Presence Of Apathy Research Articles

Strategi Pendidikan Politik KPU dalam Meningkatkan Partisipasi Pemilih Pemula pada Pemilihan Bupati dan Wakil Bupati Solok Tahun 2020 di Kabupaten Solok

The background of this research was triggered by the urgent need to increase the political participation of novice voters in general elections in Solok Regency. Data from the Solok Regency KPU illustrates a worrying trend, with the number of first-time voters declining from year to year, as well as the presence of apathy in the political process. Therefore, this study aims to analyze the factors that influence the political participation of novice voters, formulate a political education strategy that can increase the political literacy and involvement of novice voters, and identify the obstacles that may be faced in the implementation of socialization. The research method applied in this study is qualitative research, which aims to describe the object of the phenomenon or social setting in the form of narratives and words, focusing on the KPU's political education strategy in increasing the political participation of novice voters in the 2020 Solok Regent and Deputy Regent elections. The political education strategy implemented by the Solok Regency General Election Commission in the 2020 Regent and Deputy Regent elections is seen through three strategy indicators. Thus, the political education strategy of the Solok Regency KPU focuses on face-to-face approaches, synergy with mass media, and improving the quality of volunteers to increase the political participation of novice voters in the 2020 Regent and Deputy Regent elections.

Objective measurement of apathy and its differentiation from depression in dementia based on physiological reactivity to stimuli presented in virtual reality environment

AbstractBackgroundWe aimed to develop a tool for objective measurement of apathy and its differentiation from depression in the context of cognitive impairment.MethodWe exposed older adults with and without cognitive impairment (CI and CN, respectively) to emotional (i.e., positive), aversive and neutral, and to cognitive (congruent; incongruent) stimuli in a virtual reality environment and measured their physiological reactivity as reflected by autonomic nervous system (ANS) functions [heart rate (HR), heart rate variability (HRV), respiration and galvanic skin response (GSR)], and gaze [time to gaze fixation (TTGF) and total fixation duration (TFD)]. Apathy and depression were measured via the Lille Apathy Rating Scale (LARS)‐ and the Geriatric Depression Scale (GDS), respectively.ResultParticipants' characteristics are presented in Tables 1‐2. Compared to CN, CI participants had lower TFD (ANOAVE: F = 7.471, P = 0.006) and GSR reactivity (F = 6.334, P = 0.014) in response to all stimuli. Among participants with CI, those with apathy (LARS score ≥‐7) (n = 21) had shorter TFD compared to those without apathy (F = 19.259, P = 0.001), and those with depression (GDS score ≥5) (n = 46) had longer TFD compared to those without depression ((F = 33.118, P = 0.001) to all stimuli. For all participants, presence of apathy was associated with lower TFD (F = 13.807, P = 0.001) higher TTGF (F = 10.819, P = 0.001), lower HRV reactivity (F = 4.089, P = 0.043) and respiration depth reactivity (F = 8.026, P = 0.005) in response to all stimuli. In contrast, depression was associated with higher TFD (F = 8.448, P = 0.004), lower TTGF (F = 5.290, P = 0.022) and higher HRV reactivity (F = 5.171, P = 0.023) to all stimuli. Increasing LARS scores were negatively associated with respiration rate (R = ‐0.223, P = 0.025) and TFD (R = ‐0.253, P = 0.021) in response to positive emotional stimuli, and with TFD in response to congruent (R = ‐0.265, P = 0.016) and incongruent (R = ‐0.247, P = 0.024) cognitive stimuli. GDS scores were positively associated with HR (R = 0.219, P = 0.049; R = 0.217, P = 0.05 respectively) and respiration depth (R = 0.216, P = 0.048; R = 0.252, P = 0.021 respectively) reactivity to positive and aversive emotional stimuli.ConclusionANS and gaze reactivity to emotional and cognitive stimuli presented in a VR environment is sensitive to cognitive status and to apathy, even in subtle forms. Moreover, this tool can potentially differentiate apathy from depression in the context of cognitive impairment.

