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PubMed2006

Neuropsychological performance in mild cognitive impairment with and without apathy.

OBJECTIVE: To investigate the neuropsychological characteristics of patients diagnosed with mild cognitive impairment (MCI) with and without apathy. METHODS: A cohort of 245 MCI patients (mean age = 72 +/- 5.5 years; mean MMSE = 27.5 +/- 1.3) was divided into two subgroups according to their Apathy Inventory score and underwent an extensive neuropsychological battery. RESULTS: There were 94 (38.4%) patients with and 151 (61.6%) patients without apathy. At baseline the apathetic subgroup had a significantly lower total score on the free and cued selective reminding test (FCSR). Furthermore, the apathetic subgroup showed a significant deterioration in FCSR total recall score between baseline and the 1-year assessment. In conclusion, the presence of apathy in MCI patients is not associated with frontal task performance but with a higher degree of memory impairment.

Aged↗
PubMed2005

Apathy: why care?

This review presents data showing that apathy is common across a number of disorders. Apathy is not only common, but is also associated with significant problems: reduced functional level, decreased response to treatment, poor illness outcome, caregiver distress, and chronicity. Preliminary evidence of treatment efficacy exists for dopaminergic drugs and for amphetamines. Strong evidence of efficacy exists for acetylcholinesterase inhibitors in Alzheimer's disease, and for atypical antipsychotics in schizophrenia. Frontal-subcortical system(s) dysfunction is implicated in the causation of apathy; apathy subtypes based on the various frontal-subcortical loops may thus exist. Further research involving diagnosis, pathophysiology, and treatment is suggested.

Cognition Disorders↗
PubMed1995

Apathy: a treatable syndrome.

Apathy occurs frequently in neuropsychiatric disorders both as a symptom of other syndromes and as a syndrome per se. Histories are presented of patients with a syndrome of apathy who showed clinically significant, sustained benefit from pharmacological treatment. Etiologies included non-Alzheimer's frontal lobe dementia, cerebral infarction, intracranial hemorrhage, alcoholism, and traumatic brain injury. Agents included amantadine, amphetamine, bromocriptine, bupropion, methylphenidate, and selegiline. These histories support the suggestion that apathy is a discriminable dimension of behavior having its own pathophysiology and implications for psychiatric care. They raise the possibility of treatment for many patients previously thought untreatable. Studying the treatment of apathy may contribute to the clinical care and scientific understanding of neuropsychiatric disorders throughout the life span.

Adult↗
PubMed2002

Growth hormone deficiency in pituitary disease: relationship to depression, apathy and somatic complaints.

OBJECTIVE: Adults with GH deficiency (GHD) have been reported to suffer from increased levels of depression and apathy, which are thought to contribute to the reduced quality of life observed in these patients when compared with healthy controls. Recent studies, however, cast doubt on the attribution of these impairments to GHD as opposed to an unspecific stress response to the chronic medical condition. DESIGN: To further clarify this relationship, we used psychometric tests to quantify depression, apathy and typical psychosomatic complaints in patients with different types of pituitary disease and compared the results with measurements of the patients' widely varying GH status. SUBJECTS AND METHODS: In 98 patients, serum IGF-I was measured and at least one provocative test of the somatotrope pituitary axis was performed (GH-releasing hormone test (GHRHT) and/or insulin tolerance test (ITT)). All patients completed a set of well-established psychometric instruments (Beck Depression Inventory (BDI), Apathy Evaluation Scale (AS) and List of Somatic Complaints (LSC)). In addition, AS was administered in an informant report version for completion by a close relative or friend to verify the validity of the patient's self assessment. RESULTS: No relationship between measures of GHD (IGF-I, GHRHT and ITT) and psychometrically measured depression, apathy or psychosomatic well-being was found. A highly significant linear correlation between scores of all psychometric instruments (BDI, AS and LSC) was found. CONCLUSIONS: The absence of any relationship between the severity of GHD and the level of depression/apathy/psychosomatic complaints suggests that these impairments are not specific symptoms of GHD. The reported improvement of these symptoms under GH substitution therapy might thus be interpreted as a secondary effect of somatic effects of GH substitution. Consequently, indication for GH substitution therapy should not be based on psychological impairments alone without the presence of somatic symptoms of GHD.

