On the overlap between apathy and depression in dementia

• Published in: Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2005-08, Vol.76 (8), p.1070-1074
• Main Authors: Starkstein, S E, Ingram, L, Garau, M L, Mizrahi, R
• Format: Article
• Language: English
• Subjects: abulia; Aged; Alzheimer’s disease; anxiety; apathy; Biological and medical sciences; Cambridge Examination for Mental Disorders of the Elderly; CAMDEX; Comorbidity; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia; Dementia - diagnosis; Dementia - epidemiology; Dementia - psychology; Demography; depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - etiology; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Female; Humans; Interview, Psychological; Male; Medical sciences; Mini-Mental State Examination; MMSE; Mood Disorders - epidemiology; Nervous system (semeiology, syndromes); Neurology; Neuropsychological Tests; Periodicity; Psychometrics; SCID; Severity of Illness Index; Structured Clinical Interview for DSM-IV
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2004.052795

Background: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementia, its overlap with depression remains poorly understood. Aims: To assess the psychometric characteristics of a structured interview for apathy, and to examine the overlap between apathy and depression in dementia. Methods: A total of 150 patients with Alzheimer’s disease (AD) underwent a comprehensive psychiatric and cognitive assessment. Results: Twelve per cent of the sample met criteria for both apathy and depression, 7% met criteria for apathy only, and 31% met criteria for depression only. Apathy (but not depression) was significantly associated with more severe cognitive deficits. Apathy and anxiety scores accounted for 65% of the variance of depression scores in dementia, and the diagnosis of apathy had a minor impact on the rating of severity of depression. Conclusions: The Structured Interview for Apathy demonstrated adequate psychometric characteristics. Using a novel structured interview for apathy in AD we demonstrated that whereas the construct of depression primarily consists of symptom clusters of apathy and anxiety, apathy is a behavioural dimension independent of depression.