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Masud Husain - One of the best experts on this subject based on the ideXlab platform.
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beyond language impairment profiles of Apathy in primary progressive aphasia
Cortex, 2021Co-Authors: Halle Quang, Stephanie Wong, Masud Husain, Olivier Piguet, John R Hodges, Muireann Irish, Fiona KumforAbstract:Primary progressive aphasia (PPA) is characterised by predominant language and communication impairment. However, behavioural changes, such as Apathy, are increasingly recognised. Apathy is defined as a reduction in motivation and goal-directed behaviour. Recent theoretical models have suggested that Apathy can be delineated into multiple dimensions: executive Apathy (i.e., deficits in maintaining goals and organisation), emotional Apathy (i.e., emotional blunting and indifference) and initiation Apathy (i.e., reduced self-initiation). Whether the nature of Apathy differs between clinical variants of PPA, and across early and late disease stages, remains to be established. Here, carers/informants of 20 semantic variant PPA (svPPA), 15 non-fluent variant PPA (nfvPPA), 16 logopenic variant PPA (lvPPA) and 25 healthy older controls completed the Dimensional Apathy Scale to quantify executive, emotional and initiation Apathy. Voxel-based morphometry was used to identify associations between dimensions of Apathy and regions of grey matter intensity decrease. Our behavioural results showed greater executive and initiation Apathy in late svPPA than in late nfvPPA patients, while late svPPA had greater emotional Apathy than both late nfvPPA and late lvPPA groups. Executive and initiation Apathy were significantly higher than premorbid levels in all PPA subtypes, while elevated emotional Apathy was only seen in early and late svPPA. Distinct neural correlates were identified across Apathy dimensions. Executive Apathy correlated with grey matter intensity of the left dorsolateral prefrontal and inferior parietal cortices; emotional Apathy with the left medial prefrontal, insular and cerebellar regions; and initiation Apathy with right parietal areas. Our findings are the first to reveal evidence of the dimensional nature of Apathy in PPA, with different clinical signatures observed for each subtype. From a clinical standpoint, these results will inform the development of targeted interventions for specific aspects of Apathy which emerge in PPA.
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Apathy and its impact on carer burden and psychological wellbeing in primary progressive aphasia
Journal of the Neurological Sciences, 2020Co-Authors: Stephanie Wong, Masud Husain, Olivier Piguet, John R Hodges, Muireann Irish, Fiona KumforAbstract:Abstract Objective While patients with primary progressive aphasia (PPA) typically present with predominant language impairment, behavioural symptoms, such as Apathy, are often under-recognised. We aimed to systematically characterise Apathy across the three recognised subtypes of PPA, plus atypical right-lateralised presentations of semantic dementia, and to evaluate the impact of Apathy on carer burden and psychological wellbeing. Methods Baseline assessments from 114 PPA patients were included: 31 left semantic dementia (left SD) 16 right semantic dementia (right SD), 30 progressive nonfluent aphasia (PNFA) and 37 logopenic progressive aphasia (LPA). Clinician (Neuropsychiatric Inventory; NPI) and carer rated (Cambridge Behavioural Inventory; CBI, Frontal Systems Behaviour Scale; FrSBe) measures were used to quantify symptoms of Apathy, and carer burden and psychological wellbeing were determined using the Zarit Burden Interview and Depression, Anxiety and Stress Scale. Results On the NPI, symptoms of Apathy were present in 39% left SD, 56% right SD, 33% PNFA and 43% LPA patients. Multiple regression analysis revealed that 17.9% of the variance in carer burden was uniquely explained by scores on carer rated measures of Apathy (CBI, FrSBe), even after accounting for diagnosis, disease duration, and cognitive and language impairment. Conclusions Apathy is much more common than current diagnostic criteria for PPA would suggest, though the severity of Apathy is similar across patient groups. Increased awareness and routine assessments of Apathy symptoms are needed, together with targeted pharmacological and behavioural interventions. Moreover, as Apathy substantially contributes to carer burden in PPA, psychoeducation addressing behavioural symptoms may be beneficial.
