Article

The Lille Apathy Rating Scale: Validation of a caregiver-based version

Neurology and Movement Disorders Unit, EA2683, Faculty of Medicine and Lille University Hospital, Lille, France.
Movement Disorders (Impact Factor: 5.68). 04/2008; 23(6):845-9. DOI: 10.1002/mds.21968
Source: PubMed

ABSTRACT

Apathy is reported in 16.5% to 70% of Parkinson's disease (PD) patients. Our recently developed Lille Apathy Rating Scale (LARS) has been specifically validated for patient-based assessment of apathy in PD. The aim of the present study was to validate a caregiver-based version of the LARS. Sixty consecutive PD patients and their respective caregivers participated in the study. An informant-based version of the LARS (LARS-i) was developed to rate apathy via a caregiver-based structured interview. Apathy was also assessed in a patient-based interview using the LARS and the informant- and clinician-rated versions of the Apathy Evaluation Scale (AES). Cronbach's alpha and standardized alpha coefficients were 0.872 and 0.877, respectively, and the split-half reliability was 0.901 (revealing good internal consistency). The test-retest and inter-rater reliability values were 0.960 and 0.996, respectively. Criterion-related validity (according to an independent, expert diagnosis) was good. Scores on the LARS and the LARS-i were highly correlated. However, apathy was rated significantly more severely by the caregiver than by the patient. This difference was significantly higher for demented than nondemented PD patients. The LARS-i was seen to have excellent psychometric properties and appears to be valid for use in PD with respect to the patient-based LARS and the informant- and clinician-rated versions of the AES.

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    • "While we found no significant correlation between apathy and Krupp's fatigue severity scale (FSS) scores, we did find a correlation between apathy and NRS fatigability scores. That the FSS is a self-rating scale while a clinician completes the NRS may contribute to these differing results, as brain damage can decrease self-insight [Dujardin et al., 2008; Levin et al., 1987; Robert et al., 2002; Starkstein et al., 2001]. "
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    ABSTRACT: Apathy, common in neurological disorders, is defined as disinterest and loss of motivation, with a reduction in self-initiated activity. Research in diseased populations has shown that apathy is associated with variations in the volume of brain regions such as the anterior cingulate and the frontal lobes. The goal of this study was to determine the neural signatures of apathy in people with penetrating traumatic brain injuries (pTBIs), as to our knowledge, these have not been studied in this sample. We studied 176 male Vietnam War veterans with pTBIs using voxel-based lesion-symptom mapping (VLSM) and apathy scores from the UCLA Neuropsychiatric Inventory (NPI), a structured inventory of symptoms completed by a caregiver. Our results revealed that increased apathy symptoms were associated with brain damage in limbic and cortical areas of the left hemisphere including the anterior cingulate, inferior, middle, and superior frontal regions, insula, and supplementary motor area. Our results are consistent with the literature, and extend them to people with focal pTBI. Apathy is a significant symptom since it can reduce participation of the patient in family and other social interactions, and diminish affective decision-making. Hum Brain Mapp, 2013. © 2013 Wiley Periodicals, Inc.
    Full-text · Article · Mar 2014 · Human Brain Mapping
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    • "While we found no significant correlation between apathy and Krupp's fatigue severity scale (FSS) scores, we did find a correlation between apathy and NRS fatigability scores. That the FSS is a self-rating scale while a clinician completes the NRS may contribute to these differing results, as brain damage can decrease self-insight [Dujardin et al., 2008; Levin et al., 1987; Robert et al., 2002; Starkstein et al., 2001]. "

    Full-text · Article · Oct 2012 · Human Brain Mapping
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    • "The Neuropsychiatric Inventory, allowing evaluating 12 behavioural domains in neurodegenerative diseases also includes items assessing apathy (Cummings, 1997). Four other questionnaires specifically assess apathy: the ''Apathy Evaluation Scale'' (Marin, 1991), the ''Apathy Scale'' (Starkstein et al., 1992a,b), the ''Apathy Inventory'' (Robert et al., 2002) and the ''Lille Apathy Rating Scale'' (Sockeel et al., 2006; Dujardin et al., 2008). The latter is mostly focused on PD and contains items that are helpful to distinguish apathy from depression. "
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    ABSTRACT: We propose to defined apathy as a quantitative reduction of goal-directed behaviour. As such, the neural bases of apathy rely on lesions or dysfunctions of the brain structures that generate and control goal-directed behaviour: the frontal lobes, the basal ganglia and the frontal-basal ganglia circuits. Lesions or dysfunctions of the limbic territories of the frontal lobes (the orbital-mesial prefrontal cortex) and the basal ganglia (e.g., the ventral striatum) lead to apathy through difficulties to provide the affective value of a given behavioural context. We also suggest that lesions or dysfunctions of the associative ("cognitive") territories of the frontal lobes (the dorsal prefrontal cortex) and the basal ganglia (e.g., the dorsal caudate) contribute to apathy via a "cognitive inertia" - an inability to generate or activate strategies required to successfully complete a given program of actions. The most severe forms of apathy ("auto-activation deficit" syndrome), due to bilateral lesions in the prefrontal-basal ganglia circuits can be explained either by the addition of lesions in the cognitive and limbic territories or by a more general and elementary impairment that mirrored the presumed normal functions of the prefrontal-basal ganglia circuits, that is to selectively amplified the behaviour that one considers as the most adapted to one's personal needs or environmental demands. These lesions may limit the selective amplification of the signal that represents relevant thoughts and actions, leading to difficulties to disambiguate decision-making at the level of the prefrontal cortex.
    Full-text · Article · Aug 2012 · Revue Neurologique
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