Skip to main content
×
Home
    • Aa
    • Aa

Apathy and cognitive and functional decline in community-dwelling older adults: results from the Baltimore ECA longitudinal study

  • Diana E. Clarke (a1) (a2), Jean Y. Ko (a1), Constantine Lyketsos (a3), George W. Rebok (a1) and William W. Eaton (a1)...
Abstract
ABSTRACT

Background: Apathy, a complex neuropsychiatric syndrome, commonly affects patients with Alzheimer's disease. Prevalence estimates for apathy range widely and are based on cross-sectional data and/or clinic samples. This study examines the relationships between apathy and cognitive and functional declines in non-depressed community-based older adults.

Methods: Data on 1,136 community-dwelling adults aged 50 years and older from the Baltimore Epidemiologic Catchment Area (ECA) study, with 1 and 13 years of follow-up, were used. Apathy was assessed with a subscale of items from the General Health Questionnaire. Logistic regression, t-tests, χ2 and Generalized Estimating Equations were used to accomplish the study's objectives.

Results: The prevalence of apathy at Wave 1 was 23.7%. Compared to those without, individuals with apathy were on average older, more likely to be female, and have lower Mini-mental State Examination (MMSE) scores and impairments in basic and instrumental functioning at baseline. Apathy was significantly associated with cognitive decline (OR = 1.65, 95% CI = 1.06, 2.60) and declines in instrumental (OR = 4.42; 95% CI = 2.65, 7.38) and basic (OR = 2.74; 95%CI = 1.35, 5.57) function at 1-year follow-up, even after adjustment for baseline age, level of education, race, and depression at follow-up. At 13 years of follow-up, apathetic individuals were not at greater risk for cognitive decline but were twice as likely to have functional decline. Incidence of apathy at 1-year follow up and 13-year follow-up was 22.6% and 29.4%, respectively.

Conclusions: These results underline the public health importance of apathy and the need for further population-based studies in this area.

Copyright
Corresponding author
Correspondence should be addressed to: Dr. Diana E. Clarke, 624 N. Broadway Street, 8th floor, Baltimore, MD 21205, U.S.A. Phone: +1 (410) 955-0416; Fax: +1 (410) 955-9088. Email: dclarke@jhsph.edu.
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

D. E. Clarke , R. van Reekum , M. Simard , D. L. Streiner , M. Freedman and D. Conn (2007). Apathy in dementia: an examination of the psychometric properties of the Apathy Evaluation Scale. Journal of Neuropsychiatry and Clinical Neurosciences, 19, 5764.

D. E. Clarke (2008). Apathy in dementia: clinical and sociodemographic correlates. Journal of Neuropsychiatry and Clinical Neurosciences, 20, 337347.

W. W. Eaton (1997). Natural history of Diagnostic Interview Schedule/DSM-IV major depression: the Baltimore Epidemiologic Catchment Area follow-up. Archives of General Psychiatry, 54, 993999.

J. Fogel , W. W. Eaton and D. E. Ford (2006). Minor depression as a predictor of the first onset of major depressive disorder over a 15-year follow-up. Acta Psychiatrica Scandinavica, 113, 3643.

M. F. Folstein , S. E. Folstein and P. R. McHugh (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.

W. A. Kukull , E. B. Larson , L. Teri , J. Bowen , W. McCormick and M. L. Pfanschmidt (1994). The Mini-mental State Examination score and the clinical diagnosis of dementia. Journal of Clinical Epidemiology, 47, 10611067.

A. M. Landes , S. D. Sperry and M. E. Strauss (2005). Prevalence of apathy, dysphoria, and depression in relation to dementia severity in Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 342349.

H. Lavretsky , I. M. Lesser , M. Wohl , B. L. Miller and C. M. Mehringer (1999). Clinical and neuroradiologic features associated with chronicity in late-life depression. American Journal of Geriatric Psychiatry, 7, 309316.

L. Lechowski (2009). Persistent apathy in Alzheimer's disease as an independent factor of rapid functional decline: the REAL longitudinal cohort study. International Journal of Geriatric Psychiatry, 24, 341346.

C. G. Lyketsos , O. Lopez , B. Jones , A. L. Fitzpatrick , J. Breitner and S. DeKosky (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA, 288, 14751483.

R. S. Marin , R. C. Biedrzycki and S. Firinciogullari (1991). Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 38, 143162.

R. A. Miech , J. C. S. Breitner , P. P. Zandi , A. S. Khachaturian , J. C. Anthony and L. Mayer (2002). Incidence of AD may decline in the early 90s for men, later for women: the Cache County Study. Neurology, 58, 209218.

M. M. Mielke (2007). Vascular factors predict rate of progression in Alzheimer disease. Neurology, 69, 18501858.

C. U. Onyike (2007). Epidemiology of apathy in older adults: the Cache County Study. American Journal of Geriatric Psychiatry, 15, 365375.

P. H. Robert (2006). Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease: a one-year follow-up study. Clinical Neurology and Neurosurgery, 108, 733736.

M. Schützwohl , T. Kallert and L. Jurjanz (2007). Using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1) as a diagnostic interview providing dimensional measures: cross-national findings on the psychometric properties of psychopathology scales. European Psychiatry, 22, 229238.

S. E. Starkstein , G. Petracca , E. Chemeerinksi and J. Kremer (2001). Syndromic validity of apathy in Alzheimer's disease. American Journal of Psychiatry, 158, 872877.

S. E. Starkstein , R. Jorge , R. Mizrahi and R. G. Robinson (2006). A prospective longitudinal study of apathy in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 811.

P. Thomas , J. P. Clément , C. Hazif-Thomas and J. M. Leger (2001). Family, Alzheimer's disease, and negative symptoms.International Journal of Geriatric Psychiatry, 16, 192202.

R. van Reekum , D. T. Stuss and L. Ostrander (2005). Apathy: why care? Journal of Neuropsychiatry and Clinical Neuroscience, 17, 719.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: