Apathy, not depressive symptoms, as a predictor of semantic and phonemic fluency task performance in stroke and transient ischemic attack

Fishman, Keera N; Ashbaugh, Andrea R.; Lanctôt, Krista L.; Cayley, Megan L.; Herrmann, Nathan; Murray, Brian J.; Sicard, Michelle; Lien, Karen; Sahlas, Demetrios J.; Swartz, Richard H.

doi:10.1080/13803395.2017.1371282

Cited by 21 publications

(15 citation statements)

References 97 publications

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“…Importantly, apathy can be dissociated from depression in cerebrovascular diseases and in other neurological conditions more generally (Oguru et al, 2010;Starkstein et al, 2005;Tay et al, 2019;Withall et al, 2011). A substantial body of evidence suggests that the two constructs, when examined as broad syndromes, are dissociable in terms of neurobiology (Douven et al, 2017a), cognition (Fishman et al, 2018a(Fishman et al, , 2018bLohner et al, 2017), longitudinal trajectories (Caeiro et al, 2013b;Withall et al, 2011), and impact on functional outcomes (Hama et al, 2007;Hollocks et al, 2015;Mayo et al, 2009). Comorbidity estimates range between 3.8-41.9 % (Matsuzaki et al, 2015;Withall et al, 2011), although these vary by population, assessment time, and measures of apathy and depression.…”

Section: Apathy: Concept and Challengesmentioning

confidence: 99%

Network neuroscience of apathy in cerebrovascular disease

Tay

Lisiecka-Ford

Hollocks

et al. 2020

Progress in Neurobiology

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Apathy is a reduction in motivated goal-directed behavior (GDB) that is prevalent in cerebrovascular disease, providing an important opportunity to study the mechanistic underpinnings of motivation in humans. Focal lesions, such as those seen in stroke, have been crucial in developing models of brain regions underlying motivated behavior, while studies of cerebral small vessel disease (SVD) have helped define the connections between brain regions supporting such behavior. However, current lesion-based models cannot fully explain the neurobiology of apathy in stroke and SVD. To address this, we propose a network-based model which conceptualizes apathy as the result of damage to GDB-related networks. A review of the current evidence suggests that cerebrovascular disease-related pathology can lead to network changes outside of initially damaged territories, which may propagate to regions that share structural or functional connections. The presentation and longitudinal trajectory of apathy in stroke and SVD may be the result of these network changes. Distinct subnetworks might support cognitive components of GDB, the disruption of which results in specific symptoms of apathy. This network-based model of apathy may open new approaches for investigating its underlying neurobiology, and presents novel opportunities for its diagnosis and treatment. Recent research on the fundamental neuroanatomical and neurocognitive mechanisms underlying apathy has broadened our understanding of apathy in cerebrovascular disease and across neurological disorders. Despite this, theoretical work has primarily focused on linking neurodegenerative pathology to apathy, such as in Alzheimer's disease or Parkinson's disease (e.g., Lanctôt et al., 2017; Pagonabarraga et al., 2015). This has left the mechanisms underlying apathy in cerebrovascular disease comparably under-explored. Given the high prevalence of comorbid vascular pathology in neurodegenerative

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Section: Apathy: Concept and Challengesmentioning

confidence: 99%

Network neuroscience of apathy in cerebrovascular disease

Tay

Lisiecka-Ford

Hollocks

et al. 2020

Progress in Neurobiology

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“…Impairment in executive function is a key cognitive mechanism of apathy. Apathy is negatively associated with the performance of verbal fluency tasks [ 56 ]. Similarly, those with dementia and apathy have shown reduced performance on verbal fluency tasks, compared with those without apathy [ 57 ].…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, those with dementia and apathy have shown reduced performance on verbal fluency tasks, compared with those without apathy [ 57 ]. Specifically, associations have been reported between apathy and semantic fluency but not phonemic fluency [ 56 , 58 ]. Performance in verbal fluency tasks indicates executive control [ 59 ] and initiation [ 60 ].…”