SINDROM PROFESIONALNOG SAGOREVANJA KOD SOCIJALNIH RADNIKA I ZNAČAJ MENTALNOG ZDRAVLJA POMAGAČA

This paper deals with the problem of professional burnout syndrome among social workers, the factors that contribute to the occurrence of this phenomenon and the importance of prevention and care for the mental health of professional helpers. In addition to the theoretical analysis of this phenomena and risk factors associated with the nature of the social worker’s professional role, the paper also presents the results of research on the existence of professional burnout syndrome among social workers on the territory of Serbia. The presence of parameters that indicate the occurrence of burnout syndrome among professional workers within the social protection system was established. Elevated levels of stress, tension and emotional exhaustion were noted, as well as the presence of apathy, lack of connection with clients and reduced self-care. Competencies for working with clients and self-image remained preserved. Finally, the paper presents possible ways to prevent the occurrence of burnout syndrome.

Cutoff scores for the "Interest game", an application for the assessment of diminished interest in neurocognitive disorders.

Diminished interest is a core feature of apathy that shows high prevalence in people with Mild and Major Neurocognitive disorders (NCD). In the clinical setting, apathy is mainly assessed using clinical scales and questionnaires, but new technologies are starting to be employed to complement classical instruments. Here, we explored the performance of the "Interest game," a ludic application that assesses personal interests, in discriminating between persons with and without diminished interest based on the Apathy Diagnostic Criteria. Two hundred and twenty-seven elderly participants (56 healthy controls, 118 persons with mild-NCD, and 53 with major-NCD) completed the Interest game and were assessed by clinicians concerning the presence and the severity of apathy. Results showed that the application scores varied with the presence of apathy, the type of disorder, and the education level. Cutoff scores calculated for persons with Mild-NCD resulted in a sensitivity of 0.68 and a specificity of 0.65 for the main score index, suggesting the interest of employing this application in the clinical setting to complement the classical assessment.

A-104 The Effect of Apathy on Semantic Category Fluency Performance in Alzheimer’s Disease Patients with MCI

Abstract Objective: To investigate the effect of apathy on performance on a task of semantic category fluency in a sample of Alzheimer’s disease (ad) patients with mild cognitive impairment (MCI). Method: The sample (N = 3951) was selected from the Alzheimer’s Disease Research Centers database by the National Institute on Aging. Individuals with diagnosed ad and an MMSE score from 19 to 24 were included. Groups consisted of no apathy (n = 2393,Mage = 75.68,58% female), mild apathy (n = 833,Mage = 74.99,55% female), moderate apathy (n = 567,Mage = 74.72,47% female), and severe apathy (n = 158,Mage = 75.19,53% female). Participants were administered the vegetable and animal naming semantic category fluency tasks. Multiple ANCOVA were conducted while controlling for education, gender, and MMSE score to test whether the presence of apathy had an effect on performance on these measures. Results: Significant differences were found in performance on the vegetable (F(3,3800) = 2.91,p = 0.033,η2 = 0.002) and animal (F(3,3852) = 5.70,p < 0.001,η2 = 0.004) naming tasks, suggesting that individuals endorsing apathy scored lower on average than those without apathy. Conclusion: Results indicated modestly lower performance on measures of semantic category fluency in a sample of ad, MCI and apathy persons. While apathy has been associated with functional impairment, more research is needed to determine its impact on cognitive ability. These findings suggest that the apathy syndrome may be related to lower cognitive performance and highlight the importance of managing apathy in behavioral interventions for ad. Future research should investigate interventions that target apathy and its link to other cognitive domains.

Apathy Reflects Extra-Striatal Dopaminergic Degeneration in de novo Parkinson's Disease.

