Study motivated by apathy

Conversion from mild cognitive impairment to Alzheimer’s disease dementia is not related to the apathy score of the patient. But risk of conversion is significantly associated with apathy in the caregiver, according to surprising new data from Italy.

This somewhat unexpected finding is revealed in a study of people with mild cognitive impairment (MCI) at high risk of conversion. Data were presented at the European Academy of Neurology 2020 Virtual Congress by Flavio Nobili and colleagues from the University of Genoa.

Previous work had suggested that apathy might be associated with conversion from MCI to Alzheimer’s disease dementia (ADD), and a recent meta-analysis estimated that apathy among memory clinic patients doubled the risk of incident dementia.1

 

Apathy has been called “the forgotten symptom”

A feature of the prospective Genoa study was that it used the multi-domain dementia-specific Apathy Evaluation Scale (AES) developed by Marin et al.2 The scale can be given to patients and to caregivers.

 

Apathy not a sign of more aggressive disease

The study included 110 people with amnestic MCI and a mean age of 76, followed for an average of 1.6 years. During this period, forty converted to ADD.  Converters were not significantly different from non-converters on depression score or on the Mini-Mental State Examination. Neither were they different in apathy score.

However, the apathy score among the caregivers of people who converted to ADD was significantly higher than the apathy score of those who cared for non-converters. This was true for the global AES score and on the subscales relating to apathy in emotion and in cognition. Researchers are continuing the study to pick up late converters.

Few previous studies had used a dementia-specific apathy scale

Apathy is reported in around half of patients with Alzheimer’s disease.3 It is the most common neuropsychiatric symptom, and is a major source of distress to caregivers.4 But it has been described as the forgotten symptoms of dementia,3 is difficult to study since there seem to be several potentially independent domains - covering goal-directed behaviour, cognitive activity, and emotion - and considerable overlap with depression, which is also frequent in AD.

 

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. van Dalem JW, et al. JAMA Psychiatry 2018;75:1012-21

  2. Marin RS, et al. Psychiatry Res 1991;38:143-62

  3. https://www.exeter.ac.uk/news/research/title_725251_en.html [Accessed June 2020]

  4. Rajkumar AP, et al. J Am Med Dir Assoc 2016;17:741-7

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