Psychometric Properties of Apathy Scales in Dementia: A Systematic Review

Mohammad, Dana; Ellis, Courtney; Rau, Allison; Rosenberg, Paul B.; Mintzer, Jacobo; Ruthirakuhan, Myuri; Herrmann, Nathan; Lanctôt, Krista L.

doi:10.3233/jad-180485

Cited by 21 publications

(20 citation statements)

References 57 publications

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“…Future studies will have the opportunity to disentangle the contribution of each apathy sub-type by using appropriate clinical instruments, which give more detail than the NPI. Although the NPI is among the scales most often used to assess apathy in AD, other validated instruments relying on a different methodology exist, such as the Apathy Evaluation Scale (Mohammad et al, 2018). Three versions of this scale exist, and a study carried out in healthy adults and patients with MCI found a significant association between clinician-rated levels of apathy and thickness of the inferior temporal cortex (Guercio et al, 2015), a region that is not part of the theoretical frameworks this study is based upon.…”

Section: Discussionmentioning

confidence: 99%

“…The Neuropsychiatric Inventory (NPI) 2 is a quantitative scale which estimates presence, frequency and severity of twelve psychiatric symptoms (listed in Table 1) from the point of view of a caregiver (Cummings, 1997). It is among the clinical instruments most often used to assess the presence of apathy in AD (Mohammad et al, 2018), and has adequate levels of test-retest reliability (Kaufer et al, 2000). The informants were asked to complete the entire NPI but, for the purpose of this study, only the apathy section of the questionnaire was used as predictor for inferential modelling.…”

Section: 2measurement Of Apathy and Other Neuropsychiatric Symptomsmentioning

confidence: 99%

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Altered frontal and insular functional connectivity as pivotal mechanisms for apathy in Alzheimer's disease

Jones

Marco

Manca

et al. 2019

Cortex

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Background: Apathy is a common and early symptom in Alzheimer's disease (AD) and is linked to poorer prognosis. Theoretical interpretations of apathy implicate alterations of connections amongst fronto-striatal and limbic regions. Objective: To test the association between presence of apathy and patterns of brain functional connectivity in patients with clinically-established AD. Methods: Seventy AD patients were included. Thirty-five patients experienced apathy as defined by the screening question of the Neuropsychiatric Inventory, and thirty-five did not. All patients agreed to undergo an MRI protocol inclusive of resting-state acquisitions. The hemodynamic-dependent signal was extracted bilaterally from five regions of interest: ventromedial prefrontal cortices, anterior cingulate cortices, dorsolateral prefrontal cortices, insulae and amygdalae. t tests were run to compare connectivity maps of apathetic and nonapathetic patients. Age, education, Mini Mental State Examination score, gray matter volumes and gray matter fractions served as covariates. Results: At a pFWE < 0.05 threshold, apathetic patients had reduced connectivity between the left insula and right superior parietal cortex. Apathetic patients had also increased connectivity between the right dorsolateral prefrontal seed and the right superior parietal cortex. Patients with apathy were significantly more likely to experience other psychiatric symptoms. Conclusion: Our findings support a role of frontal and insular connections in coordinating value-based decisions in AD. Both down-regulation and maladaptive up-regulation mechanisms appear to be at play in these regions.

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Section: Discussionmentioning

confidence: 99%

Section: 2measurement Of Apathy and Other Neuropsychiatric Symptomsmentioning

confidence: 99%

Altered frontal and insular functional connectivity as pivotal mechanisms for apathy in Alzheimer's disease

Jones

Marco

Manca

et al. 2019

Cortex

View full text Add to dashboard Cite

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“…A general trend toward the use of Apathy Evaluation Scale (AES) and/or the aNPI have been reported. 5,34,35 A few studies have shown a positive correlation between aNPI and AES score in patients with AD. 5,10,34 In order to identify and quantify apathy, we used aNPI that is equally sensitive and less time consuming compared to AES 34,36 and is more widely used in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Association Between CSF Beta-Amyloid and Apathy in Early-Stage Alzheimer Disease

