Symptoms of Apathy Are Associated with Progression from Mild Cognitive Impairment to Alzheimer’s Disease in Non-Depressed Subjects

Abstract

Background: Apathy is a common symptom in various neuropsychiatric diseases including mild cognitive impairment (MCI) and dementia. Apathy may be associated with an increased risk of cognitive decline. The objective of this study was to investigate if apathy predicts the progression from MCI to Alzheimer’s disease (AD). Methods: The Alzheimer’s Disease Neuroimaging Initiative is a prospective multicentre cohort study. At baseline, 397 patients with MCI without major depression were included. Clinical data and the Geriatric Depression Scale at baseline were used. Apathy was defined based on the 3 apathy items of the 15-item Geriatric Depression Scale. The main outcome measure was the association of apathy with progression from MCI to AD. Results: During an average follow-up of 2.7 years (SD 1.0), 166 (41.8%) patients progressed to AD. The presence of symptoms of apathy without symptoms of depressive affect increased the risk of progression from MCI to AD (hazard ratio = 1.85, 95% CI = 1.09–3.15). Apathy in the context of symptoms of depressive affect or symptoms of depressive affect alone, without apathy, did not increase the risk of progression to AD. Conclusions: Symptoms of apathy, but not symptoms of depressive affect, increase the risk of progression from MCI to AD. Apathy in the context of symptoms of depressive affect does not increase this risk. Symptoms of apathy and depression have differential effects on cognitive decline.

Apathy in Older Patients with Type 2 Diabetes

“…This finding is consistent with previous studies demonstrating that apathy is associated with an increased risk of progression from predementia states to dementia (31,32). Type 2 diabetes is a known M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 11 risk factor for dementia and various predementia states and is also associated with an accelerated conversion to dementia from predementia (26,33,34).…”

A Novel Assessment and Profiling of Multidimensional Apathy in Alzheimer’s Disease

“…The largest of these groups was the Executive and Initiation apathy subgroup (N=43), which was reinforced by people with AD and controls self-rating group comparison and magnitude of difference between the Executive and Initiation apathy subscales. As one of the most prominent behavioral symptoms in AD, cognitive impairment is also associated with apathy [45][46][47]. While memory impairment is common in AD, attention [48] and executive dysfunction [49], such as planning, spatial navigation attention [50][51][52] and verbal fluency [53] are also particularly noted to be impaired as the disease progresses to later stages, which is particularly relevant to our sample which is more impaired.…”

Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

“…In the largest study, reporting apathy symptoms but not depressive symptoms on the relevant validated Geriatric Depression Score (GDS)-15 subscales 55 predicted conversion from aMCI to AD, but apathy symptoms alone were not a significant predictor (Figure 2e). Results from four other small studies were mixed; NPI apathy subscale scores and apathy assessed using standard criteria was associated with conversion from aMCI to AD 56 with a similar but non-significant trend reported in a second study 57 .…”