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Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders
- P. Robert, C.U. Onyike, A.F.G. Leentjens, K. Dujardin, P. Aalten, S. Starkstein, F.R.J. Verhey, J. Yessavage, J.P. Clement, D. Drapier, F. Bayle, M. Benoit, P. Boyer, P.M. Lorca, F. Thibaut, S. Gauthier, G. Grossberg, B. Vellas, J. Byrne
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- Journal:
- European Psychiatry / Volume 24 / Issue 2 / March 2009
- Published online by Cambridge University Press:
- 16 April 2020, pp. 98-104
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There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer’s disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here.
The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer’s Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria.
Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy.
Assessment of Autonomy in Instrumental Activities of Daily Living in Pre-and Demented Patients Using an Automatic Video Monitoring System
- A. König, C.F. Crispim Junior, A. Gomez Uria Covella, F. Bremond, A. Derreumaux, R. David, P. Aalten, F. Verhey, P.H. Robert
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- Journal:
- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Objectives
To investigate the use of a video monitoring system for automatic event recognition for the assessment of autonomy in Instrumental Activities of Daily Living (IADL) in dementia patients.
MethodsThree groups of participants (healthy control, Mild Cognitive Impairment and Alzheimer's disease) had to carry out a standardized scenario consisting of directed tasks (single and dual task) and IADLs such as preparing pillbox. During this time they were recorded by 3D video cameras capturing all their activities. The performance quality of each participant was manually annotated and assessed based on the amount of successfully carried out activities. Recorded data was processed by a platform of video signal analysis in order to extract kinematic parameters detecting activities undertaken by the participant. We developed a classifier based on the extracted video features for diagnostic prediction and further autonomy performance prediction.
ResultsOverall activities were correctly automatically detected. The most accurate detected activities were: using the phone with 91% accuracy and preparing pillbox with 88% accuracy. The diagnostic group classifier based on the automatically extracted video features obtained accuracy of 71.79 % when combining directed tasks and IADLs. Autonomy group classifier obtained an accuracy of 84.61% when combining directed tasks and IADLs.
ConclusionsThe results suggest that it is possible to assess autonomy with the help automatic video monitoring system (AVMS) and that the use of such technologies could provide clinicians with diagnostic relevant information and improve autonomy assessment in real time decreasing observer biases.
Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group
- P. Robert, K.L. Lanctôt, L. Agüera-Ortiz, P. Aalten, F. Bremond, M. Defrancesco, C. Hanon, R. David, B. Dubois, K. Dujardin, M. Husain, A. König, R. Levy, V. Mantua, D. Meulien, D. Miller, H.J. Moebius, J. Rasmussen, G. Robert, M. Ruthirakuhan, F. Stella, J. Yesavage, R. Zeghari, V. Manera
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- Journal:
- European Psychiatry / Volume 54 / October 2018
- Published online by Cambridge University Press:
- 17 July 2018, pp. 71-76
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Background:
Apathy is a very common behavioural and psychological symptom across brain disorders. In the last decade, there have been considerable advances in research on apathy and motivation. It is thus important to revise the apathy diagnostic criteria published in 2009. The main objectives were to: a) revise the definition of apathy; b) update the list of apathy dimensions; c) operationalise the diagnostic criteria; and d) suggest appropriate assessment tools including new technologies.
Methods:The expert panel (N = 23) included researchers and health care professionals working on brain disorders and apathy, a representative of a regulatory body, and a representative of the pharmaceutical industry. The revised diagnostic criteria for apathy were developed in a two-step process. First, following the standard Delphi methodology, the experts were asked to answer questions via web-survey in two rounds. Second, all the collected information was discussed on the occasion of the 26th European Congress of Psychiatry held in Nice (France).
Results:Apathy was defined as a quantitative reduction of goal-directed activity in comparison to the patient’s previous level of functioning (criterion A). Symptoms must persist for at least four weeks, and affect at least two of the three apathy dimensions (behaviour/cognition; emotion; social interaction; criterion B). Apathy should cause identifiable functional impairments (criterion C), and should not be fully explained by other factors, such as effects of a substance or major changes in the patient’s environment (Criterion D).
