Theoretical Analysis of the Apathy Diagnostical Measurement

The article lays out a theoretical analysis of the problem with diagnosing apathy in today's research. Apathy is a state characterized by a simultaneous decrease in the behavioral, cognitive and emotional concomitants of goal-directed behavior due to loss of motivation [15]. Behavioral changes lie in a declining everyday problem-solving effectiveness at home or work. Cognitive changes result in reduced cognitive functioning and a lack of plans and life strategies. Emotional changes manifest in a decrease in affective response to events that previously elicited either a positive or negative emotional response. Diagnostic criteria, or the 'gold standard' for apathy, identify behavioral, cognitive, emotional, and social symptoms of apathy that cause clinically significant disorders in personal, social, professional, or other important areas of life. The differential diagnosis of apathy involves its clinical distinction from syndromes such as delirium, dementia, depression, abulia, akinesia, and demoralization. The review can be useful for psychiatrists, psychologists, social workers and all practitioners who interact with people at risk of developing apathetic states.

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5). Washington. DC: APA, 2013. 947 p.
2. Ang Y.S., Lockwood P.L., Kienast A. et al. Differential impact of behavioral, social, and emotional apathy on Parkinson’s disease. Annals of Clinical and Translational Neurology, 2018, vol. 5, no. 10, pp. 1286–1291. DOI: 10.1002/acn3.626
3. Arnts H., van Erp W., Lavrijsen J.C.M. et al. On the pathophysiology and treatment of akinetic mutism. Neuroscience and Biobehavioral Reviews, 2020, vol. 112, pp. 270–278. DOI: 10.1016/j.neurobiorev.2020.02.006
4. Bock M.A., Bahorik A., Brenowitz W.D. et al. Apathy and risk of probable incident dementia among community-dwelling older adults. Neurology, 2020, vol. 95, p. 24. DOI: 10.1212/WNL.0000000000010951
5. Breitve, M.H., Brønnick, K., Chwiszczuk, L.J. et al. Apathy is associated with faster global cognitive decline and early nursing home admission in dementia with Lewy bodies. Alzheimer’s Research and Therapy, 2018, vol. 10, p. 83. DOI: 10.1186/s13195-018-0416-5
6. Buettner L.L., Fitzsimmons S., Atav S. et al. Cognitive stimulation for apathy in probable early-stage Alzheimer’s. Journal of Aging Research, 2011, article ID 480890. DOI: 10.4061/2011/480890
7. Dorst M.E.G., Rensen Y.C.M., Husain M. et al. Behavioral, emotional and social apathy in alcohol-related cognitive disorders. Journal of Clinical Medicine, 2021, vol. 10, p. 2447. DOI: 10.3390/jcm10112447
8. Friedman J.H., Goetz C.G. Apathy in Parkinson disease. Neurology, 2020, vol. 95, p. 20. DOI: 10.1212/WNL.0000000000010961
9. Kawagoe T., Onoda K., Yamaguchi S. Apathy and executive function in healthy elderly –             resting state fMRI study. Frontiers in Aging Neuroscience, 2017, vol. 9, e:124. DOI: 10.3389/fnagi.2017.00124
10. Klimiec E., Kowalska K., Pasinska P. et al. Pre-stroke apathy symptoms are associated with an increased risk of delirium in stroke patients. Scientific Reports, 2017, vol. 7, no. 1, e:7658. DOI: 10.1038/s41598-017-08087-7
11. Kroenke K., Spitzer R.L., Williams J.B.W. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 2002, vol. 64, no. 2, pp. 258–266. DOI: 10.1097/00006842-200203000-00008
12. Kurukumbi M., Dang T., Crossley N. et al. Unique presentation of akinetic mutism and coexisting thyroid storm relating to stroke. Case Reports in Neurological Medicine, 2014, article ID 320565. DOI: 10.1155/2014/320565
