Disease-specific profiles of apathy in Alzheimer’s disease and behavioural-variant frontotemporal dementia differ across the disease course

Wei, Grace; Irish, Muireann; Hodges, John R.; Piguet, Olivier; Kumfor, Fiona

doi:10.1007/s00415-019-09679-1

Cited by 41 publications

(36 citation statements)

References 47 publications

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“…This is further supported by previous research using specific and nonspecific apathy subtype measures, showing these emotional apathy characteristics are key in bvFTD. 19,[21][22][23]26 Previous research using the LARS showed bvFTD displayed greater impairment of emotional apathy and self-awareness domains in comparison with AD. 23 Emotional apathy could indeed be said to overlap contextually with loss of sympathy and empathy, which is a defining feature of bvFTD.…”

Section: Discussionmentioning

confidence: 99%

“…This could be accounted for by the lack of differentiation of dementia syndromes on the initiation apathy profile scores, which has been previously observed when comparing bvFTD and AD. 19 How apathy subtype awareness changes as disease progresses, and its interaction with cognitive functioning should be further explored, with an aim to understand the practical impact of these subtypes.…”

Section: Discussionmentioning

confidence: 99%

“… 18 More recent research using the DAS has found differing apathy profiles with higher emotional apathy in bvFTD when compared to AD and higher executive apathy in AD when compared to bvFTD. 19 However, the profile of apathy and self-awareness of demotivation has not been explored in PPA and bvFTD.…”

Section: Introductionmentioning

confidence: 99%

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Multidimensional Apathy in Behavioral Variant Frontotemporal Dementia, Primary Progressive Aphasia, and Alzheimer Disease

Radaković

Colville

Cranley

et al. 2020

J Geriatr Psychiatry Neurol

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Apathy is prevalent in dementia, such as behavioral variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD). As a multidimensional construct, it can be assessed and subsumed under a Dimensional Apathy Framework. A consistent apathy profile in bvFTD and PPA has yet to be established. The aim was to explore apathy profiles and awareness in bvFTD, PPA, and AD. A total of 12 patients with bvFTD, 12 patients with PPA, 28 patients with AD, and 20 matched controls, as well as their informants/carers, were recruited. All participants completed the Dimensional Apathy Scale (DAS), assessing executive, emotional, and initiation apathy subtypes, a 1-dimensional apathy measure, depression measure, and functional and cognitive screens. Apathy subtype awareness was determined through DAS informant/carer and self-rating discrepancy. Apathy profile comparison showed patients with bvFTD had significantly higher emotional apathy than patients with AD ( P < .01) and significantly higher apathy over all subtypes than patients with PPA ( Ps < .05). Additionally, patients with bvFTD had significantly lower awareness for emotional apathy ( P < .01) when compared to patients with AD and PPA. All patient groups had significant global apathy over all subtypes compared to controls. The emergent apathy profile for bvFTD seems to be emotional apathy (indifference or emotional/affective neutrality), with lower self-awareness in this subtype. Further, lower self-awareness for executive apathy (lack of motivation for planning, organization, or attention) differentiates bvFTD from PPA. Future research should investigate the cognitive and neural correlates as well as the practical impact of apathy subtypes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multidimensional Apathy in Behavioral Variant Frontotemporal Dementia, Primary Progressive Aphasia, and Alzheimer Disease

Radaković

Colville

Cranley

et al. 2020

J Geriatr Psychiatry Neurol

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“…Apathy is common in AD and its frequency and severity are correlated with the severity of cognitive impairment [23]. Evidence suggests that, rather than being at opposite ends of a behavioral spectrum, agitation and apathy share common neuroanatomical features involving overlapping structures (frontal, anterior cingulate, orbitofrontal cortices, amygdala and insula) [7,[24][25][26] and may copresent within a "dysexecutive syndrome" [27,28]. Agitation in AD has been associated with dysfunction in multiple neurotransmitter networks, especially the noradrenergic and serotonergic systems [6], and the same neurotransmitter systems have been implicated in apathy in other neurodegenerative disorders such as frontotemporal lobar degeneration [29] and Parkinson's disease [30,31].…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Anxiety and Incident Agitation in Alzheimer’s Disease