Depression↗
PubMed2006

[Apathy in Alzheimer's disease].

Apathy is the most common neuropsychiatry syndrome in Alzheimer's disease affecting 30-60% of patients. It can be defined as a loss of motivation and manifests in affect, cognition and behavioral changes, determining blunted emotional response, lack of insight and social retraction, respectively. In this paper, the clinical features and the therapeutic perspectives of apathy are presented. There is considerable overlap between apathy and depression in Alzheimer's disease, but both are considered discrete syndromes. Pharmacological interventions for apathy include psychostimulants, such as methylphenidate, dopaminergic agents and cholinesterase inhibitors, but the results are controversial and there is no established treatment.

Alzheimer Disease↗
PubMed2002

Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.

BACKGROUND: We report a clinical trial of olanzapine in the treatment of prominent apathy in the absence of depression in patients on long-term treatment with selective serotonin reuptake inhibitors (SSRIs) for nonpsychotic major depression. METHOD: Participants were 21 men and women who met DSM-IV criteria for major depressive disorder in full remission (Montgomery-Asberg Depression Rating Scale [MADRS] score < or = 12) who had been taking an SSRI for at least 3 months. Data are presented (last observation carried forward) based on 20 enrolled participants who completed at least 1 follow-up visit. Participants had significant symptoms of apathy, defined as a Clinical Global Impressions-Severity of Illness scale (CGI-S) score > or = 3, an Apathy Evaluation Scale (AES) score > 30, and a MADRS item 8 (inability to feel) score > or = 2. Participants with a personal or family history of psychosis were excluded. Olanzapine was titrated in 2.5-mg increments at weekly intervals, until CGI-S score improved > or = 2 points from baseline or > or = 1 point with dose-limiting side effects, and participants continued in the protocol for 8 weeks at a stable dose following this improvement. RESULTS: Improvement was clinically evident and demonstrable on all symptom assessments: AES (mean +/- SD change in score = -21.3 +/- 8.7; p < .0001), CGI-S (-2.7 +/- 0.9; p < .0001), MADRS (-5.6 +/- 5.9; p = .001), and MADRS item 8 (-2.2 +/- 1.4; p < .0001). The mean dose of olanzapine was 5.4 +/- 2.8 mg/day. CONCLUSION: These preliminary data suggest that olanzapine may be effective in treating apathy syndrome in nonpsychotic patients taking SSRIs.

Adult↗
PubMed2000

Apathy in neurologic disorders.

Recent research has greatly increased our understanding of the clinical phenomenology and etiology of apathy as a distinct clinical symptom and syndrome. Several rating scales have been developed that assist in making a diagnosis of apathy. Apathy has received increasing attention as an important source of functional disability that should be considered when assessing and treating patients with neurologic disease.

Affect↗
PubMed2006

Keep music live: music and the alleviation of apathy in dementia subjects.

BACKGROUND: A recent Cochrane report concluded that more and better quality research is required to investigate the effectiveness of music therapy in reducing problems in behavioral, social, emotional and cognitive domains in patients with dementia. This randomized placebo-controlled trial with blinded observer rater aimed to explore whether music, live or pre-recorded, is effective in the treatment of apathy in subjects with moderate to severe dementia. METHODS: Thirty-two subjects meeting ICD-10 diagnostic criteria for moderate to severe dementia and fulfilling diagnostic criteria for apathy were exposed to live interactive music, passive pre-recorded music or silence for 30 minutes. Each subject was randomized to 30-minute music or silent periods and was video recorded and the muted recording analyzed every 3 minutes using dementia care mapping to assess the quality of engagement to the blinded music intervention. RESULTS: Compared to low baseline levels of positive engagement (12.5%) in the silent placebo period, the majority of subjects (69%), regardless of dementia severity, showed a significant and positive engagement to live music. Engagement to pre-recorded music was non-significant, with just 25% of all subjects showing positive engagement. No subjects showed any evidence of experiencing a state of ill-being during either the live or pre-recorded music sessions. CONCLUSIONS: During the intervention, live interactive music has immediate and positive engagement effects in dementia subjects with apathy, regardless of the severity of their dementia. Pre-recorded music is non-harmful but less clearly beneficial.