13. Li J., Liu X., Xu L. et al. Current status of demoralization and its relationship with medical coping style, self-efficacy and perceived social support in Chinese breast cancer patients. European Journal of Psychiatry, 2020, vol. 34, no. 4, pp. 211–218. DOI: 10.1016/ j.ejpsy.2020.06.007
14. Marin R.S. Differential diagnosis and classification of apathy. American Journal of Psychiatry, 1990, vol. 147, no. 1, pp. 22–30. DOI: 10.1176/ajp.147.1.22
15. Marin R.S., Biedrzycki R.C., Firinciogullari S. Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 1991, vol. 38, no. 2, pp. 143–162. DOI: 10.1016/ 0165-1781(91)900040-v
16. Massimo L., Kales H.S., Kolanowski A. State of the science: apathy as a model for investigating behavioral and psychological symptoms in dementia. Journal of the American Geriatrics Society, 2018, vol. 66, no. 1, pp. 4–12. DOI: 10.1111/jgs.15343
17. Nobis L., Husain M. Apathy in Alzheimer’s disease. Current Opinion in Behavioral Sciences, 2018, vol. 22, pp. 7–13. DOI: 10.1016/j.cobeha.2017.12.007
18. Neugarten B.L., Havighaurst R.J., Tobin S.S. Personality and patterns of aging. In B.L. Neugarten (Ed.), Middle Age and Aging. Chicago: University of Chicago Press, 1968, pp. 173–180
19. Oliveira-Souza R.D., Figueiredo W.M. Multimodal iatrogenic apathy. Arquivos de Neuro-Psiquiatria, 1996, vol. 54, no. 2, pp. 216–221. DOI: 10.1590/s0004- 282x1996000200007
20. Pagonabarraga J., Kulisevsky J., Strafella A.P. et al. Apathy in Parkinson’s disease: clinical features, neural substrates, diagnosis, and treatment. Lancet Neurology, 2015, vol. 14, no. 5, pp. 518–531. DOI: 10.1016/S1474-4422(15)00019-8
21. Palmisano S., Fasotti L., Bertens D. Neurobehavioral initiation and motivation problems after acquired brain injury. Frontiers in Neurology, 2020, vol. 11, p. 23. DOI: 10.3389/fneur.2020.00023
22. Raskin A., Sathananthan G. Depression in the elderly. Psychopharmacology Bulletin, 1979, vol. 15, no. 2, pp. 14–16.
23. Robert P., Lanctôt K.L., Agüera-Ortiz L. et al. Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group. European Psychiatry, 2018, vol. 17, no. 54, pp. 71–76. DOI: 1016/j.eurpsy.2018.07.008
24. Schieveld J.N.M., Strik J.M.H. Hypoactive delirium is more appropriately named as “acute apathy syndrome”. Critical Care Medicine, 2018, vol. 46, no. 10, pp. 1561–1562. DOI: 10.1097/CCM.0000000000003334
25. Spiegel D.R., Warren A., Takakura W. et al. Disorders of diminished motivation: what they are, and how to treat them. Current Psychiatry, 2018, vol. 17, no. 1, pp. 10–18.
26. Tay J., Morris R.G., Tuladhar A.M. et al. Apathy, but not depression, predicts all- cause dementia in cerebral small vessel disease. Journal of Neurology, Neurosurgery and Psychiatry, 2020, vol. 91, pp. 953–959. DOI: 10.1136/jnnp-2020-323092
27. van der Linde R.M., Dening T., Stephan B.C. et al. Longitudinal course of behavioural and psychological symptoms of dementia: systematic review. British Journal of Psychiatry, 2016, vol. 209, no. 5, pp. 366–377. DOI: 10.1192/bjp.bp.114.148403
28. van Reekum R., Stuss D.T., Ostrander L. Apathy: Why care? Journal of Neuropsychiatry and Clinical Neurosciences, 2005, vol. 17, no. 1, pp. 7–19. DOI: 10.1176/ jnp.17.1.7
29. Vilalta-Franch J., Calvó-Perxas L., Garre-Olmo J. et al. Apathy syndrome in Alzheimer's disease epidemiology: prevalence, incidence, persistence, and risk and mortality factors. Journal of Alzheimer’s Disease, 2013, vol. 33, no. 2, pp. 535–543. DOI: 10.3233/JAD-2012-120913