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Garcia JM, Sehgal J, Thompson JL, Woods SP, Medina LD. The Relationship Between Apathy and Cognitive Impairment Among Hispanic/Latin Americans: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses Systematic Review. J Geriatr Psychiatry Neurol 2024; 37:175-193. [PMID: 37855134 DOI: 10.1177/08919887231207640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES The primary aim was to evaluate apathy assessment measures in relation to cognitive impairment among Hispanic/Latin Americans. METHODS A systematic review on the relationship between apathy and cognitive impairment among Hispanic/Latin Americans across normal aging and neurocognitive disorders was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and using APA PsycInfo, Embase, and PubMed databases. Inclusion criteria required (1) a sample of English or Spanish-speaking adults ages 18 years and older, (2) with measures of apathy, (3) assessment of cognitive functioning or diagnosis of neurocognitive disorder, (4) with at least 18.5% Hispanic/Latin American represented in the sample. RESULTS Only 14 papers met criteria to be included in this review. Of the 12 cross-sectional studies, 9 demonstrated significant associations between increased apathy and cognitive impairment, 1 demonstrated a descriptive difference between apathy and cognitive status (ie, no hypothesis test conducted), while 2 demonstrated null effects. These cross-sectional studies consisted of community and clinic samples of participants across North and South America. Two longitudinal studies conducted in North America demonstrated non-significant associations of apathy with cognitive status. CONCLUSIONS The Neuropsychiatric Inventory (NPI) and Neuropsychiatric Inventory Questionnaire (NPI-Q) apathy subscales were the most used measures for apathy in this review (85.7% of included studies). However, validity evidence from a review of apathy measures has warranted caution against the use of the NPI outside the context of screening for apathy. This potential measurement bias with Hispanic/Latin Americans apathy research limits conclusions drawn from the present review.
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Affiliation(s)
- Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jai Sehgal
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Thompson JL, Woods SP, Medina LD, Garcia JM, Teixeira AL. Apathy in persons living with HIV disease: A systematic narrative review. J Affect Disord 2024; 350:133-147. [PMID: 38224740 DOI: 10.1016/j.jad.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/28/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Apathy was identified as a feature of HIV early in the epidemic; however, there are no systematic reviews of the diverse literature on the sociodemographic and clinical correlates of apathy in HIV disease. METHODS The current study adopted a hybrid systematic-narrative review methodology in which we used PRISMA guidelines to identify, summarize, and critique peer-reviewed, empirical studies of apathy in HIV disease in the era of combination antiretroviral therapy. RESULTS A total of 34 studies of apathy in persons living with HIV (PLWH) were identified. Findings across these studies showed that apathy was reliably related to the structure of grey and white matter pathways commonly implicated in apathy, poorer everyday functioning, education, and other neuropsychiatric symptoms (e.g., depression). Apathy was not reliably associated with age, sex, race/ethnicity, cognition, and clinical markers of HIV disease. LIMITATIONS The current review does not provide rigorous quantitative estimates of clinical correlates of apathy, and the exclusion criteria of non-English and non-peer reviewed publications introduces risk of bias and Type I error. CONCLUSIONS Apathy occurs at higher rates in PLWH and is linked to neuroanatomical differences, as well as negative outcomes for everyday functions, aspects of neurocognition, and neuropsychiatric symptoms. As such, apathy is an important component to consider in the clinical assessment, diagnosis, and management of neurocognitive disorders in PLWH. Future work is needed to replicate existing findings with larger sample sizes and longitudinal designs, examine apathy as a multi-dimensional construct, and develop evidence-based treatments for apathy in PLWH.
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Affiliation(s)
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX 77004, USA.
