Recommendations for the Nonpharmacological Treatment of Apathy in Brain Disorders

Manera, Valéria; Abrahams, Sharon; Agüera-Ortíz, Luis; Brémond, François; David, Renaud; Fairchild, Karen D.; Gros, Auriane; Hanon, Cécile; Husain, Masud; König, Alexandra; Lockwood, Patricia L.; Pino, Maribel; Radaković, Ratko; Robert, Guillaume; Slachevsky, Andrea; Stella, Florindo; Tribouillard, Anaïs; Trimarchi, Pietro Davide; Verhey, Frans R.J.; Yesavage, Jerome A.; Zeghari, Radia; Robert, Philippe

doi:10.1016/j.jagp.2019.07.014

Cited by 47 publications

(42 citation statements)

References 52 publications

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“…For example, in addition to other mood and behavioral treatments (i.e., contingency management), improving motivation and self-direction and may serve as an additional buffer to enhance the likelihood of successful METH substance use treatment and relapse prevention through improving abstinence self-efficacy. Indeed, abstinence self-efficacy is an important predictor of these outcomes ( Tuliao & Liwag, 2011 ), and there is promising work emerging regarding the treatment of apathy by pharmacological and non-pharmacological means ( Manera, 2019 , Roth et al, 2007 ).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, current treatment programs addressing comorbid substance use disorder and depression with techniques such as behavioral activation ( Daughters, 2016 ) may be more efficacious if apathy was also an integrated treatment focus, particularly in METH. Though there is not yet a gold standard for apathy treatment, potential pharmacological and psychological treatments (e.g., acetylcholinesterase inhibitors, dopamine-reuptake inhibitors, and cognitive-communication therapies) are being investigated ( Manera, 2019 , Roth et al, 2007 ).…”

Section: Discussionmentioning

confidence: 99%

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Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence

Hussain

Iudicello

Morgan

et al. 2021

Addictive Behaviors Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence

Hussain

Iudicello

Morgan

et al. 2021

Addictive Behaviors Reports

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“…Apathy is a common neuropsychiatric syndrome observed across many neurocognitive and psychiatric disorders. In the study of Valeria et al [ 87 ], 20 experts reported that information and communications technology is “very appropriate” for apathy nonpharmacological treatment. Among all the studies included in this review, none of the studies using measurement tools detected changes in apathy before and after the intervention; however, we found some benefits in terms of motivation and compliance.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review

Zhao

Feng

et al. 2020

JMIR Serious Games

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Background Individuals with mild cognitive impairment and dementia have impaired physical and cognitive functions, leading to a reduced quality of life compared with those without such impairment. Exergaming, which is defined as a combination of exercise and gaming, is an innovative, fun, and relatively safe way to exercise in a virtual reality or gaming environment. Therefore, exergaming may help people living with mild cognitive impairment or dementia to overcome obstacles that they may experience regarding regular exercise and activities. Objective The aim of this systematic review was to review studies on exergaming interventions administered to elderly individuals with mild cognitive impairment and dementia, and to summarize the results related to physical and cognitive functions such as balance, gait, executive function, and episodic memory. Methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, Amed, and Nursing Database for articles published from the inception of the respective databases to January 2019. We included all clinical trials of exergaming interventions in individuals with mild cognitive impairment and dementia for review. The risk of bias was independently evaluated by two reviewers using the Cochrane Collaboration and Risk of Bias in Non-randomized Studies of Interventions tools. Results Ten studies involving 702 participants were included for review. There was consistent evidence from 7 studies with a low risk of bias showing statistically significant effects of exergaming on cognitive functioning in people with mild cognitive impairment and dementia. With respect to physical function, 3 of 5 full-scale studies found positive results, and the intensity of most games was classified as moderate. Conclusions Overall, exergaming is an innovative tool for improving physical and cognitive function in people with mild cognitive impairment or dementia, although there is high heterogeneity among studies in terms of the duration, frequency, and gaming platform used. The quality of the included articles was moderate to high. More high-quality studies with more accurate outcome indicators are needed for further exploration and validation of the benefits of exergaming for this population.

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“…39 Because of the lack of an established pharmacological treatment of apathy in DAT, nonpharmacological therapies, such as the use of information and communication technologies or occupational therapy, are still first-line recommendations. 40…”

Section: Discussionmentioning

confidence: 99%

Bupropion for the Treatment of Apathy in Alzheimer Disease

et al. 2020

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IMPORTANCE Apathy is a frequent neuropsychiatric symptom in dementia of Alzheimer type and negatively affects the disease course and patients' and caregivers' quality of life. Effective treatment options are needed. OBJECTIVE To examine the efficacy and safety of the dopamine and noradrenaline reuptake inhibitor bupropion in the treatment of apathy in patients with dementia of Alzheimer type. DESIGN, SETTING, AND PARTICIPANTS This 12-week, multicenter, double-blind, placebocontrolled, randomized clinical trial was conducted in a psychiatric and neurological outpatient setting between July 2010 and July 2014 in Germany. Patients with mild-to-moderate dementia of Alzheimer type and clinically relevant apathy were included. Patients with additional clinically relevant depressed mood were excluded. Data analyses were performed between August 2018 and August 2019. INTERVENTIONS Patients received either bupropion or placebo (150 mg for 4 weeks plus 300 mg for 8 weeks). In case of intolerability of 300 mg, patients continued to receive 150 mg throughout the study. MAIN OUTCOMES AND MEASURES Change on the Apathy Evaluation Scale-Clinician Version (AES-C) (score range, 18-72 points) between baseline and week 12 was the primary outcome parameter. Secondary outcome parameters included measures of neuropsychiatric symptoms, cognition, activities of daily living, and quality of life. Outcome measures were assessed at baseline and at 4, 8, and 12 weeks. RESULTS A total of 108 patients (mean [SD] age, 74.8 [5.9] years; 67 men [62%]) were included in the intention-to-treat analysis, with 54 randomized to receive bupropion and 54 randomized to receive placebo. The baseline AES-C score was comparable between the bupropion group and the placebo group (mean [SD], 52.2 [8.7] vs 50.4 [8.2]). After controlling for the baseline AES-C score, site, and comedication with donepezil or galantamine, the mean change in the AES-C score between the bupropion and placebo groups was not statistically significant (mean change, 2.22; 95% CI,-0.47 to 4.91; P = .11). Results on secondary outcomes showed statistically significant differences between bupropion and placebo in terms of total neuropsychiatric symptoms (mean change, 5.52; 95% CI, 2.00 to 9.04; P = .003) and health-related quality of life (uncorrected for multiple comparisons; mean change,-1.66; 95% CI,-3.01 to-0.31; P = .02) with greater improvement in the placebo group. No statistically significant changes between groups were found for activities of daily living (mean change,-2.92; 95% CI,-5.89 to 0.06; P = .05) and cognition (mean change,-0.27; 95% CI,-3.26 to (continued) Key Points Question Is bupropion an effective and safe treatment for apathy in nondepressed patients with dementia of Alzheimer type? Findings In this 12-week, multicenter, double-blind, placebo-controlled, randomized clinical trial, 54 patients received bupropion and 54 received placebo. The mean change in the Apathy Evaluation Scale-Clinician Version score was not statistically significant between the treatment groups....

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Recommendations for the Nonpharmacological Treatment of Apathy in Brain Disorders

Cited by 47 publications

References 52 publications

Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence

Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence

Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review

Bupropion for the Treatment of Apathy in Alzheimer Disease

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