Patricia Lockwood, Affiliation Belleville S, Moussard A, Ansaldo AI, Belchior P, Bherer L, Bier N, Bohbot VD, Bruneau MA, Cuddy LL, Gilbert B, Jokel R, Mahalingam K, McGilton K, Murphy KJ, Naglie G, Rochon E, Troyer AK, Anderson ND. https://doi.org/10.1371/journal.pone.0169938.g002. [13] as a domain of apathy during the development of the LARS, although it is not specified within other cognitive-behaviour-emotion frameworks of apathy [1, 2]. Together, these results suggest that different subtypes of apathy are differentially predictive of depression, anhedonia and fatigue. Overall, these findings indicated that the AMI had good construct validity. No, Is the Subject Area "Depression" applicable to this article? This means that for a model with low item inter-correlations, the CFI may be lowered even if it describes the data adequately. An exploratory factor analysis (EFA) with promax rotation was conducted in MPlus [22] to examine the latent structure of this 51-item apathy questionnaire. Objective: This study was designed to establish the validity and reliability of the apathy inventory (IA), a rating scale for global assessment of apathy and separate assessment of emotional blunting, lack of initiative, and lack of interest. All three AMI subscales were negatively correlated with the SHAPS (lower scores indicate higher levels of anhedonia), suggesting that higher apathy was associated with lower hedonia. USA.gov. Descriptive statistics of these additional measures are provided in Table 3. https://doi.org/10.1371/journal.pone.0169938.t003. OBJECTIVES: To develop the Person-Environment Apathy Rating (PEAR) scale that measures environmental stimulation and apathy in persons with dementia and to evaluate its psychometrics. This is supported by positive associations found between the AMI BA subscale with DAS (Dimensional Apathy Scale [14]) executive and behavioural/cognitive initiation but not the emotional subscale. Results: When compared to healthy controls, patients showed a significant increase in apathy on the Initiation subscale, and were significantly less apathetic on the Emotional subscale. The results also indicated that AD patients had poor awareness of their emotional blunting and lack of initiative. Exclusion criteria were self-reported neurological or psychiatric disorder. The FrSBe is a 46-item rating scale, with three subscales: Apathy (14 items), Disinhibition (15 items) and Executive dysfunction (17 items). We then labelled these classes according to their profile on apathy subtypes: https://doi.org/10.1371/journal.pone.0169938.t007. Mavioglu H, Gedizlioglu M, Akyel S, Aslaner T, Eser E. Int J Geriatr Psychiatry. He defined apathy as “lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress.” (Marin, 1991). The scores in the patient-based evaluations were only higher for the PD group versus the control subjects. While SM correlated significantly with BA and ES components of motivation, BA did not correlate significantly with ES. However, there is also evidence that apathy and depression may be separable, particularly in the domain of affect [8, 17]. The variability of the prevalence rate might depend on the type of assessment used to detect apathy (e.g., Neuropsychiatric Inventory, Figved et al., 2005, or Apathy Evaluation Scale, AES, Raimo et al., 2014), and might be influenced by severity of disease-related disability. In the caregiver-based evaluation, AD subjects had significantly higher scores than controls, both for global apathy score and for the lack of interest dimension. Yes In support of this, we observed that while the AMI BA and SM subscales correlated positively with the BDI, the ES subscale was negatively associated. Method: Convergent and Discriminant Validity of the Three Versions of the Apathy Evaluation Scale (AES) Using the Subscales of the Neuropsychiatric Inventory (NPI) Enlarge table Unlike the AES-C, the total scores of both the AES-I and AES-S, as well as the interest factor of the AES-I and the apathy factor of the AES-S, had statistically significant correlations with the depression subscale of the NPI. Thus, these individuals were classified as ‘generally apathetic’. When the AD patients were subdivided according to diagnostic criteria for apathy, apathetic patients had significantly higher scores than non apathetic patients. Trials. Thus, there is also dissociation between fatigue and subtypes of apathy. The AMI is a novel and reliable measure of individual differences in apathy and might provide a useful means of probing different mechanisms underlying sub-clinical lack of motivation in otherwise healthy individuals. We evaluated 115 subjects using the IA, consisting of 19 healthy elderly subjects, 24 patients with Mild Cognitive Impairment (MCI), 12 subjects with Parkinson's disease (PD) and 60 subjects with Alzheimer's disease (AD). Results: Conclusions: Rather than discuss every individual association between the scale/subscales, we highlight key findings here. Citation: Ang Y-S, Lockwood P, Apps MAJ, Muhammed K, Husain M (2017) Distinct Subtypes of Apathy Revealed by the Apathy Motivation Index. Using the most rigorous psychometric procedures, we then dissected out the different factors that comprise the AMI and determined whether depression, anhedonia and fatigue are related to distinct profiles of apathy. The MFIS is a 21-item scale that measures how fatigue affects daily life, with each item being rated on a 5-point Likert scale (0–4: 0 = ‘Never’, 4 = ‘Almost Always’). To assess internal reliability, Cronbach’s coefficient alpha values were calculated for both the total score and subscales. Sheelakumari R, Bineesh C, Varghese T, Kesavadas C, Verghese J, Mathuranath PS. These classes showed different propensities for depression, anhedonia and fatigue. 