Aged↗
PubMed2005

Selegiline in the management of apathy following traumatic brain injury.

PRIMARY OBJECTIVE: To provide a brief review of apathy following traumatic brain injury (TBI) and describe the use of selegiline in a group of patients with this symptom. MAIN OUTCOME: Four patients are described who showed improvement in Apathy Evaluation Scale scores and functional improvement, following the use of selegiline. In each case, selegiline was well tolerated whereas methylphenidate was not. CONCLUSIONS: Selegiline shows potential for the management of apathy following TBI. This provides further evidence that impaired dopaminergic processes are prominent in the genesis of these symptoms. However, these findings require confirmation in controlled studies.

Adult↗
PubMed1999

Emotional activation during therapeutic interaction in traumatic brain injury: effect of apathy, self-awareness and implications for rehabilitation.

Apathy and reduced self-awareness are frequent occurring neurobehavioural sequelae following traumatic brain injury (TBI). Apathy, in terms of reduced goal directed activity and lowered motivation, and reduced self-awareness have a negative impact on the rehabilitation process. In this study, 30 patients suffering severe TBI were clinically rated for apathy and monitored for cardiovascular and electrodermal reactivity during baseline, neutral speech and therapeutic interaction. Applying a cut-off score criterion, two thirds of the TBI sample were classified as apathetic. The apathetic patients showed less psychophysiological reactivity from neutral speech to therapeutic interaction, compared to non-apathetic patients. They also reported less perceived emotional discomfort in the therapeutic situation measured with a visual analogue scale. Moreover, reduced self-awareness was associated with low autonomic reactivity. The results suggest that the reduced psychophysiological reactivity in apathetic patients may be a correlate to the lack of emotional responsivity, disengagement, lack of insight and concern about their own situation. Clinically, these results may have implications for psychotherapeutic intervention aimed at improving self-awareness. Recording psychophysiological responses during therapeutic interaction may serve as a method for monitoring emotional involvement during psychotherapy with TBI patients.

Adolescent↗
PubMed1990

Clinical assessment of irritability, aggression, and apathy in Huntington and Alzheimer disease.

Thirty-one patients with Alzheimer disease (AD) and 26 patients with Huntington disease (HD) were assessed using new scales to measure apathy and irritability. An existing scale was used to assess aggression. A similar prevalence of apathy and irritability was found in the two groups. The HD patients were more aggressive than the AD patients. In a subsample of the two groups, matched for degree of cognitive impairment, the HD patients were found to be more apathetic than the AD group. Irritability was related to be the premorbid trait of "bad temper" in HD but not in AD. There was no interrelationship among the three symptoms in either group. The scales for irritability and apathy have both interrater and test-retest reliability. They are able to differentiate patients with AD and HD from normal, disease-free control subjects. The usefulness of these scales, in relation to preexisting scales, is discussed.

Affect↗
PubMed1981

Methylphenidate in depression and states of apathy.

Methylphenidate hydrochloride (Ritalin) has been used to treat both depression and apathy. Although it can be useful for apathy, there is little reason to prefer it over a tricyclic antidepressant in the treatment of depression. Side effects and drug interactions are generally not limiting, and methylphenidate is tentatively recommended for the patient whose apathy is jeopardizing his care.

Clinical Trials as Topic↗
PubMed2006

Association between apolipoprotein E epsilon4 allele and apathy in probable Alzheimer's disease.

OBJECTIVE: There have been inconclusive results to date on the association between the Apolipoprotein E (ApoE) genotype and neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD). We investigated whether ApoE epsilon4 allele is associated with NPS in probable AD. METHOD: Data for 197 subjects with probable AD were analysed. The Neuropsychiatric Inventory was used to evaluate the frequency and severity of NPS. Multiple logistic regression models were used to test the association between ApoE genotype and NPS in AD. RESULTS: The ApoE epsilon3/3 genotype was present in 52.3%, epsilon3/4 in 44.1%, and epsilon4/4 in 3.6% of patients. ApoE epsilon4 carriers showed a higher frequency of apathy than non-carriers. After multiple adjustments, the ApoE epsilon4 allele was significantly associated with apathy. CONCLUSION: Our results suggest a relationship between the ApoE epsilon4 allele and apathy in patients with AD.