Apathy represents a core neuropsychiatric symptom in Parkinson's disease (PD). As there is currently no established effective treatment for apathy in PD, further investigating the biological origin of this symptom is needed to design novel therapeutic strategies. Among the multiple neurotransmitter alterations that have been associated with apathy, the involvement of extra-striatal dopaminergic degeneration remains to be fully explored. To investigate whether apathy in PD reflects increased dopaminergic degeneration extending beyond striatal regions. In the de novo PD cohort of the Parkinson's Progression Markers Initiative (PPMI), we performed whole-brain I123-Ioflupane Single Photon Emission Computed Tomography (DAT-SPECT) analyses to characterize cross-sectional and longitudinal differences in DAT uptake associated with the presence of apathy. We also assessed the relationship between apathy and cognition in this sample, as apathy has been suggested to herald cognitive decline. Apathetic PD patients (N = 70) had similar sociodemographic, clinical, and biomarker profiles compared to the non-apathetic group (N = 333) at baseline. However, apathy was associated with an increased risk of developing cognitive impairment after a four-year follow-up period (p = 0.006). Compared to non-apathetic patients, apathetic patients showed a widespread reduction of extra-striatal DAT uptake at baseline as well as an increased longitudinal loss of DAT uptake (corrected p < 0.05). Isolated apathy in PD is associated with extra-striatal dopaminergic degeneration. As this abnormal dopamine depletion was in turn related to cognitive performance, this might explain, at least partially, the increased risk of apathetic PD patients to develop cognitive impairment or dementia.

Olfaction and apathy in early idiopathic Parkinson's disease

BackgroundApathy remains a disabling symptom in Parkinson's disease (PD) with limited therapeutic success. Processing of emotions and smell share neuroanatomical and evolutionary pathways. ObjectivesTo explore the association of apathy with smell dysfunction (SD) in early PD. MethodsWe analyzed patients with de-novo PD, with follow-up of at least 5 years from the Parkinson's Progression Markers Initiative. SD and apathy were defined using University of Pennsylvania Smell Identification Test and MDS-UPDRS part 1A. Odds ratios were calculated between apathy and olfaction groups. Kaplan-Meier survival analysis was grouped by presence/ absence of smell dysfunction. The Log Rank test was used to compare time to apathy. ResultsWe found no association between presence of apathy in patients with and without SD (OR 1.01 [0.49–2.08]). There was no significant difference between PD patients with and without SD in time to apathy (p = 0.72). ConclusionsSD does not portend greater risk of apathy in PD.

Apathy as a Predictor for Conversion From Mild Cognitive Impairment to Dementia: A Systematic Review and Meta-Analysis of Longitudinal Studies.

Apathy is one of the most prevalent neurobehavioral manifestations in mild cognitive impairment (MCI) and is included among the behavioral and psychological symptoms of dementia (BPSD). Studies suggest that the presence of apathy could be associated with increased dementia risk. The role of apathy in conversion from MCI to dementia, and whether apathy could be a relevant predictor for dementia progression, are still matters of investigation. To study the relationship between apathy and progression to dementia in individuals with MCI. A systematic literature search in Medline, Embase, Cochrane Library, Epistemonikos, PsychINFO, and CINAHL was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search included longitudinal studies reporting on the association between apathy and dementia. The main outcome was pooled unadjusted hazard ratios (HR) of apathy in dementia conversion and included 11 studies with 9504 individuals. There was a significant association between apathy and dementia conversion, HR = 1.54; 95% CI, 1.29, 1.84. Subgroup analysis showed a significant association between apathy and progression to AD. Apathy was associated with an increased risk of conversion to AD and all-cause dementia in patients with MCI. The role of apathy as a marker for incident dementia needs to be investigated in large, high-quality studies.

Upper motor neuron dysfunction is associated with the presence of behavioural impairment in patients with amyotrophic lateral sclerosis.

