Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Apathy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed2001

Relationship of psychosis to aggression, apathy and function in dementia.

BACKGROUND: Psychosis has been associated with aggression in dementia, but the nature of this relationship has been unclear. There has been very little research into the relations between apathy and functional status to psychosis in dementia. The purpose of this study is to investigate the relationship between psychosis and aggression, apathy, and functional status in outpatients with dementia. METHODS: The presence of psychosis was assessed by clinical interview and two scales: the Neuropsychiatric Inventory and the Columbia University Scale for Psychopathology in Alzheimer's Disease. The maximum likelihood estimation technique was used to determine the best estimate of the presence of psychosis. Aggression, apathy, and functional status (activities of daily living: ADLs) were measured using structured instruments. RESULTS: Sixty-one subjects were included. The CUSPAD and NPI provided low false positive and negative rates. ANCOVA analyses showed that psychosis was significantly associated with aggression, even when controlling for apathy, depression, and ADLs. Psychosis was related to apathy only when depression was controlled for. Hallucinations were related to impaired basic ADLs, even when depression and apathy were controlled for. CONCLUSIONS: Relationships were found between psychotic symptoms in dementia and aggression as well as apathy and impaired functional status. These relationships suggest pathophysiologic mechanisms and have possible treatment implications.

Activities of Daily Living↗
PubMed2004

A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care.

BACKGROUND: Apathy is a common symptom in patients with dementia and has adverse consequences for patients and caregivers. Most treatments for apathy, particularly non-pharmacologic interventions, have not been evaluated in controlled trials. OBJECTIVES: This study evaluated the efficacy of a kit-based activity intervention, compared to a time and attention control (one-on-one meetings with an activity therapist) in reducing apathy and improving quality of life in 37 patients with dementia. METHODS: The design was a randomized, controlled, partially masked clinical trial. All outcome measures were administered at baseline and follow-up. The primary outcome measure was the apathy score of the Neuropsychiatric Inventory (NPI). Other outcome measures were the NPI total score, the Alzheimer Disease Related Quality of Life scale(ADQRL), and the Copper Ridge Activity Index (CRAI). RESULTS: There was a significant reduction in NPI apathy scores in both treatment groups. The only significant difference between the two treatment groups was a modest advantage for the control intervention on the CRAI cueing subscale (p = 0.027), but not on the other CRAI subscales. There was also a greater within group improvement in quality of life ratings in the control intervention (p=0.03). CONCLUSIONS: Despite the substantial improvement in apathy scores during the course of the study, there was no clear advantage to the reminiscence-based intervention over the time and attention, one-on-one control intervention. More research is needed to develop specific behavioral interventions for apathy in patients with dementia.

Affective Symptoms↗
PubMed2006

Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease: a one-year follow-up study.

OBJECTIVE: To evaluate the relation between apathy and development of dementia in patients with amnestic mild cognitive impairment (MCI). METHODS: Two hundred and fifty-one French-speaking outpatients fulfilling the criteria of amnestic MCI were enrolled. Apathy was assessed with the Apathy Inventory (IA). Neuropsychiatric evaluation also included the Goldberg anxiety scale and the Montgomery and Asberg Depressive Rating Scale (MADRS). The main end point considered after a 1-year follow-up was the development of dementia of Alzheimer type (DAT). RESULTS: At baseline there were 86 (39.8%) subjects presenting at least one symptom of apathy among the 216 included in analysis. After a 1-year follow-up, 22 patients developed DAT. Of the patients with apathy at baseline 13 (15.1%) developed DAT in comparison with 9 (6.9%) of the non-apathetic patients. At the 1-year follow-up, patients developing DAT had a significantly higher frequency of apathetic symptoms (91.7%) than patients without DAT (26.9%). CONCLUSION: Taking into account that apathy is one of the most frequently observed neuropsychiatric symptoms in MCI and in DAT the present study suggests that patients with MCI and apathy should be more closely observed.

Aged↗
PubMed2005

Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits.

