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Nonpharmacological Management of Apathy in Dementia: A Systematic Review

2011; Elsevier BV; Volume: 20; Issue: 7 Linguagem: Inglês

10.1097/jgp.0b013e31822be242

ISSN

1545-7214

Autores

Henry Brodaty, Kim Burns,

Tópico(s)

Autism Spectrum Disorder Research

Resumo

Apathy is one of the most challenging and prevalent behavioral symptoms of dementia. It is associated with increased disability and caregiver frustration as well as reduced quality of life, rehabilitation outcomes and survival after nursing home admission. A literature search to set criteria yielded 56 nonpharmacological intervention studies with outcomes relevant to apathy in dementia. Studies were rated according to quality and categorized into 7 groups: exercise, music, multisensory, animals, special care programming, therapeutic activities and miscellaneous. Despite a lack of methodological rigor, it is apparent that nonpharmacological interventions have the potential to reduce apathy. This review indicates that therapeutic activities, particularly those provided individually, have the best available evidence for effectiveness in dementia. Recommendations are provided for quality research. Apathy is one of the most challenging and prevalent behavioral symptoms of dementia. It is associated with increased disability and caregiver frustration as well as reduced quality of life, rehabilitation outcomes and survival after nursing home admission. A literature search to set criteria yielded 56 nonpharmacological intervention studies with outcomes relevant to apathy in dementia. Studies were rated according to quality and categorized into 7 groups: exercise, music, multisensory, animals, special care programming, therapeutic activities and miscellaneous. Despite a lack of methodological rigor, it is apparent that nonpharmacological interventions have the potential to reduce apathy. This review indicates that therapeutic activities, particularly those provided individually, have the best available evidence for effectiveness in dementia. Recommendations are provided for quality research. Apathy represents a form of executive cognitive dysfunction,1Landes AM Sperry SD Strauss ME et al.Apathy in Alzheimer's disease.J Am Geriatr Soc. 2001; 49: 1700-1707Google Scholar which overlaps with other psychological and behavioral aspects such as mood, personality, and cognitive functioning.2Pluck GC Brown RG Apathy in Parkinson's disease.J Neurol Neurosurg Psychiatry. 2002; 73: 636-642Google Scholar Definitions tend to emphasize diminished reward and goal-directed behaviors.3Brown RG Pluck G Negative symptoms: the 'pathology' of motivation and goal-directed behaviour.Trends Neurosci. 2000; 23: 412-417Google Scholar Apathy can describe an internal state of lack of interest or a state of behavioral inaction.4Burns A Folstein S Brandt J et al.Clinical assessment of irritability, aggression, and apathy in Huntington and Alzheimer disease.J Nerv Ment Dis. 1990; 178: 20-26Google Scholar The apathy spectrum includes reduced initiative, interest, motivation, spontaneity, affection, energy, enthusiasm, emotion, and persistence as well as blunted affect.5Levy ML Cummings JL Fairbanks LA et al.Apathy is not depression.J Neuropsychiatry Clin Neurosci. 1998; 10: 314-319Google Scholar, 6Overshott R Byrne J Burns A Nonpharmacological and pharmacological interventions for symptoms in Alzheimer's disease.Expert Rev Neurotherap. 2004; 4: 809-821Google Scholar The nosology of apathy is blurred, and it has received little attention in the scientific literature in spite of its prevalence.7Tagariello P Girardi P Amore M Depression and apathy in dementia: same syndrome or different constructs? A critical review.Arch Gerontol Geriat. 