Caregiver report of apathy predicts dementia in Parkinson's disease

Abstract

Introduction Apathy is a common, troublesome symptom in Parkinson’s disease (PD). However, little is known about its relationship with long-term cognition. We sought to determine if a caregiver-reported apathy measure predicts the development of PD dementia. Methods Non-demented PD patients were recruited as part of a longitudinal study of cognition. Demographics, medications, Dementia Rating Scale-2, Unified Parkinson’s Disease Rating Scale, Geriatric Depression Scale and the Neuropsychiatric Inventory-Questionnaire (NPI-Q) ratings were obtained. Apathy was defined as an NPI-Q apathy score ≥ 1. Participants were evaluated annually with cognitive and functional assessments until the end of the study period or a physician consensus diagnosis of dementia was assigned. Cox proportional hazard models were used to assess the effects of baseline apathy on dementia development while controlling for other clinical and demographic factors. Results Of 132 PD patients 12.1% (N=16) scored in the apathetic range at baseline. A total of 19.6% (N=26) individuals developed dementia over the course of the study, 8 of whom (30.8% of future dementia patients) had baseline apathy. In bivariate analyses baseline apathy, older age, and worse cognitive, motor, and depressive symptom scores predicted the development of dementia. In a multivariate analysis the predictive effects of baseline apathy were still significant (HR=3.56; 95% CI=1.09–11.62; p=0.04). Conclusions A simple, caregiver-reported measure of apathy is an independent predictor of progression to dementia in PD. This highlights the importance of apathy as a clinical characteristic of PD and could prove useful for the prediction of future dementia.

Apathy and Reduced Speed of Processing Underlie Decline in Verbal Fluency following DBS

“…Apathy has been identified as a harbinger of PD dementia [29, 77] and several reports have revealed higher rates of apathy in PD patients with dementia [78, 79]. The link between apathy and cognitive impairment has been explained by a diffuse pathophysiology.…”

Psychometric properties of the apathy evaluation scale in patients with Parkinson's disease

“…Apathy is one of the most prevalent neuropsychiatric symptoms in PD that is associated with cognitive decline, depression, and care dependency (den Brok et al, ; Fitts et al, ). Research is hampered by the limited availability of psychometrically well‐evaluated apathy scales for this patient group (Leentjens et al, ).…”

“…Apathy could be well discriminated from cognitive dysfunction, particularly after controlling for the influence of depression. High and low apathetic patients were reported to show differences particularly in executive functioning (Butterfield et al, ; Santangelo et al, ; Varanese, Perfetti, Ghilardi, & Di Rocco, ) and recent evidence suggests that apathy predicts cognitive decline and dementia (Dujardin, Sockeel, Delliaux, Destee, & Defebvre, ; Fitts et al, ). Present findings do not indicate a substantial relation between apathy and cognitive dysfunction in this sample of predominantly mild PD patients, but a closer relationship could be assumed with disease progression.…”

“…are associated with a worse disease progression, the development of dementia, and care-dependency (Fitts et al, 2015;Riedel et al, 2012).…”

Taking a positive spin: preserved initiative and performance of everyday activities across mild Alzheimer's, vascular and mixed dementia

“…In addition to exploring the maintenance of individual IADLs across different subtypes, a further important level of analysis concerns the breakdown of activities into their different stages. Apathy, or the lack of motivation to engage in activities, is not only associated with, but also found to be predictive of developing, dementia (Fitts et al ., ; Richard et al ., ). Therefore, investigating IADL functioning separately for the initiative to perform, and the actual performance, arguably adds valuable insights into everyday functioning abilities.…”