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The Journals of Gerontology. Series B,... Aug 2020Apathy is a potential predictor of dementia in older adults, but this investigation has been limited to older adults with a preexisting neurological illness like mild...
OBJECTIVES
Apathy is a potential predictor of dementia in older adults, but this investigation has been limited to older adults with a preexisting neurological illness like mild cognitive impairment (MCI), stroke or Parkinson's disease. The objective of this study was to investigate the association between apathy at baseline and incident predementia syndromes, including MCI and motoric cognitive risk syndrome (MCR), subjective cognitive complaints and slow gait, in community-dwelling older adults.
METHOD
We prospectively studied the association between apathy (using the 3-item subscale of the Geriatric Depression Scale [GDS3A]) and incident cognitive disorders in 542 community-dwelling older adults enrolled in the Central Control of Mobility in Aging study using Cox proportional hazard models. Associations were reported as hazard ratio (HR) with 95% confidence intervals (CIs), adjusting for age, education, baseline cognitive performance, and depressive symptoms.
RESULTS
Apathy was associated with incident MCR (HR 2.39, 95% CI: 1.10-5.20), but not predementia syndromes overall nor MCI. In sensitivity analyses of MCI subtypes, apathy was associated with nonamnestic MCI (HR 2.44, 95% CI: 1.14-5.22), but not amnestic MCI. Our study was limited by a short follow-up time (median 13.6 months; interquartile range 29.8) and a brief subscale measurement of apathy, GDS3A.
DISCUSSION
In our study, apathy predicted MCR but not MCI in community-dwelling older adults. These results and the current literature suggest that apathy is an early risk factor for dementia. Additionally, apathy may be a novel treatment target that could forestall the disability of dementia.
Topics: Age Factors; Aged; Apathy; Cognitive Dysfunction; Dementia; Female; Humans; Independent Living; Male; Prodromal Symptoms; Proportional Hazards Models; Prospective Studies; Psychiatric Status Rating Scales; Risk Factors; Syndrome; Walking Speed
PubMed: 32374839
DOI: 10.1093/geronb/gbaa063 -
Neurology Nov 2020To empirically test whether apathy and impulse control disorders (ICDs) represent independent, opposite ends of a motivational spectrum.
OBJECTIVE
To empirically test whether apathy and impulse control disorders (ICDs) represent independent, opposite ends of a motivational spectrum.
METHODS
In this single-center, cross-sectional study, we obtained retrospective demographics and clinical data for 887 patients with idiopathic Parkinson disease (PD) seen at a tertiary care center. Mood and motivation disturbances were classified using recommended cutoff scores from self-reported measures of apathy, ICD, anxiety, and depression.
RESULTS
Prevalence rates included 29.0% of patients with PD with depression, 40.7% with anxiety, 41.3% with apathy, 27.6% with ICDs, and 17.0% with both apathy and ICD. The majority (61.6%) of people reporting clinically significant ICDs also reported clinically significant apathy, and more than a third of patients with apathy (41.3%) also reported elevated ICD. Anxiety and depression were highest in patients with both apathy and ≥1 ICDs. Dopamine agonist use was higher in people with only ICD compared to people with only apathy. Mood significantly interacted with demographic variables to predict motivational disturbances.
CONCLUSIONS
Motivational disturbances are common comorbid conditions in patients with PD. In addition, these complex behavioral syndromes interact with mood in clinically important ways that may influence the design of future clinical trials and the development of novel therapies. This study challenges the concept of apathy and ICD in PD as opposite ends of a spectrum.
Topics: Aged; Anxiety; Apathy; Cross-Sectional Studies; Depression; Disruptive, Impulse Control, and Conduct Disorders; Female; Humans; Male; Middle Aged; Motivation; Parkinson Disease; Retrospective Studies
PubMed: 33004605
DOI: 10.1212/WNL.0000000000010965 -
Cerebrovascular Diseases (Basel,... 2013Apathy is a disturbance of motivation, frequent in survivors of stroke. Several studies have evaluated the rate of apathy secondary to stroke and risk factors. Different... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Apathy is a disturbance of motivation, frequent in survivors of stroke. Several studies have evaluated the rate of apathy secondary to stroke and risk factors. Different conclusions and contradictory findings have been published. We aimed to perform a systematic review and meta-analysis of all studies evaluating apathy secondary to stroke to better estimate its rate and risk factors, and explore associations with poorer outcomes.
