Skip to main content
    • Aa
    • Aa

Apathy and Depression: Separate Factors in Parkinson's Disease

  • Lindsey Kirsch-Darrow (a1), Michael Marsiske (a1), Michael S. Okun (a2), Russell Bauer (a1) and Dawn Bowers (a1) (a2)...

The objective of this study was to test the hypothesis that apathy and depression are dissociable in Parkinson disease (PD) by conducting a confirmatory factor analysis (CFA) of items from two commonly used mood scales. A total of 161 non-demented PD patients (age = 64.1; ± 8.4 years) were administered the Apathy Scale and the Beck Depression Inventory-II. Items were hypothesized to load onto four factors: (1) an apathy factor representing loss of motivation, (2) dysphoric mood factor representing sadness and negativity, (3) loss of interest/pleasure factor representing the features common to both apathy and depression, and (4) a somatic factor representing bodily complaints. Results indicated a good fit for the overall CFA model, χ2 (128, N = 146) = 194.9; p<.01. RMSEA was .060 (p = .16). The four-factor model was significantly better than all alternative nested models at p < .001, including an overarching single factor model, representing “depression.” Results support the concept that apathy and depression are discrete constructs. We suggest a “factor based” scoring of the Apathy Scale and Beck Depression Inventory-II that disentangles symptoms related to apathy, depression, overlapping symptoms, and somatic complaints. Such scoring may be important in providing useful information regarding differential treatment options. (JINS, 2011, 17, 1058–1066)

Corresponding author
Correspondence and reprint requests to: Dawn Bowers, Department of Clinical & Health Psychology, University of Florida, Gainesville, FL 32611. E-mail:
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.

R.G. Brown , G. Pluck (2000). Negative symptoms: The ‘pathology’ of motivation and goal-directed behaviour. Trends in Neurosciences, 23(9), 412417. doi:S0166-2236(00)01626-X [pii]

L.C. Butterfield , C.R. Cimino , L.E. Oelke , R.A. Hauser , J. Sanchez-Ramos (2010). The independent influence of apathy and depression on cognitive functioning in Parkinson's disease. Neuropsychology, 24(6), 721730. doi:2010-19103-001 [pii] 10.1037/a0019650

V. Czernecki , B. Pillon , J.L. Houeto , J.B. Pochon , R. Levy , B. Dubois (2002). Motivation, reward, and Parkinson's disease: Influence of dopatherapy. Neuropsychologia, 40(13), 22572267. doi:S0028393202001082 [pii]

R.J. Davidson , W. Irwin (1999). The functional neuroanatomy of emotion and affective style. Trends in Cognitive Science, 3(1), 1121. doi:S1364-6613(98)01265-0 [pii]

R.D. Dobkin , L.A. Allen , M. Menza (2007). Cognitive-behavioral therapy for depression in Parkinson's disease: A pilot study. Movement Disorders, 22(7), 946952. doi:10.1002/mds.21455

R.D. Dobkin , M. Menza , K.L. Bienfait (2008). CBT for the treatment of depression in Parkinson's disease: A promising nonpharmacological approach. Expert Review of Neurotherapeutics, 8(1), 2735. doi:10.1586/14737175.8.1.27

K. Dujardin , P. Sockeel , M. Delliaux , A. Deste , L. Defebvre (2009). Apathy may herald cognitive decline and dementia in Parkinson's disease. Movement Disorders, doi:10.1002/mds.22843

K. Dujardin , P. Sockeel , D. Devos , M. Delliaux , P. Krystkowiak , A. Deste , L. Defebvre (2007). Characteristics of apathy in Parkinson's disease. Movement Disorders, 22(6), 778784. doi:10.1002/mds.21316

H.J. Groenewegen , C.I. Wright , A.V. Beijer (1996). The nucleus accumbens: Gateway for limbic structures to reach the motor system? Progress in Brain Research, 107, 485511.

