Natural History of Poststroke Apathy During Acute Rehabilitation

Abstract

To better understand the natural history of post-stroke apathy, the authors tested 96 patients undergoing acute rehabilitation for stroke using the Apathy Inventory (AI). 28% of patients had apathy, and their AI scores improved on average 1 point by week 2 and 2 points by week 3 with the majority apathetic at discharge. Apathy severity correlated with aphasia, weakness, and impaired cognition, but not with depression. The findings suggest that acute rehabilitation is an optimal setting for clinical trials for post-stroke apathy because apathy is associated with poor outcomes and shows only a small degree of spontaneous improvement.

Quantifying Poststroke Apathy With Actimeters

“…Previous studies have found that patients with post-stroke apathy recover slower during acute rehabilitation {2; 3; 17; 18}. Here we confirmed this finding as apathy severity correlated with change in FIM from admission to discharge (Pearson r = −0.44, p-value <0.001).…”

“…Our finding that apathy correlates with less recovery of disability (FIM) during rehabilitation stay is consistent with other studies {2; 3; 17; 18}. The mechanism by which apathy affects recovery is not clear.…”

“…Note that this does not reflect the demographics of the population at this hospital as reported in {3}, but rather reflects our attempt to obtain data on a similar number of subjects with versus without apathy. Apathetic and non-apathetic subjects were well matched on age and gender, but those with apathy were generally more disabled from their stroke and had less recovery during their stay in rehabilitation (Table 1).…”

“…This could include measures of fatigue and sleepiness, pain, or other measures of motivation. Further data should also come from inpatient and outpatient populations over longer periods of time, to determine if movement amount is stable, and if it correlates with the change in apathy severity that occurs in some patients naturally over time {3; 23}. Actimeters could be used as low-cost exploratory outcome measures in clinical trials of apathy treatments in a variety of conditions.…”

Apathy, Cognitive Impairment, and Social Support Contribute to Participation in Cognitively Demanding Activities Poststroke

“…Stroke is the leading cause of complex disability in the United States with an additional 3.4 million US adults projected to have a stroke by 2030 [1]. Stroke leads to lasting impairments in physical, emotional, cognitive, and language domains [2][3][4] that can negatively impact long-term participation, resumption of meaningful occupations, and quality of life (e.g., [5,6]). To individuals, stroke recovery is synonymous with resuming participation in meaningful prestroke activities and reintegrating into normal living [7].…”