Apathy in multiple sclerosis: gender matters

Abstract

Apathy has been recognized as a frequent symptom in multiple sclerosis (MS) but uncertainty remains about its prevalence and clinical correlates. Therefore, the objective of this work was to assess the prevalence of apathy in patients with MS and to identify clinical and demographic correlates. A case-control study with 30 patients and 30 healthy controls matched for age, gender and education was performed. Apathy diagnosis was established using Robert et al.'s criteria. Additionally, apathy was assessed using the 10-item short version of the clinical-rated Apathy Evaluation Scale (AES-C-10). The Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), and Montreal Cognitive Assessment (MoCA) were used to evaluate depression, fatigue and cognitive impairment, respectively. Apathy prevalence in MS patients was 43.3%. Patients with MS had higher AES-C-10 scores than controls (13.9 vs. 12.0, p=0.015). Patients with apathy presented a higher proportion of males (53.8% vs. 11.8%, p=0.02), lower educational level (53.8% vs. 11.8% of patients with up to 9years of education), higher scores on cognitive dimension of MFIS (18.0 vs. 8.0, p=0.048) and BDI (13.0 vs. 7.0, p=0.035) and worse performance on MoCA (24.0 vs. 26.0, p=0.028). Gender was the only independent predictor of apathy, with men presenting a higher risk compared to women (OR: 9.62; 95%CI: 1.02-90.61; p=0.048). In conclusion, apathy is a common neuropsychiatric disorder in MS and it is probably underdiagnosed. Male patients seem to have an increased risk of apathy, and this finding may be related to the generally more unfavorable course of MS in men.

Apathy Mediates Cognitive Difficulties in Geriatric Depression

“…Interestingly, when we examined whether the mediation effect of apathy was consistent across sex, we found that apathy mediated the effect of depression on cognitive control for women, and not for men, even though the difference between females and males failed to reach statistical significance in this sample. Studies in other clinical populations have found that while women have higher rates of depression overall, men are more likely to have depression with apathy than women, 17,18 and older age has also been observed to have higher correlation with apathy for men than women 32 . In this study, while severity of apathy present among men and women did not differ, apathy appeared to mediate cognitive control for women.…”

“…Based on the literature, we predicted that apathy would mediate memory and executive control difficulties in older adults with major depressive disorder. Further, we examined if apathy played a different role in male and female participants with late-life depression, as gender differences in apathy prevalence have been observed in other clinical samples such as Parkinson’s disease, 17 and multiple sclerosis 18 .…”

Fatigue in multiple sclerosis patients with different clinical phenotypes: a clinical and magnetic resonance imaging study

“…There is conflicting evidence in the literature on the influence of sex on MS fatigue, with one study suggesting that cognitive fatigue is prevalent in males [61] another claiming fatigue to be sex invariant [62] and recent research showing, in line with our findings, that females are more prone to experience cognitive fatigue than males [63]. In our sample, sex influence was particularly evident in RRMS patients, whilst it tended to disappear in PMS, with a trend towards significance in the analysis of interaction with phenotype.…”

Apathy as a herald of cognitive changes in multiple sclerosis: A 2-year follow-up study

“…9 Apathy is defined as a reduction or loss of motivation for behavioral, cognitive, and emotional activities. 10,11 In patients with MS, apathy occurs with a prevalence ranging from 20% to 50% 9,12–15 and is associated with neurological disability, cognitive fatigue, and increased distress in caregivers. 12,15 Most often apathy has been described in comorbidity with depression in MS, but one recent study identified “pure apathy” in MS too, in association with executive dysfunctions, in particular with deficits of inhibitory control.…”