Increasing evidence shows that approximately half of patients with amyotrophic lateral sclerosis (ALS) display cognitive (ALSci) or behavioural (ALSbi) impairment, or both (ALScbi). The aim of our study was to assess whether the burden of upper and lower motor neuron involvement is associated with the presence of cognitive and behavioural impairment. A single-centre retrospective cohort of 110 Italian ALS patients was evaluated to assess correlations between motor and cognitive/behavioural phenotypes. Upper motor neuron regional involvement was measured with the Penn Upper Motor Neuron Score (PUMNS), whilst lower motor neuron signs were assessed using the Lower Motor Neuron Score. The Edinburgh Cognitive and Behavioural ALS Screen-Italian version and the Frontal Behaviour Inventory were administered to evaluate patients' cognitive and behavioural profiles. The PUMNS at first visit was significantly higher in behaviourally impaired ALS patients (ALSbi and ALScbi) compared to behaviourally unimpaired individuals (ALS and ALSci) (9.9 vs. 6.9, p=0.014). Concerning the different Frontal Behaviour Inventory subdomains, higher PUMNS correlated with the presence of apathy, emotive indifference, inflexibility, inattention, perseveration and aggressiveness. To our knowledge, this is the first study showing that a clinical prominent upper motor neuron dysfunction is associated with a more significant behavioural impairment in ALS patients, suggesting the hypothesis of a preferential spreading of the pathology from the motor cortex to the ventromedial prefrontal and orbitofrontal cortex in this group of patients.

Apathy, Executive Function, and Emotion Recognition Are the Main Drivers of Functional Impairment in Behavioral Variant of Frontotemporal Dementia.

Background: The cognitive and neuropsychiatric deficits present in patients with behavioral variant frontotemporal dementia (bvFTD) are associated with loss of functionality in the activities of daily living (ADLs). The main purpose of this study was to examine and explore the association between the cognitive and neuropsychiatric features that might prompt functional impairment of basic, instrumental, and advanced ADL domains in patients with bvFTD.Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (<2 years of evolution) and 32 healthy control subjects. A neuropsychological assessment was carried out wherein measures of cognitive function and neuropsychiatric symptoms were obtained. The informant-report Technology–Activities of Daily Living Questionnaire was used to assess the percentage of functional impairment in the different ADL domains. To identify the best determinants, three separate multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, emotion recognition, disinhibition, and apathy as independent variables.Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which the presence of apathy (β = 0.33, p = 0.02) and disinhibition (β = 0.29, p = 0.04) were significant factors. Concerning instrumental ADLs, the model produced accounted for 63.7% of the functional variability, with the presence of apathy (β = 0.71, p < 0.001), deficits in executive function (β = −0.36, p = 0.002), and lack of emotion recognition (β = 0.28, p = 0.017) as the main contributors. Finally, in terms of advanced ADLs, the model found explained 52.6% of the variance, wherein only the presence of apathy acted as a significant factor (β = 0.59, p < 0.001).Conclusions: The results of this study show the prominent and transverse effect of apathy in the loss of functionality throughout all the ADL domains. Apart from that, this is the first study that shows that the factors associated with loss of functionality differ according to the functional domain in patients with bvFTD in its early stage. Finally, no other study has analyzed the impact of the lack of emotion recognition in the functionality of ADLs. These results could guide the planning of tailored interventions that might enhance everyday activities and the improvement of quality of life.

The relationship between subjective hearing impairment and mild behavioral impairment – A study of older adults without dementia in the COMPASS‐ND Study

AbstractBackgroundHearing loss and mild behavioral impairment (MBI) are both early warning signs of cognitive decline and dementia in older adults and have been recommended for use as non‐cognitive markers of dementia. To date, few studies have directly investigated the relationship between these two markers.MethodBaseline data from 219 non‐demented participants (10 cognitively normal; CN, 48 subjective cognitive decline; SCD, 161 mild cognitive impairment; MCI) in the COMPASS‐ND study (February 2020 release) were analyzed. Hearing impairment was measured in three ways: with a 10‐item self‐report measure using the Hearing Handicap Inventory for the Elderly – Screening Version (HHIE‐S), with a speech and noise test using the Canadian Digit Triplet Test (CDTT), and with screening audiometry using 2 discrete input levels at 2000 Hz to generate 6 hearing loss categories. Global and domain‐specific MBI burden was approximated using the Neuropsychiatric Inventory Questionnaire (NPI‐Q) with a published algorithm. Multivariable linear regressions were conducted to examine the association between the three hearing impairment measures and global MBI burden, adjusting for sex, age, education, hearing aid use, and Montreal Cognitive Assessment (MoCA) score or diagnosis. Multivariable logistic regressions were used to investigate whether the hearing variables could predict MBI domains.ResultHalf of all participants showed MBI symptoms (Figure 1). Greater self‐reported hearing impairment measured by the HHIE‐S was significantly associated with greater global MBI burden and the presence of apathy and affective dysregulation when controlling for global cognition or diagnosis (Table 1). These associations remained significant in analyses restricted to MCI alone. Performance on CDTT and screening audiometry, were not associated with global or domain‐specific MBI burden.ConclusionThe HHIE‐S, which was designed to capture the emotional and social aspects of hearing loss, was positively related to global MBI burden and more specifically to apathy and affect. Unlike audiometry and speech and noise measures, self‐reported measures of hearing impairment can be influenced by age, sex, other comorbidities, and social factors. Our findings underscore that value of self‐report measures of hearing impairment as distinct from audiometry and speech and noise measures in their association with behavioral impairment and as non‐cognitive markers of dementia.

