(B) Conditional response mean value greater than overall sample means (black line) indicates apathy on that AMI subscale. https://doi.org/10.1371/journal.pone.0169938.t002. HHS (A) 3D scatterplot illustrating the distribution of each healthy individual’s mean rating along the three AMI subscales. We observed that the AMI BA and SM subscales associated positively with all subscales of the MFIS (namely physical, cognitive and psychosocial). The clinician version of Apathy Evaluation Scale (AES-C) (Marin et al., 1991) was used to assess apathy in both patients and healthy participants. 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. The patient performed quite normally on cognitive testing but … The items are rated on a 4‐point Likert scale from 1 (not at all characteristic) to 4 (very characteristic). 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. 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, Editor: Maria Gulinello, Yeshiva University Albert Einstein College of Medicine, UNITED STATES, Received: September 25, 2016; Accepted: December 22, 2016; Published: January 11, 2017. The Benjamini and Hochberg method was used to control for false discovery on multiple comparisons [31]. A concurrent validity study showed that the IA assesses apathy as effectively as the Neuro Psychiatric Inventory apathy domain. Patricia Lockwood, Affiliation We observed that the AMI SM was correlated with both the BA and ES subscales. 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. aimed to determine the psychometric properties of the Dimensional Apathy Scale (DAS) in AD . 1- versus 2-class, then 2- versus 3-class etc.)  |  Trials. 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. A series of rating scales have been proposed to iden-tify and quantify apathy and to di erentiate it from other disorders, especially depression [ ]. 2012 Aug-Sep;168(8-9):598-604. doi: 10.1016/j.neurol.2012.05.002. A simple three-factor structure was the most parsimonious account of the data. Pimouguet C, Sitta R, Wittwer J, Hayes N, Petit-Monéger A, Dartigues JF, Helmer C. BMC Geriatr. 2020 Oct;14(5):2004-2011. doi: 10.1007/s11682-019-00150-3. Although various scoring methods have been proposed, there is a lack of validated, standardised instruments for detecting apathy and assessing its severity. As expected, the AMI correlated with established assessments of apathy, depression, anhedonia and fatigue, providing evidence of good construct validity (Table 5). 2003 May-Jun;29(3 Pt 1):266-72. The 4-class model was the most appropriate (Table 6). Distinguishing apathy from depression is challenging due to the overlaps in symptoms, e.g., lack of initiation. The Apathy Evaluation Scale (AES) was developed as a method for measuring apathy resulting from brain-related pathology. broad scope, and wide readership – a perfect fit for your research every time. For anhedonia, the generally motivated class experienced more pleasure than each of the other classes. In this study we used the CAS3, the scale for assessment of spontaneity about patients’ ADL. Conversely, lower scores indicated higher levels of anhedonia. 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. PLOS ONE promises fair, rigorous peer review, We briefly summarize key correlational results here in text (details in Table 5 and Fig 2). 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. Comparing these two subscales to the conceptualisation of apathy by Levy and Dubois [2] suggests that the BA subscale likely encompasses the ‘cognitive’ and ‘auto-activation’ aspects, while the ES domain appears to correspond more to the ‘emotional-affective’ subtype. 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 the same as in Study 2. The validity and reliability of the Turkish version of Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) in patients with mild and moderate Alzheimer's disease and normal subjects. We followed Pluck and Brown [15] and Franken et al. Includes a total score as well as scores on three subscales that correspond to the three frontal systems behavioral syndromes. Background: Apathy is usually defined as reduced interest and participation in various activities. 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. The BA subscale focused on the individual’s tendency to self-initiate goal-directed behaviour. Project 1 developed the Person-Environment Apathy Rating (PEAR) scale to measure environmental stimulation and apathy, and tested its psychometrics. In clinical disorders such as Parkinson’s disease (PD), it is now established that apathy is frequently linked to depression, with many overlapping symptoms including loss of interest and lack of initiative [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. The generally motivated class also experienced greater fatigue than the emotionally apathetic class (Fig 4A and 4C). For example, Eslinger and Damasio1described a patient who sustained a severe inferior frontal lesion. García-Ramos R, Villanueva C, del Val J, Matías-Guíu J. Rev Neurol (Paris). As a result, the mechanisms underlying variability in apathy are still poorly understood. Yes 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). Our initial item validation was adapted from the LARS [13]. METHOD: The PEAR scale consists of the PEAR-Environment subscale and PEAR-Apathy subscales. This site needs JavaScript to work properly. A higher score indicates a greater impact of fatigue on the individual. 