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Apathy is associated with large scale white matter network disruption in small vessel disease
Neurology, 2019Co-Authors: Jonathan Tay, Masud Husain, Anil M Tuladhar, Matthew J Hollocks, Rebecca L Brookes, D Tozer, Thomas R Barrick, Frankerik De Leeuw, Hugh S MarkusAbstract:OBJECTIVE: To investigate whether white matter network disruption underlies the pathogenesis of Apathy, but not depression, in cerebral small vessel disease (SVD). METHODS: Three hundred thirty-one patients with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study completed measures of Apathy and depression and underwent structural MRI. Streamlines reflecting underlying white matter fibers were reconstructed with diffusion tensor tractography. First, path analysis was used to determine whether network measures mediated associations between Apathy and radiologic markers of SVD. Next, we examined differences in whole-brain network measures between participants with only Apathy, only depression, and comorbid Apathy and depression and a control group free of neuropsychiatric symptoms. Finally, we examined regional network differences associated with Apathy. RESULTS: Path analysis demonstrated that network disruption mediated the relationship between Apathy and SVD markers. Patients with Apathy, compared to all other groups, were impaired on whole-brain measures of network density and efficiency. Regional network analyses in both the Apathy subgroup and the entire sample revealed that Apathy was associated with impaired connectivity in premotor and cingulate regions. CONCLUSIONS: Our results suggest that Apathy, but not depression, is associated with white matter tract disconnection in SVD. The subnetworks delineated suggest that Apathy may be driven by damage to white matter networks underlying action initiation and effort-based decision making.
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Apathy in rapid eye movement sleep behaviour disorder is associated with serotonin depletion in the dorsal raphe nucleus
Brain, 2018Co-Authors: Thomas R Barber, Masud Husain, Kinan Muhammed, Ludovica Griffanti, D Drew, Kevin M Bradley, Daniel R Mcgowan, Marie Crabbe, Clare E Mackay, Johannes C KleinAbstract:Apathy is a common and under-recognized disorder that often emerges in the prodromal phase of Parkinsonian diseases. The mechanism by which this occurs is not known, but recent evidence from patients with established Parkinson's disease suggests that serotonergic dysfunction may play a role. The integrity of the raphe serotonergic system can be assessed alongside dopaminergic basal ganglia imaging using the radioligand 123I-ioflupane, which binds both serotonin and dopamine transporters. To investigate the relative roles of these neurotransmitters in prodromal parkinsonism, we imaged patients with idiopathic rapid eye movement sleep behaviour disorder, the majority of whom will develop a parkinsonian disorder in future. Forty-three patients underwent brain imaging with 123I-ioflupane single photon emission computed tomography and structural MRI. Apathy was quantified using the Lille Apathy Rating Scale. Other clinical parkinsonian features were assessed using standard measures. A negative correlation was observed between Apathy severity and serotonergic 123I-ioflupane signal in the dorsal raphe nucleus (r = -0.55, P < 0.001). There was no significant correlation between Apathy severity and basal ganglia dopaminergic signal, nor between dorsal raphe signal and other neuropsychiatric scores. This specific association between Apathy and raphe 123I-ioflupane signal suggests that the serotonergic system might represent a target for the treatment of Apathy.
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Apathy in alzheimer s disease
Current opinion in behavioral sciences, 2018Co-Authors: Lisa Nobis, Masud HusainAbstract:Apathy is the most common neuropsychiatric symptom in patients with Alzheimer's disease (AD). The presence of Apathy has been related to greater caregiver distress, decreased quality of life, and increased morbidity. Here we review the most recent studies on this neuropsychiatric syndrome, focusing on prevalence, impact on quality of life, behavioural and neuroimaging studies, and treatment options. The results of some investigations on the behavioural and neuroanatomical profile of Apathy in AD point to a role of frontostriatal circuits, specifically involving the anterior cingulate cortex. However, small and heterogeneous samples, lack of control for disease severity, and non-specific Apathy scales complicate interpretation of results. Future studies might benefit from studying multiple dimensions of Apathy within conceptual frameworks which allow for a deconstruction of underlying mechanisms.