D.E. Hobson , A.E. Lang , W.R. Martin , A. Razmy , J. Rivest , J. Fleming (2002). Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: A survey by the Canadian Movement Disorders Group. Journal of the American Medical Association, 287(4), 455463. doi:joc10367 [pii]

A.J. Hughes , Y. Ben-Shlomo , S.E. Daniel , A.J. Lees (1992). What features improve the accuracy of clinical diagnosis in Parkinson's disease: A clinicopathologic study. Neurology, 42(6), 11421146.

A.J. Hughes , S.E. Daniel , L. Kilford , A.J. Lees (1992). Accuracy of clinical diagnosis of idiopathic Parkinson's disease: A clinico-pathological study of 100 cases. Journal of Neurology, Neurosurgery, and Psychiatry, 55(3), 181184.

V. Isella , P. Melzi , M. Grimaldi , S. Iurlaro , R. Piolti , C. Ferrarese , I. Appollonio (2002). Clinical, neuropsychological, and morphometric correlates of apathy in Parkinson's disease. Movement Disorders, 17(2), 366371. doi:10.1002/mds.10041 [pii]

L. Kirsch-Darrow , H.H. Fernandez , M. Marsiske , M.S. Okun , D. Bowers (2006). Dissociating apathy and depression in Parkinson disease. Neurology, 67(1), 3338. doi:67/1/33 [pii] 10.1212/01.wnl.0000230572.07791.22

L. Kirsch-Darrow , L.B. Zahodne , C. Has , A. Mikos , M.S. Okun , H.H. Fernandez , D. Bowers (2009). How cautious should we be when assessing apathy with the Unified Parkinson's Disease Rating Scale? Movement Disorders, 24(5), 684688. doi:10.1002/mds.22437

A.F. Leentjens , K. Dujardin , L. Marsh , P. Martinez-Martin , I.H. Richard , S.E. Starkstein , C.G. Goetz (2008). Apathy and anhedonia rating scales in Parkinson's disease: Critique and recommendations. Movement Disorders, 23(14), 20042014. doi:10.1002/mds.22229

A.F. Leentjens , F.R. Verhey , G.J. Luijckx , J. Troost (2000). The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease. Movement Disorders, 15(6), 12211224.

B.E. Levin , M.M. Llabre , W.J. Weiner (1988). Parkinson's disease and depression: Psychometric properties of the Beck Depression Inventory. Journal of Neurology, Neurosurgery, and Psychiatry, 51(11), 14011404.

T.D. Little , W.A. Cunningham , G. Shahar , K.F. Widaman (2002). To parcel or not to parcel: Exploring the question, weighing the merits. [Empirical Study]. Structural Equation Modeling, 9(2), 151173. doi:10.1207/s15328007sem0902_1

R.S. Marin , R.C. Biedrzycki , S. Firinciogullari (1991). Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 38(2), 143162. doi:0165-1781(91)90040-V [pii]

L. Marsh , W.M. McDonald , J. Cummings , B. Ravina (2006). Provisional diagnostic criteria for depression in Parkinson's disease: Report of an NINDS/NIMH Work Group. Movement Disorders, 21(2), 148158. doi:10.1002/mds.20723

H.S. Mayberg , S.E. Starkstein , B. Sadzot , T. Preziosi , P.L. Andrezejewski , R.F. Dannals , R.G. Robinson (1990). Selective hypometabolism in the inferior frontal lobe in depressed patients with Parkinson's disease. Annals of Neurology, 28(1), 5764. doi:10.1002/ana.410280111

G.J. Mogenson , D.L. Jones , C.Y. Yim (1980). From motivation to action: Functional interface between the limbic system and the motor system. Progress in Neurobiology, 14(2-3), 6997. doi:0301-0082(80)90018-0 [pii]

M. Oguru , H. Tachibana , K. Toda , B. Okuda , N. Oka (2010). Apathy and depression in Parkinson disease. Journal of Geriatric Psychiatry and Neurology, 23(1), 3541. doi:0891988709351834 [pii] 10.1177/0891988709351834

K.F. Pedersen , G. Alves , K. Bronnick , D. Aarsland , O.B. Tysnes , J.P. Larsen (2009). Apathy in drug-naive patients with incident Parkinson's disease: The Norwegian ParkWest study. Journal of Neurology, 257, 217223. doi:10.1007/s00415-009-5297-x

G.C. Pluck , R.G. Brown (2002). Apathy in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 73(6), 636642.