Aged↗
PubMed2006

Neuropathologic correlates of apathy in Alzheimer's disease.

Apathy is the most commonly observed behavioral disturbance in Alzheimer's disease (AD) and has been suggested to be frontally mediated. Neuritic plaque (NP) and neurofibrillary tangle (NFT) counts were performed for 8 brain regions in 29 subjects with definite AD. Neuropsychiatric Inventory (NPI) for autopsied subjects was obtained from questioning of caregivers of subjects included in the study. Chronic apathy and total NPI composite scores correlated with anterior cingulate NFT counts (r = 0.518, p = 0.01, and r = 0.438, p = 0.032). This analysis suggests that chronic apathy in AD correlates with a greater anterior cingulate NFT burden and that chronic behavioral changes are more reflective than acute changes of disease pathology.

Aged↗
PubMed1990

Differential diagnosis and classification of apathy.

This paper discusses the definition of apathy, reviews its differential diagnosis, and proposes a classification for the conditions that may produce it. Apathy is defined as diminished motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. In its differential diagnosis, abulia, akinesia and akinetic mutism, depression, dementia, delirium, despair, and demoralization must be ruled out. Classification of apathy is organized in terms of its adaptive and functional consequences, its relationship to personality or to sociocultural or environmental events, and its association with psychiatric, neurological, and medical disorders. An approach to assessment and treatment is proposed.

Akinetic Mutism↗
PubMed2004

Apathy and depression in cross-cultural survivors of traumatic brain injury.

The disturbance of motivation and its relationship to depression continues to spark contradictory findings among European and North American populations. Could a cross-cultural study shed some light on the situation? This study aims to detect the prevalence of apathy and to test whether the Apathy Evaluation Scale (AES) can spot the presence or absence of depression in survivors of traumatic brain injury (TBI) in Oman. Eighty subjects who sustained a TBI were given an Arabic version of the AES and were also interviewed with the semistructured Composite International Diagnostic Interview (CIDI). The authors found that the incidence of apathy and depression among Omani people who sustained TBI is similar to that reported elsewhere. The AES has poor discriminatory power in identifying cases of depression. These findings emphasize the importance of developing assessment tools that are culturally sensitive in light of the rising incidence of TBI in developing countries such as Oman.

Adolescent↗
PubMed2005

Apathy and pituitary disease: it has nothing to do with depression.

Increasingly, patients with pituitary disease are evaluated and treated at cancer centers. In many ways, these patients resemble patients with other malignant brain tumors. Although the majority of pituitary adenomas are benign, the physical, emotional, and cognitive changes that these patients experience on their well-being is malignant. Pituitary disease causes a variety of physical illnesses resulting from the alterations in the hypothalamic-pituitary-end organ axis. In addition, patients with pituitary diseases may experience many emotional problems, including depression, anxiety, behavioral disturbances, and personality changes, above and beyond the many reactions these patients may have to the myriad of adjustments that they must make in their lives. There is a growing understanding that pituitary patients may experience these emotional problems as a result of long-term effects that the pituitary tumor itself, treatment, and/or hormonal changes have on the hypothalamic-pituitary-end organ axis. The authors present a series of cases, in which patients with pituitary disease were diagnosed and treated for depression and showed little response to the treatment for depression. When the diagnosis of apathy syndrome was considered and treatment implemented, the patients' condition improved. A review of the literature on apathy, hypothalamic-pituitary-end organ axis dysfunction, and treatment for apathy syndrome is included.

Adenoma↗
PubMed2005

Prevalence of apathy, dysphoria, and depression in relation to dementia severity in Alzheimer's disease.

Apathy is common in Alzheimer's disease (AD) but may be confused with depression due to overlap in symptoms queried in depression assessments. Depression and dysphoria appear to occur less frequently in AD but are better researched. This study examined the relative frequency of these syndromes and their relation to disease characteristics in 131 research participants with probable or possible AD. Apathy was more prevalent than dysphoria or major depression and was more strongly associated with global disease severity, cognitive impairment, and functional deficits. Accurate differential diagnosis of apathy and depression is key to appropriate family education and effective treatment.

Aged↗