Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group

Robert, Philippe; Lanctôt, Krista L.; Agüera-Ortíz, Luis; Aalten, Pauline; Brémond, François; Defrancesco, Michaela; Hanon, Cécile; David, Renaud; Dubois, Bruno; Dujardin, Kathy; Husain, Masud; König, Alexandra; Lévy, Richard; Mantua, Valentina; Meulien, Didier; Miller, David S.; Moebius, Hans J; Rasmussen, J.; Robert, Guillaume; Ruthirakuhan, Myuri; Stella, Florindo; Yesavage, Jerome A.; Zeghari, Radia; Manera, Valéria

doi:10.1016/j.eurpsy.2018.07.008

Cited by 229 publications

(211 citation statements)

References 41 publications

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“…General level of activity: The patient has a reduced level of activity either at home or work, makes less effort to initiate or accomplish tasks spontaneously, or needs to be prompted to perform them. 18 The order of filling in the two DCA versions was randomized across subjects. Making choices: He/she has less interest or takes longer to make choices when different alternatives exist (eg, selecting TV programs, preparing meals, and choosing from a menu).…”

Section: Key Pointsmentioning

confidence: 99%

“…In the Nice center, for 52 subjects, clinicians were asked to fill in both the 2009 DCA 16 and the 2018 DCA. 18 The order of filling in the two DCA versions was randomized across subjects. A P value less than .05 was considered significant.…”

Section: Key Pointsmentioning

confidence: 99%

“…The subgroup in which subjects were classified based on the two versions of the DCA 16,18 was composed by 52 subjects (29 females and 23 males; mean age = 74.6 years, SD = 7.9 years; and two with SCD, 31 with Mild NCD, 15 with Major NCD, and four with Aff D), 20 of whom were classified as DCA+ based on the 2018 DCA (38.5%).…”

Section: Comparison Between the 2009 Dca And The 2018 Dcamentioning

confidence: 99%

“…11,12 Apathy can be found also in healthy elderly people with subjective cognitive decline (SCD), a condition characterized by self-reported cognitive problems in absence of objective cognitive dysfunction, 13 and in a minor percentage of healthy young adults. 18 The 2018 DCA are reported in Table 1. 18 The 2018 DCA are reported in Table 1.…”

Section: Introductionmentioning

confidence: 99%

“…In the last decade, there have been considerable advances in the domain of apathy, including its biological and neural bases, 17 which led a group of experts to propose a revision of the 2009 DCA. 18 The 2018 DCA are reported in Table 1. The 2018 DCA keep the same structure (criteria A to D) compared with the 2009 DCA.…”

Section: Introductionmentioning

confidence: 99%

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A survey on the prevalence of apathy in elderly people referred to specialized memory centers

Manera

Fabre

Stella

et al. 2019

Int J Geriat Psychiatry

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Background Apathy is a pervasive neuropsychiatric syndrome in people with neurocognitive and psychiatric disorders. The diagnostic criteria for apathy (DCA) have been revised in 2018. Objectives Employing the 2018 DCA, in the present study, we investigated in groups of elderly subjects suffering from different neuropsychiatric disorders (a) the apathy prevalence; (b) the most commonly affected apathy dimensions (behavior/cognition, emotion, and social interaction); (c) the sensitivity and specificity of those dimensions for apathy diagnosis; and (d) the concurrent validity of 2018 DCA compared with the 2009 DCA. Methods This multicenter survey included 166 subjects. Each center checked the presence of apathy in subjects belonging to the following DSM‐5 diagnoses: mild neurocognitive disorders (mild NCDs); major NCDs; affective disorders (Aff D); and subjective cognitive decline (SCD). Results The frequency of apathy varied significantly based on the diagnostic groups (0% of subjects with apathy in the SCD group; 25% in the mild NCD group; 77% in the major NCD group; and 57% in the Aff. D group). All subjects with apathy fulfilled the criteria for the behavior/cognition dimension, 73.1% fulfilled the criteria for the emotion dimension, and 97.4% fulfilled the criteria for the social interaction dimension. Behavior/cognition showed the highest sensitivity, the copresence of emotion and social interaction the highest specificity. The concordance between the 2009 and the 2018 DCA indicated an almost perfect agreement. Conclusions These results are consistent with previous reports and confirm that the social interaction dimension added to the 2018 DCA is present in most of subjects with apathy referred to specialized memory centers.

