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Apathy and depression in mild cognitive impairment: distinct longitudinal trajectories and clinical outcomes

Published online by Cambridge University Press:  30 January 2023

Michael H. Connors ,
Armando Teixeira-Pinto ,
David Ames ,
Michael Woodward  and
Henry Brodaty Open the ORCID record for Henry Brodaty [Opens in a new window]
Michael H. Connors
Affiliation:
Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
Armando Teixeira-Pinto
Affiliation:
School of Public Health, The University of Sydney, Sydney, Australia
David Ames
Affiliation:
National Ageing Research Institute, Melbourne, Australia University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, Australia
Michael Woodward
Affiliation:
Austin Hospital, Heidelberg, Australia
Henry Brodaty*
Affiliation:
Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, Australia
*
Correspondence should be addressed to: Henry Brodaty, Centre for Healthy Brain Ageing (CHeBA), #303, AGSM Bldg (G 27), University of New South Wales, NSW 2052, Australia. Phone: (+61 2) 9385 2585; Fax: (+61 2) 9385 2200. Email: h.brodaty@unsw.edu.au
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Abstract

Objectives:

Apathy is a common symptom in mild cognitive impairment (MCI) and may predict progression to dementia. Little research, however, has investigated the longitudinal trajectory of apathy in patients with MCI or controlled for depression, which can mimic apathy, when examining its clinical correlates. The current study sought to address these issues.

Design:

A prospective longitudinal study was conducted over 3 years.

Setting:

Nine memory clinics around Australia

Participants:

One hundred and eighty-five patients with MCI at baseline.

Measurements:

Measures of cognition, function, neuropsychiatric symptoms, caregiver burden, and medication use were completed annually with additional assessments at 3 and 6 months. Patients were also assessed for dementia by expert clinicians at these time points.

Results:

Of 164 patients who completed measures of neuropsychiatric symptoms, 59 (36.0%) had apathy and 61 (37.2%) had depression. The proportion affected by apathy and overall apathy scores increased over time, in contrast to measures of depression, which remained relatively stable. Apathy was associated with incident dementia and worse cognition, function, neuropsychiatric symptoms, and caregiver burden independent of both depression and incident dementia. Depression was associated with worse function, albeit to lesser degree than apathy, and neuropsychiatric symptoms.

Conclusions:

Apathy increases in MCI and is associated with worse clinical outcomes. These findings provide further evidence for apathy as a marker of clinical decline in older people and poorer outcomes across neurocognitive disorders.

Keywords

Alzheimer’s diseaseapathybehavioral and psychological symptoms of dementiadementiadepressionmild cognitive impairmentneuropsychiatric symptoms

Information

Type
Original Research Article
Information
International Psychogeriatrics , Volume 35 , Special Issue 11: Issue Theme: Neuropsychiatric Symptoms of Mild and Major Neurocognitive Disorders , November 2023 , pp. 633 - 642
Copyright
© International Psychogeriatric Association 2023