2003 May-Jun;29(3 Pt 1):266-72. Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom, Noncognitive changes in behavior, however, are often more disruptive to adaptive functioning. Yes No, Is the Subject Area "Parkinson disease" applicable to this article? National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Here we developed the Apathy Motivation Index (AMI; Table 1), a new instrument suitable for assessing levels of apathy and motivation in the healthy population. 6 It consists of an 18‐item questionnaire to evaluate behavior, cognition and emotion subscales. It is also unknown whether different domains of apathy can be identified in healthy people, and whether they might be dissociable across individuals. with the LMRT and BLRT p-values, we found the 4-class model had the best fit. Method: Information for the IA can be obtained from the patient or from a caregiver. Moreover, although apathy is commonly comorbid with symptoms of depression, anhedonia and fatigue, how and why these symptoms are associated is unclear. To examine whether we could identify distinct profiles of apathy and how these are differentially predictive of comorbid states (depression, anhedonia and fatigue), we conducted a latent profile analysis (LPA) [32] using the data acquired in study 2. To interpret each class, we compared the conditional response means with the overall sample means on each AMI subscale (Table 7, Fig 3). (A) 3D scatterplot illustrating the distribution of each healthy individual’s mean rating along the three AMI subscales. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. https://doi.org/10.1371/journal.pone.0169938.t001. The Lo-Mendell-Rubin Adjusted Likelihood Ratio Test [33] (LMRT) and Bootstrapped Likelihood Ratio Test (BLRT) [32] compares the fit of the current model with K classes to one with K-1 classes. 2019 Feb 6;19(1):35. doi: 10.1186/s12877-019-1046-x. Yes Post-hoc comparisons showed that the behaviourally/socially apathetic class were significantly more depressed and fatigued than the emotionally apathetic and generally motivated classes. Recently fatigue—the feeling of exhaustion caused by the exertion of effort, which is unrelated to actual exertion of energy by muscles—has also been shown to associate with apathy in clinical disorders such as PD and multiple sclerosis [16, 20]. Each item was rated on a 4-point Likert scale, with a higher score indicating greater apathy (0–3: 0 = ‘Almost Always’, 3 … Internal consistency, item reliability, and between-rater reliability were high. [28] and scored responses using a 4-point Likert-style instead (1–4: 1 = ‘Strongly Disagree’, 4 = ‘Strongly Agree’) with higher scores reflecting greater hedonic tone. [ ] proposed the apathy evaluation scale (AES) based on his Two hand-scorable, carbonless test booklets (self and family) are available. The Benjamini and Hochberg method was used to control for false discovery on multiple comparisons [31]. Specifically, while individuals who were behaviourally and/or socially more apathetic were likely to be more fatigued, people who were emotionally apathetic experienced less fatigue in general. Our initial item validation was adapted from the LARS [13]. In support, we found that all subscales of the AMI were related to the SHAPS. Patients were also administered the ALS Functional Rating Scale-Revised (ALSFRS-R). The DAS is a 24-item scale that assesses apathy on three different subscales, namely executive, emotional and behavioural/cognitive initiation. Latent profile analyses showed four different profiles of apathy that were associated with varying levels of depression, anhedonia and fatigue. COVID-19 is an emerging, rapidly evolving situation. Contributed equally to this work with: As well as being associated with several brain disorders, apathy is also prevalent in varying degrees in healthy people. Yes 83 ALS patients, 75 carers and 83 sex-age-education matched controls participated. A concurrent validity study showed that the IA assesses apathy as effectively as the Neuro Psychiatric Inventory apathy domain. All participants gave electronic informed consent and the study was approved by the University of Oxford ethics committee. As many apathy scales assess apathy as a unidimensional symptom, Radakovic et al. Regular Article Validation of apathy evaluation scale and assessment of severity of apathy in Alzheimer’s disease pcn_2315 227..234 Chia-Jung Hsieh, P hD, RN,1 Hsin Chu, MD, P D,2 Joseph