Apathy and depression in Alzheimer's disease are associated with functional deficit and psychotropic prescription

Centre mémoire de Ressources et de Recherche, Hôpital Pasteur, Nice, France.
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 04/2008; 23(4):409-14. DOI: 10.1002/gps.1895
Source: PubMed


Apathy and depression are the most common neuropsychiatric features in Alzheimer's disease (AD). The clinical and functional specific correlates of these syndromes are not well known independently from cognitive deficits and other behavioral disturbances.
Six hundred and eighty-six patients diagnosed with possible or probable AD were included in a prospective multicenter study (REAL-FR). They had an assessment of their cognitive and functional status. Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory (NPI) and caregiver's burden was measured with Zarit's Burden Scale.
A majority of patients at any stage of the disease presented with one or several behavioral and psychological disturbances. Apathy concerned 43% of patients and, with or without depression, was associated with more pronounced deficits in global cognition, everyday life and instrumental abilities, nutritional status and with a higher burden level. A high level of psychotropic prescription, especially with antidepressant, was observed in patients with apathy. In a multivariate analysis taking into account the cognitive and functional variables of AD, apathy and depression were the only significant predictors of psychotropic prescription.
Some negative neuropsychiatric symptoms such as apathy and depression have a specific relation with functional and therapeutic outcomes of AD, independently from cognitive status. Further studies are needed to establish if apathy represents a particularly severe phenotype of AD.

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    • "This was reflected by our results; in 9 studies, apathy was included in the affective factor, whereas it occurred independently or was associated with other symptoms such as sleep problems and/or appetite changes in 14 studies. The inconsistent loading of apathy does pose a problem as we know that apathy is an important symptom in terms of predicting poor outcomes for people with dementia (Landes et al., 2001; Starkstein et al., 2006; Benoit et al., 2008), so understanding more about it is important both scientifically and clinically. "
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    ABSTRACT: Objective A wide range of behavioural and psychological symptoms (BPSD) are common in dementia, and it has been suggested that groups of correlated symptoms should be studied together. Here, we describe the groups of BPSD that have been identified in the literature and how they have been used to study associations, burden, treatment and underlying biology. Methods The literature database PubMed was searched for articles that identified clusters or factors of BPSD or used previously defined symptom groups. Results Sixty-two studies were included. Generally, the following symptom groups were suggested: affective symptoms, including depression and anxiety; psychosis, including delusions and hallucinations; hyperactivity, including irritability and aggression; and euphoria. Symptoms that did not show consistent results include apathy, eating disturbances, night-time behaviour disturbances, disinhibition and aberrant motor behaviour. Symptom groups differed in their associations, treatment and biology. Conclusions Studies investigating symptom groups show relatively consistent results. Studying symptom groups allows similar symptoms to be studied together, which might strengthen results and may point to differences in their aetiology and treatment. However, a large amount of the individual variability of the symptoms could not be explained by the factors, and authors should carefully address their research question and hypotheses to decide if symptoms should be studied in groups or individually. Clinicians need to consider each symptom in its own right and also to be aware of the interrelations between them when assessing patients and developing strategies for treatment. © 2013 The Authors. International Journal of Geriatric Psychiatry by John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 06/2014; 29(6). DOI:10.1002/gps.4037 · 2.87 Impact Factor
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    • "Interestingly , apathy and depression share some clinical features, such as loss of interest, reduced activity, or hedonism (Starkstein et al., 2005a), but may have a different pathophysiology (Benoit et al., 2008). Since the prefrontal cortex is part of the mesolimbic dopaminergic circuit and imaging studies identified correlates between pathophysiological changes to this dopaminergic brain rewarding system and " apathy feelings " in AD patients (Benoit et al., 2008), AD þ D might comparably have an impaired dopaminergic neuronal connection between the prefrontal cortex (BA10) and the rest of the mesolimbic circuit. "
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    ABSTRACT: Background: Depression and aggression in Alzheimer’s disease (AD) are two of the most severe and prominent neuropsychiatric symptoms (NPS). Altered monoaminergic neurotransmitter system functioning has been implicated in both NPS, although their neurochemical etiology remains to be elucidated. Methods: Left frozen hemispheres of 40 neuropathologically confirmed AD patients were regionally dissected. Dichotomization based on depression/aggression scores resulted in depressed/nondepressed (AD+D/-D) and aggressive/nonaggressive (AD+Agr/-Agr) groups. Concentrations of dopamine, serotonin (5-HT), (nor)epinephrine ((N)E) and respective metabolites were determined using RP-HPLC. Results: Significantly lower 3-methoxy-4-hydroxyphenylglycol (MHPG) and higher homovanillic acid levels were observed in Brodmann area (BA) 9 and 10 of AD+D compared to AD-D. In AD+Agr, 5-hydroxy-3-indoleacetic acid (5-HIAA) levels in BA9, 5-HIAA/5-HT ratios in BA11, and MHPG, NE, and 5-HIAA levels in hippocampus were significantly decreased compared to AD-Agr. Conclusions: These findings indicate that brain region-specific altered monoamines and metabolites may contribute to the occurrence of depression and aggression in AD.
    Neurobiology of Aging 05/2014; 35(12):2691-2700. DOI:10.1016/j.neurobiolaging.2014.05.031 · 5.01 Impact Factor
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    • "Na população idosa é de particular relevância os transtornos depressivos, mais frequentes e intensos que nas demais faixas etárias e com implicações importantes para a saúde e inserção social (Meeks, Vahia, Lavretsky, Kulkarni & Jeste, 2011). Idosos com diagnóstico de depressão maior apresentam maior comprometimento na realização de atividades de vida diária mesmo nos quadros onde uma condição tipicamente associada com limitações funcionais como as demências esteja presente (Benoit et al., 2008). "
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    ABSTRACT: Versão em português do artigo publicado
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