Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T09:00:29.741Z Has data issue: false hasContentIssue false
  • English
  • Français

More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes

Published online by Cambridge University Press:  02 September 2013

Ruslan Leontjevas ,
Steven Teerenstra ,
Martin Smalbrugge ,
Myrra J.F.J. Vernooij-Dassen ,
Ernst T. Bohlmeijer ,
Debby L. Gerritsen  and
Raymond T.C.M. Koopmans
Ruslan Leontjevas*
Affiliation:
School of Psychology, Open University of the Netherlands, Heerlen, the Netherlands Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Centre, Nijmegen, the Netherlands
Steven Teerenstra
Affiliation:
Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
Martin Smalbrugge
Affiliation:
Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Myrra J.F.J. Vernooij-Dassen
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Centre, Nijmegen, the Netherlands Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Kalorama Foundation, Beek-Ubbergen, the Netherlands
Ernst T. Bohlmeijer
Affiliation:
Department of Mental Health Promotion, University of Twente, Enschede, the Netherlands
Debby L. Gerritsen
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Centre, Nijmegen, the Netherlands
Raymond T.C.M. Koopmans
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Centre, Nijmegen, the Netherlands
*
Correspondence should be addressed to: Ruslan Leontjevas, School of Psychology, Open University of the Netherlands, P.O. Box 2960, 6401 DL Heerlen, the Netherlands. Phone: +31-45-576-2100. Email: roeslan.leontjevas@ou.nl.
Get access

Abstract

Background:

Apathy is common in nursing home (NH) residents and it overlaps with depression. This study examines the effects of a multidisciplinary depression program on apathy and depressive motivational and mood symptoms.

Methods:

Secondary analyses of a stepped-wedge cluster-randomized controlled trial were conducted with six measurements. Sixteen dementia NH units and 17 somatic units were enrolled. In the intervention condition, a program containing depression assessment procedures and multidisciplinary treatment (activating strategies, psychotherapy, and medication) was introduced. Usual care was provided in the control condition. Outcomes were assessed using the 10-item Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia.

Results:

Intention-to-treat analyses showed that the whole depression management program reduced apathy in dementia units (p < 0.001; Cohen's d, −0.35), and depressive motivational symptoms in somatic units (p = 0.008; Cohen's d, −0.40). Depressive mood symptoms were not affected in both unit types. The effect on apathy in dementia units was mainly attributed to activating strategies (p < 0.001; Cohen's d, −0.73). The effect on motivational symptoms in somatic units was mainly attributed to psychotherapy (p = 0.002; Cohen's d, −0.80). Apathy worsening was associated with pharmacological depression treatment in both unit types (p = 0.009; Cohen's d, 0.35).

Conclusions:

Depression management may affect apathy and depressive symptoms differently, which underpins the position of apathy as a distinct syndrome. NH professionals can effectively use activating strategies in dementia units, and psychotherapy in somatic units. More research is needed on treating depressive mood symptoms, and on effects of antidepressants in NHs.

