkinson's disease

ObjectivesTo explore the relationships between nigrostriatal dysfunction and neuropsychiatric symptoms (including anxiety, depression and apathy) in a large cohort of newly diagnosed, drug-naïve Parkinson disease (PD) patients compared to a cohort of healthy controls (HC). MethodsThis is a cross-sectional analysis of the Parkinson's Progression Markers Initiative (PPMI) cohort at baseline, including 405 PD patients and 187 HC. Nigrostriatal degeneration was evaluated by means of SPECT DAT scan. Relationships between neuropsychiatric symptoms and DAT uptakes were analysed by means of stepwise multiple regression analysis. ResultsIn the PD group, lower DAT uptake in the right caudate was associated with higher STAI trait subscore (β = −2.939, 95%CI: −4.634 to −1.254, p = 0.001). Depression and apathy scores were not related with DAT uptakes. No associations were found in the HC group. ConclusionsOur cross-sectional analysis of the PPMI data shows that lower caudate DAT uptake is associated with higher level of anxiety. The data strengthens the relationship between dopaminergic dysfunction and neuropsychiatric symptoms in early PD.

Repetitive transcranial magnetic stimulation combined with cognitive training for the treatment of Alzheimer's disease

To assess the efficacy of a combination of cognitive training (COG) and repetitive transcranial magnetic stimulation (rTMS), on cognitive performance, locomotor activity, apathy, caregiver burden and dependence of patients with Alzheimer's disease (AD). A combination of COG and rTMS was performed in 10 patients with AD (NeuroAD procedure) for a period of 5weeks (one session per day, 5days a week), without maintenance sessions. Patients were evaluated at the end of the treatment (D45) and 6months later (M6) by the Mini Mental State Examination (MMSE), the Alzheimer disease assessment scale-cognitive subscale (ADAS-Cog), various neuropsychological tests and clinical scores specific for locomotor activity, apathy, caregiver burden, and dependence, recorded before the study (baseline). The primary endpoint was the improvement of the ADAS-Cog score at D45, which was reached. Six months after the end of the treatment, the ADAS-Cog score returned to baseline value, except for the best responders who remained significantly improved. The other main result was the improvement of apathy and dependence scores at both D45 and M6 for the entire series of patients. No serious adverse events occurred and all patients completed the study. The results of this open-label study confirm the feasibility of the rTMS-COG procedure in AD patients, and suggest that these patients can benefit from the procedure, in terms of cognitive performances, apathy and dependence, even in the long term. These promising results remain to be confirmed in controlled studies based on a larger population size, which could also help identify the prognostic factors associated with good outcome, in order to optimize patient selection.

Regional 18F-Fluorodeoxyglucose Hypometabolism is Associated with Higher Apathy Scores Over Time in Early Alzheimer Disease

Apathy is among the earliest and most pervasive neuropsychiatric symptoms in prodromal and mild Alzheimer disease (AD) dementia that correlates with functional impairment and disease progression. We investigated the association of apathy with regional 18F-fluorodeoxyglucose (FDG) metabolism in cognitively normal, mild cognitive impairment, and AD dementia subjects from the Alzheimer's Disease Neuroimaging Initiative database. Cross-sectional and longitudinal studies. 57 North American research sites. 402 community dwelling elders. Apathy was assessed using the Neuropsychiatric Inventory Questionnaire. Baseline FDG metabolism in five regions implicated in the neurobiology of apathy and AD was investigated in relationship to apathy at baseline (cross-sectional general linear model) and longitudinally (mixed random/fixed effect model). Covariates included age, sex, diagnosis, apolipoprotein E genotype, premorbid intelligence, cognition, and antidepressant use. Cross-sectional analysis revealed that posterior cingulate hypometabolism, diagnosis, male sex, and antidepressant use were associated with higher apathy scores. Longitudinal analysis revealed that the interaction of supramarginal hypometabolism and time, posterior cingulate hypometabolism, and antidepressant use were associated with higher apathy scores across time; only supramarginal hypometabolism was positively related to rate of increase of apathy. Results support an association of apathy with hypometabolism in parietal regions commonly affected in early stages of AD, rather than medial frontal regions implicated in the neurobiology of apathy in later stages. Further work is needed to substantiate whether this localization is specific to apathy rather than to disease stage, and to investigate the potential role of AD proteinopathies in the pathogenesis of apathy.

Neural Basis of Apathy in Patients with Amnestic Mild Cognitive Impairment.

