The syndromal validity and nosological position of apathy in Parkinson's disease

Abstract

Although apathy is among the most frequent behavioral changes in Parkinson's disease (PD), its diagnosis is still problematic, and the overlap with depression and dementia poorly studied. Aim of the study was validate specific criteria to diagnose apathy in PD, and to examine its association with subsyndromes of depression and dementia. A series of 164 patients with PD, 44 patients with "primary" depression and no PD, 23 patients with Alzheimer's disease, and 26 age-comparable healthy controls underwent a comprehensive psychiatric assessment that included a structured psychiatric interview and the Apathy Scale. A set of seven diagnostic criteria showed high sensitivity and specificity for clinically diagnosed apathy. Fifty-two of the 164 patients with PD (32%) met diagnostic criteria for apathy. Eighty-three percent of patients with apathy had comorbid depression and 56% had dementia. Only 5 of the 40 PD patients (13%) with neither depression nor dementia had apathy. We validated a set of standardized criteria for the diagnosis of apathy in PD. About one third of a series of patients attending a Movement Disorders Clinic showed apathy. Both depression and dementia were the most frequent comorbid conditions of apathy in PD.

Fatigue in Patients with Parkinson's Disease: Impact on Quality of Life

“…A recent multicenter study of 1,072 consecutive patients conducted in Italy reported that apathy was associated with worse QOL, and that fatigue had a negative impact on QOL in PD (4). These findings further suggest that fatigue and apathy are strongly associated and overlap frequently (26,27). To date, the relationship between fatigue and apathy has not been investigated in detail.…”

Acute and chronic cognitive effects of levodopa and dopamine agonists on patients with Parkinson’s disease: a review

“…Also within the domain of prefrontal executive functions more studies are needed: indeed most studies focused on functions of the orbital and of the dorsolateral frontostriatal circuits, while functions of the 'anterior cingulate' frontostriatal circuit (including the anterior cingulated cortex [ACC], the striatum [ventromedial caudate nucleus, ventral putamen] the nucleus accumbens, the olfactory tubercle, the globus pallidus [rostromedial] and the thalamus) have been scarcely investigated in PD: this circuit has been involved in motivated behavior, considering that its damages clinically result in apathetic syndromes [Bonelli and Cummings, 2007]. Apathy is a common neuropsychiatric feature also in PD patients [Starkstein et al 2009] and has been associated with cingulate anatomic reductions and functional deficits [Benoit and Robert, 2011;Kostic and Filippi, 2011] and with executive impairment [Poletti et al 2012a], but the role of nigrostriatal dopaminergic deficit on apathy in PD and the potential role played by dopaminergic drugs are actually almost unknown and deserve further empirical investigation.…”

Residual sleepiness in obstructive sleep apnoea: phenotype and related symptoms

“…They underwent a face-to-face interview and a clinical examination. They completed a standardised questionnaire including the following scales: ESS [9]; Horne-Ostberg morningness-eveningness scale [14]; Fatigue Severity Score [15,16]; Beck Depression Inventory II [17]; Hospital Anxiety and Depression Rating Scale [18]; Conners' Adult Attention Deficit-Hyperactivity Disorder Rating Scale [19]; and Apathy Scale [20]. The serum ferritin levels (as low levels promote restless legs and periodic leg movements [21]) and class II human leukocyte antigen (HLA) genotype (as the DQB1*0602 genotype is associated with sleepiness and narcolepsy) were determined.…”