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On the overlap between apathy and depression in dementia
  1. S E Starkstein1,
  2. L Ingram2,
  3. M L Garau3,
  4. R Mizrahi4
  1. 1Raul Carrea Institute of Neurological Research, Buenos Aires, Argentina
  2. 2Fremantle Hospital, Fremantle, Australia
  3. 3Departamento de Neurologia, Hospital Fernandez, Buenos Aires, Argentina
  4. 4PET Center for Addiction and Mental Health, Clarke Division, Toronto, Canada
  1. Correspondence to:
 Dr Sergio E Starkstein
 Fremantle Hospital, Education Building T-7, Fremantle WA 6959, Australia;


Background: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementia, its overlap with depression remains poorly understood.

Aims: To assess the psychometric characteristics of a structured interview for apathy, and to examine the overlap between apathy and depression in dementia.

Methods: A total of 150 patients with Alzheimer’s disease (AD) underwent a comprehensive psychiatric and cognitive assessment.

Results: Twelve per cent of the sample met criteria for both apathy and depression, 7% met criteria for apathy only, and 31% met criteria for depression only. Apathy (but not depression) was significantly associated with more severe cognitive deficits. Apathy and anxiety scores accounted for 65% of the variance of depression scores in dementia, and the diagnosis of apathy had a minor impact on the rating of severity of depression.

Conclusions: The Structured Interview for Apathy demonstrated adequate psychometric characteristics. Using a novel structured interview for apathy in AD we demonstrated that whereas the construct of depression primarily consists of symptom clusters of apathy and anxiety, apathy is a behavioural dimension independent of depression.

  • AD, Alzheimer’s disease
  • CAMDEX, Cambridge Examination for Mental Disorders of the Elderly
  • MMSE, Mini-Mental State Examination
  • SCID, Structured Clinical Interview for DSM-IV
  • abulia
  • anxiety
  • apathy
  • dementia
  • depression

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  • This study was partially supported with grants from the University of Western Australia, the Australian Rotary Health Research Fund, the Raine Medical Research Foundation, and the Fremantle Hospital Research Foundation.

  • Competing interests: none declared

  • Ethics approval: the protocol for this study was approved by the institutional Ethics Committee.