Barriers and facilitators to diagnosing and managing. A pathy is one of the most frequent behavioral abnormalities in patients with alzheimers disease, and is significantly associated with more severe impairments in activities of daily living and cognitive deficits, 1 poor awareness of behavioral and cognitive changes, and increased stress for families. The apathy evaluation scale aes was developed by marin 1991 as a method for measuring apathy resulting from brainrelated pathology. Apathy occurs frequently in diseases and acquired injuries a. Reliability and validity of the apathy evaluation scale, psychiatry research, 38. Diagnosing and treating apathy in dementia caring for. The prevalence, clinical correlates and treatment of apathy in. Depression, anxiety, and apathy in parkinsons disease. To improve current understanding of the mechanisms behind thalamic amnesia, as it is unclear whether it is directly related to damage to specific nuclei, in particular to the anterior or mediodorsal nuclei, or indirectly related to lesions of the mammillothalamic tract mtt. For this reason, the aim of this study was to validate a spanish version of lille apathy rating scale lars in a cohort of pd patients from spain.
Dujardin has been involved in the development of the lille apathy rating scale, and s. Association of daily physical activity with cognition and. Several instruments have been developed to assess apathy 18, 19. The syndromal validity and nosological position of apathy.
This interview includes questions referring to lack of motivation relative to the individuals previous level of functioning, lack of effort to perform every day. Pdf reliability and validity assessment of an apathy scale for. Jul 24, 2015 scales designed to more thoroughly assess apathy with multiple items include the 14item apathy scale, the apathy inventory, and the apathy evaluation scale aes. It covers affective, behavioral, and cognitive aspects of apathy during the past 4 weeks. Efficacy of intermittent theta burst stimulation itbs and. Exploratory factor analysis yielded a three factor solution representative of. The aes, which uses 18 specific items to quantify apathy within a scoring range of 18 to 72, is an especially promising metric for apathy in ad. Diagnosing and treating apathy in dementia caring for the ages. Development of a short version of the apathy evaluation scale specifically adapted for demented nursing home residents ulrike lueken, ph. Reprinted from seminars in clinical neuropsychiatry, vol 14, marin rs, apathy. Apathy is a state of indifference, or the suppression of emotions such as concern, excitement, motivation, or passion. Most of the research on apathy associated with ad can be ascribed to starksteins and his coworkers. The prevalence, clinical correlates and treatment of apathy. Most of the research on apathy associated with ad can be ascribed to starkstein s and his coworkers.
The sas is an instrument recommended by the movement disorders society to screen and assess severity of apathy in pd. Neuroimaging correlates of apathy and depression in alzheimers disease. Apathy is a lack of feeling, emotion, interest, or concern about something. Box 1 diagnostic criteria for apathy starkstein 20007, adapted from marin 1992 adaptations proposed by the authors are indicated in bold type a lack of motivation relative to the patients previous level of functioning or the standards of his or her age and culture as indicated either by subjective account or observation by others.
The lars represents a 33item apathy scale with nine domains that is clinicianadministered using a structured interview 59. Impaired novelty processing in apathy after subcortical stroke. The interview is structured and the questions should to be posed exactly as stated. An ignored neuropsychiatric syndrome in south africa. Brazilian caregiver version of the apathy scale scielo. Reliability, validity, and clinical correlates of apathy in parkinsons disease. The apathy evaluation scale aes was developed to quantify and characterize apathy in adult patients.
As of 2015, there are three apathy scales which may be used in the pd population based on the recommendations of the movement disorders society task force. An answer to each question was scored in 4 grades, 0 to 3, and the total score was used for the analysis. A comparative validation of the abbreviated apathy evaluation. An ignored neuropsychiatric syndrome in south africa steven harding department of psychology.
