Apathy in Parkinson’s disease
- 1Division of Psychological Medicine, Section of Old Age Psychiatry, Institute of Psychiatry, King’s College London, London SE5, UK
- 2Department of Psychology, Institute of Psychiatry
- Correspondence to: Dr G Pluck, P070, Section of Old Age Psychiatry, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK;
- Received 19 September 2001
- Accepted 15 August 2002
- Revised 16 July 2002
Objective: To assess apathy in patients with Parkinson’s disease and its relation to disability, mood, personality, and cognition.
Methods: Levels of apathy in 45 patients with Parkinson’s disease were compared with a group of 17 similarly disabled patients with osteoarthritis. Additional neuropsychiatric data were collected concerning levels of depression, anxiety, and hedonic tone. Personality was assessed with the tridimensional personality questionnaire. Cognitive testing included the mini-mental state examination, the Cambridge examination of cognition in the elderly, and specific tests of executive functioning.
Results: Patients with Parkinson’s disease had significantly higher levels of apathy than equally disabled osteoarthritic patients. Furthermore, within the Parkinson sample, levels of apathy appear to be unrelated to disease progression. The patients with Parkinson’s disease with the highest levels of apathy where not more likely to be depressed or anxious than those with the lowest levels of apathy, though they did show reduced hedonic tone. No differences in personality traits were detected in comparisons between patients with Parkinson’s disease and osteoarthritis, or between patients in the Parkinson group with high or low levels of apathy. As a group, the patients with Parkinson’s disease tended not to differ significantly from the osteoarthritic group in terms of cognitive skills. However, within the Parkinson’s disease sample, the high apathy patients performed significantly below the level of the low apathy patients. This was particularly evident on tests of executive functioning.
Conclusions: Apathy in Parkinson’s disease is more likely to be a direct consequence of disease related physiological changes than a psychological reaction or adaptation to disability. Apathy in Parkinson’s disease can be distinguished from other psychiatric symptoms and personality features that are associated with the disease, and it is closely associated with cognitive impairment. These findings point to a possible role of cognitive mechanisms in the expression of apathy.
- ADL, activities of daily living
- AES-C, clinician/researcher rated apathy evaluation scale
- AES-S, self report rated apathy evaluation scale
- BDI, Beck depression inventory
- CAMCOG, Cambridge examination of cognition in the elderly
- COWAT, controlled word association test
- HADS, hospital anxiety and depression scale
- MMSE, mini-mental state examination
- NS, novelty seeking
- PD-HA, Parkinson’s disease-high apathy
- PD-LA, Parkinson’s disease-low apathy
- SE, Schwab and England scale
- SHPS, Snaith-Hamilton pleasure scale
- TPQ, tridimensional personality questionnaire
- WCST, Wisconsin card sort test
Competing interests: none declared