Sergio E Starkstein - One of the best experts on this subject based on the ideXlab platform.
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the syndromal validity and nosological position of Apathy in parkinson s disease
Movement Disorders, 2009Co-Authors: Sergio E Starkstein, Marcelo Merello, Ricardo E Jorge, Simone Brockman, David G Bruce, Brian D PowerAbstract:Although Apathy is among the most frequent behavioral changes in Parkinson's disease (PD), its diagnosis is still problematic, and the overlap with depression and dementia poorly studied. Aim of the study was validate specific criteria to diagnose Apathy in PD, and to examine its association with subsyndromes of depression and dementia. A series of 164 patients with PD, 44 patients with "primary" depression and no PD, 23 patients with Alzheimer's disease, and 26 age-comparable healthy controls underwent a comprehensive psychiatric assessment that included a structured psychiatric interview and the Apathy Scale. A set of seven diagnostic criteria showed high sensitivity and specificity for clinically diagnosed Apathy. Fifty-two of the 164 patients with PD (32%) met diagnostic criteria for Apathy. Eighty-three percent of patients with Apathy had comorbid depression and 56% had dementia. Only 5 of the 40 PD patients (13%) with neither depression nor dementia had Apathy. We validated a set of standardized criteria for the diagnosis of Apathy in PD. About one third of a series of patients attending a Movement Disorders Clinic showed Apathy. Both depression and dementia were the most frequent comorbid conditions of Apathy in PD.
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proposed diagnostic criteria for Apathy in alzheimer s disease and other neuropsychiatric disorders
European Psychiatry, 2009Co-Authors: Philippe Robert, Chiadi U. Onyike, Kathy Dujardin, Sergio E Starkstein, Pauline Aalten, Frans R J Verhey, Albert F G Leentjens, J Yessavage, J P Clement, Dominique DrapierAbstract: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 Francaise 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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Apathy and anhedonia rating scales in parkinson s disease critique and recommendations
Movement Disorders, 2008Co-Authors: A F G Leentjens, Kathy Dujardin, Sergio E Starkstein, Laura Marsh, Pablo Martinezmartin, Irene H Richard, Daniel Weintraub, Christina Sampaio, Werner Poewe, O RascolAbstract:Apathy is a common condition in Parkinson's disease (PD) and is generally defined as a lack of motivation. It is associated with more severe cognitive dysfunction and a decrease in activities of daily living (ADL) performance. Anhedonia, the inability to experience pleasure, can be a symptom of both depressive and apathetic syndromes. The Movement Disorder Society (MDS) commissioned a task force to assess the clinimetric properties of Apathy and anhedonia scales in PD patients. A systematic literature review was conducted to identify scales that have either been validated or used in PD patients. Apathy scales identified for review include the Apathy Evaluation Scale (AES), the Apathy Scale (AS), the Apathy Inventory (AI), and the Lille Apathy Rating Scale (LARS). In addition, item 4 (motivation/initiative) of the Unified Parkinson's Disease Rating Scale (UPDRS) and item 7 (Apathy) of the Neuropsychiatric Inventory (NPI) were included. Anhedonia scales identified for review were the Snaith-Hamilton Pleasure Scale (SHAPS) and the Chapman scales for physical and social anhedonia. Only the AS is classified as "recommended" to assess Apathy in PD. Although item 4 of the UPDRS also meets the criteria to be classified as recommended, it should be considered for screening only because of the obvious limitations of a single item construct. For the assessment of anhedonia, only the SHAPS meets the criteria of "Suggested." Information on the validity of Apathy and anhedonia scales is limited because of the lack of consensus on diagnostic criteria for these conditions.
