Pharmacologic Approaches for the Management of Apathy in Neurodegenerative Disorders

Bogdan, Anamaria; Manera, Valéria; Koenig, Alexandra; David, Renaud

doi:10.3389/fphar.2019.01581

Cited by 20 publications

(11 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Symptoms of apathy can also differ depending on the type of dementia, with more severe symptoms found in the behavioral variant of frontotemporal dementia [ 20 ]. With little evidence supporting pharmacological treatment for apathy [ 21 ] and the side effects of current medications [ 22 ], alternative interventions are required.…”

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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…Despite the prevalence and consequences of having apathy, pharmacological treatment is limited and can be difficult due to differing factors including apathy subtypes, stage of neurodegeneration and age that can influence efficacy. 13 14 Non-pharmacological treatments are a safe alternative, and there is a broad consensus that non-pharmacological approaches for treating apathy, in particular, personalised therapy using information and communication technologies should be used. 15 …”

Section: Introductionmentioning

confidence: 99%

Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial

et al. 2021

View full text Add to dashboard Cite

IntroductionApathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Reminiscence therapy is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence use physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders; however, there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to identify changes in apathy after a reminiscence therapy intervention using head-mounted displays (HMDs).Methods and analysisParticipants will be allocated to one of three groups; reminiscence therapy using VR; an active control using a laptop computer or physical items and a passive control. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, and secondary outcomes include cognition and depression. Side effects from using HMDs will also be examined in the VR group. Primary and secondary outcomes at baseline and follow-up will be analysed using linear mixed modelling.Ethics and disseminationEthics approval was obtained from the University of South Australia Human Research Ethics Committee. The results from this study will be disseminated through manuscript publications and national/international conferences.Trial registration numberACTRN12619001510134.

show abstract

“…The morphology of MSNs of the NAc, and associated dendritic spines, was examined using a ballistic labeling technique after the completion of behavioral assessments. Given that pharmacological treatments for apathy 35 and/or addiction 36 are currently limited, the development of a novel therapeutic for motivational alterations associated with HIV-1 has the potential for broad clinical significance.…”

Section: Introductionmentioning

confidence: 99%

S-Equol mitigates motivational deficits and dysregulation associated with HIV-1

McLaurin

Bertrand

Illenberger

et al. 2021

Sci Rep

View full text Add to dashboard Cite

Motivational deficits (e.g., apathy) and dysregulation (e.g., addiction) in HIV-1 seropositive individuals, despite treatment with combination antiretroviral therapy, necessitates the development of innovative adjunctive therapeutics. S-Equol (SE), a selective estrogen receptor β agonist, has been implicated as a neuroprotective and/or neurorestorative therapeutic for HIV-1 associated neurocognitive disorders (HAND); its therapeutic utility for motivational alterations, however, has yet to be systematically evaluated. Thus, HIV-1 transgenic (Tg) and control animals were treated with either a daily oral dose of SE (0.2 mg) or vehicle and assessed in a series of tasks to evaluate goal-directed and drug-seeking behavior. First, at the genotypic level, motivational deficits in HIV-1 Tg rats treated with vehicle were characterized by a diminished reinforcing efficacy of, and sensitivity to, sucrose. Motivational dysregulation was evidenced by enhanced drug-seeking for cocaine relative to control animals treated with vehicle. Second, treatment with SE ameliorated both motivational deficits and dysregulation in HIV-1 Tg rats. Following a history of cocaine self-administration, HIV-1 Tg animals treated with vehicle exhibited lower levels of dendritic branching and a shift towards longer dendritic spines with decreased head diameter. Treatment with SE, however, led to long-term enhancements in dendritic spine morphology in HIV-1 Tg animals supporting a potential underlying basis by which SE exerts its therapeutic effects. Taken together, SE restored motivated behavior in the HIV-1 Tg rat, expanding the potential clinical utility of SE to include both neurocognitive and affective alterations.

show abstract

Pharmacologic Approaches for the Management of Apathy in Neurodegenerative Disorders

Cited by 20 publications

References 52 publications

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

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

Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial

S-Equol mitigates motivational deficits and dysregulation associated with HIV-1

Contact Info

Product

Resources

About