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Antonio L Teixeira
- Neuropsychiatry Program, Department of Psychiatry & Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX 77054, USA
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Kapustin D, Tumati S, Wong M, Herrmann N, Dixon RA, Seitz D, Rapoport MJ, Lanctôt KL. Sex-specific neuropsychological correlates of apathy and depression across neurodegenerative disorders. Int J Geriatr Psychiatry 2024; 39:e6080. [PMID: 38497928 DOI: 10.1002/gps.6080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Apathy and depression are common neuropsychiatric symptoms across neurodegenerative disorders and are associated with impairment in several cognitive domains, yet little is known about the influence of sex on these relationships. OBJECTIVES We examined the relationship between these symptoms with neuropsychological performance across a combined cohort with mild or major neurodegenerative disorders, then evaluated the impact of sex. DESIGN, SETTING AND PARTICIPANTS We conducted a cohort analysis of participants in the COMPASS-ND study with mild cognitive impairment (MCI), vascular MCI, Alzheimer's disease, mixed dementia, Parkinson's disease, frontotemporal dementia, and cognitively unimpaired (CU) controls. MEASUREMENTS Participants with neurodegenerative disease and CU controls were stratified by the presence (severity ≥1 on Neuropsychiatric Inventory Questionnaire) of either depressive symptoms alone, apathy symptoms alone, both symptoms, or neither. A neuropsychological battery evaluated executive function, verbal fluency, verbal learning, working memory, and visuospatial reasoning. Analysis of covariance was used to assess group differences with age, sex, and education as covariates. RESULTS Groups included depressive symptoms only (n = 70), apathy symptoms only (n = 52), both (n = 68), or neither (n = 262). The apathy and depression + apathy groups performed worse than the neither group on tests of working memory (t(312) = -2.4, p = 0.02 and t(328) = -3.8, p = 0.001, respectively) and visuospatial reasoning (t(301) = -2.3, p = 0.02 and t(321) = -2.6, p = 0.01, respectively). The depression, apathy, and depression + apathy groups demonstrated a similar degree of impairment on tests of executive function, processing speed, verbal fluency, and verbal learning when compared to participants without apathy or depression. Sex-stratified analyses revealed that compared to the male neither group, the male apathy and depression + apathy groups were impaired broadly across all cognitive domains except for working memory. Females with depression alone showed deficits on tests of executive function (t(166) = 2.4, p = 0.01) and verbal learning (t(167) = -4.3, p = 0.001) compared to the female neither group. CONCLUSIONS This study demonstrated that in neurodegenerative diseases, apathy with or without depression in males was associated with broad cognitive impairments. In females, depression was associated with deficits in executive function and verbal learning. These findings highlight the importance of effectively treating apathy and depression across the spectrum of neurodegenerative disorders with the goal of optimizing neuropsychological outcomes.
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Affiliation(s)
| | - Shankar Tumati
- University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Melissa Wong
- University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Nathan Herrmann
- University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Roger A Dixon
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Dallas Seitz
- University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark J Rapoport
- University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Yi HJ, Tan CH, Hong WP, Yu RL. Development and validation of the geriatric apathy scale: Examining multi-dimensional apathy profiles in a neurodegenerative population with cultural considerations. Asian J Psychiatr 2024; 93:103924. [PMID: 38232445 DOI: 10.1016/j.ajp.2024.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Apathy is a common motivational deficit in neurodegenerative diseases, but lacks a culturally sensitive tool accounting for ethnic Chinese culture's impact on motivation initiation. This study developed and validated the Geriatric Apathy Scale (GAS), comprehensively incorporating cultural nuances, setting diagnostic cutoffs, and examining apathy's multi-dimensional aspects in a neurodegenerative cohort. METHODS The 16-item GAS was developed by considering ethnic Chinese cultural characteristics and conducting a literature review. The study involved 296 participants, comprising 113 with Parkinson's disease (PD), 66 with Alzheimer's disease (AD), and 117 healthy controls (HC). All participants completed the GAS, Apathy Evaluation Scale (AES), Geriatric Depression Scale (GDS-15), Mini-Mental State Examination, and Activities of Daily Living (ADLs). RESULTS The GAS showed good internal consistency (r = 0.862) and test-retest reliability (r = 0.767). It correlated moderately with the AES (r = 0.639, p < .001), weakly with GDS-15 (r = 0.166, p < .01), and negatively with ADLs (r = -1.19, p < .05). Clinical diagnosis cutoff scores were identified at 15.5 for PD (sensitivity: 0.789; specificity: 0.693) and 12.5 for AD (sensitivity: 0.821; specificity: 0.632). Noteworthy disparities were observed in the Cognition and Social Motivation dimension, with elevated severity in both PD and AD compared to HC (p < .01). Interestingly, within-group comparisons revealed greater apathy severity in the Cognition and Social Motivation dimension for PD (p < .001) and AD (p = .001) versus Emotional Response and Expression and Spontaneous Behavioral Activation. CONCLUSIONS The GAS, a psychometrically validated scale, assesses apathy in neurodegenerative populations, accounting for ethnic Chinese culture's influence. It establishes clinical cutoff points and explores the multi-dimensional nature of apathy.