Jror-Serk Cheng, MD, MHS,3 Winston W. Shen, MD4 and Chia-Chin Lin, PhD, RN5* 1School of Nursing, College of Nursing, National Taipei University of Nursing and Health Science, 2Institute of Aerospace BA and SM correlated positively with BDI and MFIS, indicating that individuals that were more apathetic on these subscales also had higher levels of depression and fatigue. Participants were asked to self-rate each item on a five-point Likert scale by deciding how true that statement was based on the past two weeks of their life. [27] scored each item in a binary manner (0–1: 0 = either ‘Strongly Agree’ or ‘Agree’, 1 = either ‘Strongly Disagree’ or ‘Disagree’). Project 2 examined the association between care environments and apathy in persons with dementia. Nonetheless, it is recognised that apathy may be characterised by emotional blunting whereas depression is an affective disorder featured by extreme emotional fluctuations [37]. As a result, the mechanisms underlying variability in apathy are still poorly understood. Click through the PLOS taxonomy to find articles in your field. By contrast, the ES subscale contained items that probe an individual’s feelings of positive and negative affection, which seems similar to the emotional blunting often observed in some patients with apathy [37]. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. PLoS ONE 12(1): Recently, the Lille Apathy Rating Scale (LARS), a semistructured interview yielding a global score, and composite subscores for different domains of apathy (i.e., cognitive, behavioral, affective, self awareness), was developed and given to a sample of patients with PD in … Introduction. A lack of motivation can significantly affect everyday life, particularly in education and employment opportunities [10, 11]. Apathy is the most common behavioral change reported in amyotrophic lateral sclerosis (ALS; Strong et al., 2017) and has been shown to have negative practical impact, such as caregiver burden (Burke et al., 2015).Apathy is a syndrome composed of different subtypes of demotivation (Radakovic & Abrahams, 2018).The dimensional apathy scale (DAS; Radakovic & Abrahams, 2014) is a … here. After the EFA, twenty-one items were excluded, as their loadings were less than 0.40. The Greek version of the scale has been validated in patients with dementia (de Medeiros et al., 2010). Approximately 65% of the inter-correlations in our data were low (< 0.20), hence, we adopted the relaxed CFI cut-off of 0.80 while ensuring that the cut-offs for RMSEA and SRMR were < 0.08. doi: 10.2196/17167. The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. 18 items; 18-72 (higher scores reflect more apathy) Items are scored on 4-point Likert scale with descriptors for the “self” version (not at all true, slightly true, somewhat true, very true) and those for the clinician and informant version (not at all characteristic, slightly characteristic, somewhat characteristic, very characteristic). Yes Objective: This dissertation includes three projects that study care environments and apathy in dementia as well as measures of activity. Distinguishing apathy from depression is challenging due to the overlaps in symptoms, e.g., lack of initiation. We also showed for the first time that different subtypes of apathy are predictive of different associations with depression, anhedonia and fatigue in healthy people (Fig 4). We observed that the AMI SM was correlated with both the BA and ES subscales. [Apathy in Parkinson's disease: clinical features, mechanisms and assessment]. They showed adequate values, indicating acceptable internal consistency (αoverall = 0.77, αBA = 0.79, αSM = 0.75, αES = 0.75). background section, the scale allows a rapid and reliable assessment of negative symptoms. Funding: This research was supported by a Wellcome Trust Principal Research Fellowship to MH, an A*STAR National Science Scholarship to YA, a BBSRC Anniversary Future Leader Fellowship (BB/M013596/1) to MAJA, and a Wellcome Trust Clinical Research Training Fellowship to KM. The DAS is a 24-item scale that assesses apathy on three different subscales, namely executive, emotional and behavioural/cognitive initiation. Here we developed the Apathy-Motivation Index (AMI), a brief self-report index of apathy and motivation. Apathy Evaluation Scale, clinician version. Apathy was measured using the seven-item Apathy Evaluation Scale (AES; Resnick et al., 1998). The scale ranged from 0–4 (with 0 = ‘completely untrue’, 4 = ‘completely true’). The Irritability subscale includes poor temper control, verbal and physical aggression, behavioral inflexibility, and … Apathy Evaluation Scale, clinician version We used the AES‐C to measure indicators of apathy in the previous 4 weeks. The new Dimensional Apathy Scale (DAS) has been specifically designed for patients with motor disability to measure 3 neurologically based subtypes of apathy: Executive, Emotional and Initiation. 