Trster ai, stalp ld, paolo am, fields ja and koller wc 1995. Purpose based on the starkstein apathy scale, an apathy scale. Apathy evaluation scale self, informant, and clinician versions. Properties of the apathy scale as for use on parkinson s. Pdf purpose based on the starkstein apathy scale, an apathy scale was developed for homecare patients with parkinsons disease using structural. Depression, anxiety and apathy are common mood disturbances in parkinsons disease pd but their pathophysiology is unclear. Apathy was assessed on the starkstein apathy scale. Using a cutoff score of 12 on the apathy scale an abridged version of the apathy evaluation scale, starkstein. These require time to administer, which can be difficult during shortterm patient visits, but dr. Over the next 10 days, his apathy and depression gradually improved. Although the 14item starkstein apathy scale sas is recommended to screen for and measure the severity of apathetic symptoms in parkinson disease pd, the psychometric attributes of this scale have not yet been fully evaluated. Apathy as a syndrome or a symptom has been found in a number of neurological disorders.
The influence of apathy and depression on cognitive. Neuroimaging correlates of apathy and depression in alzheimer. The mechanism of apathy in aoathy disorders is still unknown, but several studies suggest an important role for frontal lobe and basal ganglia dysfunction. For questions 18, the scoring system is the following. Assessment of apathy minimising the effect of motor. The apathy evaluation scale department of psychology uct.
We recruited 12 patients with a left thalamic infarction and 25 healthy matched controls. Starkstein s apathy scale and itemized scores of the groups divided by the lowest quintile of total scores. Box 1 diagnostic criteria for apathy starkstein 20007. A statistical analysis also found a strong link between the total number of errors in facelike objects and the severity of apathy as determined by the starkstein apathy scale. Each item on starkstein s apathy scale 4 was quantified on a visual analog scale in.
Reliability, validity, and clinical correlates of apathy in. Two aspects in the application need to be implemented. Robert p, onyike cu, leentjens af, dujardin k, aalten p, starkstein s, et al proposed diagnostic criteria for apathy in alzheimers disease and other neuropsychiatric disorders. In dementia, apathy and depression are often seen as one disorder because of the many overlapping symptoms. Sep 30, 2019 to determine the association of daily physical activity with cognition, mood disorders, and olfactory function in treatmentnaive patients with earlystage parkinsons disease pd. Although the 14item starkstein apathy scale sas is recommended to screen for and measure the severity of apathetic symptoms in parkinson disease pd, the psychometric attributes of this. Are the available apathy measures reliable and valid. Purpose based on the starkstein apathy scale, an apathy scale was developed for homecare patients with parkinsons disease using structural equation modeling sem, with which the data compatibility of extraction factors can be verified. One of the most widespread and studied instruments is probably the apathy evaluation scale aes developed by marin et al, 1991 20.
The negative impact of apathy in parkinson s disease 181 3. Request pdf psychometric properties of the starkstein apathy scale in patients with early untreated parkinson disease. Ever since it was first defined, apathy has been described as a transnosographic entity, involved in many neuropsychiatric disorders not least depression. Aug 22, 2017 several brain imaging markers have been studied in the development of poststroke depression psd and poststroke apathy psa, but inconsistent associations have been reported.
The apathy evaluation scale has been validated to measure the severity of apathy in tbi marin et al. Hypertension and white matter lesions are independently. It is a frequent consequence of neurological and psychiatric disorders. Lille apathy rating scale and mdsupdrs for screening apathy. Databases medline, embase, psycinfo, cinahl, and cochrane database of. Apathy and depressed mood in acquired brain damage. Lille apathy rating scale instructions for administration the lille apathy rating scale lars comprises 33 queries belonging to nine domains, each corresponding to a clinical manifestation of apathy. Impact of apathy on prognosis in pd the question of whether the presence of apathy in pd impacts on prognosis is an important one since it has implications for early and robust detection and management of apathy. Apathy rating scale in parkinsons disease patients, revealed a four factor structure. Starkstein has been involved in the development of the apathy scale.
Development and validation studies are described in rs marin, rc biedrzycki, s firinciogullari. Imaging markers of poststroke depression and apathy. Apathy has been consistently described among patients with cerebrovascular disease. To develop an apathy rating scale using a structured. Apathy is usually defined as reduced interest and participation in various activities. Development of a short version of the apathy evaluation scale. Finally, it would be important to verify the existence of correlations between interest game scores and validated apathy scales, such as the dimensional apathy scale or the apathy motivation index, which allow to better quantify apathy severity. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical, or physical life and the world. Advanced neuroimaging has been increasingly used to unravel neural substrates linked to these disturbances. Psychometric properties of the starkstein apathy scale in.
