ObjectiveTo conduct a scoping review of the literature on apathy in Parkinson’s disease (PD), to better understand how apathy in Parkinson’s disease is diagnosed, treated and managed.MethodsMEDLINE, Embase, PsycINFO, CINAHL, Cochrane Central Register of Control Trials and Cochrane Database of Systematic Reviews were searched to 17 May 2017. An updated review was run from 17 May 2017 to 28 January 2019. The grey literature was searched using the CADTH Grey Matters tool. Original peer-reviewed research was included if it included individuals with PD and apathy. Non-original data was only included if it was in the form of meta-analysis. All information regarding diagnosis, treatment and management of PD was extracted. Citation screening and extraction were performed in duplicate.ResultsFrom 11 375 citations, 362 articles were included in the final review. The majority of included studies focussed on prevalence, with few studies examining treatment. Twenty screening tools for apathy were identified. Fifty per cent of treatment studies were randomised control trials (RCTs). RCTs applied treatment methods including: exercise, mindfulness, rotigotine (Neupro) transdermal patch and rivastigmine (Exelon).ConclusionsThis review identified a large body of literature describing current knowledge on diagnosing, treating and managing apathy in PD. Future research should aim to detect an ideal screening tool for apathy in PD, to identify the best treatment options for apathy and the variety of comorbidities it may present with and finally aim to better understand postoperative apathy in those with deep brain stimulation.

Purpose Students experiencing concussion symptoms also report school difficulties and academic impacts. We examined the relationship of cognitive functioning with self-reported academic concerns and school stress, hypothesizing that students with lower working memory (WM) and processing speed (PS) scores would have higher reported academic concerns and greater school stress. Methods 184 youth aged 8 to 18 diagnosed with a concussion (Mean age=14.4±2.2, 51% female, 67% white) completed the Concussion Learning Assessment and School Survey, 3rd Edition (CLASS-3), a validated self-reported rating scale of post-concussion academic problems and school stress. Pearson’s partial correlations, controlling for age and sex, assessed the relationship between the Academic Problems and School Stresses scales from the CLASS-3 with the WMI and PSI from the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) and Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V). Results There were negative correlations between Processing Speed and Academic Problems (r(144)=-.33, p<.001) and School Stresses (r(160)=-.29, p=<.001). There was also a negative correlation between Working Memory and School Stresses (r(162)=-.24, p=.002) and Academic Problems (r(144)=-.15, p=.07). Conclusions Students with lower working memory and processing speed tend to report higher academic problems and school stresses. These results suggest that students with lower cognitive function experience higher school concerns, implying a need to establish appropriate school supports, particularly in students who experience cognitive dysfunction after a concussion.

Purpose Concussion symptoms are associated with initial academic concerns in youth. We hypothesized that early academic stress and difficulty would be associated with greater symptom burden across recovery visits. Methods 200 patients aged 8 to 18 (M age=14.4±2.2, 51% female, 67% white) with a concussion completed the Concussion Learning Assessment and School Survey, 3rd Edition (CLASS-3) at first visit, a validated self-reported rating scale of academic problems (AP; 14 items) and school stresses (SS; 6 items) along with the developmentally appropriate Post-Concussion Symptom Inventory-2 (PCSI-2), which generates Retrospectively-Adjusted Post-Injury Difference (RAPID) symptom scores by 8-12 and 13-18 age groups. Subgroups of participants completed the PCSI-2 only at visit 2 (n=128) and at visit 3 (n=29). Results There were significant positive partial correlations (p<.05), controlling for age and sex, between CLASS-3 scores and the PCSI-2 RAPID scores in the 8-12 age group for AP (V1 r=.60 and V2 r=.42) and SS (V1 r=.33 and V2 r=.34) and in the 13-18 group for AP (V1 r=.72, V2 r=.51, V3 r=.52) and SS (V1 r=.50, V2 r=.49). The effect was moderate, but not statistically significant due small sample sizes, at visit 3 in 8-12 group (AP V3 r=.50; SS r= .41) and in the 13-18 group for SS (r=.34). Conclusions Students with higher early academic problems and school stresses reported higher symptom burden over time. These results suggest that early academic supports to mitigate school problems and stress may subsequently lessen symptom burden across the course of recovery.