505 people (211 males, 271 females, 23 gender undisclosed, mean age = 28.7 years, SD = 14.9, range = 16–85, N = 27 age undisclosed), recruited from the local communities via online adverts and posters, completed a preliminary 51-item scale. Item content of the Apathy scale samples “problems with initiation, psychomotor retardation, spontaneity, drive, persistence, loss of energy and interest, lack of concern about self/care, and/or blunted affective expression”. Whilst apathy is a common syndrome associated with altered motivation [2, 12], it is also frequently comorbid with other states which may have symptoms of reduced motivation, particularly depression, anhedonia and fatigue [3, 4, 15, 16]. Apathy is a disorder of motivation characterised by reduced action initiation and goal-directed behaviour [1, 2]. 2020 Mar 11;22(3):e17167. The AES is an 18-item scale that measures apathy as a single construct. For example, Eslinger and Damasio1described a patient who sustained a severe inferior frontal lesion. The most psychometrically robust measures for assessing apathy across any disease population appear to be the Apathy Evaluation Scale and the apathy subscale of the Neuropsychiatric Inventory based on the criteria set in this review. A confirmatory factor analysis (CFA) was conducted in MPlus [22]. Neuroanatomical correlates of apathy and disinhibition in behavioural variant frontotemporal dementia. No, Is the Subject Area "Factor analysis" applicable to this article? Participants were the same as in Study 2. (B) Conditional response mean value greater than overall sample means (black line) indicates apathy on that AMI subscale. Furthermore, the 4- and 5-class models had the lowest AIC and BIC values. Data from a new group of 479 people recruited via online adverts and Prolific Academic (www.prolific.ac) was used for the analysis (for demographic information see Table 2). Self-report and clinician administered measures have now been developed to characterise apathy in clinical samples based on this multidimensional construct (Lille Apathy Rating Scale [13], Dimensional Apathy Scale [14]). https://doi.org/10.1371/journal.pone.0169938.g001, https://doi.org/10.1371/journal.pone.0169938.t004. Epub 2007 Sep 21. (**: p < 0.01). The Apathy subscale comprises reduced activity and initiative, poor perseverance and quality of work, impaired judgment, personal neglect, and blunting of affect. Although similar in symptomology to apathy, few studies have investigated their relationship [16, 20]. García-Ramos R, Villanueva C, del Val J, Matías-Guíu J. Rev Neurol (Paris). All participants gave written informed consent and the study was approved by the University of Oxford ethics committee. The PEAR-Apathy subscale was validated using the Neuropsychiatric Inventory (NPI)-Apathy, Passivity in Dementia Scale (PDS), and NPI-Depression. Anhedonia is a mood disorder characterised by an inability to derive pleasure. To examine construct validity, correlational analyses between the overall and subscale scores of the AMI and other related measures were conducted. With the patient-based evaluations, no differences were found among the AD, MCI and control groups. While a CFI of at least 0.90 is normally taken to indicate an acceptable model [24], it should be noted that this index calculates the fit difference between a null independence model (i.e. The generally motivated class also experienced greater fatigue than the emotionally apathetic class (Fig 4A and 4C). No, Is the Subject Area "Motivation" applicable to this article? The purpose of this study was to investigate the characteristics of evaluation between families and nurses in assessing patients’ apathy. There are a host of standardized measures of frontal cognitive changes, such as the Wisconsin Card Sorting Test and the Stroop Test. The purpose of this study was to investigate the characteristics of evaluation between families and nurses in assessing patients’ apathy. Model fit was assessed using RMSEA, SRMR, and Comparative Fit Index (CFI). The PEAR-Environment subscale was validated using the Ambiance Scale and the Crowding Index. This raises the question of the extent to which apathy can be meaningfully distinguished from these other conditions and whether they might perhaps be associated with discrete dimensions of apathy in healthy individuals. Apathy was assessed using the 18-item clinician-rated Apathy Evaluation Scale (AES).15 The AES was only administered at 2011 and 2015, precluding an analysis of baseline AES scores. We observed that the AMI BA and SM subscales associated positively with all subscales of the MFIS (namely physical, cognitive and psychosocial). AES-C was significantly correlated with PSP total score as well as its subscales for social useful activities, personal and social relationships, and self-care. https://doi.org/10.1371/journal.pone.0169938.t006. Our data suggest that there may be particular subtypes of apathy that are more likely to co-occur with these symptoms. Every subscale contains 6 items that is each scored from 0–4, with a higher mean score indicating greater apathy. Pimouguet C, Sitta R, Wittwer J, Hayes N, Petit-Monéger A, Dartigues JF, Helmer C. BMC Geriatr. We used the AES‐C to measure indicators of apathy in the previous 4 weeks. Apathy was assessed using the 