The clinical signs grouped under the concept of apathy are a common feature of prefrontal and basal ganglia lesions or dysfunctions and can therefore help to improve our understanding of the functional anatomy of the prefrontal-basal ganglia system. Apathy is here defined as a quantitative reduction of voluntary, goal-directed behaviors. The underlying mechanisms responsible for apathy can be divided into three subtypes of disrupted processing: 'emotional-affective', 'cognitive' and 'auto-activation'. Apathy due to the disruption of 'emotional-affective' processing refers to the inability to establish the necessary linkage between emotional-affective signals and the ongoing or forthcoming behavior. It may be related to lesions of the orbital-medial prefrontal cortex or to the related subregions (limbic territory) within the basal ganglia (e.g. ventral striatum, ventral pallidum). Apathy due to the disruption of 'cognitive' processing refers to difficulties in elaborating the plan of actions necessary for the ongoing or forthcoming behavior. It may be related to lesions of the dorsolateral prefrontal cortex and the related subregions (associative territory) within the basal ganglia (e.g. dorsal caudate nucleus). The disruption of 'auto-activation' processing refers to the inability to self-activate thoughts or self-initiate actions contrasting with a relatively spared ability to generate externally driven behavior. It is responsible for the most severe form of apathy and in most cases the lesions affect bilaterally the associative and limbic territories of the internal portion of the globus pallidus. It characterizes the syndrome of 'auto-activation deficit' (also known as 'psychic akinesia' or 'athymormia'). This syndrome implies that direct lesions of the basal ganglia output result in a loss of amplification of the relevant signal, consequently leading to a diminished extraction of this signal within the frontal cortex. Likewise, apathy occurring in Parkinson's disease could be interpreted as secondary to the loss of spatial and temporal focalization of the signals transferred to the frontal cortex. In both situations (direct basal ganglia lesions and nigro-striatal dopaminergic loss), the capacity of the frontal cortex to select, initiate, maintain and shift programs of actions is impaired.

Animals↗
PubMed2005

Apathy is associated with volume of the nucleus accumbens in patients infected with HIV.

Apathy refers to a reduction in self-initiated behavior, and it is commonly reported by patients infected with human immunodeficiency virus (HIV). It remains unclear whether apathy among HIV patients reflects a direct effect of the virus on subcortical brain circuits or a secondary neuropsychiatric symptom. In the present study we examined the relationship between ratings of apathy and quantitative analysis of the nucleus accumbens (NA), a subcortical brain structure that regulates initiation of behavioral activation. Twelve HIV-positive individuals without dementia were administered the Marin Apathy Scale and underwent neuroimaging. Voxel-based quantification of the nucleus accumbens was completed using a segmentation protocol. Results of our study revealed that increased ratings of apathy were significantly correlated with lower volume of the nucleus accumbens. By contrast, ratings of depression were unrelated to either apathy or nucleus accumbens volume. These findings provide preliminary evidence that apathy reflects direct involvement of the central nervous system in patients with HIV.

Adult↗
PubMed1991

Apathy: a neuropsychiatric syndrome.

Traditionally, apathy has been viewed as a symptom indicating loss of interest or emotions. This paper evaluates evidence that neuropsychiatric disorders also produce a syndrome of apathy. Both the symptom and the syndrome of apathy are of conceptual interest because they signify loss of motivation. An apathy syndrome is defined as a syndrome of primary motivational loss, that is, loss of motivation not attributable to emotional distress, intellectual impairment, or diminished level of consciousness. Loss of motivation due to disturbance of intellect, emotion, or level of consciousness defines the symptom of apathy. Neuropsychiatric literature dealing with apathy is reviewed within the framework of three approaches to defining the concept of a syndrome. Clinical and investigative approaches for evaluating apathy when it occurs in association with other syndromes are described.

Affective Symptoms↗
PubMed1996

[Multimodal iatrogenic apathy].

The present paper reports on five patients who developed apathy as a peculiar side effect of antidepressants. Their behavioral and psychopathological changes were primarily due to the near-absence of emotional experience, a key characteristic that distinguishes apathy from avolition and abulia. The emergence of apathy in the course of an antidepressant treatment should raise the suspicion of an adverse effect of the drug and lead to its prompt withdrawal. A sample of the relevant clinical evidence favoring the distinction of apathy confined to a single sensory domain ("unimodal apathy") from apathy confined to more than one sensory realm ("multimodal apathy") is reviewed. From a pathophysiological standpoint, it would appear that neural nets centered in the amygdala-temporo polar cortex are critical for the integration of sensory perceptions and mental imagery with appropriate emotional tone and quality as well as with their accompanying somatic markers, as they receive afferents from the major projection systems of the prosencephalon and lie in nodes strategic to modify the ongoing activity of multiple parallel brain systems. The fact that one common symptom can be produced by such a heterogeneous family of substances points to a shared neurochemical mechanism of action. At present, discrete cerebral serotoninergic circuits would appear to be suitable candidates for such a role. Cases as these may be critical for the understanding of the cerebral organization of emotions in man, lending support to the notion that distinct neurochemical systems mediate discrete psychopathological symptoms.