Neuropsychiatric symptoms in patients with possible vascular cognitive impairment: Does sex matter?

AbstractBackgroundEmerging evidence shows sex differences in manifestations of neuropsychiatric symptoms (NPS) in memory clinic patients. NPS are common in patients with vascular cognitive impairment (VCI) affecting quality of life and caregiver burden, however sex differences are largely unknown. We aimed first to establish sex differences in the manifestation of NPS in memory clinic patients with possible VCI and second to investigate the association between different NPS and substantial cognitive decline stratified by sex.MethodWe included 737 memory clinic patients (age 68.1±8.4; 45% female) from the prospective TRACE‐VCI cohort study with possible VCI; cognitive complaints and vascular brain injury (moderate/severe white matter hyperintensities (n = 398), microbleeds (n = 317), lacunar (n = 167) and non‐lacunar (n = 85) infarct(s), macrobleeds (n = 14)). Dementia was diagnosed in 405 and MCI in 197 patients. NPS were measured using the 12‐item Neuropsychiatric Inventory (NPI) and dichotomized as present ≥1. Substantial cognitive decline was defined as change of CDR ≥1 or institutionalization (available for n=571 without advanced dementia at baseline). The association between NPS and cognitive decline was assessed with Cox proportional hazard models in females and males separate, adjusted for other NPS, age and clinical diagnosis.ResultWe found no difference in age nor distribution of clinical diagnoses between the sexes. Males more often presented with agitation (29% versus 17%) and irritability (58% versus 46%), while females more often presented with anxiety (32% versus 25%, all p&lt;0.05), the other 9 NPS (delusions, hallucinations, aggression, depression, anxiety, euphoria, apathy, disinhibition, aberrant motor behavior, sleep/night‐time disturbances and appetite and eating abnormalities) did not differ between the sexes. During follow‐up, occurrence of substantial cognitive decline was comparable between males (14%) and females (15%). In males, substantial cognitive decline was higher in the presence of apathy (HR 2.5, 95%CI;1.2‐5.4) and aberrant motor behavior (HR 2.2, 95%CI;1.1‐4.6) and lower in the presence of appetite and eating abnormalities (HR 0.4, 95%CI;0.2‐0.9). In females, none of the NPS were associated with substantial cognitive decline.ConclusionPattern and predictive value of NPS differs by sex in memory clinic patients with VCI. Acknowledgment of these differences could direct interventions.

Clinical and Dopamine Depletion Patterns in Hyposmia- and Dysautonomia-Dominant Parkinson's Disease.

