Importance of Lack of Interest in Patients With Mild Cognitive Impairment

Centre Mémoire de Ressources et de Recherche, CHU de Nice, INSERM JE 2441, Nice, France.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 4.24). 10/2008; 16(9):770-6. DOI: 10.1097/JGP.0b013e31817e73db
Source: PubMed


Apathy is one of the most common behavioral symptoms in mild cognitive impairment (MCI). The aim of the authors' study was to examine the influence of the apathy dimensions, i.e., emotional blunting, lack of initiative, and lack of interest, on the risk of developing of Alzheimer disease (AD) in patients with MCI.
Longitudinal study.
Fourteen French memory clinics.
Apathy was assessed in 214 MCI patients. The main endpoint considered was the development of AD during the 3-year follow-up.
The neuropsychiatric evaluation included the Goldberg anxiety scale and the Montgomery and Asberg Depression Rating Scale; apathy was assessed with the Apathy Inventory.
After 3 years, 59 patients (27.2%) had developed AD. The risk of conversion to AD was significantly higher for patients with lack of interest. Using Cox analyses, controlling for age, gender and education, the difference between survival curves was significant for lack of interest.
Lack of interest, a mild behavioral sign, could be an indicator of potential decline in MCI patients and underlines the importance of checking the cognitive status of these patients.

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Available from: Michel Benoit
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    • "In some studies , also in MCI, depressive symptoms are associated with progression to AD or dementia [37] [38]. Our findings are in line with previous research, acknowledging that depression or depressive symptoms are of prognostic value for progression from MCI to AD [38] [39] [40] [41] [42] [43], although this could not be demonstrated in some other studies [44] [45] [46] [47] [48] [49] [50]. One study even found a negative correlation between progression and the presence of affective symptoms [51]. "
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    ABSTRACT: Background: Behavioral and psychological signs and symptoms of dementia (BPSD) belong to the core symptoms of dementia and are also common in mild cognitive impairment (MCI). Objective: This study would like to contribute to the understanding of the prognostic role of BPSD in MCI for the progression to dementia due to Alzheimer's disease (AD). Methods: Data were generated through an ongoing prospective longitudinal study on BPSD. Assessment was performed by means of the Middelheim Frontality Score, Behave-AD, Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia (CSDD), and Geriatric Depression Scale 30-questions (GDS-30). Cox proportional hazard models were used to test the hypothesis that certain BPSD in MCI are predictors of developing AD. Results: The study population consisted of 183 MCI patients at baseline. At follow-up, 74 patients were stable and 109 patients progressed to AD. The presence of significant depressive symptoms in MCI as measured by the CSDD (HR: 2.06; 95% CI: 1.23-3.44; p = 0.011) and the GDS-30 (HR: 1.77; 95% CI: 1.10-2.85; p = 0.025) were associated with progression to AD. The severity of depressive symptoms as measured by the GDS-30 was a predictor for progression too (HR: 1.06; 95% CI: 1.01-1.11; p = 0.020). Furthermore, the severity of agitated behavior, especially verbal agitation and the presence of purposeless activity, was also associated with progression, whereas diurnal rhythm disturbances were associated with no progression to AD. Conclusion: Depressive symptoms in MCI appear to be predictors for progression to AD.
    Full-text · Article · Jul 2014 · Journal of Alzheimer's disease: JAD
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    • "Conversely, apathy remains an ill-defined entity and whether it can exist as an independent psychiatric condition remains an open question (Starkstein and Leentjens, 2008; Drijgers et al., 2010). Yet apathy is a powerful risk factor for conversion to dementia in MCI (Robert et al., 2006b; Teng et al., 2007; Robert et al., 2008), particularly when occurring at the stage of pre-MCI (Duara et al., 2011). When compared with depression, apathy is a better predictor of conversion to dementia (Vicini Chilovi et al., 2009; Palmer et al., 2010). "
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    ABSTRACT: Objective The goal of this study is to evaluate brain metabolism in mild cognitive impairment (MCI) patients with and without apathy (as determined by the Neuropsychiatric Inventory Questionnaire).Methods Baseline data from 65 MCI participants (11 with apathy and 54 without) from the Alzheimer's Disease (AD) Neuroimaging Initiative study were analyzed. All participants underwent a comprehensive cognitive and neuropsychiatric assessment, volumetric MRI and measures of cerebral glucose metabolism applying 18F-fluorodeoxyglucose positron emission tomography at baseline. The presence of apathy at baseline was determined by the Neuropsychiatric Inventory Questionnaire.ResultsThere was no difference between apathy and apathy-free MCI patients regarding cognitive assessment and neuropsychiatric measures when apathy-specific items were removed. Cerebrovascular disease load and cerebral atrophy were equivalent in both groups. Compared with the apathy-free MCI patients, MCI patients with apathy had significantly decreased metabolism in the posterior cingulate cortex.Conclusion The presence of apathy in MCI patients is associated with AD-specific pattern of brain metabolic defect. These results could suggest that apathy belongs to the spectrum of prodromal AD symptoms. Copyright © 2014 John Wiley & Sons, Ltd.
    Full-text · Article · Jun 2014 · International Journal of Geriatric Psychiatry
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    • "In patients with mild cognitive impairment (MCI), the presence of the apathy dimension 'lack of interest' is the strongest predictor for conversion to AD (Robert et al., 2008). Therefore, early accurate assessment of NPS and, in particular, apathy is of high importance and in this respect also the improvement of the quality of the current clinical instruments. "
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    ABSTRACT: Neuropsychiatric symptoms, such as apathy, have an important impact on the quality of life of both patients diagnosed with dementia and their caregivers and represent a strong predictor of progression of the illness. Current clinical assessment methods risk bias resulting from the assessor's subjectivity, pointing to a need for additional objective and systematic assessment tools. Therefore, the use of information and communication technologies (ICT) such as actigraphy and automatized video monitoring are of interest in addition to current assessment methods. The goal of this study is to give an overview of current assessment tools for apathy in clinical practice and new approaches to assessment methods with the help ICT. This study was conducted with the use of narrative literature overview. There is evidence that apart from the currently used assessment methods for apathy, new ICT approaches could provide clinicians with valuable additional information for an earlier detection and therefore more accurate diagnosis of apathy. There are no ICT techniques specifically designed for the assessment of apathy, but nevertheless several techniques seem to be promising and deserve more study. Copyright © 2013 John Wiley & Sons, Ltd.
    Full-text · Article · Apr 2014 · International Journal of Geriatric Psychiatry
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