Section: Introductionmentioning

confidence: 99%

Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

Saredakis

Keage

Corlis³

et al. 2020

J Med Internet Res

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Background Apathy is a common symptom in neurological disorders, including dementia, and is associated with a faster rate of cognitive decline, reduced quality of life, and high caregiver burden. There is a lack of effective pharmacological treatments for apathy, and nonpharmacological interventions are a preferred first-line approach to treatment. Virtual reality (VR) using head-mounted displays (HMDs) is being successfully used in exposure- and distraction-based therapies; however, there is limited research on using HMDs for symptoms of neurological disorders. Objective This feasibility study aimed to assess whether VR using HMDs could be used to deliver tailored reminiscence therapy and examine the willingness to participate, response rates to measures, time taken to create tailored content, and technical problems. In addition, this study aimed to explore the immediate effects between verbal fluency and apathy after exposure to VR. Methods A mixed methods study was conducted in a sample of older adults residing in aged care, and 17 participants were recruited. Apathy was measured using the Apathy Evaluation Scale (AES), and verbal fluency was used as a proxy measure of improvements in apathy and debriefing interviews to assess feedback from participants. Side effects that can occur from using HMDs were also measured. Results We recruited participants from a high socioeconomic status setting with a high education level, and the participation rate was 85% (17/20); most responses to measures were positive. Access to a wide range of freely available content and the absence of technical difficulties made the delivery of a VR reminiscence intervention highly feasible. Participants had improved semantic scores (t14=−3.27; P=.006) but not phonemic fluency scores (t14=0.55; P=.59) immediately after the intervention. Those with higher levels of apathy demonstrated the greatest cognitive improvements after a VR reminiscence experience, which was indicated by a strong positive relationship between the AES and semantic verbal fluency change scores postminus pre-VR (r=0.719; 95% CI 0.327 to 0.900; P=.003). All participants enjoyed the experience despite 35% (6/17) of participants experiencing temporary side effects. Conclusions This study provides initial evidence that it is feasible to use VR with HMDs for therapy to treat symptoms of apathy in older adults in residential aged care. However, there is a need to closely monitor the side effects of HMD use in older adults. Further research is needed using an active control group to compare the use of VR with traditional forms of reminiscence therapy.

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“…Apathetic, but not depressive, symptoms were associated with widespread reduction in white matter integrity and impaired connectivity in premotor and cingulate regions in patients with small vessel disease [31,32]. Clinically, depressive symptoms could be dissociated from apathetic symptoms in terms of longitudinal trajectories [8,18] and a connection with poststroke cognitive function [33,34]. Our results provide further evidence that the symptoms of these two neuropsychiatric syndromes are related to different functional outcome and mortality.…”

Section: Discussionmentioning

confidence: 57%

Early apathetic, but not depressive, symptoms are associated with poor outcome after stroke

Lopatkiewicz

Pera

Słowik

et al. 2021

Euro J of Neurology

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Background and purpose Depression and apathy are frequent neuropsychiatric disturbances after stroke and may appear together. Despite the overlap in symptoms between poststroke depression and apathy, these two syndromes might be associated with different prognoses and benefit from different treatments. We aimed to disentangle the relationship between early depressive and apathetic symptoms and outcome after stroke. Methods Of 698 enrolled patients with ischemic stroke, we included 443 participants (median age = 69 years, 51% female) who underwent depressive and apathetic symptom assessment on Day 8 after stroke. We divided patients into four groups: without greater depressive and apathetic symptoms (Group 1), with only apathetic symptoms (Group 2), with only depressive symptoms (Group 3), and with both depressive and apathetic symptoms (Group 4). Results After adjusting for age and stroke severity, Group 2 and Group 4 had an increased risk of poor 3‐month outcome (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.16–3.38, p = 0.01 and OR = 1.58, 95% CI = 1.24–2.01, p < 0.01, respectively). Group 2 and Group 4 also had an increased risk of poor 12‐month outcome (OR = 3.85, 95% CI = 2.19–6.78, p < 0.01 and OR = 1.54, 95% CI = 1.22–1.96, p < 0.01, respectively) and mortality (hazard ratio [HR] = 2.76, 95% CI = 1.19–6.41, p = 0.02 and HR = 1.77, 95% CI = 1.32–2.38, p < 0.01, respectively). Compared with Group 1, Group 3 did not have an increased risk of unfavorable outcomes. Conclusions Early apathetic, but not depressive, symptoms are related to worse outcomes after stroke. Our study underscores the importance of recognizing apathetic symptoms independently from depressive symptoms.

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Apathy, not depressive symptoms, as a predictor of semantic and phonemic fluency task performance in stroke and transient ischemic attack

Cited by 21 publications

References 97 publications

Network neuroscience of apathy in cerebrovascular disease

Network neuroscience of apathy in cerebrovascular disease

Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study

Early apathetic, but not depressive, symptoms are associated with poor outcome after stroke

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