Olfactory or autonomic dysfunction is one of the earliest prodromal symptoms of Parkinson's disease (PD). It has not been investigated whether PD patients have different phenotypes depending on the presence of these prodromal symptoms. To investigate whether hyposmia-dominant and dysautonomia-dominant patients with early PD have different clinical manifestations and nigrostriatal degeneration. This cross-sectional study recruited 168 drug-naive PD patients and 34 control subjects. PD patients were classified as patients without hyposmia and dysautonomia (PD-H-D-, n = 51), hyposmia-dominant patients (PD-H+D-, n = 36), dysautonomia-dominant patients (PD-H-D+, n = 33), and patients with hyposmia and dysautonomia (PD-H+D+, n = 48). We then compared the baseline clinical characteristics, striatal specific to non-specific binding ratio (SNBR), neuropsychological performance, and neuropsychiatric symptoms among the groups. The PD-H+D-group had a lower SNBR in the ventral striatum (p = 0.013), a greater asymmetric index of striatal SNBRs, and higher prevalence of apathy (p = 0.021) than the PD-H-D+ group. The PD-H-D+ group had older age at onset (p = 0.043) and a higher prevalence of REM sleep behavior disorder (p = 0.041) than the PD-H+D-group. The PD-H+D+ group had higher motor deficits, lower cognitive function, and lower SNBRs in all striatal subregions than the PD-H-D-group. Decreased SNBRs in the anterior caudate, posterior caudate, and ventral striatum were associated with the presence of apathy. The present study suggests that hyposmia-dominant and dysautonomia-dominant PD have different clinical characteristics and patterns of striatal dopamine depletion.

Serotonergic and Dopaminergic Lesions Underlying Parkinsonian Neuropsychiatric Signs.

Parkinson's disease (PD) is characterized by heterogeneous motor and nonmotor manifestations related to alterations in monoaminergic neurotransmission systems. Nevertheless, the characterization of concomitant dopaminergic and serotonergic dysfunction after different durations of Parkinson's disease, as well as their respective involvement in the expression and severity of neuropsychiatric signs, has gained little attention so far. To fill this gap, we conducted a cross-sectional study combining clinical and dual-tracer positron emission tomography (PET) neuroimaging approaches, using radioligands of dopamine ([11 C]-N-(3-iodoprop-2E-enyl)-2-beta-carbomethoxy-3-beta-(4-methylphenyl)-nortropane) ([11 C]PE2I) and serotonin ([11 C]-N,N-dimethyl-2-(-2-amino-4-cyanophenylthio)-benzylamine) ([11 C]DASB) reuptake, after different durations of Parkinson's disease (ie, in short-disease duration drug-naive de novo (n=27, 0-2 years-duration), suffering from apathy (n=14) or not (n=13); intermediate-disease duration (n=15, 4-7 years-duration) and long-disease duration, non-demented (n=15, 8-10 years-duration) patients). Fifteen age-matched healthy subjects were also enrolled. The main findings are threefold: (1) both dopaminergic and serotonergic lesions worsen with the duration of Parkinson's disease, spreading from midbrain/subcortical to cortical regions; (2) the presence of apathy at PD onset is associated with more severe cortical and subcortical serotonergic and dopaminergic disruption, similar to the denervation pattern observed in intermediate-disease duration patients; and (3) the severity of parkinsonian apathy, depression, and trait-anxiety appears primarily related to serotonergic alteration within corticostriatal limbic areas. Altogether, these findings highlight the prominent role of serotonergic degeneration in the expression of several neuropsychiatric symptoms occurring after different durations of Parkinson's disease. © 2021 International Parkinson and Movement Disorder Society.

White matter microstructural associates of apathy-avolition in schizophrenia

Apathy is present at the onset in nearly half the patients with schizophrenia. Current therapies lack the efficiency to improve apathy in patients. The presence of apathy is also associated with poorer outcomes. Despite its clinical importance, the underlying mechanism of apathy in schizophrenia is unclear, but it seems frontostriatal connections play a role. In this study, we investigated whole-brain white matter microstructural properties associated with the severity of apathy-avolition in schizophrenia. We included 80 schizophrenia patients (60 Male, 20 Female) from the Mind Clinical Imaging Consortium database and associated Apathy-Avolition score of “Scale for Assessment of Negative Symptoms” with fiber integrity measures derived from diffusion-weighted imaging using Tract-Based Spatial Statistics (TBSS). We also did tractography on eight tracts, including bilateral superior longitudinal fasciculus, uncinate fasciculus, cingulum, genu and splenium of the corpus callosum. Age, gender, years of education, chlorpromazine equivalent cumulative dose, and acquisition site were inserted as covariates. We showed a widespread association between lower fiber integrity (by measures of increased mean diffusivity and decreased fractional anisotropy) and increased apathy-avolition in TBSS, which we also validated in tractography. Moreover, mean diffusivity, and not fractional anisotropy, was associated with apathy independent of disease severity. In conclusion, we propose diffuse white-matter pathology, within the corpus callosum, limbic system, and the frontostriatal circuit is involved in apathy-avolition in schizophrenia. Also, we suggest that diffuse neuroinflammatory processes may play a part in apathy-avolition, independent of disease severity.