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Apathy and anhedonia rating scales in parkinson s disease critique and recommendations
Movement Disorders, 2008Co-Authors: Albert F G Leentjens, Kathy Dujardin, Sergio E Starkstein, Laura Marsh, Pablo Martinezmartin, Irene H Richard, Daniel Weintraub, Christina Sampaio, Werner Poewe, O RascolAbstract:Apathy is a common condition in Parkinson's disease (PD) and is generally defined as a lack of motivation. It is associated with more severe cognitive dysfunction and a decrease in activities of daily living (ADL) performance. Anhedonia, the inability to experience pleasure, can be a symptom of both depressive and apathetic syndromes. The Movement Disorder Society (MDS) commissioned a task force to assess the clinimetric properties of Apathy and anhedonia scales in PD patients. A systematic literature review was conducted to identify scales that have either been validated or used in PD patients. Apathy scales identified for review include the Apathy Evaluation Scale (AES), the Apathy Scale (AS), the Apathy Inventory (AI), and the Lille Apathy Rating Scale (LARS). In addition, item 4 (motivation/initiative) of the Unified Parkinson's Disease Rating Scale (UPDRS) and item 7 (Apathy) of the Neuropsychiatric Inventory (NPI) were included. Anhedonia scales identified for review were the Snaith-Hamilton Pleasure Scale (SHAPS) and the Chapman scales for physical and social anhedonia. Only the AS is classified as “recommended” to assess Apathy in PD. Although item 4 of the UPDRS also meets the criteria to be classified as recommended, it should be considered for screening only because of the obvious limitations of a single item construct. For the assessment of anhedonia, only the SHAPS meets the criteria of “Suggested.” Information on the validity of Apathy and anhedonia scales is limited because of the lack of consensus on diagnostic criteria for these conditions. © 2008 Movement Disorder Society
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the nosological position of Apathy in clinical practice
Journal of Neurology Neurosurgery and Psychiatry, 2008Co-Authors: Sergio E Starkstein, A F G LeentjensAbstract:Apathy is increasingly recognised as a common behavioural syndrome in psychiatric disorders, but it is conceptually ill defined. The aim of this study was to examine the concept of Apathy as it is currently used in neurology and psychiatry, by review of the literature and conceptual analysis. There is no consensus on diagnostic criteria for Apathy as a syndrome. Apathy is mostly defined as a disorder of motivation, and operationalised as diminished goal oriented behaviour and cognition. There is discussion about whether an emotional dimension should form part of the definition of Apathy. Abulia is considered a more severe type of Apathy, but its nosological position is still unclear. A structured clinical interview and a proposal for diagnostic criteria for Apathy in dementia have been recently validated. There are several valid and reliable scales to measure the severity of Apathy in patients with psychiatric and neurological disorders. In summary, Apathy is increasingly recognised as a common behavioural syndrome associated with neuropsychiatric disorders. There is a need for consensus on diagnostic criteria to facilitate future research. From a nosological perspective, future studies should examine the overlap with other psychiatric and neurodegenerative conditions and further validate specific diagnostic and assessment tools.
Fiona Kumfor - One of the best experts on this subject based on the ideXlab platform.
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beyond language impairment profiles of Apathy in primary progressive aphasia
Cortex, 2021Co-Authors: Halle Quang, Stephanie Wong, Masud Husain, Olivier Piguet, John R Hodges, Muireann Irish, Fiona KumforAbstract:Primary progressive aphasia (PPA) is characterised by predominant language and communication impairment. However, behavioural changes, such as Apathy, are increasingly recognised. Apathy is defined as a reduction in motivation and goal-directed behaviour. Recent theoretical models have suggested that Apathy can be delineated into multiple dimensions: executive Apathy (i.e., deficits in maintaining goals and organisation), emotional Apathy (i.e., emotional blunting and indifference) and initiation Apathy (i.e., reduced self-initiation). Whether the nature of Apathy differs between clinical variants of PPA, and across early and late disease stages, remains to be established. Here, carers/informants of 20 semantic variant PPA (svPPA), 15 non-fluent variant PPA (nfvPPA), 16 logopenic variant PPA (lvPPA) and 25 healthy older controls completed the Dimensional Apathy Scale to quantify executive, emotional and initiation Apathy. Voxel-based morphometry was used to identify associations between dimensions of Apathy and regions of grey matter intensity decrease. Our behavioural results showed greater executive and initiation Apathy in late svPPA than in late nfvPPA patients, while late svPPA had greater emotional Apathy than both late nfvPPA and late lvPPA groups. Executive and initiation Apathy were significantly higher than premorbid levels in all PPA subtypes, while elevated emotional Apathy was only seen in early and late svPPA. Distinct neural correlates were identified across Apathy dimensions. Executive Apathy correlated with grey matter intensity of the left dorsolateral prefrontal and inferior parietal cortices; emotional Apathy with the left medial prefrontal, insular and cerebellar regions; and initiation Apathy with right parietal areas. Our findings are the first to reveal evidence of the dimensional nature of Apathy in PPA, with different clinical signatures observed for each subtype. From a clinical standpoint, these results will inform the development of targeted interventions for specific aspects of Apathy which emerge in PPA.