Table 1 Apathy diagnostic criteria 2018. CRITERION A: A quantitative reduction of goal-directed activity either in behavioral, cognitive, emotional or social dimensions in comparison to the patient’s previous level of functioning in these areas. These changes may be reported by the patient himself/herself or by observation of others. CRITERION B: The presence of at least 2 of the 3 following dimensions for a period of at least four weeks and present most of the time B1. BEHAVIOUR & COGNITION Loss of, or diminished, goal-directed behaviour or cognitive activity as evidenced by at least one of the following: General level of activity: the patient has a reduced level of activity either at home or work, makes less effort to initiate or accomplish tasks spontaneously, or needs to be prompted to perform them. Persistence of activity: He/she is less persistent in maintaining an activity or conversation, finding solutions to problems or thinking of alternative ways to accomplish them if they become difficult. Making choices: He/she has less interest or takes longer to make choices when different alternatives exist (e.g., selecting TV programs, preparing meals, choosing from a menu, etc.) Interest in external issue: He/she has less interest in or reacts less to news, either good or bad, or has less interest in doing new things Personal wellbeing: He/she is less interested in his/her own health and wellbeing or personal image (general appearance, grooming, clothes, etc.). B2. EMOTION Loss of, or diminished, emotion as evidenced by at least one of the following: Spontaneous emotions: the patient shows less spontaneous (self-generated) emotions regarding their own affairs, or appears less interested in events that should matter to him/her or to people that he/she knows well. Emotional reactions to environment: He/she expresses less emotional reaction in response to positive or negative events in his/her environment that affect him/her or people he/she knows well (e.g., when things go well or bad, responding to jokes, or events on a TV program or a movie, or when disturbed or prompted to do things he/she would prefer not to do). Impact on others: He/she is less concerned about the impact of his/her actions or feelings on the people around him/her. Empathy: He/she shows less empathy to the emotions or feelings of others (e.g., becoming happy or sad when someone is happy or sad, or being moved when others need help). Verbal or physical expressions: He/she shows less verbal or physical reactions that reveal his/her emotional states. B3. SOCIAL INTERACTION Loss of, or diminished engagement in social interaction as evidenced by at least one of the following: Spontaneous social initiative: the patient takes less initiative in spontaneously proposing social or leisure activities to family or others. Environmentally stimulated social interaction: He/she participates less, or is less comfortable or more indifferent to social or leisure activities suggested by people around him/her. Relationship with family members: He/she shows less interest in family members (e.g., to know what is happening to them, to meet them or make arrangements to contact them). Verbal interaction: He/she is less likely to initiate a conversation, or he/she withdraws soon from it Homebound: He /She prefer to stays at home more frequently or longer than usual and shows less interest in getting out to meet people. CRITERION C These symptoms (A - B) cause clinically significant impairment in personal, social, occupational, or other important areas of functioning. CRITERION D The symptoms (A - B) are not exclusively explained or due to physical disabilities (e.g. blindness and loss of hearing), to motor disabilities, to a diminished level of consciousness, to the direct physiological effects of a substance (e.g. drug of abuse, medication), or to major changes in the patient’s environment. Conclusions:The new diagnostic criteria for apathy provide a clinical and scientific framework to increase the validity of apathy as a clinical construct. This should also help to pave the path for apathy in brain disorders to be an interventional target.
The trajectory of cognitive decline in the pre-dementia phase in memory clinic visitors: findings from the 4C-MCI study
- R. Hamel, S. Köhler, N. Sistermans, T. Koene, Y. Pijnenburg, W. van der Flier, P. Scheltens, P. Aalten, F. Verhey, P. J. Visser, I. Ramakers
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- Journal:
- Psychological Medicine / Volume 45 / Issue 7 / May 2015
- Published online by Cambridge University Press:
- 19 November 2014, pp. 1509-1519
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Background
We investigated the course of decline in multiple cognitive domains in non-demented subjects from a memory clinic setting, and compared pattern, onset and magnitude of decline between subjects who progressed to Alzheimer's disease (AD) dementia at follow-up and subjects who did not progress.
MethodIn this retrospective cohort study 819 consecutive non-demented patients who visited the memory clinics in Maastricht or Amsterdam between 1987 and 2010 were followed until they became demented or for a maximum of 10 years (range 0.5–10 years). Differences in trajectories of episodic memory, executive functioning, verbal fluency, and information processing speed/attention between converters to AD dementia and subjects remaining non-demented were compared by means of random effects modelling.
ResultsThe cognitive performance of converters and non-converters could already be differentiated seven (episodic memory) to three (verbal fluency and executive functioning) years prior to dementia diagnosis. Converters declined in these three domains, while non-converters remained stable on episodic memory and executive functioning and showed modest decline in verbal fluency. There was no evidence of decline in information processing speed/attention in either group.
ConclusionsDifferences in cognitive performance between converters to AD dementia and subjects remaining non-demented could be established 7 years prior to diagnosis for episodic memory, with verbal fluency and executive functioning following several years later. Therefore, in addition to early episodic memory decline, decline in executive functions may also flag incident AD dementia. By contrast, change in information processing speed/attention seems less informative.