Activities of Daily Living↗
PubMed1993

The sources of convergence between measures of apathy and depression.

Apathy and depression are discriminable but related dimensions of behavior. The purpose of this study was to evaluate the source of the overlap between measures of apathy and depression. We evaluated the intercorrelations between the Apathy Evaluation Scale (AES) and the Hamilton Rating Scale for Depression (HamD) in 107 subjects, aged 53-85, who met research criteria for normal aging, left or right cerebral hemisphere stroke, probable Alzheimer's disease, or major depression. We determined the correlation between the individual items on the HamD and the total scores on the AES and the HamD. The HamD items having the strongest correlations with AES total score were diminished work/interest, psychomotor retardation, anergy, and lack of insight. The correlation between AES and HamD total scores was nonsignificant when major depression subjects and these variables most closely related to apathy were excluded from consideration. These findings indicate that the convergence between HamD and AES is attributable to (i) a subset of HamD items which are consistent with the syndrome of apathy and (ii) the fact that major depression is associated with both apathy and depression. Clinical and research applications of these results are discussed.

Activities of Daily Living↗
PubMed1993

The sources of convergence between measures of apathy and depression.

Apathy and depression are discriminable but related dimensions of behavior. The purpose of this study was to evaluate the source of the overlap between measures of apathy and depression. We evaluated the intercorrelations between the Apathy Evaluation Scale (AES) and the Hamilton Rating Scale for Depression (HamD) in 107 subjects, aged 53-85, who met research criteria for normal aging, left or right cerebral hemisphere stroke, probable Alzheimer's disease, or major depression. We determined the correlation between the individual items on the HamD and the total scores on the AES and the HamD. The HamD items having the strongest correlations with AES total score were diminished work/interest, psychomotor retardation, anergy, and lack of insight. The correlation between AES and HamD total scores was nonsignificant when major depression subjects and these variables most closely related to apathy were excluded from consideration. These findings indicate that the convergence between HamD and AES is attributable to (i) a subset of HamD items which are consistent with the syndrome of apathy and (ii) the fact that major depression is associated with both apathy and depression. Clinical and research applications of these results are discussed.

Aged↗
PubMed2003

Apathy in schizophrenia: clinical correlates and association with functional outcome.

Apathy is considered one of the negative symptoms of schizophrenia, but its natural history and relationship to other clinical characteristics have not been systematically studied. The purpose of this cross-sectional study was to measure the level of apathy in schizophrenia and its relation to other symptoms and functional outcome. Twenty-eight patients with schizophrenia, and receiving antipsychotic treatment, were assessed with the Apathy Evaluation Scale (AES). The mean level of apathy of patients with schizophrenia, as rated by the AES, was significantly higher than that of matched healthy control subjects. In the patients, apathy was not significantly correlated with positive symptoms or depressive symptoms. It was significantly correlated with the item "emotional withdrawal" on the negative subscale of the Positive and Negative Syndrome Scale (PANSS), but was not correlated with the overall negative subscale score. Apathy was more highly associated with functional outcome than were other symptom measures, and it was independently associated with functional outcome above and beyond other negative symptoms. It was not associated with observed interest in playing a video game or performance on a simulated clerical task.

Activities of Daily Living↗
PubMed2004

Is apathy in late-life depressive illness related to age-at-onset, cognitive function or vascular risk?

BACKGROUND: Apathy has been shown to be an important feature of degenerative, vascular or traumatic brain disorder. Its presence is associated with high depression scores, higher age, low performance on frontal tasks, and more severe deep white matter hyperintensities. In late-life depression, lack of interest or motivation are often more prominent than depressed mood, especially in the late-onset type. It was hypothesized that in a heterogeneous sample of elderly depressed patients, apathy is associated with late-onset type of depression, cognitive dysfunction or vascular risk factors. METHOD: The Apathy Evaluation Scale (AES) was administered to twenty-nine elderly (> or = 60 years) inpatients with a DSM-IV major depression or dysthymic disorder. The severity of the depression was measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and cognitive function with the Mini-mental State Examination (MMSE). The presence of vascular risk factors was traced in the patient's medical records. RESULTS: Apathy was found in 86% of the patients. The AES-score was correlated with the negative symptom score, but not with total MADRS or MMSE-score. No difference in AES-score between early-onset depressed (n = 16) and late-onset depressed (n = 13) patients was found, and between patients with or without vascular risk. CONCLUSION: Apathy is a main feature of moderate to severe depressive illness in elderly patients and related to the negative symptoms of the disorder. Further studies should include less severely depressed patients and investigate the relation between depression severity and apathy.