Association between MMP16 rs60298754 and clinical phenotypes of Parkinson's disease in southern Chinese.

The aim was to investigate the association between MMP16 rs60298754 and symptoms of Parkinson's disease (PD) in southern Chinese. Seven hundred forty-five PD patients were recruited in this study. All patients were evaluated by Brief Pain Inventory (BPI), Hamilton anxiety rating scale and Hamilton depression rating scale, 39-item Parkinson's disease Questionnaire (PDQ-39), and MDS-Unified PD Rating Scale (MDS-UPDRS). Symptoms were also recorded. The difference of BPI and Parkinson's disease sleep scale (PDSS) between two groups was showed (BPI: MMP16 wildtypes: 14.73 ± 14.45; MMP16 carriers: 10.95 ± 10.67, p 0.002; PDSS: MMP16 wildtypes: 117.80 ± 21.45; MMP16 carriers: 108.40 ± 23.95, p < 0.001). The association of apathy, nocturia, and sensitive to light were found (apathy: p 0.001, OR: 0.49, 0.32-0.76; nocturia: p < 0.001, OR: 3.57, 1.90-7.26; sensitive to light: p < 0.001, OR: 3.99, 2.01-7.74). MMP16 rs60298754 was associated with the presence of apathy, pain, nocturia, and sensitive to light.

Neuromodulation for Apathy in Alzheimer's Disease: A Double-Blind, Randomized, Sham-Controlled Pilot Study.

Background:Apathy, a profound loss of motivation, initiation, and goal directed cognition, is a common comorbidity of Alzheimer’s disease (AD). The presence of apathy is associated with rapid progression of AD, long-term impairment, disability, and higher mortality. Pharmacological treatments of apathy are limited.Objective:The primary objective was to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for apathy in AD.Methods:A randomized, double-blind, parallel-arm, sham-controlled pilot study was conducted in subjects with AD and apathy (N = 20). Subjects were randomized to rTMS or sham treatment (5 days/week) for four weeks. Primary outcome, apathy evaluation scale-clinician version (AES-C), and secondary outcome measures, modified-Mini Mental State Examination (3MS), instrumental activities of daily living (IADL), and clinical global impression (CGI), were assessed at baseline and four weeks. Follow-up visits were conducted at 8 and 12 weeks to test the durability of effects of intervention.Results:Mean age was 77.3 (±7.2) years, 80% were Caucasians and 10% were females. After adjusting for baseline, there was a significantly greater improvement in the AES-C with rTMS compared to sham treatment (–10.1 (–15.9 to –4.3); t (16) = –3.69; p = 0.002) at 4 weeks. There was also significantly greater improvement in 3MS (6.9 (1.7 to 12.0); t (15) = 2.85; p = 0.012), IADL (3.4 (1.0 to 5.9); χ21 = 7.72; p = 0.006), CGI-S (1.4 (0.5 to 2.3), t (16) = 3.29; p = 0.005), and CGI-I (–2.56 (–3.5 to –1.6), t (17) = –5.72; p < 0.001) for rTMS compared to the sham at 4 weeks. The effects of rTMS were durable at 12 weeks.Conclusion:rTMS may be safely used in subjects with AD and may improve apathy, function, and some aspects of cognition.

