Quality of Life in Community-Dwelling Older Persons with Apathy

Groeneweg-Koolhoven, Isis; Waal, Margot W. M. de; Weele, Gerda M van der; Gussekloo, Jacobijn; Mast, Roos C. van der

doi:10.1016/j.jagp.2012.10.024

Cited by 40 publications

(43 citation statements)

References 55 publications

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“…No large epidemiological studies on the prevalence of apathy in late-life depression have been published. However two studies demonstrate a 43% (N=51) (Groeneweg-Koolhoven et al, 2014) and 53% (N=30) (Marin et al, 1994) prevalence of apathy in non-demented, elderly depressed. We observed that 15.6% of elderly, depressed individuals treated with escitalopram continued to suffer from significant apathy, consistent with prior reports that 18.6% and 16.1% of depressed patients who complete a course of SSRI treatment report persistent apathy and loss of ambition, respectively(Bolling and Kohlenberg, 2004).…”

Section: Discussionmentioning

confidence: 95%

Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response

Yuen

Gunning

Woods

et al. 2014

Journal of Affective Disorders

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Background Apathy is a prominent feature of geriatric depression that predicts poor clinical outcomes and hinders depression treatment. Yet little is known about the neurobiology and treatment of apathy in late-life depression. This study examined apathy prevalence in a clinical sample of depressed elderly, response of apathy to selective serotonin reuptake inhibitor (SSRI) treatment, and neuroanatomical correlates that distinguished responders from nonresponders and healthy controls. Methods Participants included 45 non-demented, elderly with major depression and 43 elderly comparison individuals. After a 2-week single-blind placebo period, depressed participants received escitalopram 10mg daily for 12 weeks. The Apathy Evaluation Scale (AES) and 24-item Hamilton Depression Rating Scale (HDRS) were administered at baseline and 12 weeks. MRI scans were acquired at baseline for concurrent structural and diffusion tensor imaging of anterior cingulate grey matter and associated white matter tracts. Results 35.5% of depressed patients suffered from apathy. This declined to 15.6% (p<0.1) following treatment, but 43% of initial sufferers continued to report significant apathy. Improvement of apathy with SSRI was independent of change in depression but correlated with larger left posterior subgenual cingulate volumes and greater fractional anisotropy of left uncinate fasciculi. Limitations modest sample size, no placebo control, post-hoc secondary analysis, use of 1.5T MRI scanner Conclusions While prevalent in geriatric depression, apathy is separable from depression with regards to medication response. Structural abnormalities of the posterior subgenual cingulate and uncinate fasciculus may perpetuate apathetic states by interfering with prefrontal cortical recruitment of limbic activity essential to motivated behavior.

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Section: Discussionmentioning

confidence: 95%

Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response

Yuen

Gunning

Woods

et al. 2014

Journal of Affective Disorders

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“…Apathy is one of the most common neuropsychiatric syndromes in the aging population, affecting between 3–11% of community-residing older adults (4, 21, 22) and more than 30% of individuals with late-life major depression (5–7). We observed that 16% of depressed older individuals treated with escitalopram continued to suffer from apathy, consistent with earlier studies documenting that 18.6% of depressed patients who complete a course of selective serotonin reuptake inhibitor (SSRI) treatment report persistent apathy (23).…”

Section: Discussionmentioning

confidence: 99%

Apathy in Late-Life Depression: Common, Persistent, and Disabling

Yuen

Bhutani

Lucas

et al. 2015

The American Journal of Geriatric Psychiatry

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Objectives The aims of this study were to examine: (1) the relationship between apathy and disability in late-life depression, and (2) the functional significance of improvement in apathy following escitalopram treatment in terms of its relationship to disability. Methods Subjects were 71 non-demented elderly with non-psychotic major depression. After a 2-week single-blind placebo period, subjects who had Hamilton Depression Rating Scale (HDRS) ≥ 18 received escitalopram 10mg daily for 12 weeks. Apathy and disability were assessed with the Apathy Evaluation Scale (AES) and the World Health Organization Disability Assessment Scale II (WHODAS) respectively. These measures and the HDRS were administered at baseline and again following 12 weeks of treatment. Results At baseline, 38% of depressed subjects had significant apathy (AES ≥ 36.5). Severity of apathy at baseline significantly correlated with severity of disability. In a multivariate regression model, baseline severity of apathy, but not the overall depressive syndrome (HDRS), significantly correlated with baseline disability. Following escitalopram treatment, improvement in apathy significantly correlated with improvement in disability measures, while change in the rest of the depressive syndrome did not. The overall change in apathy and disability in response to escitalopram treatment was significant but small. Conclusions Apathy is common in late-life depression and is associated with disability above and beyond the influence of other depressive symptoms. Given the strong relationship between apathy and disability, understanding the neurobiology of apathy and developing treatments for apathy may improve the functional outcomes of late-life depression.

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“…The presence of apathy in type 2 diabetes is likely to have other clinical consequences. Apathy has an adverse impact on personal quality of life (35), and would be expected to have adverse effects on the spouse or supporting family because of the need to assume more of the burden of managing the complex care commonly employed to control diabetes. Undetected apathy is likely to thwart the efforts of diabetes clinical staff who may attempt to deploy fruitless educational or motivational strategies or increase the complexity of diabetes treatment regimes.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%