Although apathy is associated with damage to the frontal and temporal lobes in Alzheimer's disease (AD), the crucial regions for apathy in patients with amnestic mild cognitive impairment (aMCI) are unknown. To identify brain regions associated with apathy in aMCI patients. The subjects of this study were 98 aMCI patients who were entered in our dementia registry between March 1, 2009 and April 30, 2015 and who satisfied our criteria for aMCI. The association between the apathy score of the Neuropsychiatric Inventory and regional gray matter volume was analyzed using voxel-based morphometry. The association between apathy score and regional cerebral blood flow (rCBF) measured with single photon emission computed tomography (SPECT) was analyzed using Statistical Parametric Mapping. The aMCI patients were classified into aMCI with and without "SPECT images suggestive of AD" (aMCI-AD+ and aMCI-AD-, respectively) based on the Z-score summation analysis method. In aMCI-AD+ (n = 31), apathy was significantly and negatively correlated with gray matter volume in the right caudate nucleus and with rCBF in five regions (left posterior-medial frontal lobe, right superior frontal lobe, bilateral culmen-fusiform gyri, and left occipital lobe). In aMCI-AD-(n = 67), apathy was significantly and negatively correlated with gray matter volumes in five regions but it was not correlated with rCBF in any regions. In patients with ahigh probability of being in the aMCI stage of AD, apathy was associated with atrophy of the right caudate nucleus and hypoperfusion in the frontal, temporal and occipital lobes.

Alzheimer's Disease Severity is Not Significantly Associated with Short Sleep: Survey by Actigraphy on 208 Mild and Moderate Alzheimer's Disease Patients.

In epidemiological surveys, cognitive decline has been found to be associated with both short and long sleep duration. Our goal was to objectively determine how total sleep time (TST) at night was associated or not with apathy or severity scores in patients with Alzheimer 's disease (AD). During an observational first step of a clinical trial, sleep was assessed in institutionalized patients with mild or moderate AD using actigraphy (MW8, Camtech, Cambridge, UK) for 14 consecutive 24-hour periods. Sleep parameters analyzed were: TST, time in bed (TIB), wake after sleep onset (WASO), sleep efficiency (SE) defined by the ratio TST/TIB, in percentage), the number and length of awakenings, the night fragmentation index, the interdaily stability, and intradaily variability indexes. Statistical association analyses were tested between these values and AD apathy and severity scores. 208 individuals coming from 82 centers worldwide (France, Germany, Spain, Italy, Portugal, Poland, United States, Canada, and Australia) and≥50 years old participated. Their average TST was 7 hours and 35 minutes and the average WASO 58 minutes. TST and SE were significantly higher in patients with apathy and the number of awakenings was significantly lower. TST was also positively associated with functional disability (ADCS-ADL scores), but it was not found significantly greater in patients with a moderate AD severity compared to the mild. Despite several and long awakenings, TST was not shorter in patients with AD. TST was even significantly increased with disability and apathy.

Effects of a progressive muscle relaxation intervention on dementia symptoms, activities of daily living, and immune function in group home residents with dementia in Japan.

AimTo evaluate the effects of progressive muscle relaxation on the behavioral and psychological symptoms of dementia, activities of daily living, and immune function of elderly patients with dementia in group homes.MethodsThe participants were ranked by their group home unit. Odd ranks were assigned to the intervention group and even ranks to the control group. The intervention group participated in progressive muscle relaxation for 15 min each day for 90 days in the group environment; the control group members continued with their normal routine. All the participants’ secretory immunoglobulin A was measured and they were assessed with the Neuropsychiatric Inventory‐Nursing Home version, Nishimura Mental State Scale for the Elderly, and Nishimura Activities of Daily Living Scale.ResultsThe intervention group comprised 18 participants from six units and the control group comprised 19 participants from five units. After the intervention, the Neuropsychiatric Inventory scores were significantly better in the intervention group, particularly for Agitation and Anxiety. The intervention group also showed significantly lower Apathy and Irritability scores and significant improvement in the Interest, Volition, and Social relationships scores on the Mental State Scale, with improvement in the activities of daily living total. However, there was no difference in the secretory immunoglobulin A level between the groups.ConclusionThe results suggest that progressive muscle relaxation improves the behavioral and psychological symptoms of dementia and activities of daily living in group home residents with dementia, but does not affect their immune function.

Positive affect and regional cerebral blood flow in Alzheimer's disease

Quality of life (QOL) has been recently recognized as the central purpose of healthcare, and positive affect is one of the core dimension of QOL. However, positive affect among patients with dementia or Alzheimer's disease (AD) has not received much attention in the medical research field. One hundred sixteen consecutive patients with AD were recruited from the outpatient units of the Memory Clinic of Okayama University Hospital. The positive affect score was evaluated using the positive affect domain of the Quality of Life questionnaire for Dementia (QOL-D). Patients underwent brain SPECT with 99mTc-ethylcysteinate dimer. Positive affect scores were inversely related to apathy scores, subjective depressive scores, and delusion scores. After removing the effects of age, sex, duration of education, and cognitive function, positive affect scores showed a significant correlation with regional cerebral blood flow in the left premotor and superior frontal gyri. The left premotor and superior frontal area is significantly involved in the pathogenesis of the decrease of positive affect in AD. Apathy and depression are closely related to the prefrontal area in AD, and they may affect the relationship between positive affect and the left prefrontal area.