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Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Comparison Between the 2009 Dca And The 2018 Dcamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A survey on the prevalence of apathy in elderly people referred to specialized memory centers

Manera

Fabre

Stella

et al. 2019

Int J Geriat Psychiatry

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Comparison of Functional and Structural Neural Network Features in Older Adults With Depression With vs Without Apathy and Association With Response to Escitalopram

et al. 2022

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IMPORTANCEApathy is prevalent among individuals with late-life depression and is associated with poor response to pharmacotherapy, including chronicity and disability. Elucidating brain networks associated with apathy and poor treatment outcomes can inform intervention development. OBJECTIVES To assess the brain network features of apathy among individuals with late-life depression and identify brain network abnormalities associated with poor antidepressant response. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a single-group, open-label nonrandomized clinical trial of escitalopram conducted at an outpatient geriatric psychiatry clinic enrolled 40 adults aged 59 to 85 years with major depressive disorder from July 1, 2012, to July 31, 2019. INTERVENTIONS After a 2-week washout period, participants received escitalopram titrated to a target of 20 mg/d for 12 weeks. MAIN OUTCOMES AND MEASURES Baseline and posttreatment magnetic resonance imaging (MRI), clinical, and cognitive assessments were conducted. Functional MRI was used to map group differences in resting state functional connectivity (rsFC) of the salience network, and diffusion MRI connectometry was performed to evaluate pathway-level disruptions in structural connectivity. The Apathy Evaluation Scale was used to quantify apathy, and the Hamilton Depression Rating Scale (HAM-D) was used to quantify the primary outcome of depression severity. RESULTS Forty participants (26 women [65%]; mean [SD] age, 70.0 [6.6] years [range, 59-85 years]) with depression were included; 20 participants (50%) also had apathy. Relative to nonapathetic participants with depression, those with depression and apathy had lower rsFC of salience network seeds with the dorsolateral prefrontal cortex (DLPFC), premotor cortex, midcingulate cortex, and paracentral lobule and greater rsFC with the lateral temporal cortex and temporal pole (z score >2.7; Bonferroni-corrected threshold of P < .0125). Compared with participants without apathy, those with apathy had lower structural connectivity in the splenium, cingulum, and fronto-occipital fasciculus (t score >2.5; false discovery rate-corrected P = .02). Twenty-seven participants completed escitalopram treatment; 16 (59%) achieved remission (HAM-D score <10). Lower insula-DLPFC/midcingulate cortex rsFC was associated with less symptomatic improvement (HAM-D % change) (β [df] = 0.588 [26]; P = .001) and a higher likelihood of nonremission (odds ratio, 1.041 [95% CI, 1.003-1.081]; P = .04) after treatment and, in regression models, was a mediator of the association between baseline apathy and persistence of depression.(continued) Key Points Question What are the brain network features of apathy in late-life depression, and how are they associated with treatment outcomes? Findings In this secondary analysis of a 12-week nonrandomized single-group trial of escitalopram titrated to 20 mg/d, compared with 20 older adults with depression without apathy, 20 older adults with depression and apathy showed distinct alterations in ne...

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Diagnostic criteria for apathy in neurocognitive disorders

Miller¹,

Robert

Ereshefsky³

et al. 2021

Alzheimer's & Dementia

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Introduction:Apathy is common in neurocognitive disorders (NCD) but NCD-specific diagnostic criteria are needed. Methods: The International Society for CNS Clinical Trials Methodology Apathy WorkGroup convened an expert group and sought input from academia, health-care, industry, and regulatory bodies. A modified Delphi methodology was followed, and included an extensive literature review, two surveys, and two meetings at international conferences, culminating in a consensus meeting in 2019. Results:The final criteria reached consensus with more than 80% agreement on all parts and included: limited to people with NCD; symptoms persistent or frequently recurrent over at least 4 weeks, a change from the patient's usual behavior, and including one of the following: diminished initiative, diminished interest, or diminished emotional expression/responsiveness; causing significant functional impairment and not exclusively explained by other etiologies.Discussion: These criteria provide a framework for defining apathy as a unique clinical construct in NCD for diagnosis and further research.

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Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group

Abstract: The new diagnostic criteria for apathy provide a clinical and scientific framework to increase the validity of apathy as a clinical construct. This should also help to pave the path for apathy in brain disorders to be an interventional target.

Cited by 229 publications

References 41 publications

A survey on the prevalence of apathy in elderly people referred to specialized memory centers

A survey on the prevalence of apathy in elderly people referred to specialized memory centers

Comparison of Functional and Structural Neural Network Features in Older Adults With Depression With vs Without Apathy and Association With Response to Escitalopram

Diagnostic criteria for apathy in neurocognitive disorders

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