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Apathy and its impact on carer burden and psychological wellbeing in primary progressive aphasia
Journal of the Neurological Sciences, 2020Co-Authors: Stephanie Wong, Masud Husain, Olivier Piguet, John R Hodges, Muireann Irish, Fiona KumforAbstract:Abstract Objective While patients with primary progressive aphasia (PPA) typically present with predominant language impairment, behavioural symptoms, such as Apathy, are often under-recognised. We aimed to systematically characterise Apathy across the three recognised subtypes of PPA, plus atypical right-lateralised presentations of semantic dementia, and to evaluate the impact of Apathy on carer burden and psychological wellbeing. Methods Baseline assessments from 114 PPA patients were included: 31 left semantic dementia (left SD) 16 right semantic dementia (right SD), 30 progressive nonfluent aphasia (PNFA) and 37 logopenic progressive aphasia (LPA). Clinician (Neuropsychiatric Inventory; NPI) and carer rated (Cambridge Behavioural Inventory; CBI, Frontal Systems Behaviour Scale; FrSBe) measures were used to quantify symptoms of Apathy, and carer burden and psychological wellbeing were determined using the Zarit Burden Interview and Depression, Anxiety and Stress Scale. Results On the NPI, symptoms of Apathy were present in 39% left SD, 56% right SD, 33% PNFA and 43% LPA patients. Multiple regression analysis revealed that 17.9% of the variance in carer burden was uniquely explained by scores on carer rated measures of Apathy (CBI, FrSBe), even after accounting for diagnosis, disease duration, and cognitive and language impairment. Conclusions Apathy is much more common than current diagnostic criteria for PPA would suggest, though the severity of Apathy is similar across patient groups. Increased awareness and routine assessments of Apathy symptoms are needed, together with targeted pharmacological and behavioural interventions. Moreover, as Apathy substantially contributes to carer burden in PPA, psychoeducation addressing behavioural symptoms may be beneficial.
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Apathy in alzheimer s disease and frontotemporal dementia distinct clinical profiles and neural correlates
Cortex, 2018Co-Authors: Fiona Kumfor, Olivier Piguet, John R Hodges, Alice Zhen, Muireann IrishAbstract:Abstract Objective Apathy is the most prevalent and disabling non-cognitive symptom of dementia and affects 90% of patients across the disease course. Despite its pervasiveness, how Apathy manifests across dementia syndromes and the neurobiological mechanisms driving these symptoms are poorly understood. Here, we applied the multidimensional ABC model of Apathy, which recognizes Affective, Behavioural and Cognitive Apathy, in Alzheimer's disease (AD) and behavioural-variant frontotemporal dementia (bvFTD). Methods One hundred and twenty-two patients (53 AD; 69 bvFTD) were included. Informants completed the Neuropsychiatric Inventory (NPI), Cambridge Behavioral Inventory and Disability and Dementia scale to quantify Affective, Behavioural and Cognitive Apathy. All patients underwent structural magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) was employed to identify brain regions correlated with increased Affective, Behavioural and Cognitive Apathy. Results On the NPI, 60% of AD and 84% of bvFTD patients had some degree of Apathy, but bvFTD had more severe and more frequent symptoms than AD. Importantly, bvFTD patients had higher affective and cognitive Apathy whereas AD had higher cognitive Apathy only. Neuroimaging analyses revealed that affective Apathy was associated with the ventral prefrontal cortex; behavioural Apathy with the basal ganglia; and cognitive Apathy with the dorsomedial prefrontal cortex. Finally, affective and behavioural Apathy significantly predicted carer burden. Conclusions Our results support the notion that Apathy is multidimensional and manifests differently across dementia syndromes. Thus, novel interventions which target these divergent mechanisms will be necessary to improve motivation and goal-directed behaviour in people with dementia.
Hugh S Markus - One of the best experts on this subject based on the ideXlab platform.
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Apathy is associated with large scale white matter network disruption in small vessel disease
Neurology, 2019Co-Authors: Jonathan Tay, Masud Husain, Anil M Tuladhar, Matthew J Hollocks, Rebecca L Brookes, D Tozer, Thomas R Barrick, Frankerik De Leeuw, Hugh S MarkusAbstract:OBJECTIVE: To investigate whether white matter network disruption underlies the pathogenesis of Apathy, but not depression, in cerebral small vessel disease (SVD). METHODS: Three hundred thirty-one patients with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study completed measures of Apathy and depression and underwent structural MRI. Streamlines reflecting underlying white matter fibers were reconstructed with diffusion tensor tractography. First, path analysis was used to determine whether network measures mediated associations between Apathy and radiologic markers of SVD. Next, we examined differences in whole-brain network measures between participants with only Apathy, only depression, and comorbid Apathy and depression and a control group free of neuropsychiatric symptoms. Finally, we examined regional network differences associated with Apathy. RESULTS: Path analysis demonstrated that network disruption mediated the relationship between Apathy and SVD markers. Patients with Apathy, compared to all other groups, were impaired on whole-brain measures of network density and efficiency. Regional network analyses in both the Apathy subgroup and the entire sample revealed that Apathy was associated with impaired connectivity in premotor and cingulate regions. CONCLUSIONS: Our results suggest that Apathy, but not depression, is associated with white matter tract disconnection in SVD. The subnetworks delineated suggest that Apathy may be driven by damage to white matter networks underlying action initiation and effort-based decision making.
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differential relationships between Apathy and depression with white matter microstructural changes and functional outcomes
Brain, 2015Co-Authors: Matthew J Hollocks, Masud Husain, Rebecca L Brookes, Thomas R Barrick, Andrew J Lawrence, Robin G Morris, Hugh S MarkusAbstract:Small vessel disease is a stroke subtype characterized by pathology of the small perforating arteries, which supply the sub-cortical structures of the brain. Small vessel disease is associated with high rates of Apathy and depression, thought to be caused by a disruption of white matter cortical-subcortical pathways important for emotion regulation. It provides an important biological model to investigate mechanisms underlying these key neuropsychiatric disorders. This study investigated whether Apathy and depression can be distinguished in small vessel disease both in terms of their relative relationship with white matter microstructure, and secondly whether they can independently predict functional outcomes. Participants with small vessel disease (n = 118; mean age = 68.9 years; 65% male) defined as a clinical and magnetic resonance imaging confirmed lacunar stroke with radiological leukoaraiosis were recruited and completed cognitive testing, measures of Apathy, depression, quality of life and diffusion tensor imaging. Healthy controls (n = 398; mean age = 64.3 years; 52% male) were also studied in order to interpret the degree of Apathy and depression found within the small vessel disease group. Firstly, a multilevel structural equation modelling approach was used to identify: (i) the relationships between median fractional anisotropy and Apathy, depression and cognitive impairment; and (ii) if Apathy and depression make independent contributions to quality of life in patients with small vessel disease. Secondly, we applied a whole-brain voxel-based analysis to investigate which regions of white matter were associated with Apathy and depression, controlling for age, gender and cognitive functioning. Structural equation modelling results indicated both Apathy (r = -0.23, P ≤ 0.001) and depression (r = -0.41, P ≤ 0.001) were independent predictors of quality of life. A reduced median fractional anisotropy was significantly associated with Apathy (r = -0.38, P ≤ 0.001), but not depression (r = -0.16, P = 0.09). On voxel-based analysis, Apathy was associated with widespread reduction in white matter integrity, with the strongest effects in limbic association tracts such as the anterior cingulum, fornix and uncinate fasciculus. In contrast, when controlling for Apathy, we found no significant relationship between our white matter parameters and symptoms of depression. In conclusion, white matter microstructural changes in small vessel disease are associated with Apathy but not directly with depressive symptoms. These results suggest that Apathy, but not depression, in small vessel disease is related to damage to cortical-subcortical networks associated with emotion regulation, reward and goal-directed behaviour.