2009; 49: 246-249Google Scholar, 8Vijayaraghavan L Krishnamoorthy ES Brown RG et al.Abulia: a Delphi survey of British neurologists and psychiatrists.Mov Disord. 2002; 17: 1052-1057Google Scholar, 9Duffy JD Apathy in neurologic disorders.Current Psychiatry Reports. 2000; 2: 434-439Google Scholar Synonyms for apathy include passivity, abulia, and amotivation. Apathy can be a symptom of many neuropsychiatric disorders or a syndrome per se.10Marin RS Fogel BS Hawkins J et al.Apathy: a treatable syndrome.J Neuropsychiatry Clin Neurosci. 1995; 7: 23-30Google Scholar, 11McAllister TW Apathy.Semin Clin Neuropsychiatry. 2000; 5: 275-282Google Scholar At a symptomatic level, Marin12Marin RS Apathy: a neuropsychiatric syndrome.J Neuropsychiatry Clin Neurosci. 1991; 3: 243-254Google Scholar defines apathy as "loss of motivation due to disturbance of intellect, emotion or level of consciousness" and at syndromal level as primary motivational loss or "loss of motivation not attributable to emotional distress, intellectual impairment or diminished level of consciousness." Individuals with apathy "do less, think less and feel less."13Robert PH Darcourt G Koulibaly MP et al.Lack of initiative and interest in Alzheimer's disease: a single photon emission computed tomography study.Eur J Neurol. 2006; 13: 729-735Google Scholar Stuss et al.14Stuss DT van Reekum R Murphy KJ Differentiation of states and causes of apathy.in: Borod JC The Neuropsychology of Emotion. Oxford University Press, New York2000: 340-363Google Scholar proposes three subtypes of apathy: emotional, cognitive, and behavioral defined on the basis of the anatomical regions and psychological mechanisms involved. Diagnostic criteria for apathy were initially proposed by Marin.12Marin RS Apathy: a neuropsychiatric syndrome.J Neuropsychiatry Clin Neurosci. 1991; 3: 243-254Google Scholar, 15Marin RS Differential diagnosis and classification of apathy.Am J Psychiatry. 1990; 147: 22-30Google Scholar Lack of motivation is evidenced by diminished goal-directed behavior, goal-directed cognition, and emotion, relative to previous functioning levels and not attributable to intellectual impairment, emotional distress, or diminished consciousness. Emotional distress is absent. These criteria have been adapted over time.16Starkstein SE Apathy and withdrawal.Int Psychogeriatr. 2000; 12: 135-137Google Scholar, 17Starkstein SE Leentjens AF The nosological position of apathy in clinical practice.J Neurol Neurosurg Psychiatry. 2008; 79: 1088-1092Google Scholar Recent modifications propose that diminished motivation must be present most of the time for at least 4 weeks and a minimum of one symptom should be evident from two of the behavioral, cognitive, and emotional domains.18Robert P Onyike CU Leentjens AFG et al.Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders.Eur Psychiatry. 2009; 24: 98-104Google Scholar, 19Robert PH Mulin E Mallea P et al.Apathy diagnosis, assessment, and treatment in Alzheimer's disease.CNS Neurosci Ther. 2010; 16: 263-271Google Scholar In addition, symptoms should cause clinically significant functional impairment and not be attributable to physical disabilities, motor disabilities, or direct physiological effects of a substance. Apathy is related to but distinct from depression5Levy ML Cummings JL Fairbanks LA et al.Apathy is not depression.J Neuropsychiatry Clin Neurosci. 1998; 10: 314-319Google Scholar, 20Wongpakaran N Van Reekum R Wongpakaran T et al.Selective serotonin reuptake inhibitor use associates with apathy among depressed elderly: a case-control study.Ann Gen Psychiatry. 