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References

Aizenstein, H. J. et al. (2016). Vascular depression consensus report – a critical update. BMC Medicine, 14, 161. https://doi.org/10.1186/s12916-016-0720-5.CrossRefGoogle ScholarPubMed
Apostolova, L. G. and Cummings, J. L. (2008). Neuropsychiatric manifestations in mild cognitive impairment: a systematic review of the literature. Dementia and Geriatric Cognitive Disorders, 25, 115–126. https://doi.org/10.1159/000112509.CrossRefGoogle ScholarPubMed
Bédard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A. and O'Donnell, M. (2001). The Zarit Burden Interview: a new short version and screening version. Gerontologist, 41, 652–657. https://doi.org/10.1093/geront/41.5.652.CrossRefGoogle ScholarPubMed
Bock, M. A., Bahorik, A., Brenowitz, W. D. and Yaffe, K. (2020). Apathy and risk of probable incident dementia among community-dwelling older adults. Neurology, 95, e3280–e3287. https://doi.org/10.1212/WNL.0000000000010951.CrossRefGoogle ScholarPubMed
Brodaty, H. et al. (2013). Mild cognitive impairment in a community sample: the Sydney Memory and Ageing Study. Alzheimer’s & Dementia, 9, 310–317. https://doi.org/10.1016/j.jalz.2011.11.010.CrossRefGoogle Scholar
Brodaty, H. et al. (2017). Operationalizing the diagnostic criteria for mild cognitive impairment: the salience of objective measures in predicting incident dementia. American Journal of Geriatric Psychiatry, 25, 485–497. https://doi.org/10.1016/j.jagp.2016.12.012.CrossRefGoogle ScholarPubMed
Brodaty, H., Altendorf, A., Withall, A. and Sachdev, P. (2010). Do people become more apathetic as they grow older? A longitudinal study in healthy individuals. International Psychogeriatrics, 22, 426–436. https://doi.org/10.1017/S1041610209991335.CrossRefGoogle Scholar
Brodaty, H. and Connors, M. H. (2020). Pseudodementia, pseudo-pseudodementia, and pseudodepression. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 12, e12027. https://doi.org/10.1002/dad2.12027.Google ScholarPubMed
Brodaty, H., Connors, M. H., Xu, J., Woodward, M. and Ames, D. (2015). The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. Journal of the American Medical Directors Association, 16, 380–387. https://doi.org/10.1016/j.jamda.2014.12.018.CrossRefGoogle ScholarPubMed
Brodaty, H., Woodward, M., Boundy, K., Ames, D. and Balshaw, R. (2011). Patients in Australian memory clinics: baseline characteristics and predictors of decline at six months. International Psychogeriatrics, 23, 1086–1096. https://doi.org/10.1017/S1041610211000688.CrossRefGoogle ScholarPubMed
Clarke, D. E., Ko, J. Y., Lyketsos, C., Rebok, G. W. and Eaton, W. W. (2010). Apathy and cognitive and functional decline in community-dwelling older adults: results from the Baltimore ECA longitudinal study. International Psychogeriatrics, 22, 819–829. https://doi.org/10.1017/S1041610209991402.CrossRefGoogle ScholarPubMed
Connors, M. H., Seeher, K., Teixeira-Pinto, A., Woodward, M., Ames, D. and Brodaty, H. (2020). Dementia and caregiver burden: a three-year longitudinal study. International Journal of Geriatric Psychiatry, 35, 250–258. https://doi.org/10.1002/gps.5244.CrossRefGoogle ScholarPubMed
Connors, M. H., Teixeira-Pinto, A., Ames, D., Woodward, M. and Brodaty, H. (2022a). Distinguishing apathy and depression in dementia: a longitudinal study. Australian and New Zealand Journal of Psychiatry, 000486742211145. Advance online publication. https://doi.org/10.1177/00048674221114597.Google ScholarPubMed
Connors, M. H., Teixeira-Pinto, A. and Loy, C. T. (2022b). Apathy and depression in Huntington disease: distinct longitudinal trajectories and clinical correlates. Journal of Neuropsychiatry and Clinical Neurosciences. Advance online publication. https://doi.org/10.1176/appi.neuropsych.21070191.Google ScholarPubMed
Cooper, C., Sommerlad, A., Lyketsos, C. G. and Livingston, G. (2015). Modifiable predictors of dementia in mild cognitive impairment: a systematic review and meta-analysis. American Journal of Psychiatry, 172, 323–334. https://doi.org/10.1176/appi.ajp.2014.14070878.CrossRefGoogle ScholarPubMed
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–S16.CrossRefGoogle ScholarPubMed
Cummings, J. L. (2003). The Neuropsychiatry of Alzheimer’s Disease and Related Dementias. London, UK: Martin Dunitz.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Farias, S. T., Mungas, D., Reed, B. R., Harvey, D. and DeCarli, C. (2009). Progression of mild cognitive impairment to dementia in clinic- vs community-based cohorts. Archives of Neurology, 66, 1151–1157. https://doi.org/10.1001/archneurol.2009.106.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state. Journal of Psychiatric Research, 12, 189–198. https://doi.org/10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Geda, Y. E. et al. (2014). Baseline neuropsychiatric symptoms and the risk of incident mild cognitive impairment: a population-based study. American Journal of Psychiatry, 171, 572–581. https://doi.org/10.1176/appi.ajp.2014.13060821.CrossRefGoogle ScholarPubMed
Guercio, B. J. et al. (2015). The Apathy Evaluation Scale: a comparison of subject, informant, and clinician report in cognitively normal elderly and mild cognitive impairment. Journal of Alzheimer’s Disease, 47, 421–432. https://doi.org/10.3233/JAD-150146.CrossRefGoogle Scholar
Hébert, R., Carrier, R. and Bilodeau, A. (1988). The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps. Age and Ageing, 17, 293–302. https://doi.org/10.1093/ageing/17.5.293.CrossRefGoogle ScholarPubMed
Henstra, M. J. et al. (2018). Apathy is associated with greater decline in subjective, but not in objective measures of physical functioning in older people without dementia. The Journals of Gerontology: Series A, 74, 254–260. https://doi.org/10.1093/gerona/gly014.CrossRefGoogle Scholar
Huffman, J. C. and Stern, T. A. (2007). Neuropsychiatric consequences of cardiovascular medications. Dialogues in Clinical Neuroscience, 9, 29–45. https://doi.org/10.31887/DCNS.2007.9.1/jchuffman.CrossRefGoogle ScholarPubMed
Johansson, M. et al. (2020). Apathy and anxiety are early markers of Alzheimer’s disease. Neurobiology of Aging, 85, 74–82. https://doi.org/10.1016/j.neurobiolaging.2019.10.008.CrossRefGoogle ScholarPubMed
Lanctôt, K. L. et al. (2017). Apathy associated with neurocognitive disorders: recent progress and future directions. Alzheimer’s & Dementia, 13, 84–100. https://doi.org/10.1016/j.jalz.2016.05.008.CrossRefGoogle ScholarPubMed
Lanctôt, K. L. et al. (2021). Measuring apathy in Alzheimer’s disease in the Apathy in Dementia Methylphenidate Trial 2 (ADMET 2): a comparison of instruments. American Journal of Geriatric Psychiatry, 29, 81–89. https://doi.org/10.1016/j.jagp.2020.05.020.CrossRefGoogle ScholarPubMed
Le Heron, C., Apps, M. A. J. and Husain, M. (2018). The anatomy of apathy: a neurocognitive framework for amotivated behaviour. Neuropsychologia, 118, 54–67. https://doi.org/10.1016/j.neuropsychologia.2017.07.003.CrossRefGoogle Scholar
Lövheim, H., Sandman, P.-O., Karlsson, S. and Gustafson, Y. (2008). Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment. International Psychogeriatrics, 20, 777–789. https://doi.org/10.1017/S1041610208006777.CrossRefGoogle ScholarPubMed
Mitchell, A. J. and Shiri-Feshki, M. (2009). Rate of progression of mild cognitive impairment to dementia – meta-analysis of 41 robust inception cohort studies. Acta Psychiatrica Scandinavica, 119, 252–265. https://doi.org/10.1111/j.1600-0447.2008.01326.x.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology, 43, 2412–2414. https://doi.org/10.1212/wnl.43.11.2412-a CrossRefGoogle ScholarPubMed
Mortby, M. E. et al. (2022). Apathy as a treatment target in Alzheimer’s disease: implications for clinical trials. American Journal of Geriatric Psychiatry, 30, 119–147. https://doi.org/10.1016/j.jagp.2021.06.016.CrossRefGoogle ScholarPubMed
O’Bryant, S. E., et al. (2008). Staging dementia using clinical dementia rating scale sum of boxes scores: A Texas Alzheimer's research consortium study. Archives of Neurology, 65, 1091–1095. https://doi.org/10.1001/archneur.65.8.1091 CrossRefGoogle ScholarPubMed
Sherman, C., Liu, C. S., Herrmann, N. and Lanctôt, K. L. (2018). Prevalence, neurobiology, and treatments for apathy in prodromal dementia. International Psychogeriatrics, 30, 177–184. https://doi.org/10.1017/S1041610217000527.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Jorge, R., Mizrahi, R. and Robinson, R. G. (2006). A prospective longitudinal study of apathy in Alzheimer’s disease. Journal of Neurology, Neurosurgery & Psychiatry, 77, 8–11. https://doi.org/10.1136/jnnp.2005.069575.CrossRefGoogle ScholarPubMed
Terum, T. M., Andersen, J. R., Rongve, A., Aarsland, D., Svendsboe, E. J. and Testad, I. (2017). The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review. International Journal of Geriatric Psychiatry, 32, 703–717. https://doi.org/10.1002/gps.4704.CrossRefGoogle ScholarPubMed
van Dalen, J., van Wanrooij, L. L., Moll van Charante, E. P., Brayne, C., van Gool, W. A. and Richard, E. (2018). Association of apathy with risk of incident dementia: a systematic review and meta-analysis. JAMA Psychiatry, 75, 1012–1021. https://doi.org/10.1001/jamapsychiatry.2018.1877.CrossRefGoogle ScholarPubMed
Ward, A., Arrighi, H. M., Michels, S. and Cedarbaum, J. M. (2012). Mild cognitive impairment: disparity of incidence and prevalence estimates. Alzheimer’s & Dementia, 8, 14–21. https://doi.org/10.1016/j.jalz.2011.01.002.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246. https://doi.org/10.1111/j.1365-2796.2004.01380.x.CrossRefGoogle Scholar
Zhu, C. W., Grossman, H. T. and Sano, M. (2019). Why do they just sit? Apathy as a core symptom of Alzheimer disease. American Journal of Geriatric Psychiatry, 27, 395–405. https://doi.org/10.1016/j.jagp.2018.12.013.CrossRefGoogle ScholarPubMed
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