Chiadi U. Onyike - One of the best experts on this subject based on the ideXlab platform.
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Apathy associated with neurocognitive disorders recent progress and future directions
Alzheimers & Dementia, 2017Co-Authors: Krista L Lanctot, Gad A Marshall, Luis Agueraortiz, Henry Brodaty, Paul T Francis, Yonas E Geda, Zahinoor Ismail, Moyra E Mortby, Chiadi U. OnyikeAbstract:Abstract Introduction Apathy is common in neurocognitive disorders (NCDs) such as Alzheimer's disease and mild cognitive impairment. Although the definition of Apathy is inconsistent in the literature, Apathy is primarily defined as a loss of motivation and decreased interest in daily activities. Methods The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Neuropsychiatric Syndromes Professional Interest Area (NPS-PIA) Apathy workgroup reviewed the latest research regarding Apathy in NCDs. Results Progress has recently been made in three areas relevant to Apathy: (1) phenomenology, including the use of diagnostic criteria and novel instruments for measurement, (2) neurobiology, including neuroimaging, neuropathological and biomarker correlates, and (3) interventions, including pharmacologic, nonpharmacologic, and noninvasive neuromodulatory approaches. Discussion Recent progress confirms that Apathy has a significant impact on those with major NCD and those with mild NCDs. As such, it is an important target for research and intervention.
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proposed diagnostic criteria for Apathy in alzheimer s disease and other neuropsychiatric disorders
European Psychiatry, 2009Co-Authors: Philippe Robert, Chiadi U. Onyike, Kathy Dujardin, Sergio E Starkstein, Pauline Aalten, Frans R J Verhey, Albert F G Leentjens, J Yessavage, J P Clement, Dominique DrapierAbstract: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 Francaise 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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Epidemiology of Apathy in older adults: the Cache County Study.
The American Journal of Geriatric Psychiatry, 2007Co-Authors: Chiadi U. Onyike, Jeannie-marie E. Sheppard, Joann T. Tschanz, Maria C. Norton, Robert C. Green, Martin H. Steinberg, Kathleen A. Welsh-bohmer, John C.s. Breitner, Constantine G. LyketsosAbstract:Objectives The objectives of this study are to describe the distribution of Apathy in community-based older adults and to investigate its relationships with cognition and day-to-day functioning. Methods Data from the Cache County Study on Memory, Health and Aging were used to estimate the frequency of Apathy in groups of elders defined by demographic, cognitive, and functional status and to examine the associations of Apathy with impairments of cognition and day-to-day functioning. Results Apathy was measured with the Neuropsychiatric Inventory. Clinical Apathy (Neuropsychiatric Inventory score ≥4) was found in 1.4% of individuals classified as cognitively normal, 3.1% of those with a mild cognitive syndrome, and 17.3% of those with dementia. Apathy status was associated with cognitive and functional impairments and higher levels of stress experienced by caregivers. Among participants with normal cognition, Apathy was associated with worse performance on the Mini-Mental State Examination, the Boston Naming and Animal Fluency tests, and the Trail Making Test—Part B. The association of Apathy with cognitive impairment was independent of its association with Neuropsychiatric Inventory depression. Conclusions In a cohort of community-based older adults, the frequency and severity of Apathy is positively correlated with the severity of cognitive impairment. In addition, Apathy is associated with cognitive and functional impairments in elders adjudged to have normal cognition. The results suggest that Apathy is an early sign of cognitive decline and that delineating phenotypes in which Apathy and a mild cognitive syndrome co-occur may facilitate earlier identification of individuals at risk for dementia.