Age of Onset↗
PubMed2006

[Psychometric properties of a German version of the Apathy Evaluation Scale].

Apathy is a common feature of a variety of different psychiatric, neurological, and medical disorders. It can be defined as lack of motivation affecting cognitive, emotional, and overt behavioural aspects. Despite being associated with other clinical disorders, apathy can also occur as an independent syndrome (e. g., after brain injuries), now depicting a primary loss of motivation. However, apathy is predominantly assessed within the scope of superordinate psychiatric disorders. As a syndrome-independent scale, the Apathy Evaluation Scale (AES) claims to assess levels of apathy in different disorders. The aim of the present study is to provide German speaking researchers with an authorized German translation of the AES (AES (D)). The scale was evaluated in a sample of 217 subjects, consisting of patients suffering from dementia (n=120), remission-phase schizophrenia (n=20), Parkinson's disease (n=12), stroke (n=28), as well as elderly healthy controls (n=37). Preliminary results concerning the factorial structure, item characteristics, reliability, and construct validity demonstrate favourable statistical properties and suggest that the AESD is comparable to its original. The scale seems well-suited to detect apathy in different clinical groups. Differences between informant sources (clinician interview, self-, and informant ratings) seem to be related to the severity of symptoms or expert practice.

Aged↗
PubMed2004

Testosterone deficiency and apathy in Parkinson's disease: a pilot study.

BACKGROUND: Low testosterone in men with Parkinson's disease may be associated with non-motor symptoms of the disease, such as apathy. OBJECTIVE: To determine the association between free serum testosterone level and apathy in elderly men with Parkinson's disease. METHODS: Consecutive non-demented patients (n = 49) and knowledgeable informants (n = 40) participated in the study. Patients and informants reported on apathy using the Frontal Systems Behavior Scale and two visual analogue scales. Patients also provided self reported symptoms of depression on the Beck depression inventory-II. Blood samples were drawn at the time of assessment to determine testosterone levels. RESULTS: A low total testosterone concentration was found in 46.9% of the patients, defined as < or = 325 ng/dl. Free testosterone was significantly correlated with both patient reported and informant reported apathy, independent of disease severity. CONCLUSIONS: Apathy is common in Parkinson's disease and is inversely correlated with free testosterone. Testosterone replacement therapy could be considered as a potential treatment for apathy in some men with Parkinson's disease. More research is needed to replicate these findings and to investigate the response to treatment.

Adult↗
PubMed1998

Apathy and hypersomnia are common features of myotonic dystrophy.

OBJECTIVES: Myotonic dystrophy is a disease characterised by myotonia and muscle weakness. Psychiatric disorder and sleep problems have also been considered important features of the illness. This study investigated the extent to which apathy, major depression, and hypersomnolence were present. The objective was to clarify if the apathy reported anecdotally was a feature of CNS involvement or if this was attributable to major depression, hypersomnolence, or a consequence of chronic muscle weakness. METHODS: These features were studied in 36 adults with non-congenital myotonic dystrophy and 13 patients with Charcot-Marie-Tooth disease. By using patients with Charcot-Marie-Tooth disease as a comparison group the aim was to control for the disabling effects of having an inherited chronic neurological disease causing muscle weakness. Standardised assessment instruments were used wherever possible to facilitate comparison with other groups reported in the medical literature. RESULTS: There was no excess of major depression on cross sectional analysis in these patients with mild myotonic dystrophy. However, apathy was a prominent feature of myotonic dystrophy in comparison with a similarly disabled group of patients with Charcot-Marie-Tooth disease (clinician rated score; Mann Whitney U test, p=0.0005). Rates of hypersomnolence were greater in the myotonic dystrophy group, occurring in 39% of myotonic dystrophy patients, but there was no correlation with apathy. CONCLUSION: These data suggest that apathy and hypersomnia are independent and common features of myotonic dystrophy. Apathy cannot be accounted for by clinical depression or peripheral muscle weakness and is therefore likely to reflect CNS involvement. These features of the disease impair quality of life and may be treatable.

Activities of Daily Living↗
PubMedDate not supplied

Relationship among activities of daily living, apathy, and subjective well-being in elderly people living alone in a rural town.

BACKGROUND: There are limited psychological data on the quality of life and activities of daily living among elderly Japanese who live alone. OBJECTIVE: The aim of this study was to examine the frequency of apathy and its correlation with activities of daily living and with subjective well-being in elderly people living alone in a depopulated rural area. METHODS: We evaluated 96 individuals aged 70 years or older (mean age 77.8 years) who lived alone at home in a rural town. To evaluate activities of daily living, apathy, and subjective well-being, the Tokyo Metropolitan Institute of Gerontology Competence Index, the Apathy Scale, and the Philadelphia Geriatric Center Morale Scale (subjective well-being scale) were used. RESULTS: Of the 96 subjects, 94 (97.9%) showed apathy. The total score of the index of activities of daily living was primarily related to age and the apathy score and less to the PGC Morale Scale score. CONCLUSION: These findings demonstrate that apathy in subjects who live alone appears to exert a marked effect on their ability to perform routine activities of daily living.

Activities of Daily Living↗
PubMed2003

Treating apathy in Alzheimer's disease.

Apathy, a syndrome of decreased initiation and motivation, affects over 70% of individuals with Alzheimer's disease (AD) and is the most common neuropsychiatric symptom reported in AD patients. The syndrome of apathy is associated with functional impairment among patients and elevated stress among their caregivers. Apathy is one of the primary neuropsychiatric manifestations of frontal system dysfunction, and AD-related apathy is thought to reflect the interaction between cholinergic deficiency and neuropathological changes in frontal brain regions. This article reviews the assessment and treatment of apathy in AD, with emphasis on the utility of acetylcholinesterase inhibitors for reducing apathy in AD. The potential benefits of other pharmacologic agents and combined pharmacologic-behavioral interventions are also discussed, and recommendations for future research are provided.

Aged↗
PubMed1992

Reliability, validity, and clinical correlates of apathy in Parkinson's disease.

The authors examined a consecutive series of 50 patients for the presence of apathy, depression, anxiety, and neuropsychological deficits using a neuropsychological battery that included a recently designed apathy scale. This scale was found to be reliable and valid in the diagnosis of apathy in patients with PD. Of patients in the study, 12% showed apathy as their primary psychiatric problem, and 30% were both apathetic and depressed. Patients with apathy (with or without depression), showed significantly more deficits in both tasks of verbal memory and time-dependent tasks. Results suggest that apathy is a frequent finding in PD, is significantly associated with specific cognitive impairments, and may have a different mechanism than depression.

Aged↗
PubMed2004

Brain perfusion correlates of the apathy inventory dimensions of Alzheimer's disease.

BACKGROUND: Apathy is defined as a lack of motivation in behavior, cognition and affect. This syndrome is frequent in various neuropsychiatric diseases but little is known about its pathophysiology. OBJECTIVES: The aim of this study was to investigate the metabolic correlates of the behavioral, cognitive and emotional, aspects of apathy in Alzheimer's disease (AD). METHOD: Thirty AD patients were included. Lack of initiative, lack of interest and of emotional blunting were assessed with the Apathy Inventory (IA), a tool designed to provide a separate assessment of the behavioral, cognitive and emotional, aspects of apathy. Brain perfusion was measured by (99m)Tc-labeled bicisate (ECD) single photon emission tomography. RESULTS: The Statistical Parametric Mapping software provides negative correlation between IA total score and brain perfusion in left and right superior orbito-frontal gyrus, and to a lesser extent in left middle frontal gyrus (BA10). Lack of initiative score was negatively correlated with perfusion in right anterior cingulate cortex. Lack of interest score was negatively correlated with perfusion in right middle orbitofrontal gyrus). Emotional blunting score correlated negatively with in left superior dorsolateral prefrontal cortex activity. CONCLUSION: These results underline that the cognitive, behavioral and affective components of motivation are mediated by different fronto-sub-cortical circuits and are differently lateralized. In particular, left prefrontal hypoperfusion is involved in emotional blunting, as it was often demonstrated in depressive disorders. These distinct components of apathy may be targeted by different therapeutic means, in which dopaminergic enhancement might play a major role.

Aged↗