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Affiliation(s)
- Hsin-Jou Yi
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsiang Tan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Pin Hong
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Rwei-Ling Yu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Office of Strategic Planning, National Cheng Kung University, Tainan, Taiwan.
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Robinson L, Dreesen E, Mondesir M, Harrington C, Wischik C, Riedel G. Apathy-like behaviour in tau mouse models of Alzheimer's disease and frontotemporal dementia. Behav Brain Res 2024; 456:114707. [PMID: 37820751 DOI: 10.1016/j.bbr.2023.114707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023]
Abstract
Apathy is the most common behavioural and psychological symptom in Alzheimer's disease (AD) and other neurodegenerative diseases including frontotemporal dementia (FTD) and Parkinson's disease (PD). In patients, apathy can include symptoms of loss of motivation, initiative, and interest, listlessness, and indifference, flattening of emotions, absence of drive and passion. Researchers have later refined this to a reduction in goal direct behaviours. In animals, specific symptoms of apathy-like behaviour have been modelled including goal directed or nest-building behaviour which are seen as indicative of proxies for motivation and daily activities. In the present study a nest-building protocol was established using four different inbred mouse strains (CD1, BALB/c, C57Bl/6J, C3H) before assessing AD and FTD tau transgenic mice of Line 1 (L1) and Line 66 (L66) in this paradigm. Female mice aged 5 - 6 months were assessed in the home cage over a period of 7 days with nest-building behaviour scored by three independent experimenters at intervals of 1-, 2- and 7-days post nestlet introduction. Inbred mouse strains displayed different levels of nesting behaviour. BALB/c mice were more proficient than CD1 and C3H mice, while all strains displayed similar nest-building behaviour by day 7. In the tau mouse models, L66 presented with impaired nesting compared to wild-type on days 1 and 2 (not day 7), whereas L1 performed like wild-type on all days. Anhedonia measured in a sucrose preference test was only observed in L66. Anhedonia and low nesting scores in L66 mice are indicative of apathy-like phenotypes. Differences evident between the L1 and L66 tau transgenic mouse models are likely due to the different human tau species expressed in these mice.
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Affiliation(s)
- Lianne Robinson
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill AB25 2ZD, United Kingdom.
| | - Eline Dreesen
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill AB25 2ZD, United Kingdom
| | - Miguel Mondesir
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill AB25 2ZD, United Kingdom
| | - Charles Harrington
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill AB25 2ZD, United Kingdom; TauRx Therapeutics Ltd, 395 King Street, Aberdeen AB24 5RP, United Kingdom
| | - Claude Wischik
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill AB25 2ZD, United Kingdom; TauRx Therapeutics Ltd, 395 King Street, Aberdeen AB24 5RP, United Kingdom
| | - Gernot Riedel
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill AB25 2ZD, United Kingdom
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Chau JPC, Lo SHS, Zhao J, Choi KC, Butt L, Thompson DR. Apathy mediates the association between age and cognition after stroke. Disabil Rehabil 2023:1-6. [PMID: 38153242 DOI: 10.1080/09638288.2023.2297921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/16/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To examine if the association between age and post-stroke cognition is mediated by apathy. METHODS A cross-sectional investigation was carried out with 389 stroke survivors and informants. Data were collected through the Apathy Evaluation Scale (AES-C) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Bivariate analyses were conducted between the IQCODE total score and each of the demographic and clinical characteristics as well as apathy, while Baron and Kenny's 4-step approach was used to examine the mediating effect of apathy on the association between age and post-stroke cognition. RESULTS Participants were aged 64.3 years on average, with a mean IQCODE score of 97.6 (SD: 14.8) and a mean AES-C score of 41.3 (SD: 8.0). IQCODE scores were positively correlated with age (r = 0.32, p < 0.001) and apathy (r = 0.54, p < 0.001). Apathy contributed to 24% of the total effect of age on post-stroke cognition, exerting a significant mediating effect on the relationship between age and post-stroke cognition. CONCLUSIONS Apathy may have a significant impact on the cognitive health of stroke survivors. Therefore, the early identification of apathy symptoms could facilitate consideration of potential interventions, such as multisensory and cognitive stimulation, designed to improve cognitive outcomes in this population.