P. Remy , M. Doder , A. Lees , N. Turjanski , D. Brooks (2005). Depression in Parkinson's disease: Loss of dopamine and noradrenaline innervation in the limbic system. Brain, 128(Pt 6), 13141322. doi:awh445 [pii] 10.1093/brain/awh445

G. Santangelo , C. Vitale , L. Trojano , K. Longo , A. Cozzolino , D. Grossi , P. Barone (2009). Relationship between depression and cognitive dysfunctions in Parkinson's disease without dementia. Journal of Neurology, 256(4), 632638. doi:10.1007/s00415-009-0146-5

A. Schrag , P. Barone , R.G. Brown , A.F. Leentjens , W.M. McDonald , S. Starkstein , C.G. Goetz (2007). Depression rating scales in Parkinson's disease: Critique and recommendations. Movement Disorders, 22(8), 10771092. doi:10.1002/mds.21333

P. Sockeel , K. Dujardin , D. Devos , C. Deneve , A. Deste , L. Defebvre (2006). The Lille apathy rating scale (LARS), a new instrument for detecting and quantifying apathy: Validation in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77(5), 579584. doi:77/5/579 [pii] 10.1136/jnnp.2005.075929

S.E. Starkstein , H.S. Mayberg , T.J. Preziosi , P. Andrezejewski , R. Leiguarda , R.G. Robinson (1992). Reliability, validity, and clinical correlates of apathy in Parkinson's disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 4(2), 134139.

S. Thobois , C. Ardouin , E. Lhomme , H. Klinger , C. Lagrange , J. Xie , P. Krack (2010). Non-motor dopamine withdrawal syndrome after surgery for Parkinson's disease: Predictors and underlying mesolimbic denervation. Brain, 133(Pt 4), 11111127. doi:awq032 [pii] 10.1093/brain/awq032

R. van Reekum , D.T. Stus , L. Ostrander (2005). Apathy: Why care? The Journal of Neuropsychiatry and Clinical Neurosciences, 17(1), 719. doi:17/1/7 [pii] 10.1176/appi.neuropsych.17.1.7

M. Visser , A.F. Leentjens , J. Marinus , A.M. Stiggelbout , J.J. van Hilten (2006). Reliability and validity of the Beck depression inventory in patients with Parkinson's disease. Movement Disorders, 21(5), 668672. doi:10.1002/mds.20792

L.B. Zahodne , S. Young , L. Kirsch-Darrow , A. Nisenzon , H.H. Fernandez , M.S. Okun , D. Bowers (2009). Examination of the Lille Apathy Rating Scale in Parkinson disease. Movement Disorders, 24(5), 677683. doi:10.1002/mds.22441

D.J. Zgaljardic , J.C. Borod , N.S. Foldi , M. Rocco , P.J. Mattis , M.F. Gordon , D. Eidelberg (2007). Relationship between self-reported apathy and executive dysfunction in nondemented patients with Parkinson disease. Cognitive and Behavioral Neurology, 20(3), 184192. doi:10.1097/WNN.0b013e318145a6f6 00146965-200709000-00008 [pii]

B. Ferencz , L. Kirsch-Darrow , M. Bogordskaya , M.S. Okun , D. Bowers (2010). Toys and Gadgets: Construct Validity of Apathy in Parkinson Disease. Abstract accepted for presentation at the American Academy of Neurology 62nd Annual Meeting.

M.L. Levy , J.L. Cummings , L.A. Fairbanks , D. Masterman , B.L. Miller , A.H. Craig , (1998). Apathy is not depression. J Neuropsychiatry Clin Neurosci, 10(3), 314319.

J.M. Lyness , M.L. Bruce , H.G. Koenig , P.A. Parmelee , R. Schulz , M.P. Lawton , (1996). Depression and medical illness in late life: report of a symposium. J Am Geriatr Soc, 44(2), 198203.

Recommend this journal

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

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *