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Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders

Published online by Cambridge University Press:  16 April 2020

P. Robert ,
C.U. Onyike ,
A.F.G. Leentjens ,
K. Dujardin ,
P. Aalten ,
S. Starkstein ,
F.R.J. Verhey ,
J. Yessavage ,
J.P. Clement  and
D. Drapier
...Show all authors
P. Robert*
Affiliation:
Centre Mémoire de Ressources et de Recherche, CHU de Nice, Nice, France
C.U. Onyike
Affiliation:
Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins School of Medicine, Baltimore, MD, USA
A.F.G. Leentjens
Affiliation:
Department of Psychiatry, Maastricht University Medical Center, Alzheimer Center Limburg, Maastricht, The Netherlands
K. Dujardin
Affiliation:
Neurology and Movement Disorders Unit, EA2683, Faculty of Medicine and Lille University Hospital, Lille, France
P. Aalten
Affiliation:
Department of Psychiatry, Maastricht University Medical Center, Alzheimer Center Limburg, Maastricht, The Netherlands
S. Starkstein
Affiliation:
Department of Psychiatry, University of Western Australia, Australia
F.R.J. Verhey
Affiliation:
Department of Psychiatry, Maastricht University Medical Center, Alzheimer Center Limburg, Maastricht, The Netherlands
J. Yessavage
Affiliation:
Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto VA Health Care System, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
J.P. Clement
Affiliation:
J.P. Clement CMRR du Limousin, CHU-CH, Limoges, France
D. Drapier
Affiliation:
Department of Psychiatry, Unité de Recherche Universitaire «Comportements et noyaux gris centraux» Université de Rennes, France
F. Bayle
Affiliation:
Université Paris Descartes, CH Sainte-Anne, INSERM U 796, Paris, France
M. Benoit
Affiliation:
Centre Mémoire de Ressources et de Recherche, Department of Psychiatry CHU de Nice, France
P. Boyer
Affiliation:
Institute of Mental Health Research, Ottawa, Ontario, Canada
P.M. Lorca
Affiliation:
Université d’Auvergne, CHU Clermont-Ferrand, France
F. Thibaut
Affiliation:
University Hospital Ch Nicolle, INSERM U 614, University of Medicine, Rouen, France
S. Gauthier
Affiliation:
McGill Center for Studies in Aging, Douglas Mental Health Research Institute, Canada
G. Grossberg
Affiliation:
Department of Neurology and Psychiatry, St Louis University School of Medicine, St Louis, MO, USA
B. Vellas
Affiliation:
Gerontopole, Inserm U 558, CHU Toulouse, France
J. Byrne
Affiliation:
Old Age Psychiatry, University of Manchester, UK
*
*Corresponding author. Centre Mémoire de Ressources et de Recherche, Pavillon Mossa, Hôpital de Cimiez, 4 Avenue Reine Victoria, 06003 NICE Cedex 1, France. Tel.: +33 4 92 03 47 70; fax: +33 4 92 03 47 72. E-mail address: phil.robert15@orange.fr (P. Robert).
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Abstract

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 Française 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.

Keywords

ApathyAlzheimer’s diseaseNeuropsychiatryDiagnostic criteria
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 2 , March 2009 , pp. 98 - 104
Copyright
Copyright © Elsevier Masson SAS 2009

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References

Aalten, P., Verhey, F., Boziki, M., Bullock, R., Byrne, E.J., Camus, V.et al.Neuropsychiatric syndromes in dementia; results from the European Alzheimer disease consortium. Dement Geriatr Cogn Disord 2007;24:457–463CrossRefGoogle ScholarPubMed
Aalten, P., Verhey, F., Boziki, M., Bullock, R., Byrne, E.J., Camus, V.et al.Consistency of neuropsychiatric syndromes across dementia; results from the European Alzheimer disease consortium. Dement Geriatr Cogn Disord 2008;25:1–8CrossRefGoogle ScholarPubMed
Andreasen, N.C.The scale for the assessment of negative symptoms (SANS): conceptual and theoretical foundations. Br J Psychiatry 1989;7:49–58CrossRefGoogle Scholar
Benoit, M., Koulibaly, P.M., Migneco, O., Darcourt, J., Pringuey, D.J., Robert, P.H.Brain perfusion in Alzheimer’s disease with and without apathy: a SPECT study with statistical parametric mapping analysis. Psychiatr Res Neuroimaging 2002;114(2):103–111CrossRefGoogle ScholarPubMed
Berridge, K.C., Robinson, T.E.What is the role of dopamine in reward: hedonic impact, reward learning, or incentive salience. Brain Res Brain Rev 1998;28:309–369CrossRefGoogle ScholarPubMed
Boyle, P.A., Malloy, P.F.Treating apathy in Alzheimer’s disease. Dement Geriatr Cogn Disord 2004;17(1–2):91–99CrossRefGoogle ScholarPubMed
Breiter, H.C., Aharon, I., Kahneman, D., Dale, A., Shizgal, P.Functional imaging of neural responses to expectancy and experience of monetary gains and losses. Neuron 2001;30(2):619–639CrossRefGoogle ScholarPubMed
Brown, R.G., Pluck, G.Negative symptoms: the pathology of motivation and goal-directed behavior. Trends Neurosci 2000;23(9):412–417CrossRefGoogle Scholar
Cohen, J.D., Botvinick, M.M., Carter, C.S.Anterior cingulate and prefrontal cortex: who’s in control?. Nat Neurosci 2000;3:421–423CrossRefGoogle ScholarPubMed
Copeland, M.P., Daly, E., Hines, V., Mastromauro, C., Zaitchik, D., Gunther, J.et al.Psychiatric symptomatology and prodromal Alzheimer’s disease. Alzheimer Dis Assoc Disord 2003;17(1):1–8CrossRefGoogle ScholarPubMed
Corbetta, M., Miezin, F.M., Schulman, G.L., Petersen, S.E.A PET study of visuospatial attention. J Neurosci 1993;13:1202–1226CrossRefGoogle ScholarPubMed
Craig, A.H., Cummings, J.L., Fairbanks, L., Itti, L., Miller, B., Li, J.et al.Cerebral blood flow correlates of apathy in Alzheimer disease. Arch Neurol 1996;53:1116–1120CrossRefGoogle ScholarPubMed
Cummings, J.L., Mega, M.S., Gray, K., Rosemberg-Thompson, S., Gornbein, T.The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2314CrossRefGoogle ScholarPubMed
Cummings, J.L., Mackell, J., Kaufer, D.Behavioral effects of current Alzheimer’s disease treatments: a descriptive review. Alzheimers Dement 2008;4(1):49–60CrossRefGoogle ScholarPubMed
Czanecki, K., Kumar, N., Josephs, K.A.Parkinsonism and tardive antecollis in frontotemporal dementia increased sensitivity to newer antipsychotics?. Eur J Neurol 2008;15(2):199–201CrossRefGoogle Scholar
Derouesné, G.Apathy: a useful but limited concept. Psychol Neuropsychiatr Vieil 2004;2(1):19–28Google ScholarPubMed
Devinsky, O., Morrell, M., Vogt, B.Contributions of anterior cingulate cortex to behaviour. Brain 1995;118:279–306CrossRefGoogle ScholarPubMed
Feldman, H., Scheltens, P., Scarpini, E., Hermann, N., Mesenbrink, P., Mancione, L.et al.Behavioral symptoms in mild cognitive impairment. Neurology 2004;62(7):1199–1201CrossRefGoogle ScholarPubMed
Frith, C.D.The cognitive neuropsychology of schizophrenia 1 ed.HoveL. Erlbaum Associates Publishers 1992Google Scholar
Hermann, N., Rothenburg, L.S., Black, S., Ryan, M., Liu, B.A., Busto, U.E.et al.Methylphenidate for the treatment of apathy in Alzheimer disease: prediction of response using dextroamphetamine. J Clin Psychopharmacol 2008;28(3):296–301CrossRefGoogle Scholar
Holmes, C., Wilkinson, D., Dean, C.The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease. Neurology 2004;63:214–219CrossRefGoogle ScholarPubMed
Hwang, T.J., Masterman, D.L., Ortiz, F., Fairbanks, L.A., Cummings, J.L.Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms. Alzheimer Dis Assoc Disord 2004;18(1):17–21CrossRefGoogle ScholarPubMed
Kuzis, G., Sabe, L., Tiberti, C., Dorrego, F., Starkstein, S.E.Neuropsychological correlates of apathy and depression in patients with dementia. Neurology 1999;52:1403–1407CrossRefGoogle ScholarPubMed
Landes, A.M., Sperry, S.D., Strauss, M.E., Geldmacher, D.S.Apathy in Alzheimer’s disease. J Am Geriatr Soc 2001;49:1700–1707CrossRefGoogle ScholarPubMed
Levy, M.L., Cummings, J.L., Fairbanks, L.A., Masterman, D., Miller, B.L., Craig, A.H.et al.Apathy is not depression. J Neuropsychiatry Clin Neurosci 1998;10:314–319CrossRefGoogle Scholar
Levy, R., Dubois, B. Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex 2005; 1–13 [published on line October 5]Google Scholar
Lyketsos, C.G., Lopez, O., Jones, B., Fitzpatrick, A.L., Breitner, J., DeKosky, S.Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA 2002;288(12):1475–1483CrossRefGoogle ScholarPubMed
Marin, R.S.Differential diagnosis and classification of apathy. Am J Psychiatry 1990;147:22–30Google ScholarPubMed
Marin, R.S., Biedrzycki, R.C., Firinciogullari, S.Reliability and validity of the apathy evaluation scale. Psychiatry Res 1991;38:143–162CrossRefGoogle ScholarPubMed
McPherson, S., Fairbanks, L., Tiken, S., Cummings, J.L., Back-Madruga, C.Apathy and executive function in Alzheimer’s disease. J Int Neuropsychol Soc 2002;8(3):373–381CrossRefGoogle ScholarPubMed
Mega, M.S., Cummings, J.L., Fiorello, T.The spectrum of behavioral changes in Alzheimer’s disease. Neurology 1996;46:130–135CrossRefGoogle ScholarPubMed
Migneco, O., Benoît, M., Koulibaly, P.M., Dygai, I., Bertogliati, C., Desvignes, P.et al.Perfusion brain SPECT and statistical parametric mapping analysis indicate that apathy is a cingulate syndrome: a study in Alzheimer’s disease and non demented patients. NeuroImage 2001;13:896–902CrossRefGoogle Scholar
Mueser, K.T., McGurk, S.R.Schizophrenia. Lancet 2004;363(June 19):2063–2072CrossRefGoogle ScholarPubMed
Onyike, C.U., Sheppard, J.M., Tschanz, J.T., Norton, M.C., Green, R.C., Steinberg, M.et al.Epidemiology of apathy in older adults: the Cache County study. Am J Geriatr Psychiatry 2007;15(5):365–375CrossRefGoogle ScholarPubMed
Padala, P.R., Burke, W.J., Bhatia, S.C., Petty, F.Treatment of apathy with methylphenidate. J Neuropsychiatry Clin Neurosci 2007;19(1):81–83CrossRefGoogle ScholarPubMed
Politis, A.M., Vozzella, S., Mayer, L.S., Onyike, C.U., Baker, A.S., Lyketsos, C.G.A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. Int J Geriatr Psychiatry 2004;19:1087–1094CrossRefGoogle ScholarPubMed
Ready, R.E., Ott, B.R., Grace, J., Cahn-Weiner, D.A.Apathy and executive dysfunction in mild cognitive impairment and Alzheimer disease. Am J Geriatr Psychiatry 2003;11(2):222–228CrossRefGoogle ScholarPubMed
Robert, P., Berr, C., Volteau, M., Bertogliati, C., Benoit, M., Sarrazin, M.et al.Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer’s disease: a one year follow up study. Clin Neurol Neurosurg 2006;108:733–736CrossRefGoogle ScholarPubMed
Robert, P., Verhey, F., Byrne, E.J., Hurt, C., De Deyn, P.P., Nobili, F.et al.Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium. Eur Psychiatry 2005;20(7):490–496CrossRefGoogle ScholarPubMed
Robert, P.H., Berr, C., Volteau, M., Bertogliati, C., Benoit, M., Guerin, O.et al.Importance of lack of interest in patients with mild cognitive impairment. Am J Geriatr Psychiatry 2008;16:770–776CrossRefGoogle ScholarPubMed
Robert, P.H., Clairet, S., Benoit, M., Koutaich, J., Bertogliati, C., Tible, O.et al.The apathy inventory: assessment of apathy and awareness in Alzheimer’s disease, Parkinson’s disease and mild cognitive impairment. Int J Geriatr Psychiatry 2002;17:1099–1105CrossRefGoogle ScholarPubMed
Sockeel, P., Dujardin, K., Devos, D., Denève, C., Destée, A., Defebvre, L.The Lille apathy rating scale (LARS), a new instrument for detecting and quantifying apathy: validation in Parkinson’s Disease. J Neurol Neurosurg Psychiatr 2006;77:579–584CrossRefGoogle ScholarPubMed
Starkstein, S.E., Ingram, L., Garau, M.L., Mizrahi, R.On the overlap between apathy and depression in dementia. J Neurol Neurosurg Psychiatr 2005;76:1070–1074CrossRefGoogle ScholarPubMed
Starkstein, S.E., Leentjens, A.F.G. The nosological position of apathy. J Neurol Neurosurg Psychiatr 2008; [published online January 10]CrossRefGoogle Scholar
Starkstein, S.E., Mayberg, H.S., Preziosi, T.J., Andrezejewski, P., Leiguarda, R., Robinson, R.G.Reliability, validity and clinical correlates of apathy in Parkinsons’s disease. J Neuropsychiatry Clin Neurosci 1992;4:134–139Google Scholar
Starkstein, S.E., Petracca, G., Chemerinski, E., Kremer, J.Syndromic validity of apathy in Alzheimer’s disease. Am J Psychiatry 2001;158:872–877CrossRefGoogle ScholarPubMed
Stuss, D.T., Van Reekum, R., Murphy, K.J.Differentiation of states and causes of apathy 1 ed.New YorkOxford University Press 2000Google Scholar
Van Reekum, R., Stuss, D.T., Ostrander, R.Apathy: why care?. J Neuropsy Clin N 2005;17(1):7–19CrossRefGoogle ScholarPubMed
Verghese, J., Le Valley, A., Derby, C., Kuslansky, G., Katz, M., Hall, C.et al.Leisure activities and the risk of amnestic mild cognitive impairment in the elderly. Neurology 2006;66(6):821–827CrossRefGoogle ScholarPubMed
Vijayaraghavan, L., Krishnamoorthy, E.S., Brown, R.G., Trimble, M.R.Abulia: a delphi survey of British neurologist and psychiatrist. Mov Disord 2002;17(5):1052–1057CrossRefGoogle Scholar
Winograd-Gurvich, C., Fitzgerald, P.B., Georgiou-Karistianis, N., Bradshaw, J.L., White, O.B.Negative symptoms: a review of schizophrenia, melancholic depression and Parkinson’s disease. Brain Res Bull 2006;70:312–321CrossRefGoogle ScholarPubMed
Levy, Dubois, Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cerb Cortex 2006;16(7):916–928CrossRefGoogle ScholarPubMed
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