Vergallo

Giampietri

Pagni

et al. 2019

J Geriatr Psychiatry Neurol

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Aim: The apathetic syndrome is a common clinical feature in patients with Alzheimer diseases (AD), from preclinical phases to late stages of dementia, and it is strongly related to major disease outcomes. Unfortunately, no specific pharmacological treatments for apathy have been accomplished so far. Translational evidences have previously shown that a link between apathy and hallmarks of AD-related pathophysiology, that is, b-amyloid (Ab) plaques and neurofibrillary tangles, exists. However, only few studies investigated the association between core biomarkers of AD and apathy scores, finding conflicting results. Methods: Thirty-seven patients were identified as having AD dementia according to National Institute on Aging-Alzheimer Association 2011 criteria. All participants underwent an extensive diagnostic workup including cerebrospinal fluid (CSF) assessment to measure the concentrations of Ab 42 , t-tau, and pTau 181. To follow, they were stratified as: apathy absence, apathy mild, and apathy severe according to the Neuro Psychiatric Inventory-apathy item scores. We investigated for potential associations between apathy scores and CSF biomarkers concentrations as well as for differences in terms of clinical and CSF biomarkers data across the 3 apathy groups. Results: The CSF Ab 42 concentrations were negatively correlated with apathy scores. In addition, patients with severe apathy had significantly lower Ab 42 levels compared to nonapathetic ones. Conclusion: Based on our results, we encourage further studies to untangle the potential association between the complex pathophysiological dynamics of AD and apathy which may represent an innovative reliable clinical outcome measure to use in clinical trials, investigating treatments with either a symptomatic or a disease-modifying effect.

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“…It is the most frequent behavioral syndrome in neurological and psychiatric diseases, such as Alzheimer's disease (AD), Parkinson's disease, stroke and schizophrenia (3–10). Apathy is usually assessed by questionnaires (scales) administered to the patient and/or caregiver and providing information about the patient's internal state, thoughts and past activities, globally suggesting a loss of motivation to perform daily activities (11, 12). However, these scales are biased by the subjective nature of the patient or caregiver's perspective (13).…”

Section: Introductionmentioning

confidence: 99%

Exploration Deficits Under Ecological Conditions as a Marker of Apathy in Frontotemporal Dementia

et al. 2019

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Apathy is one of the six clinical criteria for the behavioral variant of frontotemporal dementia (bvFTD), and it is almost universal in this disease. Although its consequences in everyday life are debilitating, its underlying mechanisms are poorly known, its assessment is biased by subjectivity and its care management is very limited. In this context, we have developed “ECOCAPTURE,” a method aimed at providing quantifiable and objective signature(s) of apathy in order to assess it and identify its precise underlying mechanisms. ECOCAPTURE consists of the observation and recording of the patient's behavior when the participant is being submitted to a multiple-phase scenario reproducing a brief real-life situation. It is performed in a functional exploration platform transformed into a fully furnished waiting room equipped with a video and sensor-based data acquisition system. This multimodal method allowed video-based behavior analyses according to predefined behavioral categories (exploration behavior, sustained activities or inactivity) and actigraphy analyses from a 3D accelerometer. The data obtained were also correlated with behavioral/cognitive tests and scales assessing global cognitive efficiency, apathy, cognitive disinhibition, frontal syndrome, depression and anxiety. Here, bvFTD patients (n = 14) were compared to healthy participants (n = 14) during the very first minutes of the scenario, when the participants discovered the room and were encouraged to explore it. We showed that, in the context of facing a new environment, healthy participants first explored it and then engaged in sustained activities. By contrast, bvFTD patients were mostly inactive and eventually explored this new place, but in a more irregular and less efficient mode than normal subjects. This exploration deficit was correlated with apathy, disinhibition and cognitive and behavioral dysexecutive syndromes. These findings led us to discuss the presumed underlying mechanisms responsible for the exploration deficit (an inability to self-initiate actions, to integrate reward valuation and to inhibit involuntary behavior). Altogether, these results pave the way for simple and objective assessment of behavioral changes that represents a critical step for the evaluation of disease progression and efficacy of treatment in bvFTD.

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Psychometric Properties of Apathy Scales in Dementia: A Systematic Review

Cited by 21 publications

References 57 publications

Altered frontal and insular functional connectivity as pivotal mechanisms for apathy in Alzheimer's disease

Altered frontal and insular functional connectivity as pivotal mechanisms for apathy in Alzheimer's disease

Association Between CSF Beta-Amyloid and Apathy in Early-Stage Alzheimer Disease

Exploration Deficits Under Ecological Conditions as a Marker of Apathy in Frontotemporal Dementia

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