Persistent apathy in Alzheimer's disease as an independent factor of rapid functional decline: the REAL longitudinal cohort study

Lechowski, L.; Benoît, Michel; Chassagne, Philippe; Vedel, Isabelle; Tortrat, D.; Teillet, Laurent; Vellas, Bruno

doi:10.1002/gps.2125

Cited by 71 publications

(69 citation statements)

References 22 publications

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“…Apathy is also significantly associated with depression in these individuals, although depression is neither necessary nor sufficient to produce apathy (Lechowski et al 2009). Alzheimer patients who develop apathy reportedly decline faster cognitively than those who do not manifest apathy (Lechowski et al 2009). In other dementias (including frontotemporal, Lewy body and vascular) as well as in mild cognitive impairment (MCI), the reported prevalence of apathy ranges from 38 to 95% (Robert et al 2006;Galvin et al 2007).…”

Section: Prevalence and Clinical Characteristicsmentioning

confidence: 97%

“…It generally tends to afflict those with the greatest cognitive impairment and global disease severity (Starkstein et al 2006). Apathy is also significantly associated with depression in these individuals, although depression is neither necessary nor sufficient to produce apathy (Lechowski et al 2009). Alzheimer patients who develop apathy reportedly decline faster cognitively than those who do not manifest apathy (Lechowski et al 2009).…”

Section: Prevalence and Clinical Characteristicsmentioning

confidence: 98%

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Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment

Chase¹

2010

Neurotox Res

116

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Apathy is an increasingly recognized concomitant of a broad range of central nervous system disorders. Nevertheless, its nosology, pathogenesis and therapy remain shrouded in confusion and controversy. As yet, there is little consensus regarding methods for detecting apathy, or distinguishing it from depression, or for assessing its severity. Many now regard the apathy syndrome as primarily reflecting a lack of motivation that compromises emotional, cognitive, and overt behavioral function. Even though under-recognized and under-diagnosed, apathy hardly appears uncommon: current epidemiologic studies suggest over 10 million Americans may be affected. Its reported frequency in various neurologic and psychiatric conditions varies widely, from less than 10 to over 80%, reflecting differences in population characteristics and assessment procedures. Often apathy has been associated with such neurodegenerative disorders as Alzheimer's disease, Parkinson's disease, and fronto-temporal dementia. But it also occurs in those with psychiatric disorders such as schizophrenia and major depression. Clinical, neuropathologic, and neuroimaging observations increasingly suggest that apathy reflects dysfunction of frontal-subcortical circuits, especially those linking the ventromedial prefrontal cortex to related regions in the basal ganglia. Therapeutically, numerous small studies suggest that psychostimulants, dopaminergics, and cholinesterase inhibitors may benefit those manifesting this syndrome. However, no adequately powered, randomized controlled trials have reported success and no medication have ever been approved for this disorder. The accelerating pace of current research nevertheless promises to improve our understanding of apathy and to better address the unmet medical needs of those suffering its consequences.

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Section: Prevalence and Clinical Characteristicsmentioning

confidence: 97%

Section: Prevalence and Clinical Characteristicsmentioning

confidence: 98%

Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment

Chase¹

2010

Neurotox Res

116

View full text Add to dashboard Cite

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“…Among these variables, we think that the significant relationship that emerged between higher NPI scores at baseline and autonomy loss is particularly interesting. The role played by behavioral disturbances in the loss of autonomy in AD has yet to be completely clarified [41] ; recent data seem to show that a marked decline in autonomy is associated with a greater decrease in MMSE and a faster progression of behavioral disturbances, especially apathy [42,43] . The protective role of drugs other than AChEIs on mortality and disability that we found in our sample -mortality and autonomy loss were found to be lower in the subjects who took drugs -can be interpreted in the light of these considerations.…”

Section: Discussionmentioning

confidence: 99%

Impact of Gender Differences on the Outcome of Alzheimer’s Disease

Sinforiani

Citterio

Zucchella

et al. 2010

Dement Geriatr Cogn Disord

101

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Background and Aims: Since little is known about the role of gender in the course of Alzheimer’s disease (AD), a prospective epidemiological study was conducted to detect gender differences in relation to AD evolution and outcome. Methods: Six hundred AD patients, 214 men and 386 women, first seen between September 2000 and December 2003, were enrolled; the follow-up period lasted until December 2008. Results: The men had greater comorbidity and higher mortality than the women, who instead recorded more disability and longer survival. Survival curves showed that women reach partial loss of autonomy faster than men. Higher Neuropsychiatric Inventory scores at baseline showed a predictive value for loss of autonomy regardless of gender. Pharmacological treatment seems to have a protective role on disability and mortality. Conclusions: Gender influences disease evolution not only directly but also through other factors such as comorbidity.

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“…Apathy or executive dysfunctions, very frequent features in AD, can be assumed to contribute also strongly to functional decline, particularly persistent apathy [25][26][27][28] . In the present study, age was found to be a non-negligible factor for decline in BADL score.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Loss of Basic Activities of Daily Living in Alzheimer Patients: A Cross-Sectional Study of the French REAL Cohort

Lechowski

Pradelles²,

Crane³

et al. 2010

Dement Geriatr Cogn Disord

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Background/Aims: To characterize loss of basic activities of daily living (BADL) in 687 Alzheimer’s disease (AD) community-dwelling patients included in the French REAL cohort. Methods: Patients had mild to moderately severe AD, and the mean age was 77.8 years. Patterns of loss of the 6 BADL were described at inclusion using the Lawton scale. Results: With 6 binary BADL scores, each patient presented at inclusion a set of losses. For 53% of women, the sets of losses were included within each other or were identical, adding losses in physical ambulation, grooming, bathing, dressing, toilet and feeding, respectively. For 47% of men, a similar sequence was identified, with loss of dressing occurring secondly. A global cohesion of sets of losses was found for 87% of women and 86% of men. The Lawton scale is very useful for the assessment of AD patients.

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Persistent apathy in Alzheimer's disease as an independent factor of rapid functional decline: the REAL longitudinal cohort study

Abstract: In this study, a rapid loss in IADL score was partly explained by persistent apathy.

Cited by 71 publications

References 22 publications

Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment

Apathy in Neuropsychiatric Disease: Diagnosis, Pathophysiology, and Treatment

Impact of Gender Differences on the Outcome of Alzheimer’s Disease

Patterns of Loss of Basic Activities of Daily Living in Alzheimer Patients: A Cross-Sectional Study of the French REAL Cohort

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