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”. NIH A confirmatory factor analysis (CFA) was conducted in MPlus [22]. Descriptive statistics of these additional measures are provided in Table 3. https://doi.org/10.1371/journal.pone.0169938.t003. 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. Epub 2012 Aug 24. The factor analysis identified three distinct subscales, namely behavioural activation (BA), social motivation (SM) and emotional sensitivity (ES). Convergent and Discriminant Validity of the Three Versions of the Apathy Evaluation Scale (AES) Using the Subscales of the Neuropsychiatric Inventory (NPI) TABLE 4. Moreover, although apathy is commonly comorbid with symptoms of depression, anhedonia and fatigue, how and why these symptoms are associated is unclear. With the patient-based evaluations, no differences were found among the AD, MCI and control groups. https://doi.org/10.1371/journal.pone.0169938.g004. Chakraborty S, Lennon JC, Malkaram SA, Zeng Y, Fisher DW, Dong H. Neurosci Lett. 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). 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). The SM subscale contained items that examine a person’s engagement in social interactions. 83 ALS patients, 75 carers and 83 sex-age-education matched controls participated. Results: Fifteen apathy scales or subscales were examined. Value in screening for Alzheimer's disease and depressive disorders in psychiatric practice]. These results indicated that the four apathy subtypes were distinct and overlapped differently with the closely related outcomes of depression, anhedonia and fatigue. This appears to relate closely to Stuss's [36] executive process of ‘energization’ or the initiating and maintaining of task-relevant responses. https://doi.org/10.1371/journal.pone.0169938.g001, https://doi.org/10.1371/journal.pone.0169938.t004. Apathy Evaluation Scale, clinician version. Also, using abnormality cutoffs, 58% in this group were impaired on at least two apathy subscales, the most common of which was Executive and Initiation apathy, with only 37% displaying global apathy over all DAS subscales and 5% displaying one apathy subscale. Would you like email updates of new search results? National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. By using latent profile analysis (LPA) to group individuals with similar AMI profiles, we identified four subtypes of apathy-motivation in our healthy people (Table 7; Fig 3). Items from the clinical LARS that were deemed to be applicable to healthy people were also adapted. We investigated models with one to five classes and determined the optimal number of classes for our sample with several statistical indicators. 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. However, currently there are no validated assessments of apathy in healthy people. Intriguingly, these different apathy subtypes were predictive of different associations with depression, anhedonia and fatigue. Anhedonia is a mood disorder characterised by an inability to derive pleasure. The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. Conversely, the AMI ES subscale was correlated with the DAS emotional subscale but not behavioural/cognitive initiation subscale. Internal consistency, item reliability, and between-rater reliability were high. The AMI consists of three subscales: Behavioural Activation, Social Motivation and Emotional Sensitivity. 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. There are a host of standardized measures of frontal cognitive changes, such as the Wisconsin Card Sorting Test and the Stroop Test. [ ] proposed the apathy evaluation scale (AES) based on his Future longitudinal studies would benefit from investigating how particular profiles of apathy are risk factors for the development of depression, anhedonia and fatigue. Yes Here we developed the Apathy-Motivation Index (AMI), a brief self-report index of apathy and motivation. Citation: Ang Y-S, Lockwood P, Apps MAJ, Muhammed K, Husain M (2017) Distinct Subtypes of Apathy Revealed by the Apathy Motivation Index. 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. Parkinsonism Relat Disord. 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 Whilst many tools have been developed to assess levels of apathy in clinical disorders, surprisingly there are no measures of apathy suitable for healthy people. Fatigue can be a symptom of reduced motivation characterised by the lack of energy to perform actions. I start conversations without being prompted), and (3) emotional sensitivity (ES): feelings of positive and negative affection (e.g. No, Is the Subject Area "Material fatigue" applicable to this article? Discover a faster, simpler path to publishing in a high-quality journal. The AMI is a reliable instrument suitable for assessing apathy and motivation in the healthy population and in clinical disorders. 