Anxiety is related to Alzheimer cerebrospinal fluid markers in subjects with mild cognitive impairment
- I. H. G. B. Ramakers, F. R. J. Verhey, P. Scheltens, H. Hampel, H. Soininen, P. Aalten, M. Olde Rikkert, M. M. Verbeek, L. Spiru, K. Blennow, J. Q. Trojanowski, L. M. Shaw, P. J. Visser, the Alzheimer's Disease Neuroimaging Initiative and DESCRIPA Investigators
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- Journal:
- Psychological Medicine / Volume 43 / Issue 5 / May 2013
- Published online by Cambridge University Press:
- 07 September 2012, pp. 911-920
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Background
Anxiety, apathy and depression are common in subjects with mild cognitive impairment (MCI) and may herald Alzheimer's disease (AD). We investigated whether these symptoms correlated with cerebrospinal fluid (CSF) markers for AD in subjects with MCI.
MethodSubjects with MCI (n=268) were selected from the ‘Development of screening guidelines and criteria for pre-dementia Alzheimer's disease’ (DESCRIPA) and Alzheimer's Disease Neuroimaging Initiative (ADNI) studies. We measured amyloid β(1-42) protein (Aβ42) and total tau (t-tau) in CSF. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory.
ResultsDepressive symptoms were reported by 55 subjects (21%), anxiety by 35 subjects (13%) and apathy by 49 subjects (18%). The presence of anxiety was associated with abnormal CSF Aβ42 [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6–3.3] and t-tau (OR 2.6, 95% CI 1.9–3.6) concentrations and with the combination of abnormal concentrations of both Aβ42 and t-tau (OR 3.1, 95% CI 2.0–4.7). The presence of agitation and irritability was associated with abnormal concentrations of Aβ42 (agitation: OR 1.6, 95% CI 1.1–2.3; irritability: OR 2.2, 95% CI 1.5–3.3). Symptoms of depression and apathy were not related to any of the CSF markers.
ConclusionsIn subjects with MCI, symptoms of anxiety, agitation and irritability may reflect underlying AD pathology, whereas symptoms of depression and apathy do not.
Affective symptoms as predictors of Alzheimer's disease in subjects with mild cognitive impairment: a 10-year follow-up study
- I. H. G. B. Ramakers, P. J. Visser, P. Aalten, A. Kester, J. Jolles, F. R. J. Verhey
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- Journal:
- Psychological Medicine / Volume 40 / Issue 7 / July 2010
- Published online by Cambridge University Press:
- 11 November 2009, pp. 1193-1201
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Background
Affective symptoms are common in subjects with mild cognitive impairment (MCI), but there is disagreement whether these symptoms are predictive for Alzheimer's disease (AD). We investigated the predictive accuracy of affective symptoms for AD during a follow-up study in subjects with MCI, and whether the predictive accuracy was modified by age, the presence of amnestic MCI or the length of follow-up.
MethodNewly referred subjects (n=263) with MCI older than 55 years were selected from a memory clinic and followed up after 2, 5 and 10 years. Predictors investigated were: symptoms of depression, anxiety, apathy and sleeping problems.
ResultsAffective symptoms were present in 50–70% of the subjects. The average follow-up period was 5.4 years and 79 subjects (29%) developed AD. Sleeping problems were associated with a decreased risk for AD [odds ratio (OR) 0.35, p<0.001]. Symptoms of depression (OR 0.61, p=0.059) and anxiety (OR 0.58, p=0.051) showed a trend in the same direction. The OR of apathy for AD was 0.67 (p=0.14). Depression was associated with a decreased risk for AD only in subjects without amnestic MCI, but not in subjects with amnestic MCI. Moreover, anxiety was related to the risk for AD differently between subjects diagnosed with AD at the 5-year follow-up (OR 0.23) and subjects diagnosed with AD at the 10-year follow-up (OR 1.7).
ConclusionsAffective symptoms are associated with a decreased risk for AD. The risk may be dependent on MCI subtype or length of follow-up, but it does not depend on age.
Software Packages for the Automatic Assessment of XRF Data for Qualitative and Semi-Quantitative Analysis
- P. L. Warren, A. E. Smith, J. D. V. Aalten, N. Hodkinson
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- Journal:
- Advances in X-ray Analysis / Volume 35 / Issue B / 1991
- Published online by Cambridge University Press:
- 06 March 2019, pp. 711-713
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- 1991
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Qualitative inorganic analysis is required for the identification of unknowns, the classification of type, and sometimes to decide what subsequent quantitative analysis is needed. The traditional way of performing qualitative XRF analysis on unknown materials is by subjecting the sample to a full spectral scan. This takes time and an experienced operator to interpret the spectra. Classifying the elements detected as major, minor or trace can also be person dependent. Round robin tests have confirmed this by showing considerable variation in results between laboratories.