Article

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

ABSTRACT

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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    • "Recent research on pathological apathy in patients with brain disorders has led to dissociation of apathy into several domains, for example: behavioral, cognitive, and emotional (Levy and Dubois 2006; Sockeel et al. 2006; Robert et al. 2009; Radakovic and Abrahams 2014). Here, we focus on " behavioral apathy " — tensor imaging (DTI) to investigate how differences in white matter microstructure in pathways connecting regions functionally involved in evaluation, weighing or action anticipation might underlie interindividual difference in apathy traits. "
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    ABSTRACT: Lack of physical engagement, productivity, and initiative-so-called "behavioral apathy"-is a common problem with significant impact, both personal and economic. Here, we investigate whether there might be a biological basis to such lack of motivation using a new effort and reward-based decision-making paradigm, combined with functional and diffusion-weighted imaging. We hypothesized that behavioral apathy in otherwise healthy people might be associated with differences in brain systems underlying either motivation to act (specifically in effort and reward-based decision-making) or in action processing (transformation of an intention into action). The results demonstrate that behavioral apathy is associated with increased effort sensitivity as well as greater recruitment of neural systems involved in action anticipation: supplementary motor area (SMA) and cingulate motor zones. In addition, decreased structural and functional connectivity between anterior cingulate cortex (ACC) and SMA were associated with increased behavioral apathy. These findings reveal that effort sensitivity and translation of intentions into actions might make a critical contribution to behavioral apathy. We propose a mechanism whereby inefficient communication between ACC and SMA might lead to increased physiological cost-and greater effort sensitivity-for action initiation in more apathetic people.
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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.
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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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