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Query: UMLS:C0085632 (apathy)
 4,089 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article presents evidence for the reliability and construct validity of the Apathy Evaluation Scale (AES). Conceptually, apathy is defined as lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. Operationally, the AES treats apathy as a psychological dimension defined by simultaneous deficits in the overt behavioral, cognitive, and emotional concomitants of goal-directed behavior. Three versions of the AES (clinician, informant, and self-rated) were evaluated for 123 subjects, ages 53-85, meeting research criteria for right or left hemisphere stroke, probable Alzheimer's disease, major depression, or well elderly control. Multiple forms of reliability (internal consistency, test-retest, and interrater) were satisfactory. Several types of validity evidence are presented for each version of the scale, including the following: ability of the AES to discriminate between groups according to mean levels of apathy, discriminability of apathy ratings from standard measures of depression and anxiety, convergent validity between the three versions of the scale, and predictive validity measures derived from observing subjects' play with novelty toys and videogames. Guidelines for the administration of the AES are presented, along with suggestions for potential applications of the scale to clinical and research questions.
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PMID:Reliability and validity of the Apathy Evaluation Scale. 175 29

The basal ganglia are recognized as putative mediators of certain cognitive and behavioral symptoms of major depression. Moreover, patients with basal ganglia lesions have repeatedly exhibited significant affective symptomatology, including apathy, depressive mood, and psychosis. Using high resolution, axial T2 intermediate magnetic resonance images, and a systematic sampling stereologic method, we assessed putamen nuclei volumes in 41 patients with major depression (DSM-III) and 44 healthy volunteer controls of similar age. Depressed patients had significantly smaller putamen nuclei compared with controls. Age was negatively correlated with putamen size in both groups. These results are the first demonstration of diminished putamen volumes in depression and further support a role for basal ganglia structures in the etiopathogenesis of depression.
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PMID:A magnetic resonance imaging study of putamen nuclei in major depression. 176 44

An unselected community sample of 128 patients were studied over the 12 months after their first stroke, and compared with a control sample of subjects from the general population. Psychiatric status was assessed using the PSE and BDI. Symptoms of mood disorder were commoner in the stroke patients than the controls, but the differences were not substantial and had largely disappeared by 12 months. Psychiatric problems encountered included agoraphobia, social withdrawal, apathy and self-neglect, irritability and pathological emotionalism. While there was a high cumulative incidence of psychiatric disorder, little of it persisted: only two cases of major depression were present for the whole 12 months. We believe undue emphasis has been placed in the recent literature on major depression as a specific syndrome following stroke.
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PMID:Mood disorders in the year after first stroke. 201 56

Neurobehavioral sequelae of strokes can limit a patient's ability to describe or express emotion, can cause him to give "yes" answers to the clinician who expects them, or can directly cause apathy or crying spells. Also, anosognosia for depressive signs can cause the patient to deny depressive signs that are objectively observable. These diagnostic confounders have not been adequately assessed in previous research on poststroke depression; thus many studies are of doubtful validity, as shown by studies of the dexamethasone suppression test for melancholia in stroke patients. Future studies on depression after stroke must prospectively rule out fluent aphasia, motor aprosody, and amnesia before relying on diagnostic information from the psychiatric interview, and the interview should always be supplemented by direct observation of vegetative signs and other behavior. With this extended information, major depression can and should be diagnosed using accepted symptom and duration criteria.
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PMID:Diagnosing depression after stroke. 759 71

The authors review the records of 6 patients with Huntington's disease (HD) who received electroconvulsive therapy (ECT) for depression. Five patients met criteria for major depression and 1 for bipolar disorder, depressed. None of the patients had responded to pharmacologic intervention, and 5 improved after ECT treatment. The 2 patients who had prominent delusions showed the greatest improvement. Apathy, and to some extent irritability, responded less well. One patient developed delirium, and the movement disorder worsened in another patient. ECT should be a treatment option in the management of depression in Huntington's disease, particularly when depression is resistant to pharmacologic treatment.
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PMID:ECT as a treatment for depression in Huntington's disease. 804 37

Apathy and depression are discriminable but related dimensions of behavior. The purpose of this study was to evaluate the source of the overlap between measures of apathy and depression. We evaluated the intercorrelations between the Apathy Evaluation Scale (AES) and the Hamilton Rating Scale for Depression (HamD) in 107 subjects, aged 53-85, who met research criteria for normal aging, left or right cerebral hemisphere stroke, probable Alzheimer's disease, or major depression. We determined the correlation between the individual items on the HamD and the total scores on the AES and the HamD. The HamD items having the strongest correlations with AES total score were diminished work/interest, psychomotor retardation, anergy, and lack of insight. The correlation between AES and HamD total scores was nonsignificant when major depression subjects and these variables most closely related to apathy were excluded from consideration. These findings indicate that the convergence between HamD and AES is attributable to (i) a subset of HamD items which are consistent with the syndrome of apathy and (ii) the fact that major depression is associated with both apathy and depression. Clinical and research applications of these results are discussed.
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PMID:The sources of convergence between measures of apathy and depression. 832 82

