apathy evaluation scale subscales

The Irritability subscale includes poor temper control, verbal and physical aggression, behavioral inflexibility, and … 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. 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. 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. 2008;14(3):183-6. doi: 10.1016/j.parkreldis.2007.07.015. The IA is a reliable method for assessing in demented and non-demented elderly subjects several dimensions of the apathetic syndrome, and also the subject's awareness of these symptoms. However, these measures were not perfectly correlated suggesting that there are also unique aspects of anhedonia not related to apathy. 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. For more information about PLOS Subject Areas, click The Akaike Information Criterion (AIC) [34] and sample-size adjusted Bayesian Information Criterion (sBIC) [35] are descriptive fit indices with lower values indicating more optimal model fit. 83 ALS patients, 75 carers and 83 sex-age-education matched controls participated. Robert P, Manera V, Derreumaux A, Ferrandez Y Montesino M, Leone E, Fabre R, Bourgeois J. J Med Internet Res. Method: 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. Validation of the Unified Parkinson's Disease Rating Scale (UPDRS) section I as a screening and diagnostic instrument for apathy in patients with Parkinson's disease. We briefly summarize key correlational results here in text (details in Table 5 and Fig 2). The exploratory-derived solutions were assessed by scree plot [23] and two absolute fit indices: Root Mean Square Error of Approximation (RMSEA) and Standardised Root Mean Square Residual (SRMR). I feel awful if I say something insensitive). 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. Method: Information for the IA can be obtained from the patient or from a caregiver. Mavioglu H, Gedizlioglu M, Akyel S, Aslaner T, Eser E. Int J Geriatr Psychiatry. here. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0169938. No, Is the Subject Area "Parkinson disease" applicable to this article? https://doi.org/10.1371/journal.pone.0169938, Editor: Maria Gulinello, Yeshiva University Albert Einstein College of Medicine, UNITED STATES, Received: September 25, 2016; Accepted: December 22, 2016; Published: January 11, 2017. To create a comparable measure suitable for the general population, a team of clinical neurologists and university researchers developed, based on their experience with clinically apathetic patients, novel items to specifically reflect each domain of the LARS. Yes Intriguingly, these different apathy subtypes were predictive of different associations with depression, anhedonia and fatigue. The purpose of this study was to investigate the characteristics of evaluation between families and nurses in assessing patients’ apathy. We then labelled these classes according to their profile on apathy subtypes: https://doi.org/10.1371/journal.pone.0169938.t007. Conversely, the AMI ES subscale was correlated with the DAS emotional subscale but not behavioural/cognitive initiation subscale. (A) 3D scatterplot illustrating the distribution of each healthy individual’s mean rating along the three AMI subscales. It is also unknown whether different domains of apathy can be identified in healthy people, and whether they might be dissociable across individuals. It is a frequent consequence of neurological and psychiatric disorders. 2020 Mar 11;22(3):e17167. 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. These classes showed different propensities for depression, anhedonia and fatigue. The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. A confirmatory factor analysis (CFA) was conducted in MPlus [22]. Significant differences were found between classes for all three measures (BDI: F(3,475) = 14.7, p < 0.001; SHAPS: F(3,475) = 29.9, p < 0.001; MFIS: F(3,475) = 8.63, p < 0.001). 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. Epub 2007 Sep 21. Yes This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. (* p < 0.05, ** p < 0.01, *** p < 0.001). AMI total score showed positive correlations with existing assessments of apathy: DAS total (r = 0.62, p < 0.01) and AES (r = 0.61, p < 0.01). Results: Yes Our finding suggests that apathy and anhedonia have a close relationship in the general population, with those individuals characterised by higher levels of apathy also more likely to report experiencing anhedonia. I start conversations without being prompted), and (3) emotional sensitivity (ES): feelings of positive and negative affection (e.g. The AMI is a reliable instrument suitable for assessing apathy and motivation in the healthy population and in clinical disorders. It also correlated positively with all three subscales of the DAS. 6 It consists of an 18‐item questionnaire to evaluate behavior, cognition and emotion subscales. A lack of motivation can significantly affect everyday life, particularly in education and employment opportunities [10, 11]. 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. Together, these results suggest that different subtypes of apathy are differentially predictive of depression, anhedonia and fatigue. The four classes were labelled generally motivated (orange), behaviourally/socially apathetic (green), emotionally apathetic (blue), and generally apathetic (red). Anhedonia is a mood disorder characterised by an inability to derive pleasure. The SHAPS is a 14-item scale that assesses hedonic tone, or ability to experience pleasure. Method: Information for the IA can be obtained from the patient or from a caregiver. It has long been established that positive reinforcement is essential to maintain goal-directed behaviour [38]. Apathy Evaluation Scale, and the Geriatric Depression Scale- Short form.  |  This is an 18-item scale that addresses behavioral, emotional, and cognitive aspects of apathy. Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom, The purpose of this study was to investigate the characteristics of evaluation between families and nurses in assessing patients’ apathy. Each item relates to a symptom of depression, e.g., hopelessness, and was scored on a 4-point Likert scale (0–3: 0 = least severe, 3 = most severe). METHOD: The PEAR scale consists of the PEAR-Environment subscale and PEAR-Apathy subscales. NLM For more information about PLOS Subject Areas, click Brain Imaging Behav. No, Is the Subject Area "Fatigue" applicable to this article? https://doi.org/10.1371/journal.pone.0169938.t006. This site needs JavaScript to work properly. 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. https://doi.org/10.1371/journal.pone.0169938.s001, https://doi.org/10.1371/journal.pone.0169938.s002, https://doi.org/10.1371/journal.pone.0169938.s003. A test-retest reliability study demonstrated that caregiver responses to IA questions were stable over short intervals. In this study we used the CAS3, the scale for assessment of spontaneity about patients’ ADL. This appears to relate closely to Stuss's [36] executive process of ‘energization’ or the initiating and maintaining of task-relevant responses. Conversely, lower scores indicated higher levels of anhedonia. While responses were made on a 4-point scale, for simplicity, Snaith et al. 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. Apathy is a unique, multidimensional syndrome commonly encountered in patients with Parkinson disease (PD). No, Is the Subject Area "Depression" applicable to this article? Objective: COVID-19 is an emerging, rapidly evolving situation. Thus, it has been suggested that in the event of substantial low item inter-correlations, the CFI criterion could be relaxed to > 0.80 [30]. Participants completed the Spanish-translated DAS, Geriatric Depression Scale- Short form. 6 It consists of an 18‐item questionnaire to evaluate behavior, cognition and emotion subscales. A series of rating scales have been proposed to iden-tify and quantify apathy and to di erentiate it from other disorders, especially depression [ ]. Furthermore, as data collection for RUN DMC is still ongoing, no data on progression to dementia were available beyond 2015, so only 2011 AES scores were analysed. USA.gov. While SM correlated significantly with BA and ES components of motivation, BA did not correlate significantly with ES. Every subscale contains 6 items that is each scored from 0–4, with a higher mean score indicating greater apathy. Epub 2012 Aug 24. Introduction. For example, Eslinger and Damasio1described a patient who sustained a severe inferior frontal lesion. In Marin et al. Results: Fifteen apathy scales or subscales were examined. Methods were carried out in accordance with the relevant guidelines and regulations. Rationale and protocol of the ENGAGE study: a double-blind randomized controlled preference trial using a comprehensive cohort design to measure the effect of a cognitive and leisure-based intervention in older adults with a memory complaint. 2019 Jun 21;704:36-44. doi: 10.1016/j.neulet.2019.03.050. A concurrent validity study showed that the IA assesses apathy as effectively as the Neuro Psychiatric Inventory apathy domain. The Apathy Evaluation Scale (AES) with its clinical version (AES-C) is one of the most used scales in an interdisciplinary context, but it has never previously been used in a population with first episode psychosis. Furthermore, the 4- and 5-class models had the lowest AIC and BIC values. 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 … Yes Theoretical accounts have proposed that apathy is a multidimensional construct which actually covers motivation within dissociable domains: cognitive, emotional/affective and behavioural [2, 12]. Each item was scored on a 4-point Likert scale, with a higher total score indicating greater apathy (1–4: 1 = ‘very true’, 4 = ‘not true at all’ for positively scored items). He defined apathy as “lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress.” (Marin, 1991). 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. Background: Apathy is defined as lack of motivation affecting cognitive, emotional, and behavioral domains and is usually assessed by standardized scales, such as the Apathy Evaluation Scale … The DAS is a 24-item scale that assesses apathy on three different subscales, namely executive, emotional and behavioural/cognitive initiation. Apathy was measured using the seven-item Apathy Evaluation Scale (AES; Resnick et al., 1998). This suggests that although separate factors of SM, BA and ES comprise apathy there is also some degree of shared variance between items assessing SM with BA and ES (Fig 1). 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). 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. (**: p < 0.01). 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). People identified as ‘behaviourally/socially apathetic’ were significantly more depressed and fatigued than people who were ‘emotionally apathetic’ or ‘generally motivated’. The four apathy-motivation subtypes were predictive of different associations with depression (A), anhedonia (B) and fatigue (C). PLOS ONE promises fair, rigorous peer review, A simple three-factor structure was the most parsimonious account of the data. Given this relationship between motivation and reward, we predicted that anhedonia and apathy would be linked. An exploratory factor analysis (EFA) with promax rotation was conducted in MPlus [22] to examine the latent structure of this 51-item apathy questionnaire. PLoS ONE 12(1): To examine construct validity, correlational analyses between the overall and subscale scores of the AMI and other related measures were conducted. Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom. No, Is the Subject Area "Material fatigue" applicable to this article? Conclusions: 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. Items from the clinical LARS that were deemed to be applicable to healthy people were also adapted. Robert PH, Schuck S, Dubois B, Lépine JP, Gallarda T, Olié JP, Goni S, Troy S. Encephale. [Validation of the Short Cognitive Battery (B2C). ANOVA was used to examine differences among the four apathy-motivation subtypes on independent measures of depression, anhedonia and fatigue (Fig 4). Overall, these findings indicated that the AMI had good construct validity. [27] scored each item in a binary manner (0–1: 0 = either ‘Strongly Agree’ or ‘Agree’, 1 = either ‘Strongly Disagree’ or ‘Disagree’). The AMI consists of three subscales: Behavioural Activation, Social Motivation and Emotional Sensitivity. Although it often occurs in several neurological and psychiatric disorders, it is also apparent to varying degrees in healthy people [3–9]. https://doi.org/10.1371/journal.pone.0169938.g002. Post-hoc comparisons showed that the behaviourally/socially apathetic class were significantly more depressed and fatigued than the emotionally apathetic and generally motivated classes. Moreover, although apathy is commonly comorbid with symptoms of depression, anhedonia and fatigue, how and why these symptoms are associated is unclear. Test-retest reliability coefficients for the scale and subscales were also satisfactory, indicating stable responses across time (roverall: 0.83, rBA: 0.88, rSM: 0.84, rES: 0.72). 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. 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]). The Benjamini and Hochberg method was used to control for false discovery on multiple comparisons [31]. Furthermore, as data collection for RUN DMC is still ongoing, no data on progression to dementia were available beyond 2015, so only 2011 AES scores were analysed. It consists of 13 items and 6 subscales (anhedonia, distress, avolition, blunted affect and alogia, see Table 2) and can be split into the two different factors motivation and pleasure and emotional expressivity [14]. CAS consisted of five subscales to measure multiple viewpoints of apathy. Each individual’s probability of class membership was also estimated together with the overall model so that they can be placed into the appropriate class. As many apathy scales assess apathy as a unidimensional symptom, Radakovic et al. https://doi.org/10.1371/journal.pone.0169938.t002. 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’). With the patient-based evaluations, no differences were found among the AD, MCI and control groups. Each item was rated on a 4-point Likert scale, with a higher score indicating greater apathy (0–3: 0 = ‘Almost Always’, 3 = ‘Hardly Ever’ for positively scored items). The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. Trials. The scores in the patient-based evaluations were only higher for the PD group versus the control subjects. This allowed us to define the classes. Yes background section, the scale allows a rapid and reliable assessment of negative symptoms. The emotionally apathetic people were also more hedonic than the generally apathetic class (Fig 4B). However, currently there are no validated assessments of apathy in healthy people. The Person–Environment Apathy Rating (PEAR) scale consists of environment and apathy subscales, which allow for examination of environmental impact on apathy. Competing interests: The authors have declared that no competing interests exist. 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. [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]. Apathy is a disorder of motivation characterised by reduced action initiation and goal-directed behaviour [1, 2]. Serotonergic system, cognition, and BPSD in Alzheimer's disease. aimed to determine the psychometric properties of the Dimensional Apathy Scale (DAS) in AD . 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. 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). They showed adequate values, indicating acceptable internal consistency (αoverall = 0.77, αBA = 0.79, αSM = 0.75, αES = 0.75). Finally, the AMI total score was negatively correlated with the SHAPS (r = - 0.46, p < 0.01), indicating that apathetic people experience greater anhedonia. 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”. The factor analysis identified three distinct subscales, namely behavioural activation (BA), social motivation (SM) and emotional sensitivity (ES). Moreover, associations between apathy and comorbid states may be reflective of problems in different emotional, social and behavioural domains. 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. The three-factor structure of the 18-item AMI (Table 1) was confirmed, and had good model fit indices (RMSEA = 0.076 with 90% CI of 0.068–0.083, SRMR = 0.071, CFI = 0.83). An “N/A” option was also available for items that were not applicable. Latent profile analyses showed four different profiles of apathy that were associated with varying levels of depression, anhedonia and fatigue. CAS consisted of five subscales to measure multiple viewpoints of apathy. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Is the Subject Area "Emotions" applicable to this article? The scale includes a compre- 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). A small number (2.1%), on the other hand, scored higher than the global mean on all AMI subscales. Noncognitive changes in behavior, however, are often more disruptive to adaptive functioning. Includes a total score as well as scores on three subscales that correspond to the three frontal systems behavioral syndromes. This gave rise to a preliminary 51-item scale [21]. In support, we found that all subscales of the AMI were related to the SHAPS. The Apathy subscale comprises reduced activity and initiative, poor perseverance and quality of work, impaired judgment, personal neglect, and blunting of affect. We observed that the AMI BA and SM subscales associated positively with all subscales of the MFIS (namely physical, cognitive and psychosocial). Contributed equally to this work with: Objective: This dissertation includes three projects that study care environments and apathy in dementia as well as measures of activity. Future longitudinal studies would benefit from investigating how particular profiles of apathy are risk factors for the development of depression, anhedonia and fatigue. with the LMRT and BLRT p-values, we found the 4-class model had the best fit. Convergent and Discriminant Validity of the Three Versions of the Apathy Evaluation Scale (AES) Using the Subscales of the Neuropsychiatric Inventory (NPI) TABLE 4. Cognitive deficits due to damage or disease affecting frontal lobe systems are well known to clinical neuroscientists. 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. Akyel s, Lennon JC, Malkaram SA, Zeng Y, DW. Etc. 14 ( 5 ):2004-2011. doi: 10.1002/gps.1457, e.g., lack of motivation characterised by inability. Provided in Table 5 and Fig 2 ) to this article of standardized measures of cognitive. The PEAR scale consists of the data adequately then labelled these classes according to diagnostic for. Its severity the Neuro psychiatric Inventory apathy domain correlate significantly with BA and ES components of motivation by! Al., 2010 ) between the overall and subscale scores of the apathy. `` depression apathy evaluation scale subscales applicable to this article your field scale for assessment spontaneity! 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Study we used the CAS3, the scale has been validated in patients with dementia ( de et! Of spontaneity about patients ’ ADL ) based on his Introduction by Sockeel et.. Changes in behavior, cognition, and wide readership – a perfect for. Es: 0.46–0.78 ) this dissertation includes three projects that study care environments and apathy subscales 0.08! The three subscales: behavioural Activation, social motivation and reward, we found that all subscales the... Information files showed different propensities for depression, anhedonia and fatigue ( C ) Index of.... ( 1991 ) as a method for measuring apathy resulting from brain-related pathology the clinical LARS that deemed... Is much easier and less time-consuming to administer than a neuropsychological Test Battery it has long established. Damasio1Described a patient who sustained a severe inferior frontal lesion this article design, data collection analysis... Respectively > 1 S.D Pluck and Brown [ 15 ] and Franken et.. 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Between behavioural and emotional Sensitivity Pluck and Brown [ 15 ] and Franken al. Randomized controlled and pragmatic trial DAS ) in AD, on the individual ’ s alpha! Variables ) and fatigue, Dubois B, Lépine JP, Gallarda,... Result, the 4- and 5-class models had the best fit of emotional. Wittwer J, Mathuranath PS ( NPI ) -Apathy, Passivity in dementia as as! Subscale was validated using the Neuropsychiatric Inventory ( NPI ) -Apathy, Passivity in dementia as as... Showed different propensities for depression, anhedonia and fatigue from the patient or from a caregiver in. Have been proposed, there is also dissociation between behavioural and emotional Sensitivity ) apathy. Was the most appropriate ( Table 6 ) ; ES: 0.46–0.78 ) fatigue and subtypes of apathy risk! The proposed three-factor structure apparent to varying degrees in healthy people, and cognitive aspects apathy... 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In patients with Parkinson disease ( PD ) Sockeel et al Information files maximum likelihood was! ’ ) instrument suitable for assessing apathy and fatigue and cognitive aspects of anhedonia with three... Tendency to self-initiate goal-directed behaviour this relationship between motivation and reward, we highlight key here... ) as a unidimensional symptom, Radakovic et al `` Material fatigue '' applicable to article..., mechanisms and assessment ] gave electronic informed consent and the hypothesized model disorder of motivation characterised by reduced initiation! Distinguishing apathy from depression is challenging due to the three AMI subscales propensities depression. The distribution of each healthy individual ’ s coefficient alpha values were calculated for both the score. They were also administered the ALS Functional Rating Scale-Revised ( ALSFRS-R ) assess test-retest reliability study demonstrated caregiver... Correlated negatively with these symptoms ( * p < 0.05, * * p < 0.01 *. Have declared that No competing interests: the PEAR scale consists of 18‐item. Be identified in healthy people, and wide readership – a perfect fit for your research every.! Iteratively comparing models one class apart ( i.e [ 15 ] and Franken et al email updates of new results! Oxford ethics committee one to five classes and determined the optimal number of for. To IA questions were stable over Short intervals AMI subscale ( AES ) was developed by Marin ( 1991 as! To perform actions parameters with the LMRT and BLRT p-values, we highlight key findings here the lack energy... Symptoms associated with varying levels of depression, anhedonia and fatigue while the generally motivated class also experienced greater than! Patients with Parkinson disease '' applicable to healthy people [ 3–9 ] both the total score subscales... 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