A Systematic Review of Pharmacological Interventions for Apathy in Aging Neurocognitive Disorders

Theleritis, Christos; Siarkos, Kostas; Politis, Anastasios; Smyrnis, Nikolaos; Papageorgiou, Charalabos; Politis, Antonios

doi:10.3390/brainsci13071061

Cited by 3 publications

(2 citation statements)

References 131 publications

(168 reference statements)

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“…Pharmacological and non-pharmacological interventions for apathy in LBD are complex and under-investigated (4,46). Evidence of efficacy of non-pharmacological interventions are not robust (47).…”

Section: Discussionmentioning

confidence: 99%

Apathy in Lewy body disease and its effects on functional impairment over time

Zhu,

Grossman,

Elder

et al. 2024

Front. Neurol.

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Background and objectivesApathy strongly affects function in Alzheimer’s disease and frontotemporal dementia, however its effect on function in Lewy Body Disease (LBD) has not been well-described. This study aims to (1) examine the prevalence and persistence of apathy in a large, national cohort of well-characterized patients with LBD, and (2) estimate the effect of apathy on function over time.MethodsStudy included 676 participants with mild cognitive impairment (MCI) or dementia in the National Alzheimer’s Coordinating Center Uniform Data Set. Participants were followed for an average of 3.4 ± 1.7 years and consistently had a primary diagnosis of LBD. Apathy was defined by clinician judgment, categorized into four mutually exclusive profiles: (1) never apathetic across all visits, (2) at least one but <50% of visits with apathy (intermittent apathy), (3) ≥50% but not all visits with apathy (persistent apathy), and (4) always apathy across all visits. Dementia severity was measured by baseline Clinical Dementia Rating score. Parkinsonism was defined by the presence of bradykinesia, resting tremor, rigidity, gait, and postural instability. Functional impairment was assessed using the Functional Assessment Questionnaire (FAQ).ResultsBaseline characteristics of the sample were: average age = 72.9 ± 6.9, years of education = 15.6 ± 3.4, Mini Mental State Exam (MMSE) = 24.4 ± 5.4, Geriatric Depression Scale (GDS) = 3.8 ± 3.2, FAQ = 12.0 ± 9.1. 78.8% were male and 89% were non-Hispanic white. Prevalence of apathy increased from 54.4% at baseline to 65.5% in year 4. 77% of participants had apathy at some point during follow-up. Independent of cognitive status and parkinsonian features, FAQ was significantly higher in participants with intermittent/persistent and always apathetic than never apathetic. Annual rate of decline in FAQ was faster in participants who were always apathetic than never apathy.DiscussionIn this large national longitudinal cohort of LBD patients with cognitive impairment, apathy was strongly associated with greater functional impairment at baseline and faster rate of decline over time. The magnitude of these effects were clinically important and were observed beyond the effects on function from participants’ cognitive status and parkinsonism, highlighting the importance of specifically assessing for apathy in LBD.

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Section: Discussionmentioning

confidence: 99%

Apathy in Lewy body disease and its effects on functional impairment over time

Zhu,

Grossman,

Elder

et al. 2024

Front. Neurol.

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“…These therapies can be broadly divided into two groups: pharmacological and nonpharmacological. The most extensively researched and commonly prescribed pharmacological treatments for apathy are dopaminergic agents (e.g., rotigotine) and cholinesterase inhibitors (e.g., rivastigmine) [1,25]. However, the list of trialled therapies continues to grow, and recently published studies have examined vortioxetine [26] and the experimental compound pirepemat [27].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Apathy in Parkinson’s Disease and Implications for Underlying Pathophysiology

Maher,

Donlon,

Mullane

et al. 2024

JCM

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Apathy is a prevalent and highly debilitating non-motor symptom of Parkinson’s disease (PD) that is often overlooked in clinical practice due to its subtle nature. This review aims to provide a comprehensive overview of the current evidence for the treatment of apathy in PD, highlighting recent advancements and emerging therapeutic avenues. In this review, we analyse a diverse array of treatment strategies for apathy in PD, including pharmacological interventions, non-pharmacological approaches, and emerging neuromodulation techniques. We evaluate the efficacy, safety, and limitations of established pharmacotherapies, such as dopaminergic agents, antidepressants, and cognitive enhancers. Additionally, we examine the promising role of non-pharmacological interventions, encompassing psychotherapies and behavioural interventions, in ameliorating apathetic symptoms. Furthermore, this review explores the effects of neuromodulation techniques on apathy, including the modulation of apathy via deep brain stimulation and emerging data on the potential influence of transcranial magnetic stimulation (TMS) on apathy in PD. Ultimately, a deeper understanding of effective treatment strategies for apathy has the potential to significantly improve the quality of life and overall well-being of individuals living with PD.

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Biochemical and Neuropharmacology of Psychiatric Disorders

Ghallab,

Elassal

2024

Nutritional Neurosciences

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A Systematic Review of Pharmacological Interventions for Apathy in Aging Neurocognitive Disorders

Cited by 3 publications

References 131 publications

Apathy in Lewy body disease and its effects on functional impairment over time

Apathy in Lewy body disease and its effects on functional impairment over time

Treatment of Apathy in Parkinson’s Disease and Implications for Underlying Pathophysiology

Biochemical and Neuropharmacology of Psychiatric Disorders

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