2007; 6: 7Google Scholar, 21Barnhart WJ Makela EH Latocha MJ SSRI-induced apathy syndrome: a clinical review.J Psychiatr Pract. 2004; 10: 196-199Google Scholar, 22Brodaty H Sachdev PS Withall A et al.Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke: the Sydney Stroke Study.Psychol Med. 2005; 35: 1707-1716Google Scholar, 23Marin RS Firinciogullari S Biedrzycki RC The sources of convergence between measures of apathy and depression.J Affect Disord. 1993; 28: 7-14Google Scholar, 24Marin RS Firinciogullari S Biedrzycki RC Group differences in the relationship between apathy and depression.J Nerv Ment Dis. 1994; 182: 235-239Google Scholar, 25Starkstein SE Jorge R Mizrahi R et al.A prospective longitudinal study of apathy in Alzheimer's disease.J Neurol Neurosurg Psychiatry. 2006; 77: 8-11Google Scholar and dysphoria.1Landes AM Sperry SD Strauss ME et al.Apathy in Alzheimer's disease.J Am Geriatr Soc. 2001; 49: 1700-1707Google Scholar, 26McPherson S Fairbanks L Tiken S et al.Apathy and executive function in Alzheimer's disease.J Int Neuropsychol Soc. 2002; 8: 373-381Google Scholar, 27Webster J Grossberg GT Disinhibition, apathy, indifference, fatigability, complaining, and negativism.Int Psychogeriatr. 1996; 8: 403-408Google Scholar Although there is an overlap in symptoms, individuals with apathy present as compliant or passive, whereas those with depression are deliberately avoidant.15Marin RS Differential diagnosis and classification of apathy.Am J Psychiatry. 1990; 147: 22-30Google Scholar Further evidence of the distinction between apathy and depression is the stronger association between degree of apathy and degree of cognitive impairment, particularly in executive functioning, than in depression.3Brown RG Pluck G Negative symptoms: the 'pathology' of motivation and goal-directed behaviour.Trends Neurosci. 2000; 23: 412-417Google Scholar, 28Reichman WE Coyne AC Amirneni S et al.Negative symptoms in Alzheimer's disease.Am J Psychiatry. 1996; 153: 424-426Google Scholar Assessment of apathy in dementia is further complicated by the need to distinguish between diminished behavior due to loss of motivation and loss of ability secondary to cognitive impairment.7Tagariello P Girardi P Amore M Depression and apathy in dementia: same syndrome or different constructs? A critical review.Arch Gerontol Geriat. 2009; 49: 246-249Google Scholar, 15Marin RS Differential diagnosis and classification of apathy.Am J Psychiatry. 1990; 147: 22-30Google Scholar The use of antipsychotic, antidepressant, and neuroleptic medications, which can induce side effects such as fatigue, lethargy, listlessness, and reduced response to stimuli, can initiate, maintain, or imitate apathetic behaviors.29Colling KB Passive behaviors in dementia. Clinical application of the need-driven dementia-compromised behavior model.J Gerontol Nurs. 1999; 25: 27-32Google Scholar Apathy has been associated with neurological, psychiatric, medical, drug-induced, and socioenvironmental conditions.30Marin RS Apathy: concept, syndrome, neural mechanisms, and treatment.Semin Clin Neuropsychiatry. 1996; 1: 304-314Google Scholar The frequency of apathy in neurological disorders ranges from 0% to 92%3Brown RG Pluck G Negative symptoms: the 'pathology' of motivation and goal-directed behaviour.Trends Neurosci. 2000; 23: 412-417Google Scholar with the highest prevalence reported in progressive supranuclear palsy,31Ghosh BCP Rowe JB Calder AJ et al.Emotion recognition in progressive supranuclear palsy.J Neurol Neurosurg Psychiatry. 1998; 80: 1143-1145Google Scholar, 32Litvan I Mega M Cummings J et al.Neuropsychiatric aspects of progressive supranuclear palsy.Neurology. 