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To:
Journal of PRACTICAL NEUROLOGY Letters
Electronic Letters to:
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Electronic letters published:
![[Read eLetter]](/icons/misc/sectionDOWN.gif){kind=icon}
Mild dementia and the role of apathy on cognitive and functional status
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Angelo Bianchetti, Physician Geriatric Research Group, Italy, Alessandro Margiotta, Piera Ranieri, Marco Trabucchi
Send letter to journal:
angelo.biancetti{at}libero.it Angelo Bianchetti, et al.
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Dear Editor, Starkstein and colleagues in their recent paper (1) found that apathy is a marker of more aggressive disease in a group of Alzheimer’s disease (AD) patients in various stages of dementia. On the same line, we recently carried out a multicentric longitudinal study on 168 elderly outpatients (58% female) affected by mild dementia, identified by a Mini Mental State Examination (MMSE) (2) score greater or equal to 18/30 (mean value 22,2±3,3), mainly AD (83%). The mean age was 77, 2±6, 6 years; symptoms duration 26, 8±16, 2 months. The assessment of functional status (basic activity of daily living – BADL) (3), instrumental activity of daily living (IADL) (4), and behavioural symptoms (Neuropsychiatric Inventory –NPI) (5) was performed. 126 patients (75% of initial sample) underwent a follow-up examination after 12 months. The presence of apathy (detected by means of the NPI) was found in 53 patients (42%) both at baseline and follow-up examination, while 28 (22%) had new onset apathy and 41 (32%) showed no apathy neither at baseline nor at follow-up examination. The small sample of patients with apathy at baseline but no apathy at follow-up (4 patients; 3%) was not included in the following statistical analysis. The analysis of paired sample t-test of functional and cognitive parameters between baseline and follow-up in the whole sample showed, as expected, a worsening of cognition (MMSE 22.2±3.3 vs 20.3±4.8, p<0.001) and function (BADL lost 0.8±1.4 and 1.2±1.7, p<0.03 and IADL lost 2.8±2.3 and 3.4±2.3, p<0.004 respectively at baseline and follow-up). The examination of the cognitive and functional decline in relation to the presence of apathy revealed that patients with apathy on both assessments had a significant worsening in MMSE score (21.4±2.8 at baseline vs. 19.1±4.6 at follow-up, p<0.001) and in number of BADL lost (1.5±1.7 at baseline vs 2.3±1.9 at follow-up, p<0.008) with substantial stable IADL score (4.1±2.1 at baseline vs 4.5±2.2 at follow-up, ns), and that subjects with new onset apathy presented a significant cognitive decline (21.2±3.6 at baseline vs 17.5±4.8 at follow-up, p<0.009), more pronounced than in the other groups. The absence of apathy on both assessments was not associated with statistically rilevant decline in functional (BADL lost 0.4±0.9 vs. 0.5±1.2, ns, and IADL lost 1.7±2.0 and 2.4±1.9, ns, respectively at baseline and follow-up) and cognitive parameters (MMSE score 23.2±3.1 at baseline and 22.0±3.8 at follow-up). Our data indicate that in mild demented subjects the presence of apathy at baseline is associated with significant functional and cognitive decline at short-term follow-up (12 months), and that the new onset of apathy leads to a faster cognitive decline. Mild demented patients without apathy had a slower progression of dementia symptoms, with a substantial stability of cognitive and functional status after 12 months. These findings confirm Starkstein’s data and suggest that apathy should be considered an important marker of short term cognitive and functional decline even in early stages of dementia. It would be of interest to study the biological mechanisms underlying the relationship of apathy with cognitive function. References 1. Starkstein ES, Jorge R, Mizrahi R, Robinson RG. A prospective longitudinal study of apathy in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2006;77:8-11. 2. Folstein MF, Folstein SE, McHugh PR. "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician. Journal Psychiatric Research 1975;12:189-198. 3. Katz S, Ford AB, Moskowitz RW et al. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914-919. 4. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186. 5. Binetti G, Mega MS, Magni E, Padovani A, Rozzini L, Bianchetti A, Cummings J, Trabucchi M: Behavioral disorders in Alzheimer’s Disease: a transcultural perspective. Arch Neurol 1998; 55:539-544. |
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