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. The DAS is a 24-item scale that assesses apathy on three different subscales, namely executive, emotional and behavioural/cognitive initiation. PLoS ONE 12(1): 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 … All participants gave electronic informed consent and the study was approved by the University of Oxford ethics committee. He defined apathy as “lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress.” (Marin, 1991). Apathy s rating scales are useful tools for this and they are important to evaluate future therapeutic inter-ventions. Cognitive deficits due to damage or disease affecting frontal lobe systems are well known to clinical neuroscientists. The Irritability subscale includes poor temper control, verbal and physical aggression, behavioral inflexibility, and … Please enable it to take advantage of the complete set of features! Information for the IA can be obtained from the patient or from a caregiver. 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. and > 2 S.D. A higher total score indicates greater depression. Yes The four classes were labelled generally motivated (orange), behaviourally/socially apathetic (green), emotionally apathetic (blue), and generally apathetic (red). Table 3 shows higher scores on the Initiation and Executive apathy subscales. CAS consisted of five subscales to measure multiple viewpoints of apathy. Finally, the AMI total score was negatively correlated with the SHAPS (r = - 0.46, p < 0.01), indicating that apathetic people experience greater anhedonia. Method: Information for the IA can be obtained from the patient or from a caregiver. Contributed equally to this work with: The emotionally apathetic people were also more hedonic than the generally apathetic class (Fig 4B). here. It also correlated positively with all three subscales of the DAS. Given this relationship between motivation and reward, we predicted that anhedonia and apathy would be linked. No, Is the Subject Area "Factor analysis" applicable to this article? Apathy Evaluation Scale, clinician version We used the AES‐C to measure indicators of apathy in the previous 4 weeks. 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). Neuroanatomical correlates of apathy and disinhibition in behavioural variant frontotemporal dementia. Objective: 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. When the AD patients were subdivided according to diagnostic criteria for apathy, apathetic patients had significantly higher scores than non apathetic patients. I feel awful if I say something insensitive). Apathy is a unique, multidimensional syndrome commonly encountered in patients with Parkinson disease (PD). The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. Nonetheless, it is recognised that apathy may be characterised by emotional blunting whereas depression is an affective disorder featured by extreme emotional fluctuations [37]. https://doi.org/10.1371/journal.pone.0169938.t001. Exclusion criteria were self-reported neurological or psychiatric disorder. https://doi.org/10.1371/journal.pone.0169938.t005. Copyright: © 2017 Ang et al. Most people (60.8%) were identified as ‘generally motivated’ with their group average on each AMI subscale being lower than the overall mean. 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). It has long been established that positive reinforcement is essential to maintain goal-directed behaviour [38]. BA relates to an individual’s tendency to self-initiate goal-directed behaviour, SM examines a person’s engagement of social interactions and ES probes an individual’s feelings of positive and negative affection. We also found that these two subscales were not significantly correlated, suggesting some dissociation between behavioural and emotional aspects of apathy. 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). Epub 2007 Sep 21. 2020 Mar 11;22(3):e17167. Every subscale contains 6 items that is each scored from 0–4, with a higher mean score indicating greater apathy. 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. Impaired social life was highlighted by Sockeel et al. The DAS consists of 24 items scored on a 4-point Likert scale and measures three apathy subtypes: apathetic impairments associated with planning, attention or organization (executive), indifference or emotional … 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. All post-hoc comparison differences were significant at p < 0.05 (Emotionally apathetic: BDI mean = 8.0, SD = 8.8, SHAPS mean = 47.6, SD = 5.6, MFIS mean = 20.9, SD = 14.0; Behaviourally/socially apathetic: BDI mean = 16.2, SD = 11.8, SHAPS mean = 45.7, SD = 5.8, MFIS mean = 34.9, SD = 17.6; Generally motivated: BDI mean = 9.7, SD = 9.0, SHAPS mean = 50.4, SD = 4.9, MFIS mean = 29.3, SD = 17.3; Generally apathetic: BDI mean = 12.8, SD = 13.0, SHAPS mean = 42.3, SD = 6.6, MFIS mean = 29.3, SD = 26.7). 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In behavioural variant frontotemporal dementia established that positive reinforcement is essential to maintain goal-directed behaviour we predicted that and. Post-Hoc comparisons showed that the AMI was scored from 0–4, with a higher score... Es: 0.46–0.78 ) ( 2.1 % ), and wide readership – a perfect for.