Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults

Abstract

Objective Although depressive symptoms are widely recognized as a predictor of functional decline among older adults, little is known about the predictive utility of apathy in this population. We prospectively examined apathy symptoms as predictors of incident slow gait, frailty and disability among non-demented, community-dwelling older adults. Methods We examined two independent prospective cohort studies - the LonGenity study (N = 625, 53% women, mean age 75.2 years) and the Central Control of Mobility in Aging (CCMA) study (N = 312, 57% women, mean age 76.4 years). Individuals were recruited from 2008 to 2014. Apathy was assessed using 3 items from the Geriatric Depression Scale. Slow gait was defined as 1 standard deviation or more below age and sex-adjusted mean values, frailty was defined using the Cardiovascular Health Study criteria, and disability was assessed with a well-validated disability scale. Results The prevalence of apathy was 20% in LonGenity cohort and 26% in the CCMA cohort. The presence of apathy at baseline, independent of depressive symptoms (besides apathy), increased risk of developing incident slow gait (hazard ratio [HR] = 2.10; CI = 1.36–3.24; p = .001), frailty (HR = 2.86; CI = 1.96–4.16; p < .001), and disability (HR = 3.43; CI = 1.73–6.79; p < .001) in the pooled sample. These associations remained significant when accounting for demographics, medical illnesses, and cognitive function. Conclusions Apathy is associated with increased risk of developing slow gait, frailty, and disability, independent of other established risk factors, in non-demented older adults. Apathy should be screened as a potentially preventable cause of functional decline in clinical psychiatric settings.

Multidimensional Approach to Frailty

“…This risk increases with the increase in apathy. This relationship was independent of depressive symptoms even after taking into account demographic factors, health status and cognitive functioning (Ayers et al, 2017).…”

“…Since depression is a psychiatric determinant of FS, one should also mention the other relevant neuropsychiatric symptoms of apathy common in the elderly population. Apathy symptoms more likely result from damage to the fronto-subcortical pathways that manifest in declining cognitive, emotional, and motoric goal-directed behavior (Ayers et al, 2017). Although apathy in displayed symptoms resembles depression, clinically this other pronounced psychiatric condition that can occur in the absence of depression and apathy pose a certain diagnostic challenge.…”

<p>Clinical and Neurocognitive Predictors of Functional Outcome in Depressed Patients with Partial Response to Treatment: One Year Follow-Up Study</p>

“…4 Some authors have found a significant association between depression and disability. 5,6 Cognitive dysfunction represents a distinct biological and clinical dimension in MDD. It is well known that cognitive performance strongly affects psychosocial functioning and, particularly, working ability in patients diagnosed with MDD 7 as well as with bipolar disorder.…”

Chapter 1 Frailty: Definition, diagnosis, epidemiology

“…Prevalence was 21.6% among the 777 individuals (mean age 76.5 years) receiving outpatient care for a chronic disease. 12 As for the prevalence of frailty in nursing homes, a review of the literature by Kojima showed that as many as 46…”

“…As for the psychological risk factors, a review by Vaughan et al 45 highlighted the significance of depression, and a review by Ayers et al found apathy to be another risk factor. 46 Monin et al reported a partner effect whereby an individual's frailty predicted the spouse's frailty. 47 Other physical factors reported to be significantly associated with incident frailty include hearing impairment, 48 chronic widespread pain 49 and polypharmacy 50,51 (see CQ37).…”