Pituitary disorders as a predictor of apathy and executive dysfunction in adult survivors of childhood brain tumors.

The relationship between apathy and endocrine dysfunction, both frequent outcomes of neurological insult, has not yet been investigated in brain tumor survivors. The present study aimed to assess the relationship between pituitary disorders and apathy and other facets of executive function in long-term adult survivors of childhood brain tumors and to differentiate between apathy and depression in this population. Seventy-six adult survivors of childhood brain tumors at least 5 years past diagnosis participated. An informant completed the Frontal Systems Behavior Scale (FrSBe), and 75 of the 76 participants completed a Structured Clinical Interview for the DSM-IV-TR (SCID). Information on neuroendocrine dysfunction was obtained through medical chart review. Clinically significant levels of apathy on the FrSBe were identified in 41% of survivors. Pituitary dysfunction significantly explained 9% of the variance in apathy scores and affected whether an individual presented with clinical levels of apathy. Pituitary dysfunction predicted higher levels of executive dysfunction but did not impact whether a participant reached clinical levels of executive dysfunction. A past major depressive episode (MDE) significantly predicted current apathy but showed no relationship with pituitary disorders. Radiation treatment predicted pituitary dysfunction but not the differences in apathy or executive functions. Apathy and executive dysfunction in survivors of childhood brain tumors are strongly predicted by pituitary dysfunction, and individuals with pituitary dysfunction are more likely to present with clinical levels of apathy as adults. Clinical levels of apathy may present absent of current depression, and pituitary dysfunction impacts apathy uniquely.

Perceived autonomy support, psychological needs satisfaction, depressive symptoms and apathy in French hospitalized older people

Based on the self-determination theory, the aim of the present study was (1) to provide a better understanding of older people’s psychological needs satisfaction in geriatric care units, then to link this information with depressive symptoms and apathy; (2) to examine whether the perceived autonomy support from health care professionals differs between needs satisfaction profiles; and (3) to investigate for all participants how each need satisfaction was related to depressive symptoms and apathy. Participants (N=100; Mage=83.33years, SD=7.78, 61% female) completed the measures of psychological needs satisfaction, perceived autonomy support, geriatric depression and apathy. Sociodemographic data were also collected. Cluster analyses showed three distinct profiles: one profile with low-moderate need satisfaction, one profile with high-moderate need satisfaction and one profile with high need satisfaction. These profiles are distinct, and did not differ in terms of participants' characteristics, except gender. Multivariate analysis of covariance (MANCOVA) revealed that participants with low-moderate need satisfaction profile have significantly higher level of depressive symptoms and apathy, and lower levels of perceived autonomy support than participants of the two other profiles. Moreover, for all participants, regression analyses revealed that both competence and relatedness needs satisfaction significantly and negatively explained 28% of the variance in depressive symptoms score and 44% of the variance in apathy score. Our results highlight the interest to examine more thoroughly the variables fostering autonomy-supportive environment in geriatric care units, and to deepen the relationship between competence and relatedness needs satisfaction and depressive symptoms and apathy.

Latent class analysis of the Apathy Scale does not identify subtypes of apathy in general population-based older persons.

To identify clinically relevant subtypes of apathy in older persons using latent class analysis (LCA) and investigate the distribution of different characteristics across these subtypes. Cross-sectional data of 122 older persons (mean age 84 years, 60% female) participating in the general population-based PROactive Management Of Depression in the Elderly study, with apathy according to a score of 14 or higher on the Apathy Scale, were included for LCA. All 14 items of the Apathy Scale were used as indicator variables. Several characteristics were examined including sociodemographics, depressive, and anxiety symptoms; global cognitive function; quality of life indicators; hazardous alcohol intake (drinking ≥ 14 consumptions per week); and perceived chronic pain. Three distinct LCA classes were found classifying 17%, 7%, and 76% of the participants respectively. Individuals in the first class had a higher level of education and were less likely to live alone. Those in the second class had higher apathy and depression scores, lived more frequently alone and used more alcohol. Individuals in the third class showed a lower level of education and worse cognitive function. In multivariable multinomial analyses, only a lower educational level and higher scores on the Apathy Scale were significant predictors for class membership. Differences between LCA-derived classes were minimal, suggesting that in a general population-based cohort the Apathy Scale measures a homogeneous construct. Copyright © 2016 John Wiley & Sons, Ltd.