Apathy in patients with Alzheimer's disease is a cost‐driving factor

Kruse, Christopher; Maier, Franziska; Spottke, Annika; Bach, Jan-Philipp; Bartels, Claudia; Büerger, Katharina; Fellgiebel, Andreas; Fließbach, Klaus; Frölich, Lutz; Hausner, Lucrezia; Hellmich, Martin; Klöppel, Stefan; Klostermann, Arne; Kornhuber, Johannes; Laske, Christoph; Peters, Oliver; Priller, Josef; Richter‐Schmidinger, Tanja; Schneider, Anja; Shah‐Hosseini, Kija; Teipel, Stefan J.; Arnim, Christine A. F. Von; Wiltfang, Jens; Wurp, Hendrik van der; Dodel, Richard; Jessen, Frank

doi:10.1002/alz.12915

Cited by 3 publications

(5 citation statements)

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“…Results showed that among those who had a clinician judgment of apathy, 87% also were reported as having apathy on the NPI-Q. These results are similar to earlier reports that showed high correlation between clinician judgment of apathy and the NPI-Q in AD (7), which strengthens confidence in these results. The dataset does not include sufficient information to apply the newly developed diagnostic criteria for apathy in neurocognitive disorders.…”

Section: Discussionsupporting

confidence: 87%

“…Apathy is increasingly recognized as one of the most prevalent and disabling behavioral symptoms in neurocognitive disorders and can have profound consequences for morbidity, mortality, quality of life, caregiver burden, healthcare costs and progression of cognitive impairment (1)(2)(3)(4)(5)(6)(7)(8). Recently published diagnostic criteria for apathy in neurocognitive disorders address conditions from mild cognitive impairment (MCI) to dementia across etiologies (9).…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

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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“…Overall, apathy represents a complex and multifaceted symptom that has far-reaching implications. Its diverse dimensions and associations with functional decline and mortality, as well as caregiver burden and increased healthcare costs, emphasize the importance of understanding and addressing apathy in clinical practice and research ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation for apathy in patients with neurodegenerative conditions, cognitive impairment, stroke, and traumatic brain injury: a systematic review

Espiritu,

Hara,

Tolledo

et al. 2023

Front. Psychiatry

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BackgroundWe aimed to determine the effects and tolerability of repetitive transcranial magnetic stimulation (rTMS) on apathy in patients with neurodegenerative conditions, mild cognitive impairment (MCI), stroke, and traumatic brain injury (TBI) via systematic review.MethodsWe conducted a systematic search in major electronic health databases, including PubMed, Scopus, and PsycINFO, covering the period from inception to June 2023. Comparative clinical trials and cohort studies, and studies with before-after designs were considered for inclusion. We used the Cochrane Risk of Bias and the National Institutes of Health (NIH) tools to assess methodological quality.ResultsOut of 258 records identified, 14 studies met our eligibility criteria (11 randomized controlled trials (RCT) and 3 studies utilized before-and-after designs) with a total of 418 patients (overall female-to-male ratio 1:1.17) included in the review. The overall methodological quality of the included studies was assessed to be fair to good. The stimulation parameters used varied considerably across the studies. The summary findings of our review indicate the following observations on the effects of rTMS on apathy: (1) the results of all included studies in Alzheimer’s disease investigating the effects of rTMS on apathy have consistently shown a positive impact on apathy; (2) the majority of studies conducted in Parkinson’s disease have not found statistically significant results; (3) a single study (RCT) on patients with primary progressive aphasia demonstrated significant beneficial effects of rTMS on apathy; (4) the trials conducted on individuals with MCI yielded varying conclusions; (5) one study (RCT) in chronic stroke suggested that rTMS might have the potential to improve apathy; (6) one study conducted on individuals with mild TBI did not find a significant favorable association on apathy; and (7) the use of different rTMS protocols on the populations described is generally safe.ConclusionThe feasibility of utilizing rTMS as a treatment for apathy has been suggested in this review. Overall, limited evidence suggests that rTMS intervention may have the potential to modify apathy among patients with AD, PPA, MCI and chronic stroke, but less so in PD and mild TBI. These findings require confirmation by larger, well-designed clinical trials.

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“…Therefore, apathy could be considered a marker of impending cognitive decline and future risk for dementia 16 . Moreover, apathy has been associated with frailty 24 , functional decline [25][26][27][28] , poorer quality of life 14,19,29 , higher mortality 30,31 , and higher healthcare costs 32 .…”

mentioning

confidence: 99%

“…In addition, some studies suggest that apathy can negatively affect physical activity [23][24][25][26][27][28][29][30][31][32][33][34][35][36] , which includes exercise, sports, active travel (cycling, walking), household chores, and work-related physical activity 37 . This potential effect of apathy is worth investigating since physical activity is now widely recognized as one of the top contributors to physical and mental health, improving cognitive functioning 38 , and reducing rates of cardiovascular disease 39 , cancer 40 , hypertension 41 , diabetes 42 , obesity 43 , depression 44 , and functional dependence 44,45 .…”

mentioning

confidence: 99%

Apathy and Physical Activity: A Systematic Review and Meta-Analysis

Farajzadeh,

Hébert,

Lahart

et al. 2024

Preprint

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Background. Patient motivation is essential for the success of their rehabilitation. Apathy, a state of primary motivational deficiency, may therefore hinder physiotherapists' interventions, such as those aimed at increasing patients' physical activity. This study aims to examine the negative relationship between apathy and physical activity and to identify the factors that influence this relationship. Methods. Six databases were searched for articles including both a measure of apathy and physical activity. Two reviewers screened articles for inclusion, assessed risk of bias, and extracted data from each study. Pearson product-moment correlations were pooled from eligible studies using the generic inverse pooling and random effects method to examine the relationship between apathy and physical activity. Results. Twenty-eight articles were included in the systematic review and 22 studies (n = 12,541 participants) in the meta-analysis. Results showed a small negative correlation between apathy and physical activity (r = -0.13; 95% CI: -0.18 to -0.09; p < 0.0001). A subgroup meta-analysis revealed that the correlation was statistically significant in patients with Parkinson's disease and in older adults who were healthy, depressed, fallers, or had mild cognitive impairment. A meta-regression suggested an effect of age, with older age being associated with a stronger correlation between apathy and physical activity. Conclusion. Our results suggest that higher levels of apathy are associated with lower levels of physical activity and that this negative association is strengthened with aging. Therefore, apathy could be a limiting factor to exercise therapy and may have prognostic implications in patients whose condition requires physical activity.

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Apathy in patients with Alzheimer's disease is a cost‐driving factor

Cited by 3 publications

References 59 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

Repetitive transcranial magnetic stimulation for apathy in patients with neurodegenerative conditions, cognitive impairment, stroke, and traumatic brain injury: a systematic review

Apathy and Physical Activity: A Systematic Review and Meta-Analysis

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