A-166 The Role of Apathy on Executive Functioning After Stroke

Abstract Objective This study examined the role of apathy on performance of an executive functioning task. Method The data for this study was derived from the National Alzheimer’s Coordinating Center’s Uniform Data Set containing neuropsychological information for stroke patients (n = 317) who completed the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and the Trail Making Test (Part B). The sample was divided into two groups. One which endorsed feelings of apathy in the last month (n = 102; mean age = 84,SD = 8.33) and a second group which denied feelings of apathy within the last month (n = 215; mean age = 86, SD = 8.02). Results After controlling for depression [as measured by the Geriatric Depression Scale (GDS)], age, gender, and motor impairment, the results of an ANCOVA showed that those who reported apathy performed significantly slower on the Trail Making Test—Part B than those who did not report it [F(1,312 = 6.01, p = .02]. Conclusions It has previously been found that cognitive performance can be impacted by depression on stroke patients. However, recently, it has been identified that apathy specifically, can have an effect on cognitive domains such as verbal learning, short-term, and long-term memory. The present study further supports that apathy may play a role in overall cognitive performance. Therefore, even if patients do not meet criteria for depression, the presence of apathy should still be taken into account. Future research should examine other possible contributing factors such as processing speed should be taken into account as they could be affecting the scores. Finally, researchers should utilize additional measures of executive functioning as only one was available for this study.

Selective serotonin reuptake inhibitors-associated apathy syndrome: A cross sectional study.

Selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression, are associated with loss of motivation, anergy, and lack of curiosity often referred collectively as apathy. However, this association has not been systematically assessed using a specific rating scale for measuring apathy syndrome. Our objective was to study the association between SSRI use and apathy syndrome.We conducted a retrospective chart review of 125 patients enrolled in an outpatient psychiatry clinic. The prevalence of apathy syndrome and its clinical significance (based on standardized assessment) were compared between patients treated and not treated with SSRIs. Apathy was assessed using the Apathy Evaluation Scale-clinician version with a score ranging 18–72 with higher score for worse apathy. A score of greater than 30 is considered clinically significant apathy.Among 119 patients, the mean apathy scores were significantly higher in those treated with SSRIs compared to those not treated with SSRIs (42.5 ± 9.2 vs 31.3 ± 6, P < .0001). The SSRI group also had a significantly higher percentage of patients with clinically significant apathy (92% vs 61%, P < .0001). Use of all SSRIs was associated with the presence of apathy. Apathy was seen in all mental health diagnostic categories with highest Apathy evaluation scale-clinician version scores in those with dementia.SSRI use may be associated with higher rates of apathy syndrome. Clinicians should specifically inquire about iatrogenic apathy syndrome when evaluating patients on an SSRI if there is suspicion of loss of motivation. Limitations of this study included retrospective nature of this study, and that majority of the sample was males. Prospective studies are needed to elucidate information regarding the prevalence, etiology, and treatment response for SSRI-associated apathy syndrome.

The Association Between Biomarkers and Neuropsychiatric Symptoms Across the Alzheimer's Disease Spectrum

To investigate the relationship between Alzheimer's disease biomarkers and neuropsychiatric symptoms. Data from two large cohort studies, the Dutch Parelsnoer Institute - Neurodegenerative Diseases and the Alzheimer's Disease Neuroimaging Initiative was used, including subjects with subjective cognitive decline (N = 650), mild cognitive impairment (N = 887), and Alzheimer's disease dementia (N = 626). Cerebrospinal fluid (CSF) levels of Aβ42, t-tau, p-tau, and hippocampal volume were associated with neuropsychiatric symptoms (measured with the Neuropsychiatric Inventory) using multiple logistic regression analyses. The effect of the Mini-Mental State Examination (as proxy for cognitive functioning) on these relationships was assessed with mediation analyses. Alzheimer's disease biomarkers were not associated with depression, agitation, irritability, and sleep disturbances. Lower levels of CSF Aβ42, higher levels of t- and p-tau were associated with presence of anxiety. Lower levels of CSF Aβ42 and smaller hippocampal volumes were associated with presence of apathy. All associations were mediated by cognitive functioning. The association between Alzheimer's disease pathology and anxiety and apathy is partly due to impairment in cognitive functioning.