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Affiliation(s)
- Janita Pak Chun Chau
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Suzanne Hoi Shan Lo
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jie Zhao
- School of Nursing, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Kai Chow Choi
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Laveeza Butt
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Espiritu AI, Hara T, Tolledo JK, Blair M, Burhan AM. Repetitive transcranial magnetic stimulation for apathy in patients with neurodegenerative conditions, cognitive impairment, stroke, and traumatic brain injury: a systematic review. Front Psychiatry 2023; 14:1259481. [PMID: 38034914 PMCID: PMC10684725 DOI: 10.3389/fpsyt.2023.1259481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background We aimed to determine the effects and tolerability of repetitive transcranial magnetic stimulation (rTMS) on apathy in patients with neurodegenerative conditions, mild cognitive impairment (MCI), stroke, and traumatic brain injury (TBI) via systematic review. Methods We conducted a systematic search in major electronic health databases, including PubMed, Scopus, and PsycINFO, covering the period from inception to June 2023. Comparative clinical trials and cohort studies, and studies with before-after designs were considered for inclusion. We used the Cochrane Risk of Bias and the National Institutes of Health (NIH) tools to assess methodological quality. Results Out of 258 records identified, 14 studies met our eligibility criteria (11 randomized controlled trials (RCT) and 3 studies utilized before-and-after designs) with a total of 418 patients (overall female-to-male ratio 1:1.17) included in the review. The overall methodological quality of the included studies was assessed to be fair to good. The stimulation parameters used varied considerably across the studies. The summary findings of our review indicate the following observations on the effects of rTMS on apathy: (1) the results of all included studies in Alzheimer's disease investigating the effects of rTMS on apathy have consistently shown a positive impact on apathy; (2) the majority of studies conducted in Parkinson's disease have not found statistically significant results; (3) a single study (RCT) on patients with primary progressive aphasia demonstrated significant beneficial effects of rTMS on apathy; (4) the trials conducted on individuals with MCI yielded varying conclusions; (5) one study (RCT) in chronic stroke suggested that rTMS might have the potential to improve apathy; (6) one study conducted on individuals with mild TBI did not find a significant favorable association on apathy; and (7) the use of different rTMS protocols on the populations described is generally safe. Conclusion The feasibility of utilizing rTMS as a treatment for apathy has been suggested in this review. Overall, limited evidence suggests that rTMS intervention may have the potential to modify apathy among patients with AD, PPA, MCI and chronic stroke, but less so in PD and mild TBI. These findings require confirmation by larger, well-designed clinical trials.