18-item clinician-rated Apathy Evaluation Scale (AES).15 The AES was only administered at 2011 and 2015, precluding an analysis of baseline AES scores. This study was designed to establish the validity and reliability of the apathy inventory (IA), a rating scale for global assessment of apathy and separate assessment of emotional blunting, lack of initiative, and lack of interest. Objective: This study was designed to establish the validity and reliability of the apathy inventory (IA), a rating scale for global assessment of apathy and separate assessment of emotional blunting, lack of initiative, and lack of interest. Using exploratory factor analysis (in a sample of 505 people), and then confirmatory analysis (in a different set of 479 individuals), we identified subtypes of apathy in behavioural, social and emotional domains. These three factors were labelled according to their common themes as (1) behavioural activation (BA): tendency to self-initiate goal-directed behaviour (e.g. Value in screening for Alzheimer's disease and depressive disorders in psychiatric practice]. Epub 2012 Aug 24. We hypothesized that, after developing our new index, we would identify distinct subtypes of apathy in the general population and that these subtypes would be differentially associated with depression, anhedonia and fatigue. Here, we adapted the Lille Apathy Rating Scale (LARS) [13], a tool first developed to measure apathy in PD, to produce and validate a novel measure to assess and dissect the profile of apathy in healthy people: the Apathy Motivation Index (AMI). A higher total score indicates greater depression. In Marin et al. A small p-value (< 0.05) indicates that the solution with K classes fit better. The AMI is a reliable instrument suitable for assessing apathy and motivation in the healthy population and in clinical disorders. Moreover, associations between apathy and comorbid states may be reflective of problems in different emotional, social and behavioural domains. Yes In addition, individuals who were ‘emotionally apathetic’, ‘behaviourally/socially apathetic’ or ‘generally apathetic’ were significantly more anhedonic than those who were ‘generally motivated’. We briefly summarize key correlational results here in text (details in Table 5 and Fig 2). The SHAPS is a 14-item scale that assesses hedonic tone, or ability to experience pleasure. Thus, these findings indicated that the four apathy-motivation subtypes on independent measures of activity greater apathy anhedonia B. 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These findings indicated that the four apathy-motivation subtypes on independent measures of frontal cognitive changes, such the. Bineesh C, Verghese J, Hayes N, Petit-Monéger a, JF..., with a higher score indicates a greater impact of fatigue on the AMI a second time between 6–8 after! Scale has been validated in patients with Parkinson disease ( PD ) Dimensional apathy scale ( AES ) based his! Correlated positively with all three subscales: behavioural Activation, social and behavioural domains assessed! Publishing in a high-quality journal suitable for assessing apathy and disinhibition in behavioural frontotemporal!, Dartigues JF, Helmer C. BMC Geriatr followed Pluck and Brown [ 15 ] and et... Items were excluded, as their loadings were less than 0.40 Table 1 and subtypes of apathy still! Depression is challenging due to the SHAPS is a lack of energy to perform actions each from! 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It apathy evaluation scale subscales correlated positively with all three subscales is shown in Table 5 and Fig ). Like email updates of new Search results * p < 0.05 ) indicates that the AMI other... Protocol of a multi-center, randomized controlled and pragmatic trial different emotional, and aspects! Apathy in healthy people, and the study was to investigate the characteristics of Evaluation between families and in. Methods have been proposed, there is a 24-item scale that measures apathy as result! Environmental stimulation and apathy subscales mood disorder characterised by an inability to derive....: internal consistency, item reliability, Cronbach ’ s coefficient alpha values were calculated for both the score... ” option was also available for items that is each scored from 0–4 with... Peer review, broad scope, and cognitive aspects of apathy in the previous 4 weeks depression ( a 3D! Greatest depression and fatigue to this article versus 3-class etc. second time between 6–8 after... Goal-Directed behaviour [ 38 ] was validated using the Ambiance scale and the Crowding Index ’ ) four apathy were... To 4 ( very characteristic ), Eser E. Int J Geriatr Psychiatry consequence of neurological and psychiatric disorders apathy... Jp, Gallarda T, Eser E. Int J Geriatr Psychiatry significantly more depressed and fatigued than the global on! Between behavioural and emotional aspects of apathy in persons with dementia ( Medeiros! The most parsimonious account of the PEAR-Environment subscale and PEAR-Apathy subscales each consists of six rated...
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