Impact of apathy on health‐related quality of life in recently diagnosed Parkinson's disease: The ANIMO study

Benito‐León, Julián; Cubo, Esther; Coronell, Carlos

doi:10.1002/mds.23872

Cited by 113 publications

(105 citation statements)

References 32 publications

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“…In the present study we also observed a trend for improvement in quality of life, which, in the absence of motor improvement, is likely related to the improvement of apathy, which is one of the key factors of reduced quality of life in patients with Parkinson's disease (Schrag et al, 2000;Chaudhuri and Schapira, 2009;Barone et al, 2010;Benito-Leon et al, 2012). However, in this relatively small series, this improvement did not reach significance level.…”

Section: Discussioncontrasting

confidence: 39%

Parkinsonian apathy responds to dopaminergic stimulation of D2/D3 receptors with piribedil

Thobois

Lhommée

Klinger

et al. 2013

Brain

226

177

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Apathy is one of the most common symptoms encountered in Parkinson's disease, and is defined as a lack of motivation accompanied by reduced goal-directed cognition, behaviour and emotional involvement. In a previous study we have described a delayed withdrawal syndrome after successful motor improvement related to subthalamic stimulation allowing for a major decrease in dopaminergic treatment. This withdrawal syndrome correlated with a diffuse mesolimbic dopaminergic denervation. To confirm our hypothesis of parkinsonian apathy being related to mesolimbic dopaminergic denervation, we performed a randomized controlled study using piribedil, a relatively selective D2/D3 dopamine agonist to treat parkinsonian apathy, using the model of postoperative apathy. A 12-week prospective, placebo-controlled, randomized, double-blinded trial was conducted in 37 patients with Parkinson's disease presenting with apathy (Starkstein Apathy Scale score 4 14) following subthalamic nucleus stimulation. Patients received either piribedil up to 300 mg per day (n = 19) or placebo (n = 18) for 12 weeks. The primary end point was the improvement of apathy under treatment, as assessed by the reduction of the Starkstein Apathy Scale score in both treatment groups. Secondary end points included alleviation in depression (Beck Depression Inventory), anxiety (Beck Anxiety Inventory), improvement of quality of life (PDQ39) and anhedonia (Snaith-Hamilton Pleasure Scale). Exploratory endpoints consisted in changes of the Robert Inventory score and Hamilton depression scales. An intention to treat analysis of covariance analysis was performed to compare treatment effects (P 5 0.05). The number of premature study dropouts was seven in the placebo and five in the piribedil groups, mostly related to intolerance to hypodopaminergic symptoms. At follow-up evaluation, the apathy score was reduced by 34.6% on piribedil versus 3.2% on placebo (P = 0.015). With piribedil, modifications in the Beck depression and anxiety scores were À19.8% and À 22.8%, respectively versus + 1.4% and À 8.3% with placebo, without reaching significance level. Piribedil led to a trend towards improvement in quality of life ( À 16.2% versus + 6.7% on placebo; P = 0.08) and anhedonia (À 49% versus À 5.6% on the placebo; P = 0.08). Apathy, assessed by the Robert Inventory score, improved by 46.6% on piribedil and worsened by 2.3% on placebo (P = 0.005). Depression, measured by the Hamilton score, improved in the piribedil group (P = 0.05). No significant side effects were observed. The present study provides a class II evidence of the efficacy of the dopamine agonist piribedil in the treatment of apathy in Parkinson's disease.

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Section: Discussioncontrasting

confidence: 39%

Parkinsonian apathy responds to dopaminergic stimulation of D2/D3 receptors with piribedil

Thobois

Lhommée

Klinger

et al. 2013

Brain

226

177

View full text Add to dashboard Cite

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“…There were no treatment interventions during the course of this study. The ANIMO (Spanish word for 'good spirit') Group was formed in 2007 by a group of Spanish neurologists with expertise in PD [6] . We sampled a series of patients from 102 Spanish PD outpatient clinics from October 2008 to June 2009.…”