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Affiliation(s)
- Adrian I. Espiritu
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry and Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Takatoshi Hara
- Department of Rehabilitation Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Mervin Blair
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Lawson Research Institute, London, ON, Canada
| | - Amer M. Burhan
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Nijsten JMH, Smalbrugge M, Plouvier AOA, Koopmans RTCM, Leontjevas R, Gerritsen DL. Identifying and managing apathy in people with dementia living in nursing homes: a qualitative study. BMC Geriatr 2023; 23:727. [PMID: 37946109 PMCID: PMC10636808 DOI: 10.1186/s12877-023-04422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Although apathy is common in people with dementia and has profound negative effects, it is rarely diagnosed nor specifically treated in nursing homes. The aim of this study is to explore experiences in identifying and managing apathy from the perspectives of people with dementia and apathy (PwA), family caregivers (FCs) and professional caregivers (PCs). METHODS Descriptive qualitative study with purposive sampling, comprising eleven semi-structured in-depth interviews with PwA, FCs or PCs and focus groups with twelve PCs in Dutch nursing homes. Seventeen additional in-depth interviews with caregivers were held, after signals of increasing apathy during the first Covid-19 lockdown. Using an inductive approach, data was analysed thematically to explore the experiences in identifying and managing apathy from the perspective of different stakeholders. RESULTS Three themes were identified: 1) the challenge to appraise signals, 2) the perceived impact on well-being, 3) applied strategies to manage apathy. Although participants described apathy in line with diagnostic criteria, they were unfamiliar with the term apathy and had difficulties in appraising signals of apathy. Also, the perceived impact of apathy varied per stakeholder. PwA had difficulties reflecting on their internal state. FCs and PCs experienced apathy as challenging when it reduced the well-being of PwA or when they themselves experienced ambiguity, frustration, insecurity, disappointment or turning away. Dealing with apathy required applying specific strategies that included stimulating meaningful contact, adjusting one's expectations, and appreciating little successes. CONCLUSIONS When addressing apathy in nursing homes, it is important to consider that a) all stakeholders experience that appraising signals of apathy is challenging; b) apathy negatively influences the well-being of people with dementia and especially their FCs and PCs; and c) FCs and PCs can successfully, albeit temporarily, manage apathy by using specific strategies.
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Affiliation(s)
- Johanna M H Nijsten
- Radboud University, Nijmegen, The Netherlands.
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Radboud Alzheimer Centre, Nijmegen, The Netherlands.
- Archipel, Landrijt Expertise Centre for Specialized Care, Eindhoven, The Netherlands.
| | - Martin Smalbrugge
- Department of Medicine for Older People, UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Annette O A Plouvier
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
- Waalboog, Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Ruslan Leontjevas
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
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Zhou Y, Han W, Yao X, Xue J, Li Z, Li Y. Developing a machine learning model for detecting depression, anxiety, and apathy in older adults with mild cognitive impairment using speech and facial expressions: A cross-sectional observational study. Int J Nurs Stud 2023; 146:104562. [PMID: 37531702 DOI: 10.1016/j.ijnurstu.2023.104562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Depression, anxiety, and apathy are highly prevalent in older people with preclinical dementia and mild cognitive impairment. These symptoms have also proven valuable in predicting the progression from mild cognitive impairment to dementia, enabling a timely diagnosis and treatment. However, objective and reliable indicators to detect and distinguish depression, anxiety, and apathy are relatively scarce. OBJECTIVE This study aimed to develop a machine learning model to detect and distinguish depression, anxiety, and apathy based on speech and facial expressions. DESIGN An observational, cross-sectional study design. SETTING(S) The memory outpatient department of a tertiary hospital. PARTICIPANTS 319 older adults diagnosed with mild cognitive impairment. METHODS Depression, anxiety, and apathy were evaluated by the Public Health Questionnaire, General Anxiety Disorder, and Apathy Evaluation Scale, respectively. Speech and facial expressions of older adults with mild cognitive impairment were digitally captured using audio and video recording software. Open-source data analysis toolkits were utilized to extract speech, facial, and text features. The multiclass classification was used to develop classification models, and shapely additive explanations were used to explain the contribution of each feature within the model. RESULTS The random forest method was used to develop a multiclass emotion classification model, which performed well in classifying emotions with a weighted-average F1 score of 96.6 %. The model also demonstrated high accuracy, precision, and recall, with 87.4 %, 86.6 %, and 87.6 %, respectively. CONCLUSIONS The machine learning model developed in this study demonstrated strong classification performance in detecting and differentiating depression, anxiety, and apathy. This innovative approach combines text, audio, and video to provide objective methods for precise classification and remote monitoring of these symptoms in nursing practice. REGISTRATION This study was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR1900023892; registration date: June 19th, 2019).