Keywords

collaborative treatmentintervention studylong-term carepsychosocial interventionsdementia
Type
2013 IPA Junior Research Awards – Third Prize Winner
Information
International Psychogeriatrics , Volume 25 , Issue 12 , December 2013 , pp. 1941 - 1952
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988a). Cornell Scale for Depression in dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988b). Use of the Cornell Scale in nondemented patients. Journal of the American Geriatrics Society, 36, 230–236.CrossRefGoogle ScholarPubMed
American Psychiatric Association (APA). (2000). Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.Google Scholar
Barnhart, W. J., Makela, E. H. and Latocha, M. J. (2004). SSRI-induced apathy syndrome: a clinical review. Journal of Psychiatric Practice, 10, 196–199.CrossRefGoogle ScholarPubMed
Bohlmeijer, E., Smit, F. and Cuijpers, P. (2003). Effects of reminiscence and life review on late-life depression: a meta-analysis. International Journal of Geriatric Psychiatry, 18, 1088–1094.CrossRefGoogle ScholarPubMed
Bohlmeijer, E., Steunenberg, B., Leontjevas, R., Mahler, M., Daniël, R. and Gerritsen, D. (2010). Dierbare Herinneringen: Protocol voor Individuele Life-Review Therpaie Gebaseerd op Autobiografische Oefening. Enschede, Netherlands: Universiteit Twente.Google Scholar
Boyce, R. D., Hanlon, J. T., Karp, J. F., Kloke, J., Saleh, A. and Handler, S. M. (2012). A review of the effectiveness of antidepressant medications for depressed nursing home residents. Journal of the American Medical Directors Association, 13, 326–331.CrossRefGoogle ScholarPubMed
Brodaty, H. and Burns, K. (2012). Nonpharmacological management of apathy in dementia: a systematic review. American Journal of Geriatric Psychiatry, 20, 549–564.CrossRefGoogle ScholarPubMed
Diesfeldt, H. F., van Houte, L. R. and Moerkens, R. M. (1986). Duration of survival in senile dementia. Acta Psychiatrica Scandinavica, 73, 366–371.CrossRefGoogle ScholarPubMed
Gerritsen, D. L., Jongenelis, K., Steverink, N., Ooms, M. E. and Ribbe, M. W. (2005). Down and drowsy? Do apathetic nursing home residents experience low quality of life? Aging & Mental Health, 9, 135–141.CrossRefGoogle ScholarPubMed
Gerritsen, D. L.et al. (2011). Act in case of depression: the evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study protocol. BioMed Central Psychiatry, 11, 91–98.CrossRefGoogle ScholarPubMed
Hsieh, C.-J.et al. (2010). Reminiscence group therapy on depression and apathy in nursing home residents with mild-to-moderate dementia. Journal of Experimental & Clinical Medicine, 2, 72–78.CrossRefGoogle Scholar
Hussey, M. A. and Hughes, J. P. (2007). Design and analysis of stepped wedge cluster randomized trials. Contemporary Clinical Trials, 28, 182–191.CrossRefGoogle ScholarPubMed
Ishii, S., Weintraub, N. and Mervis, J. R. (2009). Apathy: a common psychiatric syndrome in the elderly. Journal of the American Medical Directors Association, 10, 381–393.CrossRefGoogle Scholar
Jongenelis, K.et al. (2007). Construction and validation of a patient- and user-friendly nursing home version of the Geriatric Depression Scale. International Journal of Geriatric Psychiatry, 22, 837–842.CrossRefGoogle ScholarPubMed
Kazdin, A. E. and Bass, D. (1989). Power to detect differences between alternative treatments in comparative psychotherapy outcome research. Journal of Consulting and Clinical Psychology, 57, 138–147.CrossRefGoogle ScholarPubMed
Leontjevas, R., van Hooren, S., Waterink, W. and Mulders, A. (2009). Apathy and depressive mood in nursing home patients with early-onset dementia. American Journal of Alzheimer's Disease and Other Dementias, 24, 341–348.CrossRefGoogle ScholarPubMed
Leontjevas, R., Gerritsen, D. L., Koopmans, R. T., Smalbrugge, M. and Vernooij-Dassen, M. J. (2012a). Process evaluation to explore internal and external validity of the “Act in Case of Depression” care program in nursing homes. Journal of the American Medical Directors Association, 13, e481–488.CrossRefGoogle ScholarPubMed
Leontjevas, R.et al. (2012b). A comparative validation of the abbreviated Apathy Evaluation Scale (AES-10) with the Neuropsychiatric Inventory Apathy subscale against diagnostic criteria of apathy. Journal of the American Medical Directors Association, 13, e301–306.CrossRefGoogle ScholarPubMed
Leontjevas, R., Gerritsen, D. L., Vernooij-Dassen, M. J., Smalbrugge, M. and Koopmans, R. T. (2012c). Comparative validation of proxy-based Montgomery–Asberg Depression Rating Scale and Cornell Scale for Depression in Dementia in nursing home residents with dementia. American Journal of Geriatric Psychiatry, 20, 985–993.CrossRefGoogle Scholar