However, he had developed a severe isolated apathy starkstein apathy scale score 3642 without depression beck depression inventory 1563 or anxiety. A questionnaire survey anonymous, selfadministered was carried out by. Although the 14item starkstein apathy scale sas is recommended to screen for and measure the severity of apathetic symptoms in parkinson disease pd. Starkstein et al 12 examined the frequencyand correlates of apathy in a series of 80 patients with stroke. Simultaneously, caregivers, who were blind to the results of these interviews, rated the patients behaviors with the apathy scale. To date, no rating scales for detecting apathy in parkinsons disease pd patients have been validated in spanish. When the patient came back to the surgical centre, stimulation parameters and his motor state had remained stable and he was still without dopaminergic treatment. Designed to screen for symptoms of apathy as operationalized by starkstein and colleagues, in patients with alzheimers disease. In addition, the apathy evaluation scale clinical version.
Although various scoring methods have been proposed, there is a lack of validated, standardised instruments for detecting apathy and assessing its severity. Reliability and validity assessment of an apathy scale for homecare. Apathy is associated with motor symptoms in parkinsons disease pd. The negative impact of apathy in parkinson s disease. Diagnoses of apathy were generated based on caregivers ratings on the apathy scale, using the diagnostic criteria for apathy reported previously. Apathy evaluation scale self, informant, and clinician. The prevalence, clinical correlates and treatment of. Properties of the apathy scale as for use on parkinsons patients. Apathy and anhedonia rating scales in parkinsons disease. On neuropsychological assessment, he scored 2 points on the minimental state examination, 3042 on the starkstein apathy scale cutoff score 16, and 5980 on the zung selfrating depression scale cutoff score40. Validation of a spanish version of the lille apathy rating. Discuss why apathy is such a problem in parkinsons disease. Starkstein, daniel tranel, in handbook of clinical neurology, 2012. The scale was developed to ascertain and quantify apathy in the month prior to the assessment and validated in individuals with pd.
A pattern of impairment distinguishable from alzheimers disease. Proposed diagnostic criteria for the syndrome of apathy starkstein and leentjens 2008, adapted from marin, 1991. Individuals were excluded if they had significant symptoms of depression based on a score of 9 or above on the short form of the geriatric depression scale 24, 25 or evidence of signifi. The lille apathy rating scale lars, a new instrument for. He defined apathy as lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. The apathy evaluation scale was developed by robert s.
The eeg analysis found those in the prehd group had a significant reduction in the n170 signal when shown faces or facelike objects compared to the group of relatives. The sas has a sensitivity of 66% and specificity of 100% 22, 23. Jul 01, 2018 two validated scales can be used to determine the degree of apathy. Neuropsychological impairment in parkinsons disease with and without depression. However, the literature does not adequately emphasize the links between depression and apathy. Sample version of the lille apathy rating scale lars. View enhanced pdf access article on wiley online library html view. Development and validation studies are described in marin et al. Owing to its impact on therapeutic outcomes and morbidity, this clinical dimension is of considerable interest in the pathophysiology of depression. Supplementary administration guidelines are available from the author. Psychometric testing of a swedish version of the apathy. However, in clinical research and in most pharmacological intervention studies, apathy is. A set of seven diagnostic criteria showed high sensitivity and.
The apathy evaluation scale aes is an 18item scale developed by marin et al. Exercise increases caudate dopamine release and ventral. Separate neural representations of depression, anxiety and. Screening for apathy in nh residents is important because apathy is associated with a number of adverse outcomes and its recognition may be helpful in differential diagnosis and formulation of treatment strategies. Although the item starkstein apathy scale sas is recommended to screen for and measure the severity of apathetic symptoms in parkinson disease pd. Two validated scales can be used to determine the degree of apathy. Lille apathy rating scale and mdsupdrs for screening. Repetitive transcranial magnetic stimulation rtms is an effective adjuvant therapy but still not ideal. Presymptomatic huntingtons patients show poorer ability. Psychometric properties of the starkstein apathy scale in patients. The influence of depression on cogni tion in parkinsons disease.