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Neuropsychological correlates of apathy in mild cognitive impairment and Alzheimer's disease: the role of executive functioning

Published online by Cambridge University Press:  28 June 2011

Rosa L. Drijgers ,
Frans R. J. Verhey ,
Albert F. G. Leentjens ,
Sebastian Köhler  and
Pauline Aalten
Rosa L. Drijgers
Affiliation:
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience/Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
Frans R. J. Verhey
Affiliation:
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience/Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
Albert F. G. Leentjens
Affiliation:
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience/Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
Sebastian Köhler
Affiliation:
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience/Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
Pauline Aalten*
Affiliation:
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience/Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
*
Correspondence should be addressed to: Dr. P. Aalten, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience/Alzheimer Center Limburg, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Phone: +31 43 3877443; Fax: +31 43 3875444. Email: p.aalten@maastrichtuniversity.nl.
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Abstract

Background: Apathy is a common and important behavioral syndrome in various neuropsychiatric diseases, such as mild cognitive impairment (MCI) and Alzheimer's disease (AD). So far, only few studies have compared the neuropsychological correlates of apathy in patients with MCI and dementia. The aim of the current study was to examine the association between apathy and neuropsychological functioning in patients with MCI and AD.

Methods: Two-hundred-and-sixty AD patients and 178 MCI patients visiting the Memory Clinic of the Maastricht University Medical Centre participated in the study. Linear regression analysis, corrected for age, gender, level of education and depression, was performed to reveal cross-sectional associations between apathy and scores on neuropsychological tests of memory, attention, psychomotor speed and executive functioning.

Results: In patients with MCI, apathy was characterized by decreased verbal fluency and psychomotor tracking. In AD, patients with apathy differed from non-apathetic patients only on a verbal fluency task.

Conclusion: Apathy is related to executive dysfunction in the early phases of cognitive decline. In particular, in the prodromal phase of AD, apathy seems to be characterized by poor initiating. In the more advanced stages of cognitive deterioration, associations between apathy and specific neuropsychological correlates may be obscured by the more severe neuropathology. Awareness of apathy in the early phase of cognitive impairment may help in early diagnosis of AD.

Keywords

apathyneuropsychological profileAlzheimer'sMCI
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 8 , October 2011 , pp. 1327 - 1333
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Aalten, P., De Vugt, M. E., Jaspers, N., Jolles, J. and Verhey, F. R. J. (2005). The course of neuropsychiatric symptoms in dementia: Part I. Findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry, 20, 523–530.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.Washington, DC: American Psychiatric Press.Google Scholar
Chase, T. N. (2011). Apathy in neuropsychiatric disease: diagnosis, pathophysiology and treatment. Neurotoxicity Research, 19, 266–278.CrossRefGoogle Scholar
Chow, T. W. et al. (2010). Apathy symptom profile and behavioral associations in frontotemporal dementia vs dementia of Alzheimer type. Archives of Neurology, 66, 888–893.Google Scholar
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.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Drijgers, R. L., Aalten, P., Winogrodzka, A., Verhey, F. R. J. and Leentjens, A. F. G. (2009). Pharmacological treatment of apathy in neurodegenerative diseases: a systematic review. Dementia and Geriatric Cognitive Disorders, 28, 13–22.CrossRefGoogle ScholarPubMed
Dubois, B. et al. (2010). Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurology, 9, 1118–1127.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.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
Jack, C. R. et al. (2010). Hypothetical model of dynamic biomarkers of the Alzheimer's pathological cascade. Lancet Neurology, 9, 119–128.CrossRefGoogle ScholarPubMed
Kat, M., De Jonghe, J., Aalten, P., Kalisvaart, C., Droes, R. and Verhey, F. (2002). Neuropsychiatric symptoms of dementia:psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI). Tijdschrift voor Gerontologie en Geriatrie, 33, 150–155.Google ScholarPubMed
Kuzis, G., Sabe, L., Tiberti, C., Dorrego, F. and Starkstein, S. E. (1999). Neuropsychological correlates of apathy and depression in patients with dementia. Neurology, 52, 1403–1407.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
McPherson, S., Fairbanks, L., Tiken, S., Cummings, J. L. and Back-Madruga, (2002). Apathy and executive function in Alzheimer's disease. Journal of the International Neuropsychological Society, 8, 373–381.CrossRefGoogle ScholarPubMed
Monastero, R., Mangialasche, F., Camarda, C., Ercolani, S. and Camarda, R. (2009). A systematic review of neuropsychiatric symptoms in mild cognitive impairment. Journal of Alzheimer's Disease, 18, 11–30.CrossRefGoogle ScholarPubMed
Onyike, C. U. et al. (2007). Epidemiology of apathy in older adults: the Cache County Study. American Journal of Geriatric Psychiatry, 15, 365–375.CrossRefGoogle ScholarPubMed
Palmer, K. et al. (2010). Neuropsychiatric predictors of progression from amnestic-mild cognitive impairment to Alzheimer's disease: the role of depression and apathy. Journal of Alzheimer's Disease, 20, 175–183.CrossRefGoogle ScholarPubMed
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.CrossRefGoogle ScholarPubMed
Ready, R. E., Ott, B. R., Grace, J. and Cahn-Weiner, D. A. (2003). Apathy and executive dysfunction in mild cognitive impairment and Alzheimer disease. American Journal of Geriatric Psychiatry, 11, 222–228.CrossRefGoogle ScholarPubMed
Reisberg, B., Ferris, S., De Leon, M. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Robert, P. et al. (2006a). 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, 733–736.CrossRefGoogle ScholarPubMed
Robert, P. H. et al. (2006b). Neuropsychological performance in mild cognitive impairment with and without apathy. Dementia and Geriatric Cognitive Disorders, 21, 192–197.CrossRefGoogle ScholarPubMed
Robert, P. H. et al. (2009). Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders. European Psychiatry, 24, 98–104.CrossRefGoogle ScholarPubMed
Robert, P. H., Mulin, E., Mallea, P. and David, R. (2010). Apathy diagnosis, assessment, and treatment in Alzheimer's disease. CNS Neuroscience and Therapeutics, 16, 263–271.CrossRefGoogle ScholarPubMed
Rubin, D. (1976). Inference and missing data. Biometrika, 63, 581–592.CrossRefGoogle Scholar
Schafer, J. and Graham, J. (2002). Missing data: our view of the state of the art. Psychological Methods, 7, 147–177.CrossRefGoogle ScholarPubMed
StataCorp (2009). STATA Statistical Software: Release 11.0. College Station, TX: StataCorp.Google Scholar
Tun, S. M., Murman, D. L., Long, H. L., Colenda, C. C. and von Eye, A. (2007). Predictive validity of neuropsychiatric subgroups on nursing home placement and survival in patients with Alzheimer disease. American Journal of Geriatric Psychiatry, 15, 780–789.CrossRefGoogle ScholarPubMed
van der Elst, W., van Boxtel, M. P., van Breukelen, G. J. and Jolles, J. (2005). Rey's verbal learning test: normative data for 1855 healthy participants aged 24–81 years and the influence of age, sex, education, and mode of presentation. Journal of the International Neuropsychological Society, 11, 290–302.CrossRefGoogle ScholarPubMed
van der Elst, W., van Boxtel, M. P., van Breukelen, G. J. and Jolles, J. (2006). The Concept Shifting Test: adult normative data. Psychological Assessment, 18, 424–442.CrossRefGoogle ScholarPubMed