Liu

Costello

Reeves

et al. 2020

JAD

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Background: Agitation in Alzheimer’s disease (AD) has been hypothesized to be an expression of anxiety, but whether anxiety early in the course of dementia could be a risk factor for developing later agitation is unknown. Objective: We used the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database to examine the longitudinal relationship between anxiety and incident agitation in individuals with a diagnosis of AD at baseline or during follow-up. Methods: Longitudinal neuropsychiatric symptom data from AD individuals who were agitation-free at study baseline (N = 272) were analyzed using mixed effects regression models to test the longitudinal relationship between baseline and incident anxiety with incident agitation. Results: Anxiety at baseline was not associated with subsequent agitation, but there was a positive linear relationship between incident anxiety and agitation over the study duration. Baseline apathy and delusions were consistently associated with subsequent agitation and greater disease severity and illness duration also appeared to be risk factors for agitation. Conclusion: Our findings support the concept that anxiety and agitation are likely to be distinct rather than equivalent constructs in mild-moderate AD. Future longitudinal cohort studies are needed to replicate these findings and further characterize potential risk factors for agitation, such as apathy and delusions.

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“…Apathy is characterized by multidimensional symptoms and can define a clinical syndrome per se, even in the absence of co-morbid depression [ 25 , 29 , 49 ]. In early AD, apathy shows a prevalence that reaches 70% [ 50 , 51 ] and is more typically characterized by the loss of motivation and executive dysfunction [ 52 , 53 ], whilst in bvFTD apathy occurs in up to 80% cases [ 32 , 54 ], presenting itself with a more frequent emotional profile [ 55 ]. Apathy also occurs in more than one third of subjects affected by PD and in a half of those with HD, typically leading to difficulties in organization and planning in these populations [ 56 , 57 , 58 ].…”

Section: Psychiatric Symptoms In the Clinical Course Of Neurodegenerative And Neuroinflammatory Diseasesmentioning

confidence: 99%

Insights into the Pathophysiology of Psychiatric Symptoms in Central Nervous System Disorders: Implications for Early and Differential Diagnosis

Menculini

Chipi

Paoletti

et al. 2021

IJMS

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Different psychopathological manifestations, such as affective, psychotic, obsessive-compulsive symptoms, and impulse control disturbances, may occur in most central nervous system (CNS) disorders including neurodegenerative and neuroinflammatory diseases. Psychiatric symptoms often represent the clinical onset of such disorders, thus potentially leading to misdiagnosis, delay in treatment, and a worse outcome. In this review, psychiatric symptoms observed along the course of several neurological diseases, namely Alzheimer’s disease, fronto-temporal dementia, Parkinson’s disease, Huntington’s disease, and multiple sclerosis, are discussed, as well as the involved brain circuits and molecular/synaptic alterations. Special attention has been paid to the emerging role of fluid biomarkers in early detection of these neurodegenerative diseases. The frequent occurrence of psychiatric symptoms in neurological diseases, even as the first clinical manifestations, should prompt neurologists and psychiatrists to share a common clinico-biological background and a coordinated diagnostic approach.

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Disease-specific profiles of apathy in Alzheimer’s disease and behavioural-variant frontotemporal dementia differ across the disease course

Cited by 41 publications

References 47 publications

Multidimensional Apathy in Behavioral Variant Frontotemporal Dementia, Primary Progressive Aphasia, and Alzheimer Disease

Multidimensional Apathy in Behavioral Variant Frontotemporal Dementia, Primary Progressive Aphasia, and Alzheimer Disease

The Relationship Between Anxiety and Incident Agitation in Alzheimer’s Disease

Insights into the Pathophysiology of Psychiatric Symptoms in Central Nervous System Disorders: Implications for Early and Differential Diagnosis

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