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Occurrence and risk factors for apathy in Parkinson disease: a 4-year prospective longitudinal study
  1. K F Pedersen1,2,
  2. G Alves1,2,
  3. D Aarsland1,3,4,
  4. J P Larsen1,2,4
  1. 1
    The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
  2. 2
    Department of Neurology, Stavanger University Hospital, Stavanger, Norway
  3. 3
    Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
  4. 4
    Institute of Clinical Medicine, University of Bergen, Bergen, Norway
  1. Correspondence to Dr K F Pedersen, The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway; kenfrp{at}


Background: Apathy is a common but under-recognised behavioural disorder associated with depression and cognitive impairment in patients with Parkinson disease (PD). However, the longitudinal course of apathy in PD has not been studied.

Objective: To examine the occurrence of and risk factors for apathy over time in a representative sample of patients with PD.

Methods: A sample of 139 patients was drawn from a population-based prevalence study of PD in Rogaland County, Western Norway. Apathy was measured with the Neuropsychiatric Inventory, using a composite score ⩾4 to indicate clinically significant apathy. Additional measurements included standardised rating scales for parkinsonism, depression and cognitive impairment. A follow-up evaluation was carried out in 79 patients (78.2% of the survivors) 4 years later.

Results: Of the 79 patients included in this study, 29 patients (36.7%) had never had apathy, 11 (13.9%) had persistent apathy, and a further 39 (49.4%) developed apathy during follow-up. At follow-up, patients with apathy were more frequently depressed and demented than never-apathetic patients. Dementia at baseline and a more rapid decline in speech and axial impairment during follow-up were independent risk factors for incident apathy.

Conclusions: Apathy is a persistent behavioural feature in PD with a high incidence and prevalence over time. Progression of motor signs predominantly mediated by non-dopaminergic systems may be a useful preclinical marker for incident apathy in PD.

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  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Regional Committee for Medical Research Ethics at the University of Bergen, Norway.

  • Patient consent Obtained.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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