1996; 47: 1184-1189Google Scholar, 33Litvan I Paulsen JS Mega MS et al.Neuropsychiatric assessment of patients with hyperkinetic and hypokinetic movement disorders.Arch Neurol. 1998; 55: 1313-1319Google Scholar, 34Litvan I Cummings JL Mega M Neuropsychiatric features of corticobasal degeneration.J Neurol Neurosur Psychiatry. 1998; 65: 717-721Google Scholar frontotemporal dementia,35Shinagawa S Ikeda M Fukuhara R et al.Initial symptoms in frontotemporal dementia and semantic dementia compared with Alzheimer's disease.Dement Geriatr Cogn Disord. 2006; 21: 74-80Google Scholar, 36Hodges JR Frontotemporal dementia (Pick's disease): clinical features and assessment.Neurology. 2001; 56: S6-S10Google Scholar, 37Levy ML Miller BL Cummings JL et al.Alzheimer disease and frontotemporal dementias. Behavioral distinctions.Arch Neurol. 1996; 53: 687-690Google Scholar, 38Liu W Miller BL Kramer JH et al.Behavioral disorders in the frontal and temporal variants of frontotemporal dementia.Neurology. 2004; 62: 742-748Google Scholar and severe Alzheimer disease (AD).39Mega MS Cummings JL Fiorello T et al.The spectrum of behavioral changes in Alzheimer's disease.Neurology. 1996; 46: 130-135Google Scholar The commonest causes of clinically significant apathy are dementia and schizophrenia.3Brown RG Pluck G Negative symptoms: the 'pathology' of motivation and goal-directed behaviour.Trends Neurosci. 2000; 23: 412-417Google Scholar Our focus is on dementia, in which apathy is one of the most challenging, prevalent, and persistent behavioral symptoms,1Landes AM Sperry SD Strauss ME et al.Apathy in Alzheimer's disease.J Am Geriatr Soc. 2001; 49: 1700-1707Google Scholar, 25Starkstein SE Jorge R Mizrahi R et al.A prospective longitudinal study of apathy in Alzheimer's disease.J Neurol Neurosurg Psychiatry. 2006; 77: 8-11Google Scholar, 27Webster J Grossberg GT Disinhibition, apathy, indifference, fatigability, complaining, and negativism.Int Psychogeriatr. 1996; 8: 403-408Google Scholar, 40Craig D Mirakhur A Hart DJ et al.A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease.Am J Geriatr Psychiatry. 2005; 13: 460-468Google Scholar, 41Piccininni M Di Carlo A Baldereschi M et al.Behavioral and psychological symptoms in Alzheimer's disease: frequency and relationship with duration and severity of the disease.Dement Geriatr Cogn Disord. 2005; 19: 276-281Google Scholar, 42Lyketsos CG Lopez O Jones B et al.Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study.JAMA. 2002; 288: 1475-1483Google Scholar, 43Aalten P de Vugt ME Jaspers N et al.The course of neuropsychiatric symptoms in dementia. Part I: findings from the two-year longitudinal Maasbed study.Int J Geriatr Psychiatry. 2005; 20: 523-530Google Scholar, 44Robert PH Verhey FRJ Byrne EJ et al.Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium.Eur Psychiatry: J Assoc Eur Psychiatr. 2005; 20: 490-496Google Scholar, 45Benoit M Clairet S Koulibaly PM et al.Brain perfusion correlates of the apathy inventory dimensions of Alzheimer's disease.Int J Geriatr Psychiatry. 2004; 19: 864-869Google Scholar, 46Craig AH Cummings JL Fairbanks L et al.Cerebral blood flow correlates of apathy in Alzheimer disease.Arch Neurol. 1996; 53: 1116-1120Google Scholar, 47Benoit M Koulibaly PM Migneco O et al.Brain perfusion in Alzheimer's disease with and without apathy: a SPECT study with statistical parametric mapping analysis.Psychiatry Res. 2002; 114: 103-111Google Scholar, 48Rosen HJ Allison SC Schauer GF et al.Neuroanatomical correlates of behavioural disorders in dementia.Brain. 2005; 128: 2612-2625Google Scholar, 49Lam LCW Tam CWC Chiu HFK et al.Depression and apathy affect functioning in community active subjects with questionable dementia and mild Alzheimer's disease.Int J Geriatr Psychiatry. 2007; 22: 431-437Google Scholar, 50Zawacki TM Grace J Paul R et al.Behavioral problems as predictors of functional abilities of vascular dementia patients.J Neuropsychiatry Clin Neurosci. 2002; 14: 296-302Google Scholar, 51Migneco O Benoit M Koulibaly PM et al.Perfusion brain SPECT and statistical parametric mapping analysis indicate that apathy is a cingulate syndrome: a study in Alzheimer's disease and nondemented patients.Neuroimage. 2001; 13: 896-902Google Scholar, 52Aarsland D Cummings JL Larsen JP Neuropsychiatric differences between Parkinson's disease with dementia and Alzheimer's disease.Int J Geriatr Psychiatry. 2001; 16: 184-191Google Scholar, 53Savva GM Zaccai J Matthews FE et al.Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population.Br J Psychiatry. 2009; 194: 212-219Google Scholar, 54Benoit M Staccini P Brocker P et al.Behavioral and psychological symptoms in Alzheimer's disease: results from REAL. FR study.Rev Med Interne. 2003; 24: 319s-324sGoogle Scholar particularly the subcortical dementias. In studies using the Neuropsychiatric Inventory,55Cummings JL Mega M Gray K et al.The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.Neurology. 1994; 44: 2308-2314Google Scholar a structured caregiver interview to assess the frequency and severity of specific behaviors in dementia, apathy occurred in up to 70% of patients with AD.13Robert PH Darcourt G Koulibaly MP et al.Lack of initiative and interest in Alzheimer's disease: a single photon emission computed tomography study.Eur J Neurol. 2006; 13: 729-735Google Scholar, 24Marin RS Firinciogullari S Biedrzycki RC Group differences in the relationship between apathy and depression.J Nerv Ment Dis. 1994; 182: 235-239Google Scholar, 56Benoit M Dygai I Migneco O et al.Behavioral and psychological symptoms in Alzheimer's disease. Relation between apathy and regional cerebral perfusion.Dement Geriatr Cogn Disord. 1999; 10: 511-517Google Scholar, 57Hart DJ Craig D Compton SA et al.A retrospective study of the behavioural and psychological symptoms of mid and late phase Alzheimer's disease.Int J Geriatr Psychiatry. 2003; 18: 1037-1042Google Scholar, 58Starkstein SE Jorge R Mizrahi R The prevalence, clinical correlates and treatment of apathy in Alzheimer's disease.Eur J Psychiatry. 2006; 20: 96-106Google Scholar Apathy is a major clinical feature of dementia with subcortical and frontal pathology such as dementia with Lewy bodies,59Bostrom F Jonsson L Minthon L et al.Patients with dementia with lewy bodies have more impaired quality of life than patients with Alzheimer disease.Alzheimer Dis Assoc Disord. 2007; 21: 150-154Google Scholar, 60Galvin J Duda J Kaufer D et al.Lewy body dementia: caregiver burden and unmet needs.Alzheimer Dis Assoc Disord. 2010; 24: 177-181Google Scholar, 61Borroni B Agosti C Padovani A Behavioral and psychological symptoms in dementia with Lewy-bodies (DLB): frequency and relationship with disease severity and motor impairment.Arch Gerontol Geriatr. 2008; 46: 101-106Google Scholar Huntington's disease,33Litvan I Paulsen JS Mega MS et al.Neuropsychiatric assessment of patients with hyperkinetic and hypokinetic movement disorders.Arch Neurol. 1998; 55: 1313-1319Google Scholar, 62Caine ED Shoulson I Psychiatric syndromes in Huntington's disease.Am J Psychiatry. 1983; 140: 728-733Google Scholar, 63Paulsen JS Ready RE Hamilton JM et al.Neuropsychiatric aspects of Huntington's disease.J Neurol Neurosurg Psychiatry. 2001; 71: 310-314Google Scholar, 64Hamilton JM Salmon DP Corey-Bloom J et al.Behavioural abnormalities contribute to functional decline in Huntington's disease.J Neurol Neurosurg Psychiatry. 