Section: General Study Designmentioning

confidence: 99%

Clinical Correlates of Apathy in Patients Recently Diagnosed with Parkinson’s Disease: The ANIMO Study

Cubo¹,

Benito‐León²,

Coronell

et al. 2012

Neuroepidemiology

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Objective: Little is known about apathy in the early stages of Parkinson’s disease (PD). We determined the clinical correlates of apathy in a large representative sample of patients recently diagnosed with PD (ANIMO study). Methods: PD patients, diagnosed within 2 years of inclusion, were recruited in 102 outpatient clinics situated in 82 populations throughout Spain. Apathy was quantified using the Lille Apathy Rating Scale (LARS). Clinical comparisons and correlations were performed using nonparametric tests. Regression analyses were used to test the association of clinical variables with apathy. Results: We recruited 557 PD patients (60.3% men) with a mean age of 68.8 ± 9.7 years, and UPDRS motor score of 21.1 ± 10.8. Apathy only was diagnosed in 186 (33.4%), and apathy and depression in 215 patients (38.6%). Patients with higher comorbidity (OR = 1.10, 95% CI 1.01–1.20, p = 0.001), motor impairment (OR = 1.07, 95% CI 1.03–1.10, p < 0.0001), and lower education (OR = 2.16, 95% CI 1.21–3.85, p = 0.009) had higher odds of having apathy, in contrast to patients living in a rural environment (OR = 0.35, 95% CI 0.32–0.85, p = 0.01), and left predominant PD motor laterality (OR = 0.34, 95% CI 0.13–0.88, p = 0.01). LARS scores were significantly correlated with UPDRS motor scores (r_s = 0.44, p < 0.001), predominantly with axial score (r_s = 0.43, p < 0.001). Conclusions: In PD, apathy is a very common and disabling nonmotor symptom separable from depression. Patients living in a rural environment, with lower comorbidity and motor impairment, higher education background, and left predominant PD motor laterality are at lower risk of suffering from apathy.

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“…In the present issue a review by Santangelo et al [16] specifically addressed apathy, i.e. lack of motivation, that is associated with decreased daily function, and increased stress for families [5,17]. Apathy 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 diseases such as PD.…”

mentioning

confidence: 99%

Towards a Deeper Comprehension of Relationships among Cognitive, Behavioral and Psychiatric Symptoms in Parkinson’s Disease

Trojano

Santangelo

Conson

et al. 2013

Behavioural Neurology

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Parkinson's Disease (PD) is nowadays considered as a complex clinical condition in which motor symptoms coexist with several non-motor symptoms. A growing body of literature has addressed non-motor symptoms in PD [1], that are progressively being recognized as a potential source of distress for patients and their families, even greater than that imposed by the well-known motor impairments [2][3][4].The aim of this special issue was to gather together studies providing new findings about a specific subset of non-motor symptoms in PD: cognitive, behavioural and psychological disturbances, that are likely those with the highest impact on patient's daily life [5,6]. Within this framework we collected papers addressing neuropsychological defects (particularly frontal dysfunctions and dysexecutive syndromes) and neuropsychiatric disorders (such as hallucinations, depression and apathy, compulsive behavior), and highlighting the possible relationships of these symptoms with pharmacological treatment, and, above all, with each other.In the present issue a review by Friedman et al.[7] addressed occurrence of psychosis and hallucinations in PD. Psychotic symptoms are common in drug treated PD patients: visual hallucinations (VH) have been reported to occur in about 30%, whereas delusions, typically paranoid in nature, occur in about 5%. These

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Impact of apathy on health‐related quality of life in recently diagnosed Parkinson's disease: The ANIMO study

Cited by 113 publications

References 32 publications

Parkinsonian apathy responds to dopaminergic stimulation of D2/D3 receptors with piribedil

Parkinsonian apathy responds to dopaminergic stimulation of D2/D3 receptors with piribedil

Clinical Correlates of Apathy in Patients Recently Diagnosed with Parkinson’s Disease: The ANIMO Study

Towards a Deeper Comprehension of Relationships among Cognitive, Behavioral and Psychiatric Symptoms in Parkinson’s Disease

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