METHODS
We searched PubMed, Cochrane Library, PsychINFO and PsycBITE databases and screened references of included studies and review articles for additional citations. Search results and data extraction was performed independently. We systematically reviewed available publications reporting investigations on ischemic and intracerebral hemorrhagic stroke and apathy. Quality assessment of the studies was performed independently. Subgroup analyses were performed according to stroke phase (acute and post-acute), stroke past history (first-ever and any-stroke) and patient age (younger and older patients). Pooled odds ratios (OR) and standardized mean difference, and 95% confidence intervals (CI), were derived by random-effects meta-analysis. Heterogeneity was assessed with I(2) test.
RESULTS
From the initial 1,399 publications, we included 19 studies (2,221 patients). The pooled rate of apathy was 36.3% (95% CI 30.3-42.8; I(2) = 46.8), which was similar for acute [39.5% (95% CI 28.9-51.1)] and post-acute phase [34.3% (95% CI 27.8-41.4)], and about three times higher than the rate of depression [12.1% (95% CI 8.2-17.3)]. Apathetic patients were on average 2.74 years older (95% CI 1.25-4.23; I(2) = 0%). No gender differences were found. Depression (OR 2.29; 95% CI 1.41-3.72; I(2) = 44%) and cognitive impairment (OR 2.90; 95% CI 1.09-7.72; I(2) = 14%) were more frequent and severe in apathetic patients. Apathy rate was similar for ischemic and hemorrhagic stroke type and for left- and right-sided hemispheric lesions. Clinical global outcome was similar between apathetic and nonapathetic patients.
CONCLUSION
Apathy secondary to stroke is a more frequent neuropsychiatric disturbance than depression. Apathetic patients are more frequently and severely depressed and cognitively impaired. A negative impact of apathy secondary to stroke on clinical global outcome cannot be ascribed. Future research should properly address its predictor factors and evaluate the impact of apathy treatment options in stroke patients.
Topics: Adult; Aged; Aged, 80 and over; Apathy; Cognition; Cognition Disorders; Depression; Executive Function; Female; Humans; Male; Middle Aged; Motivation; Odds Ratio; Prognosis; Risk Assessment; Risk Factors; Stroke; Stroke Rehabilitation; Young Adult
PubMed: 23428994
DOI: 10.1159/000346076 -
International Journal of Geriatric... Feb 2023This narrative review describes the clinical features of apathy and depression in individuals with neurocognitive disorders (NCDs), with the goal of differentiating the... (Review)
Review
Distinguishing apathy from depression: A review differentiating the behavioral, neuroanatomic, and treatment-related aspects of apathy from depression in neurocognitive disorders.
OBJECTIVES
This narrative review describes the clinical features of apathy and depression in individuals with neurocognitive disorders (NCDs), with the goal of differentiating the two syndromes on the basis of clinical presentation, diagnostic criteria, neuropathological features, and contrasting responses to treatments.
METHODS
Literature was identified using PubMed, with search terms to capture medical conditions of interest; additional references were also included based on our collective experience and knowledge of the literature.
RESULTS
Evidence from current literature supports the distinction between the two disorders; apathy and depression occur with varying prevalence in individuals with NCDs, pose different risks of progression to dementia, and have distinct, if overlapping, neurobiological underpinnings. Although apathy is a distinct neuropsychiatric syndrome, distinguishing apathy from depression can be challenging, as both conditions may occur concurrently and share several overlapping features. Apathy is associated with unfavorable outcomes, especially those with neurodegenerative etiologies (e.g., Alzheimer's disease) and is associated with an increased burden for both patients and caregivers. Diagnosing apathy is important not only to serve as the basis for appropriate treatment, but also for the development of novel targeted interventions for this condition. Although there are currently no approved pharmacologic treatments for apathy, the research described in this review supports apathy as a distinct neuropsychiatric condition that warrants specific treatments aimed at alleviating patient disability.
CONCLUSIONS
Despite differences between these disorders, both apathy and depression pose significant challenges to patients, their families, and caregivers; better diagnostics are needed to develop more tailored treatment and support.
Topics: Humans; Apathy; Depression; Neurocognitive Disorders; Alzheimer Disease; Motivation
PubMed: 36739588
DOI: 10.1002/gps.5882 -
Neurology Dec 2020To evaluate the association between baseline apathy and probable incident dementia in a population-based sample of community-dwelling older adults.
OBJECTIVE
To evaluate the association between baseline apathy and probable incident dementia in a population-based sample of community-dwelling older adults.