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Affiliation(s)
- Ying Zhou
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xiuyu Yao
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - JiaJun Xue
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yingxin Li
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
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Harrison F, Mortby ME, Mather KA, Sachdev PS, Brodaty H. Apathy as a determinant of health behaviors in older adults: Implications for dementia risk reduction. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12505. [PMID: 38026759 PMCID: PMC10668002 DOI: 10.1002/dad2.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 08/04/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Long-term improvements in physical inactivity and other behavioral risk factors are integral to dementia risk reduction; however, sustained behavior change is challenging. Apathy, depression, and fatigue may impact engagement in health behaviors, but their presentation overlaps. This study investigates whether these symptoms are differentially associated with multiple health behaviors. METHODS In 1037 community-dwelling older adults without dementia (aged 70-90, 55% women), regression analyses examined apathy, depression, and fatigue as predictors of health behaviors (physical activity, diet, alcohol, smoking) and a behavioral risk index. RESULTS Apathy was associated with reduced physical activity and alcohol use, and one or multiple behavioral risk factors. No or inconsistent relations were found between depression or fatigue and health behaviors. DISCUSSION Apathy is relevant to multiple health behaviors and should be considered when designing health promotion for older adults, including interventions for dementia risk reduction. Findings highlight the importance of distinguishing apathy from comorbid symptoms. Highlights Novel theory-based perspective on behavioural risk factors for dementia.Higher apathy predicted less physical activity and alcohol use, and increased odds of lifestyle risk factors.Depressive symptoms were not associated with any health behavior.Apathy may be a determinant of multiple health behaviors in older adults, distinct from depression and fatigue.Considering apathy in precision prevention of dementia appears warranted.
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Affiliation(s)
- Fleur Harrison
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry & Mental HealthFaculty of Medicine & Health, UNSW SydneySydneyNew South WalesAustralia
| | - Moyra E. Mortby
- School of Psychology, UNSW SydneySydneyNew South WalesAustralia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
- UNSW Ageing Futures Institute, UNSW SydneySydneyNew South WalesAustralia
| | - Karen A. Mather
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry & Mental HealthFaculty of Medicine & Health, UNSW SydneySydneyNew South WalesAustralia
- Neuroscience Research AustraliaSydneyNew South WalesAustralia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry & Mental HealthFaculty of Medicine & Health, UNSW SydneySydneyNew South WalesAustralia
- NeuroPsychiatric InstitutePrince of Wales HospitalRandwickNew South WalesAustralia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry & Mental HealthFaculty of Medicine & Health, UNSW SydneySydneyNew South WalesAustralia
- Older People's Mental Health ServicePrince of Wales HospitalRandwickNew South WalesAustralia
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Fang Y, Chen L, Zhang Y, Yuan W, Han B. Association between apathy in patients with maintenance dialysis and hospitalization or mortality: a prospective cohort study. Front Psychiatry 2023; 14:1007977. [PMID: 37265555 PMCID: PMC10231221 DOI: 10.3389/fpsyt.2023.1007977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/04/2023] [Indexed: 06/03/2023] Open
Abstract
Background Patients receiving maintenance dialysis experience increased rates of hospitalization and mortality. Apathy is associated with reduced quality of life and increased hospitalization, institutionalization, and death. Whether apathy contributes to poor outcomes in population undergoing maintenance dialysis remain unknown. Methods We conducted a prospective cohort study of maintenance dialysis population who were consecutively recruited at the Dialysis Center of Shanghai General Hospital between July 2017 and August 2018 and were followed up for 3 year. Apathy status was measured by the Apathy Evaluation Scale. The study outcomes were the occurrence of death and first hospitalization. Results A total of 647 participants included in this study, 274 (42.3%) had a current apathy and 373 (57.7%) were not. During the follow-up period, 394 (60.9%) were hospitalized, and 169 (26.1%) died. Kaplan-Meier analysis showed that the risks of hospitalization and mortality were significantly higher in individuals with apathy than in those without apathy (both p < 0.001). Apathy at baseline was associated with hospitalization and death both in univariate analysis and in all multivariable models (all p < 0.001). Conclusion Apathy was highly prevalent and independently correlated with an increased risk of poor outcomes in patients with maintenance dialysis.
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Affiliation(s)
- Yu Fang
- Department of Psychiatry, Huzhou Third People’s Hospital, The Affiliated Hospital of Huzhou University, Huzhou, China
| | - Lei Chen
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yueyue Zhang
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weijie Yuan
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Han
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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