Leontjevas, R., Gerritsen, D. L., Vernooij-Dassen, M. J., Teerenstra, S., Smalbrugge, M. and Koopmans, R. T. (2012d). Nijmegen observer-rated depression scale for detection of depression in nursing home residents. International Journal of Geriatric Psychiatry, 27, 1036–1044.CrossRefGoogle ScholarPubMed
Leontjevas, R., Gerritsen, D. L., Smalbrugge, M., Teerenstra, S., Vernooij-Dassen, M. J. F. J. and Koopmans, R. T. C. M. (2013). A structural multidisciplinary approach to depression management in nursing home residents: a multicentre, stepped-wedge cluster-randomised trial. Lancet, 381, 2255–2264.CrossRefGoogle ScholarPubMed
Levin, C. A., Wei, W., Akincigil, A., Lucas, J. A., Bilder, S. and Crystal, S. (2007). Prevalence and treatment of diagnosed depression among elderly nursing home residents in Ohio. Journal of the American Medical Directors Association, 8, 585–594.CrossRefGoogle ScholarPubMed
Levy, M. L.et al. (1998). Apathy is not depression. Journal of Neuropsychiatry & Clinical Neurosciences, 10, 314–319.CrossRefGoogle Scholar
Lueken, U., Seidl, U., Volker, L., Schweiger, E., Kruse, A. and Schroder, J. (2007). Development of a short version of the Apathy Evaluation Scale specifically adapted for demented nursing home residents. American Journal of Geriatric Psychiatry, 15, 376–385.CrossRefGoogle Scholar
Marin, R. S., Biedrzycki, R. C. and Firinciogullari, S. (1991). Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 38, 143–162.CrossRefGoogle ScholarPubMed
Molloy, D. W., Alemayehu, E. and Roberts, R. (1991). Reliability of a standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. American Journal of Psychiatry, 148, 102–105.Google ScholarPubMed
Olin, J. T.et al. (2002). Provisional diagnostic criteria for depression of Alzheimer's disease. American Journal of Geriatric Psychiatry, 10, 125–128.CrossRefGoogle Scholar
Ready, R. E., Ott, B. R., Grace, J. and Cahn-Weiner, D. A. (2003). Apathy and executive dysfunction in mild cognitive impairment and Alzheimer's disease. American Journal of Geriatric Psychiatry, 11, 222–228.CrossRefGoogle Scholar
Roben, G. (2012). Effect of antidepressant medication on depression and apathy in nursing home residents. MD thesis, Nijmegen, Netherlands: Radboud University Nijmegen Medical Centre.Google Scholar
Robert, P.et al. (2009). Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders. European Psychiatry, 24, 98–104.CrossRefGoogle ScholarPubMed
Samus, Q. M.et al. (2005). The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia. Gerontologist, 45, 19–26.CrossRefGoogle ScholarPubMed
Selbaek, G., Engedal, K. and Bergh, S. (2013). The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. Journal of the American Medical Directors Association, 14, 161–169.CrossRefGoogle ScholarPubMed
Settle, E. C. Jr. (1998). Antidepressant drugs: disturbing and potentially dangerous adverse effects. Journal of Clinical Psychiatry, 59(Suppl 16), 25–30.Google 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.CrossRefGoogle ScholarPubMed
Starkstein, S. E. and Leentjens, A. F. (2008). The nosological position of apathy in clinical practice. Journal of Neurology, Neurosurgery & Psychiatry, 79, 1088–1092.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Petracca, G., Chemerinski, E. and Kremer, J. (2001). Syndromic validity of apathy in Alzheimer's disease. American Journal of Psychiatry, 158, 872–877.CrossRefGoogle ScholarPubMed
Tagariello, P., Girardi, P. and Amore, M. (2009). Depression and apathy in dementia: same syndrome or different constructs? A critical review. Archives of Gerontology and Geriatrics, 49, 246–249.CrossRefGoogle ScholarPubMed
Teri, L., Logsdon, R. G., Uomoto, J. and McCurry, S. M. (1997). Behavioral treatment of depression in dementia patients: a controlled clinical trial. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 52, 159–166.CrossRefGoogle ScholarPubMed
Van Reekum, R., Stuss, D. T. and Ostrander, L. (2005). Apathy: why care? Journal of Neuropsychiatry & Clinical Neurosciences, 17, 7–19.CrossRefGoogle ScholarPubMed
Verbeke, G. and Molenberghs, G. (2000). Linear Mixed Models for Longitudinal Data. New York, NY: Springer.Google Scholar
Verkaik, R., Francke, A. L., van Meijel, B., Spreeuwenberg, P. M., Ribbe, M. W. and Bensing, J. M. (2011). The effects of a nursing guideline on depression in psychogeriatric nursing home residents with dementia. International Journal of Geriatric Psychiatry, 26, 723–732.CrossRefGoogle ScholarPubMed
Zwarenstein, M.et al. (2008). Improving the reporting of pragmatic trials: an extension of the CONSORT statement. British Medical Journal, 337, 1223–1226.CrossRefGoogle ScholarPubMed
Supplementary material: File

Leontjevas Supplementary Material

Checklist

Download Leontjevas Supplementary Material(File)
File 18.7 KB
Supplementary material: PDF

Leontjevas Supplementary Material

Supplementary Material

Download Leontjevas Supplementary Material(PDF)
PDF 448.3 KB