Premium
Natural history of apathy in Alzheimer’s disease
Author(s) -
Zhu Carolyn W.,
Grossman Hillel,
Sano Mary
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.038675
Subject(s) - apathy , dementia , depression (economics) , incidence (geometry) , psychiatry , psychology , medicine , disease , clinical psychology , physics , optics , economics , macroeconomics
Background Apathy is a common behavioral symptom of dementia, yet information on its impact dementia is limited. This study examines prevalence, incidence, and persistence of apathy longitudinally. Method Sample was drawn from the National Alzheimer's Coordinating Center Uniform Data Set (NACC‐UDS) including participants enrolled 9/2005‐5/2019 with at least one follow‐up, with baseline diagnosis of MCI or AD. Presence of apathy was defined using clinician judgment within the NACC‐UDS protocol, indicating whether the participant currently manifests meaningful change in behavior in apathy (yes=1/no=0). Incidence of apathy was defined as the proportion of participants who did not have an endorsement of apathy at baseline but had a new endorsement of apathy at that visit. Persistence of apathy was defined as the proportion of participants who had an endorsement of apathy between two consecutive visits. Result Sample included 9,607 participants with baseline CDR=0.5 (n=5,323), 1 (n=3,115), 2/3 (n=1169). Apathy was endorsed in 59.4% of participants at some point during follow‐up (CDR=0.5: 46.6%, CDR=1: 72.9%, CDR=2/3: 81.2%). Participants with apathy differed from those who never had apathy in: being male (49.0% vs. 44.7%), education (14.6±3.7 vs. 14.9±3.6), reporting depression in the past 2 years (42.7% vs. 26.6%), having at least one APOE e4 allele (58.7% vs. 52.9%), follow‐up years (4.1± 2.1 vs 3.8±2.2), MMSE (21.5±6.3 vs. 24.2±5.1), and FAQ (13.8±9.0 vs. 7.6±8.2) (all p<0.01). Differences in baseline age and comorbidities were statistically insignificant. Presence of apathy increased over time in participants with baseline CDR=0.5 (baseline to visit 5: 19.8% to 33.8%) and CDR=1 (43.9% to 59.9%), but fluctuated around 62.4% in CDR=2/3. Incidence of apathy fluctuated around 12.5%, 15.7% and 13.4 % for each baseline CDR group. Persistence of apathy between consecutive visits increased over time in participants with baseline CDR=0.5 (baseline to visit 5: 12.6% to 21.4%) and CDR=1 (33.2% to 44.8%), but fluctuated around 49.2% in CDR=2/3. Conclusion Prevalence and persistence of apathy increased over time and correlated with disease severity. Incident apathy appears to plateau after CDR=1. The increasing impact of apathy over the course of dementia has clinical relevance and should be considered in designing intervention studies.