METHODS
We studied 2,018 white and black community-dwelling older adults from the Health, Aging, and Body Composition (Health ABC) study. We measured apathy at year 6 (our study baseline) with the modified Apathy Evaluation Scale and divided participants into tertiles based on low, moderate, or severe apathy symptoms. Incident dementia was ascertained over 9 years by dementia medication use, hospital records, or clinically relevant cognitive decline on global cognition. We examined the association between apathy and probable incident dementia using a Cox proportional hazards model adjusting for demographics, cardiovascular risk factors, status, and depressed mood. We also evaluated the association between the apathy group and cognitive change (as measured by the modified Mini-Mental State Examination and Digit Symbol Substitution Test over 5 years) using linear mixed effects models.
RESULTS
Over 9 years of follow-up, 381 participants developed probable dementia. Severe apathy was associated with an increased risk of dementia compared to low apathy (25% vs 14%) in unadjusted (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.5-2.5) and adjusted models (HR 1.7, 95% CI 1.3-2.2). Greater apathy was associated with worse cognitive score at baseline, but not rate of change over time.
CONCLUSION
In a diverse cohort of community-dwelling adults, apathy was associated with increased risk of developing probable dementia. This study provides novel evidence for apathy as a prodrome of dementia.
Topics: Aged; Aged, 80 and over; Apathy; Cognitive Dysfunction; Dementia; Female; Health Surveys; Humans; Incidence; Independent Living; Longitudinal Studies; Male; Prodromal Symptoms; Proportional Hazards Models; Risk; United States
PubMed: 33055276
DOI: 10.1212/WNL.0000000000010951 -
PLoS Biology Mar 2022Real-life decision-making often comprises sequences of successive decisions about whether to take opportunities as they are encountered or keep searching for better ones...
Real-life decision-making often comprises sequences of successive decisions about whether to take opportunities as they are encountered or keep searching for better ones instead. We investigated individual differences related to such sequential decision-making and link them especially to apathy and compulsivity in a large online sample (discovery sample: n = 449 and confirmation sample: n = 756). Our cognitive model revealed distinct changes in the way participants evaluated their environments and planned their own future behaviour. Apathy was linked to decision inertia, i.e., automatically persisting with a sequence of searches for longer than appropriate given the value of searching. Thus, despite being less motivated, they did not avoid the effort associated with longer searches. In contrast, compulsivity was linked to self-reported insensitivity to the cost of continuing with a sequence of searches. The objective measures of behavioural cost insensitivity were clearly linked to compulsivity only in the discovery sample. While the confirmation sample showed a similar effect, it did not reach significance. Nevertheless, in both samples, participants reported awareness of such bias (experienced as "overchasing"). In addition, this awareness made them report preemptively avoiding situations related to the bias. However, we found no evidence of them actually preempting more in the task, which might mean a misalignment of their metacognitive beliefs or that our behavioural measures were incomplete. In summary, individual variation in distinct, fundamental aspects of sequential decision-making can be linked to variation in 2 measures of behavioural traits associated with psychological illness in the normal population.
Topics: Apathy; Decision Making; Humans; Metacognition
PubMed: 35358177
DOI: 10.1371/journal.pbio.3001566 -
Translational Psychiatry Dec 2022Apathy is a common condition that involves diminished initiative, diminished interest and diminished emotional expression or responsiveness. It is highly prevalent in... (Review)
Review
Apathy is a common condition that involves diminished initiative, diminished interest and diminished emotional expression or responsiveness. It is highly prevalent in the context of a variety of neuropsychiatric disorders and is related to poor health outcomes. Presence of apathy is associated with cognitive and functional decline in dementia. Despite its negative impact on health, there is no definitive treatment for apathy, a clinical reality that may be due in part to lack of knowledge about assessment, neuropsychological features and neurobiological underpinnings. Here, we review and synthesize evidence from clinical, epidemiological, neuropsychological, peripheral biomarker and neuroimaging research. Apathy is a common feature of depression and cognitive disorders and is associated with impairment in executive function. Neuropsychological and neuroimaging studies point to dysfunction of brain circuitry involving the prefrontal cortex, especially the dorsolateral prefrontal cortex circuit, the dorsomedial prefrontal cortex circuit, and the ventromedial prefrontal cortex circuit. However, inconsistent findings, particularly in neuroimaging may be due to heterogeneity of apathy symptoms (with a need to better elucidate subtypes), neuropsychiatric comorbidities, the severity of cognitive impairment and other factors. These factors need to be accounted for in future studies so that biomarker research can make progress. On the whole, the literature on apathy has identified likely neurocognitive, peripheral biomarker and neuroimaging targets for understanding apathy, but also points to the need to address methodological issues that will better inform future studies. In turn, as we learn more about the underpinning of apathy and its subtypes, subsequent research can focus on new neurally based interventions that will strengthen the clinical management of apathy in the context of its comorbidities.
