Apathy and risk of probable incident dementia among community-dwelling older adults

Abstract

ObjectiveTo evaluate the association between baseline apathy and probable incident dementia in a population-based sample of community-dwelling older adults.MethodsWe studied 2,018 white and black community-dwelling older adults from the Health, Aging, and Body Composition (Health ABC) study. We measured apathy at year 6 (our study baseline) with the modified Apathy Evaluation Scale and divided participants into tertiles based on low, moderate, or severe apathy symptoms. Incident dementia was ascertained over 9 years by dementia medication use, hospital records, or clinically relevant cognitive decline on global cognition. We examined the association between apathy and probable incident dementia using a Cox proportional hazards model adjusting for demographics, cardiovascular risk factors, APOE-4 status, and depressed mood. We also evaluated the association between the apathy group and cognitive change (as measured by the Modified Mini Mental State Examination and Digit Symbol Substitution Test over 5 years) using linear mixed effects models.ResultsOver 9 years of follow-up, 381 participants developed probable dementia. Severe apathy was associated with an increased risk of dementia compared to low apathy (25% vs 14%) in unadjusted (HR 1.9, 95% CI 1.5–2.5) and adjusted models (HR 1.7, 95% CI 1.3–2.2). Greater apathy was associated with worse cognitive score at baseline, but not rate of change over time.ConclusionIn a diverse cohort of community-dwelling adults, apathy was associated with increased risk of developing probable dementia. This study provides novel evidence for apathy as a prodrome of dementia.

Aberrant Topological Patterns of Structural Covariance Networks in Cognitively Normal Elderly Adults With Mild Behavioral Impairment

“…Another longitudinal study on cognitively normal individuals reported that of those who progressed from being normal to MCI or dementia, more than 59% developed NPSs before the diagnosis of any cognitive disorder ( Wise et al, 2019 ). A recent study involving community-dwelling adults showed an association of apathy with an increased risk of developing probable dementia ( Bock et al, 2020 ). Therefore, MBI is becoming increasingly recognized as a prodromal stage of dementia.…”

Resting-State Functional Connectivity Signatures of Apathy in Community-Living Older Adults

“…Research has shown that apathy increases with age (Brodaty et al, 2010) and is associated with poor outcomes in older adults, such as difficulties in daily functioning and decreased quality of life (Tierney et al, 2018). Growing evidence indicates a link between apathy and incident dementia in healthy older adults (van Dalen et al, 2018;Bock et al, 2020) and provides support for the hypothesis that apathy may be a prodromal feature of Alzheimer's disease spectrum (Munro et al, 2015). These findings highlight the need to investigate the association between apathy and brain changes that have unfavorable implications for healthy aging.…”

Psychopathology of Dementia: Psychology’s Pivotal Role

“…We do not know why this happens, whether it is the final stages of our development through a comprehensive isomorphic representation and the belief that we know the answers already, or whether it is emotional, related to the loss of zest for life. One of the most consistent findings in the etiology of dementia is the emerging expression of apathy and depression as a prodrome of dementia [100], [101]. Apathy and depression highlight a perceptual change [102] with longterm consequences.…”