2003; 74: 120-122Google Scholar, 65Rosenblatt A Leroi I Neuropsychiatry of Huntington's disease and other basal ganglia disorders.Psychosomatics. 2000; 41: 24-30Google Scholar, 66Baudic S Maison P Dolbeau G et al.Cognitive impairment related to apathy in early Huntington's disease.Dementia and Geriatric Cognitive Disorders. 2006; 21: 316-321Google Scholar Binswanger's disease,67Caplan LR Binswanger's disease-revisited.Neurology. 1995; 45: 626-633Google Scholar, 68Bernard B Wilson R Gilley D et al.The dementia of Binswanger's disease and Alzheimer's disease cognitive, affective, and behavioral aspects.Neuropsychiatry Neuropsychol Behav Neurol. 1994; 7: 30-35Google Scholar and vascular dementia.50Zawacki TM Grace J Paul R et al.Behavioral problems as predictors of functional abilities of vascular dementia patients.J Neuropsychiatry Clin Neurosci. 2002; 14: 296-302Google Scholar, 69Staekenborg SS Su T van Straaten EC et al.Behavioural and psychological symptoms in vascular dementia; differences between small- and large-vessel disease.J Neurol Neurosurg Psychiatry. 2010; 81: 547-551Google Scholar Apathy in AD has also been significantly related to older age and depression.25Starkstein SE Jorge R Mizrahi R et al.A prospective longitudinal study of apathy in Alzheimer's disease.J Neurol Neurosurg Psychiatry. 2006; 77: 8-11Google Scholar Rates of apathy in Parkinson's disease range between 16.5% and 51%70Thanvi BR Munshi SK Vijaykumar N et al.Neuropsychiatric non-motor aspects of Parkinson's disease.Postgrad Med J. 2003; 79: 561-565Google Scholar, 71Borek LL Chou KL Friedman JH Management of the behavioral aspects of Parkinson's disease.Expert Rev Neurother. 2007; 7: 711-725Google Scholar, 72Ferreri F Agbokou C Gauthier S Recognition and management of neuropsychiatric complications in Parkinson's disease.Can Med Assoc J. 2006; 175: 1545-1552Google Scholar, 73Richard IH Depression and apathy in Parkinson's disease.Curr Neurol Neurosci Rep. 2007; 7: 295-301Google Scholar, 74Ready RE Friedman J Grace J et al.Testosterone deficiency and apathy in Parkinson's disease: a pilot study.J Neurol Neurosurg Psychiatry. 2004; 75: 1323-1326Google Scholar, 75Elias JW Treland JE Executive function in Parkinson's disease and subcortical disorders.Semin Clin Neuropsychiatry. 1999; 4: 34-40Google Scholar, 76Kirsch-Darrow LM Fernandez HFM Marsiske MP et al.Dissociating apathy and depression in Parkinson disease.Neurology. 2006; 67: 33-38Google Scholar and following stroke between 22.5% and 27%.22Brodaty H Sachdev PS Withall A et al.Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke: the Sydney Stroke Study.Psychol Med. 2005; 35: 1707-1716Google Scholar, 77Galynker I Prikhojan A Phillips E et al.Negative symptoms in stroke patients and length of hospital stay.J Nerv Ment Dis. 1997; 185: 616-621Google Scholar, 78Paranthaman R Baldwin RC Treatment of psychiatric syndromes due to cerebrovascular disease.Int Rev Psychiatry. 2006; 18: 453-470Google Scholar, 79Bourgeois JA Hilty DM Chang CH et al.Poststroke neuropsychiatric illness: an integrated approach to diagnosis and management.Curr Treat Opt Neurol. 2004; 6: 403-420Google Scholar, 80Robinson RG Neuropsychiatric consequences of stroke.Annu Rev Med. 1997; 48: 217-229Google Scholar AD with a stroke prior to onset is also associated with an increased risk of apathy.81Treiber KA Lyketsos CG Corcoran C et al.Vascular factors and risk for neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study.Int Psychogeriatr. 2008; 20: 538-553Google Scholar Apathy following a cerebrovascular event has been associated with older age and right fronto-subcortical pathway pathology.22Brodaty H Sachdev PS Withall A et al.Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke: the Sydney Stroke Study.Psychol Med. 2005; 35: 1707-1716Google Scholar In mild cognitive impairment, apathy occurs in between 11.1%82Geda YE Smith GE Knopman DS et al.De novo genesis of neuropsychiatric symptoms in mild cognitive impairment (MCI).Int Psychogeriatr. 2004; 16: 51-60Google Scholar and 39.8%42Lyketsos CG Lopez O Jones B et al.Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study.JAMA. 2002; 288: 1475-1483Google Scholar, 83Robert PH Berr C Volteau M et al.Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease: a one-year follow-up study.Clin Neurol Neurosurg. 2006; 108: 733-736Google Scholar, 84Hwang TJ Masterman DL Ortiz F et al.Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms.Alzheimer Dis Assoc Disord. 2004; 18: 17-21Google Scholar of cases, which is intermediate between rates in elderly normal controls and AD85Ready RE Ott BR Grace J et al.Apathy and executive dysfunction in mild cognitive impairment and Alzheimer disease.Am J Geriatr Psychiatry. 2003; 11: 222-228Google Scholar, 86Crocco EA Loewenstein DA Psychiatric aspects of mild cognitive impairment.Current Psychiatry Reports. 2005; 7: 32-36Google Scholar and predicts a higher rate of conversion to AD.82Geda YE Smith GE Knopman DS et al.De novo genesis of neuropsychiatric symptoms in mild cognitive impairment (MCI).Int Psychogeriatr. 2004; 16: 51-60Google Scholar, 83Robert PH Berr C Volteau M et al.Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease: a one-year follow-up study.Clin Neurol Neurosurg. 2006; 108: 733-736Google Scholar, 84Hwang TJ Masterman DL Ortiz F et al.Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms.Alzheimer Dis Assoc Disord. 2004; 18: 17-21Google Scholar, 87Copeland MP Daly E Hines V et al.Psychiatric symptomatology and prodromal Alzheimer's disease.Alzheimer Dis Assoc Disord. 2003; 17: 1-8Google Scholar, 88Bartolini M Coccia M Luzzi S et al.Motivational symptoms of depression mask preclinical Alzheimer's disease in elderly subjects.Dement Geriatr Cogn Disord. 2005; 19: 31-36Google Scholar, 89Robert PH Berr C Volteau M et al.Neuropsychological performance in mild cognitive impairment with and without apathy.Dement Geriatr Cogn Disord. 2006; 21: 192-197Google Scholar Discrepancies in the frequency of estimates of apathy in neuropsychiatric conditions may be attributed to a lack of standardized diagnostic criteria58Starkstein SE Jorge R Mizrahi R The prevalence, clinical correlates and treatment of apathy in Alzheimer's disease.Eur J Psychiatry. 2006; 20: 96-106Google Scholar, 90Starkstein SE Petracca G Chemerinski E et al.Syndromic validity of apathy in Alzheimer's disease.Am J Psychiatry. 2001; 158: 872-877Google Scholar and assessment methods.7Tagariello P Girardi P Amore M Depression and apathy in dementia: same syndrome or different constructs? A critical review.Arch Gerontol Geriat. 2009; 49: 246-249Google Scholar, 17Starkstein SE Leentjens AF The nosological position of apathy in clinical practice.J Neurol Neurosurg Psychiatry. 2008; 79: 1088-1092Google Scholar, 91Starkstein SE Ingram L Garau ML et al.On the overlap between apathy and depression in dementia.J Neurol Neurosurg Psychiatry. 2005; 76: 1070-1074Google Scholar Furthermore, apathy may be underreported because as a negative symptom, it is more difficult for family caregivers to identify and quantify in comparison to other behavioral symptoms of dementia.1Landes AM Sperry SD Strauss ME et al.Apathy in Alzheimer's disease.J Am Geriatr Soc. 2001; 49: 1700-1707Google Scholar Apathy is associated with increased disability and frustration as well as decreased quality of life in patients and caregivers alike.92Aarsland D Litvan I Larsen JP Neuropsychiatric symptoms of patients with progressive supranuclear palsy and Parkinson's disease.J Neuropsychiatry Clin Neurosci. 