Apathy and depression are discriminable but related dimensions of behavior. The purpose of this study was to evaluate the source of the overlap between measures of apathy and depression. We evaluated the intercorrelations between the Apathy Evaluation Scale (AES) and the Hamilton Rating Scale for Depression (HamD) in 107 subjects, aged 53-85, who met research criteria for normal aging, left or right cerebral hemisphere stroke, probable Alzheimer's disease, or major depression. We determined the correlation between the individual items on the HamD and the total scores on the AES and the HamD. The HamD items having the strongest correlations with AES total score were diminished work/interest, psychomotor retardation, anergy, and lack of insight. The correlation between AES and HamD total scores was nonsignificant when major depression subjects and these variables most closely related to apathy were excluded from consideration. These findings indicate that the convergence between HamD and AES is attributable to (i) a subset of HamD items which are consistent with the syndrome of apathy and (ii) the fact that major depression is associated with both apathy and depression. Clinical and research applications of these results are discussed.
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PMID:The sources of convergence between measures of apathy and depression. 835 67

Owing to the lack of instruments specifically constructed to study emotional and affective disorders of stroke patients, the nature of post-stroke depression (PSD) remains controversial. With this in mind, the authors constructed a new scale, the Post-Stroke Depression Scale (PSDS) which takes into account a series of symptoms and problems commonly observed in depressed stroke patients. The PSDS and the Hamilton Depression Rating Scale (HDS) were administered to a group of 124 patients, who had been classified, on the basis of DSM III-R diagnostic criteria, in the following categories: No depression (n = 32); Minor PSD (n = 47); Major PSD (n = 45). Scores obtained by these stroke patients on the PSDS and on the HDS were compared to those obtained on the same scales by 17 psychiatric patients also classified as major depression on the basis of DSM III-R diagnostic criteria. An analysis of the symptomatological profiles clearly showed that: (1) a continuum exists between the so-called "major" and "minor" forms of PSD; (2) in both groups of depressed stroke patients the depressive symptomatology seems due to the psychological reaction to the devastating consequences of stroke, since the motivated aspects of depression prevailed in depressed stroke patients, whereas the (biologically determined) unmotivated aspects prevailed in patients with a functional form of major depression; and (3) in stroke patients a DSM III-based diagnosis of major PSD could be in part inflated by symptoms (such as apathy and vegetative disorders) that are typical of major depression in a patient free from brain damage, but that could be due to the brain lesion per se in a stroke patient.
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PMID:The Post-Stroke Depression Rating Scale: a test specifically devised to investigate affective disorders of stroke patients. 926 9

It has been recognized for some time that psychiatric symptoms, such as depression, anxiety, and behavioral alterations, may occur in patients who have pituitary disease. From other research focused on endocrine abnormalities seen in patients with psychiatric illness, it is understood that there is a significant interrelationship between the endocrine system and mental health. More recent research focusing on neural circuits in the brain and the impact of alterations in neurotransmission and neurohormonal modulation has shown that the prefrontal cortex can be affected by perturbations in functioning occurring in distant sites. Such is the situation with the hypothalamic-pituitary axis. Through its rich connections with other limbic structures, the hypothalamic-pituitary axis may affect the behavioral control exerted by the prefrontal cortex, causing mood and personality alterations. In the more severe cases, an apathy syndrome may develop which must be carefully differentiated from depression and other cognitive disorders. This report will review: (1) the neuroanatomical components that cause the behavioral changes observed in many patients with pituitary disease; (2) the current concept of apathy syndrome; (3) the differentiation of apathy syndrome from major depression; (4) the underlying neurobiology of apathy, and (5) potential treatments.
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PMID:Neuropsychiatry and pituitary disease: an overview. 966 59

Depressive disorders--both major depression and other less severe but nonetheless clinically significant depressions--are common comorbidities, components, or complications of dementia. Depression with reversible cognitive impairment may be a prodrome for dementia rather than a separate and distinct disorder. Recent research has demonstrated that both the diagnosis of major depression and the assessment of typical depressive symptoms can be conducted reliably, even in patients with mild-to-moderate levels of cognitive impairment. Self-ratings of depressive symptoms with the Geriatric Depression Scale remain valid in patients with Mini-Mental State Examination scores of at least 15. Among interviewer-administered instruments, the Hamilton Rating Scale for Depression and the Cornell Scale are the best established. Potential difficulties with assessment include problems with ascertainment (because families, in general, report greater depression in patients than do clinicians) and the ambiguity of symptoms (because apathy and related symptoms can result from both depression and Alzheimer's disease). Brain changes due to Alzheimer's disease may lead to fundamental differences in drug responses. Nevertheless, randomized clinical trials have demonstrated that depression in dementia responds to specific psychopharmacologic or psychosocial treatments.
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PMID:Diagnosis and treatment of depression in patients with Alzheimer's disease and other dementias. 972 Apr 86


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