Topics: Humans; Aged; Apathy; Depression; Brain; Cognition Disorders; Cognitive Dysfunction; Neuropsychological Tests
PubMed: 36572691
DOI: 10.1038/s41398-022-02292-3 -
Molecular Neurodegeneration Jan 2021Successful development of agents that improve cognition and behavior in Alzheimer's disease (AD) is critical to improving the lives of patients manifesting the symptoms... (Review)
Review
BACKGROUND
Successful development of agents that improve cognition and behavior in Alzheimer's disease (AD) is critical to improving the lives of patients manifesting the symptoms of this progressive disorder.
DISCUSSION
There have been no recent approvals of cognitive enhancing agents for AD. There are currently 6 cognitive enhancers in Phase 2 trials and 4 in phase 3. They represent a variety of novel mechanisms. There has been progress in developing new treatments for neuropsychiatric symptoms in AD with advances in treatment of insomnia, psychosis, apathy, and agitation in AD. There are currently 4 AD-related psychotropic agents in Phase 2 trials and 7 in Phase 3 trials. Many novel mechanisms are being explored for the treatment of cognitive and behavioral targets. Progress in trial designs, outcomes measures, and population definitions are improving trial conduct for symptomatic treatment of AD.
CONCLUSIONS
Advances in developing new agents for cognitive and behavioral symptoms of AD combined with enhanced trial methods promise to address the unmet needs of patients with AD for improved cognition and amelioration of neuropsychiatric symptoms.
Topics: Aged; Alzheimer Disease; Anxiety; Apathy; Cognition; Depression; Humans; Psychomotor Agitation
PubMed: 33441154
DOI: 10.1186/s13024-021-00424-9 -
Behavioural Neurology Jan 2013Apathy has been defined as lack of motivation. It has been traditionally considered as a symptom of psychiatric disorders, such as major depression and schizophrenia,... (Review)
Review
Apathy has been defined as lack of motivation. It has been traditionally considered as a symptom of psychiatric disorders, such as major depression and schizophrenia, but more recently it has been recognized as a specific neuropsychiatric syndrome associated with neurodegenerative such as Parkinson's disease (PD). As a consequence the reported prevalence of apathy in PD ranges from 13.9% to 70%; the mean prevalence is 35%. Prevalence of "pure apathy" (i.e., of apathy without comorbid depression and dementia) seems to be substantially lower, from 3 to 47.9%. High levels of apathy in PD are associated with decreased daily function, specific cognitive deficits and increased stress for families. Although neuroimaging studies do not provide a unique anatomic pattern, several data suggest that the ventromedial prefrontal cortex and the basal ganglia connected through frontal-subcortical circuits, are particularly involved in the genesis of apathy. At present, there are no approved medications for the treatment of apathy in and no proof of efficacy exists for any drug in current use. Further studies and innovative pharmacologic approaches are thus needed to ameliorate our understanding and treatment of apathy in PD.
Topics: Affective Symptoms; Apathy; Caregivers; Cognition Disorders; Depression; Diagnosis, Differential; Humans; Parkinson Disease; Prevalence; Quality of Life
PubMed: 23242365
DOI: 10.3233/BEN-129025 -
Neurological Sciences : Official... Apr 2024The aim of this review is to provide an overview on prevalence and clinical tools for the diagnosis of apathy, as well as on neurophysiological and neuroimaging findings... (Review)
Review
OBJECTIVES
The aim of this review is to provide an overview on prevalence and clinical tools for the diagnosis of apathy, as well as on neurophysiological and neuroimaging findings obtained from studies in patients with apathy in different forms of dementia, including Alzheimer's disease (AD), vascular (VaD) and mixed dementia, frontotemporal dementia (FTD), and Parkinson's disease dementia (PDD).
METHODS
Randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series from four databases (WebOfScience, Scopus, Pubmed, and PsycINFO) addressing apathy in adults or older people aged over 65 years of age affected by dementia were included.
RESULTS
The prevalence of apathy was 26-82% for AD, 28.6-91.7 for VaD, 29-97.5% in PDD, and 54.8-88.0 in FTD. The assessment of apathy was not consistent in the reviewed studies. Methylphenidate was the most successful pharmacological treatment for apathy. Neurobiological studies highlighted the relationship between both structural and functional brain areas and the presence or severity of apathy.
CONCLUSION
Apathy is a very common disorder in all types of dementia, although it is often underdiagnosed and undertreated. Further studies are needed to investigate its diagnosis and management. A consensus on the different evaluation scales should be achieved.
Topics: Humans; Aged; Apathy; Frontotemporal Dementia; Prevalence; Parkinson Disease; Alzheimer Disease
PubMed: 38015288
DOI: 10.1007/s10072-023-07197-7