Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders

Centre Mémoire de Ressources et de Recherche, CHU de Nice, Nice, France.
European Psychiatry (Impact Factor: 3.44). 03/2009; 24(2):98-104. DOI: 10.1016/j.eurpsy.2008.09.001
Source: PubMed


There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer's disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here. The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer's Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria. Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy.

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    • "Of the three factors we identified, the interest and motivation factor had the strongest signal in the various analyses. Of note, two of our factors ( " interest and motivation " and " task completion " ) correspond to the proposed diagnostic criteria for apathy, which include the core feature of decreased motivation, as well as the dimension of reduced goal-directed activity ; the third criterion of functional impairment was not clearly captured in our subjects since they were CN elderly or had MCI and therefore lacked significant functional impairment [70]. The current study has several notable limitations. "
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    ABSTRACT: Background: Apathy is a common neuropsychiatric symptom in Alzheimer's disease (AD) dementia and mild cognitive impairment (MCI). Detecting apathy accurately may facilitate earlier diagnosis of AD. The Apathy Evaluation Scale (AES) is a promising tool for measurement of apathy in prodromal and possibly preclinical AD. Objective: To compare the three AES sub-scales- subject-reported (AES-S), informant-reported (AES-I), and clinician-reported (AES-C)- over time in individuals at risk for AD due to MCI and advanced age (cognitively normal [CN] elderly). Methods: Mixed effects longitudinal models were used to assess predictors of score for each AES sub-scale. Cox proportional hazards models were used to assess which AES sub-scales predict progression from MCI to AD dementia. Results: Fifty-seven MCI and 18 CN subjects (ages 53-86) were followed for 1.4 ± 1.2 years and 0.7 ± 0.7 years, respectively. Across the three mixed effects longitudinal models, the common findings were associations between greater apathy and greater years in study, a baseline diagnosis of MCI (compared to CN), and male gender. CN elderly self-reported greater apathy compared to that reported by informants and clinicians, while individuals with MCI under-reported their apathy compared to informants and clinicians. Of the three sub-scales, the AES-C best predicted transition from MCI to AD dementia. Conclusion: In a sample of CN elderly and elderly with MCI, apathy increased over time, particularly in men and those with MCI. AES-S scores may be more sensitive than AES-I and AES-C scores in CN elderly, but less reliable if subjects have MCI. Moreover, the AES-C sub-scale predicted progression from MCI to AD dementia.
    Journal of Alzheimer's disease: JAD 09/2015; 47(2):421-432. DOI:10.3233/JAD-150146 · 4.15 Impact Factor
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    • "To identify clinically significant apathy, a clinical interview based on diagnostic criteria for apathy [8] and the self-rated version of Apathy Evaluation Scale (AES-S), validated in PD [9], were administrated. AES-S consists of 18 items; all items are scored on 4-point Likert scale with the following descriptors: not at all true, slightly true, somewhat true, very true. "
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    ABSTRACT: Apathy is a neuropsychiatric symptom in Parkinson's Disease (PD) which has a negative impact on quality of life and might be related in part to damage of presynaptic dopaminergic system. Little is known about relationship between striatal dopamine levels and apathy in PD patients without dementia and/or depression. The aim of the present study was to investigate the relationship between "pure apathy" and striatal dopamine uptake in untreated, drug-naïve PD patients without clinically significant dementia and/or depression. Fourteen PD patients with pure apathy and 14 PD patients without apathy, matched for age, side of motor symptoms at onset, motor disability and disease duration, underwent both neuropsychological and behavioral examination including self-rated version of the Apathy Evaluation Scale (AES-S). All patients underwent 123 I-FP-CIT (DaT-SCAN) SPECT to assess dopamine transporter (DAT) striatal uptake. PD patients with apathy showed lower DAT levels in the striatum than non-apathetic patients. After Bonferroni correction the difference between groups was significant in the right caudate. Apathy is associated with reduced striatal dopamine transporter levels, independent of motor disability and depression in non-demented PD patients. These findings suggest that dysfunction of dopaminergic innervation in the striatum and particularly in the right caudate may contribute to development of apathy in early PD. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Parkinsonism & Related Disorders 02/2015; 21(5). DOI:10.1016/j.parkreldis.2015.02.015 · 3.97 Impact Factor
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    • "For the purpose of standardization, we employed receiver-operating characteristic (ROC) curve analysis, using diagnostic criteria for apathy [31] "
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    ABSTRACT: Results AES-S was easy to administer and acceptable, and showed fair internal consistency (Cronbach's alpha, α = 0.87). The factorial analysis identified three factors, representing the cognitive dimension (α = 0.87), a general aspect of apathy (α = 0.84), and the behavioral-emotional aspects (α = 0.74), respectively. The factors were significantly correlated with the total AES score (all rrho ≥ 0.73, p < 0.001). The total AES score showed fair convergent validity (rrho = 0.38) and discriminant validity when compared to Expanded Disability Status Scale (rrho = 0.38), Mini Mental State Examination (rrho = - 0.17), and Hamilton Depression Rating Scale (rrho = 0.37). Receiver-operating characteristic curve analysis demonstrated that a cutoff > 35.5 can identify clinically significant apathy with good sensitivity (88%) and specificity (72%); such a cutoff identified apathy in 35.7% of our sample of non-demented MS patients. Total AES score was significantly correlated with reduced global cognitive efficiency and more severe frontal executive dysfunctions.
    Journal of the Neurological Sciences 10/2014; 347(1-2). DOI:10.1016/j.jns.2014.10.027 · 2.47 Impact Factor
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