2001; 13: 42-49Google Scholar Families not recognizing an apathetic state may become increasingly resentful as they misperceive the patient as lazy.11McAllister TW Apathy.Semin Clin Neuropsychiatry. 2000; 5: 275-282Google Scholar, 93Colling KB Caregiver interventions for passive behaviors in dementia: links to the NDB model.Aging Ment Health. 2004; 8: 117-125Google Scholar, 94Campbell JJ Duffy JD Treatment strategies in amotivated patients.Psychiatr Ann. 1997; 27: 44-49Google Scholar, 95Overshott R Burns A Treatment of dementia.Neurol Pract. 2005; 76: v53-v59Google Scholar The potential for apathy to prevent patients seeking assistance, to be misdiagnosed with depression or to become noncompliant with treatment further exacerbates the degree of dysfunction.93Colling KB Caregiver interventions for passive behaviors in dementia: links to the NDB model.Aging Ment Health. 2004; 8: 117-125Google Scholar Apathy is significantly related to reduced independence in activities of daily living,28Reichman WE Coyne AC Amirneni S et al.Negative symptoms in Alzheimer's disease.Am J Psychiatry. 1996; 153: 424-426Google Scholar, 96Sacks AL Effects of Snoezelen behavior therapy on increasing independence in activities of daily living of elders with dementia on a short term geriatric psychiatric unit. Fairleigh Dickinson University, United States—New Jersey2005Google Scholar, 97Yamashita K Iijima K Kobayashi S Relationship among activities of daily living, apathy, and subjective well-being in elderly people living alone in a rural town.Gerontology. 1999; 45: 279-282Google Scholar survival duration after nursing home admission,98Diesfeldt HFA Van Houte LR Moerkens RM Duration of survival in senile dementia.Acta Psychiatr Scand. 1986; 73: 366-371Google Scholar and poor outcomes in rehabilitation.86Crocco EA Loewenstein DA Psychiatric aspects of mild cognitive impairment.Current Psychiatry Reports. 2005; 7: 32-36Google Scholar, 99Williams A Motivation and Dementia.Top Geriatr Rehabil. 2005; 21: 123-126Google Scholar Patients with apathy may retain capacity but not self-initiative and hence may undertake activities in groups that they are unable to do alone.77Galynker I Prikhojan A Phillips E et al.Negative symptoms in stroke patients and length of hospital stay.J Nerv Ment Dis. 1997; 185: 616-621Google Scholar Morbidity and mortality may also be indirectly related to apathy as residents in long-term care tend to be less noticed by care staff and receive fewer direct care hours.29Colling KB Passive behaviors in dementia. Clinical application of the need-driven dementia-compromised behavior model.J Gerontol Nurs. 1999; 25: 27-32Google Scholar, 75Elias JW Treland JE Executive function in Parkinson's disease and subcortical disorders.Semin Clin Neuropsychiatry. 1999; 4: 34-40Google Scholar In addition, behavioral deficits influence staff-resident interactions and quality of care100Burgio L Interventions for the behavioral complications of Alzheimer's disease: behavioral approaches.Int Psychogeriatr. 1996; 8: 45-52Google Scholar as well as staff distress, frustration, and job satisfaction. In summary, apathy has significant consequences and is common in neurological disorders, with the highest prevalence occurring in people with dementia. While studies of its measurement, prevalence, and etiology are increasing, management has been largely neglected. Recognized guidelines for the management of apathy do not exist.101van Reekum R

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