Use of the Apathy Evaluation Scale as a Measure of Motivation in Elderly People

Abstract

Motivation plays an important part in an elderly individual's ability to recover from a disabling event. On the other hand, apathy is a lack of motivation. The Apathy Evaluation Scale (AES) is an 18‐item instrument that rates a person's thoughts, actions, and emotions over the previous 4 weeks. The purpose of this study was to use the AES with 102 patients in a geriatric rehabilitation program to determine if it predicted improved function after rehabilitation. In addition, a short 7‐item version of the AES was tested. A strong correlation was demonstrated between the 18‐item AES and the 7‐item AES, the Mini‐Mental State Examination, and the Geriatric Depression Scale. In separate regression analyses, we found that admission function and both the 18‐item and 7‐item AES were significant predictors of discharge function, and that functional level at admission to rehabilitation accounted for 31% of the variance in function after rehabilitation. The findings suggest that the AES might be an appropriate measure of motivation in older adults and might predict success in rehabilitation. Moreover, the ability to identify patients with low motivation can alert healthcare providers to develop interventions to improve older adults' motivation and help them attain and maintain their highest functional level.

Are the available apathy measures reliable and valid? A review of the psychometric evidence

“…Statistically significant and fair to high correlation between the AES-I and AES-C and other measures of apathy (e.g., NPI-apathy subscale (57), the Lille Apathy Rating Scale [LARS] (59;60), and the PANSS-negative symptom (NS) subscale, particularly the emotional withdrawal item (58) indicated fair to good convergent validity. Understandably, the AES-I was also correlated highly with scores on the 7-item Apathy Scale (AS-7) (61) that was validated in a geriatric rehabilitation inpatients and the 10-item Apathy Scale (AS-10) (62) that was validated in geriatric nursing home residents given seven or more common items. Good discriminant validity was also demonstrated for the AES-I and AES-C as evident by low correlations with depression and anxiety measures (46;47;57) and the positive factor of the PANSS (58).…”

“…Resnick et al’s AS-7 (61) and Leuken et al’s AS-10 (62) represent truncated versions of the AES that result from removal of some items that were determined to be redundant (53;61) or inappropriate for the group being assessed (62). Judgment of redundancy was based on factor analyses (53;61) whereas inappropriateness was judged by experts with special knowledge of the population being assessed (61;62). The intent of these abridged versions of the AES was to better capture apathy in the respective populations with reliable and valid measures while possibly requiring less time although not explicitly stated.…”

“…As with the original scale, each item is rated a 4-point scale. The total scores range from 0–21 for the AS-7 (61), 0–30 for the AS-10 (62), and 0–42 for the AS-14 (53), with higher scores indicating more severe apathy.…”

Apathy in Parkinson's disease

“…It contributes significantly to carer burden 9 10 and has negative implications for treatment and long term outcome. [11][12][13] In Parkinson's disease, there is no evidence that the symptoms of apathy are improved by levodopa treatment, although there are early indications that the dopamine D3 receptor agonist, pramipexole, 14 15 and cholinesterase inhibitors may be of some value. 16 17 Current estimates of the prevalence of apathy in Parkinson's disease vary between 16.5% 6 and 42%, 2 depending upon the instrument used for assessment and on the samples examined.…”

An Open-Label Pilot Study of Acetylcholinesterase Inhibitors to Promote Functional Recovery in Elderly Cognitively Impaired Stroke Patients

“…Impairments in cognition [1] and motivation [2] are common after stroke and predict poor functional recovery [3,4,5]. We propose that pharmacological agents that enhance cognition and/or diminish apathy may, when combined with traditional rehabilitative efforts, lead to improved functional recovery.…”