Do people become more apathetic as they grow older? A longitudinal study in healthy individuals

School of Psychiatry, University of New South Wales, Sydney, Australia.
International Psychogeriatrics (Impact Factor: 1.93). 12/2009; 22(3):426-36. DOI: 10.1017/S1041610209991335
Source: PubMed


The aim of this study was to determine levels, rates and progression of apathy in healthy older persons and to investigate factors associated with its progression.
Seventy-six healthy elderly subjects, aged 58-85 years (mean 69.9), who were recruited by general advertisement and through local community groups, participated as a control group for a longitudinal study of stroke patients. Data were collected on demographic, psychological, neuropsychological and neuroimaging (MRI) variables and apathy was rated by informants on the Apathy Evaluation Scale (AES).
Apathy scores and rates increased over 5 years, especially in men. Change of apathy was associated with informant ratings of cognitive decline in the years prior to baseline assessment but not to subsequent neuropsychological, neuroimaging or functional changes.
Apathy increases with age in otherwise healthy community-dwelling individuals, particularly in men.

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    • "Finally, a study of 425 demented and non-demented elderly in acute geriatric wards also showed a greater prevalence of apathy in men compared to women [68]. The mechanism underlying this association between apathy and aging men is unclear [67]. Of note, differences in apathy between genders have not been previously observed in the specific contexts of AD dementia [4] or MCI [5]. "
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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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    • "on . This was because this study was designed to identify differences in neural networks between apathy and depression , without being confounded by factors associated with neurological , or psychological disorders per se . Apathy is highly prevalent in populations of normal , elderly people , with prevalence rates ranging from 6 . 0% to 15 . 8% ( Brodaty et al . , 2010 ) . Interestingly , the prevalence of apathy in the current study was much higher than that indicated by Brodaty et al . No study to date has examined differences in apathy between normal adults and patients with neurological disorders . Although there are no reasons to believe that apathy is different between these two groups , because"
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    ABSTRACT: Apathy is defined as a mental state characterized by a lack of goal-directed behavior. However, the underlying mechanisms of apathy remain to be fully understood. Apathy shares certain symptoms with depression and both these affective disorders are known to be associated with dysfunctions of the frontal cortex-basal ganglia circuits. It is expected that clarifying differences in neural mechanisms between the two conditions would lead to an improved understanding of apathy. The present study was designed to investigate whether apathy and depression depend on different network properties of the frontal cortex-basal ganglia circuits, by using resting state fMRI. Resting-state fMRI measurement and neuropsychological testing were conducted on middle-aged and older adults (N=392). Based on graph theory, we estimated nodal efficiency (functional integration), local efficiency (functional segregation), and betweenness centrality. We conducted multiple regression analyses for the network parameters using age, sex, apathy, and depression as predictors. Interestingly, results indicated that the anterior cingulate cortex showed lower nodal efficiency, local efficiency, and betweenness centrality in apathy, whereas in depression, it showed higher nodal efficiency and betweenness centrality. The anterior cingulate cortex constitutes the so-called "salience network," which detects salient experiences. Our results indicate that apathy is characterized by decreased salience-related processing in the anterior cingulate cortex, whereas depression is characterized by increased salience-related processing. Copyright © 2015. Published by Elsevier Ltd.
    Neuropsychologia 07/2015; 77. DOI:10.1016/j.neuropsychologia.2015.07.030 · 3.30 Impact Factor
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    • "Cognitive decline, disability, and an increasing number of health conditions are all significantly related to apathy (Adams, 2001; Onyike et al., 2007; Brodaty et al., 2010; Clarke et al., 2010) and are known to be related to vascular disease outcomes (Elwood et al., 2002; Braunstein et al., 2003). Therefore, in an exploratory fourth model, additional adjustments were made for cognitive status using the MMSE score, disability using the ALDS, and number of nonvascular prescriptions as a proxy for other comorbidities (Agostini et al., 2004; Brodaty et al., 2010). All analyses have been repeated within the unimputed dataset. "
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    ABSTRACT: Although depression is considered to be associated with cardiovascular disease (CVD), specifically symptoms of apathy have been strongly associated with a history of CVD in recent studies. In this study, we prospectively assess whether symptoms of apathy and depression are independent risk factors for incident CVD and stroke. We carried out a prospective cohort study of 1810 community-dwelling older individuals (70-78 years) without a history of CVD or stroke. Symptoms of apathy and depression were assessed with the 15-item Geriatric Depression Scale. Incident CVD and stroke were assessed after 2 years follow-up. The associations of symptoms of apathy and depression with incident CVD and stroke were analyzed separately using logistic regression analysis. Symptoms of apathy and depression were present in 281 (15.5%) and 266 (14.7%) participants, respectively. Incident CVD occurred in 62 (3.5%) participants and stroke in 55 (3.1%) participants. Apathy was associated with incident CVD after adjustment for demographics and cardiovascular risk factors (odds ratio (OR) = 2.60, 95% CI = 1.46-4.65). Exclusion of subjects with depressive symptoms yielded a similar OR (2.94, 95% CI = 1.45-5.96, n = 1544). No association was found between depressive symptoms and incident CVD. Neither apathy symptoms nor depressive symptoms were associated with incident stroke. Apathy, but not depression, is a strong, independent risk factor for incident CVD. It may be a marker of underlying vascular disease. By its nature, apathy may cause non-adherence to a healthy lifestyle, diminished activities, and possibly even withdrawal from clinical care aimed at improving vascular risk profiles. Copyright © 2013 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 05/2014; 29(5). DOI:10.1002/gps.4026 · 2.87 Impact Factor
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