Apathy Symptom In Alzheimer’s Disease

Objective: To verify the reliability and validity of apathy evaluation scale-clinicianadministrated version (AES-C) in normal controls and Alzheimer’s disease patients.At the same time, to investigate the factors which affect the prevalence of apatheticsymptom, as well as the relationship between apathy symptom and cognitiveimpairment by evaluating the AES-C in Alzheimer’s disease patients and normalsubjects.Method: This study incorporated34normal elderly subjects and32AD patients whomet the criteria developed by both the National Institute of Neurological andCommunicative Disorders and Stroke and the Alzheimer’s Disease and RelatedDisorders Association (NINCDS-ADEDA) and the American Statistical Manual ofMental Disorder Fourth Edition Diagnostic Classification (DSM-IV), and the patientswere the elderly outpatients, inpatients and the following-up visitors of clinical trialsof one drug of Shanghai Jiao Tong University Shanghai Mental Health Center, and thecontrols were mainly from the family members of the patients. Each was assessedsuccessively by apathy evaluation scale-clinician administrated version (AES-C),mini mental state examination (MMSE), the geriatric depression screening scale(GDS) and neuropsychiatric inventory (NPI). Assessed the internal consistency ofAES-C, namely the Cronbach α coefficient.30%of all the participants wererandomly chosen to receive the retest of AES-C2weeks after their first assessment,and compared the correlation of two AES-C scores. Simultaneously, compared thecorrelation analysis between AES-C and total NPI scores (NPI-T) and apathy itemscores (NPI-A) to test the parallel validity of AES-C. SPSS13.0statistical softwarewere applied for data statistical analysis. On the basis of significant importance ofunivariate analysis, we took AES-C scores as the dependent variable, while thegeneral information(eg. gender, age and education), MMSE score, and GDS score asthe independent variables, and used the multiple stepwise regression analysis tocomprehend the influence of these factors on the occurrence of apathy symptom, as well as the relationship between AES-C and MMSE scores and further analyze therelationship between the degree of apathy symptom and cognitive impairment.Results:(1)The Cronbach coefficient of AES-C was0.965and the retest correlationcoefficient was0.906(p<0.01), which signified that the internal consistency and retestreliability of the scale were good for assessing apathy symptoms of AD patients. Thecorrelation coefficients between AES-C and NPI-T and NPI-A were respectively0.762and0.847(p<0.001), which suggested that AES-C and NPI had a good parallelvalidity.(2) The scores of AES-C, GDS, NPI-T and NPI-A in AD patients weresignificantly higher than those in NC group (p<0.001).While in AD group, MMSEscores were significantly lower than in NC group. The correlation between AES-Cand MMSE scores was-0.754(p<0.001). Meanwhile, the prevalence of apathy in theAD patients was62.5%. The results of multiple stepwise regression analysis showedthat the independents of MMSE scores, age, and GDS scores entered the regressionequation, and that MMSE had a greater influence on the occurrence of apathy. Thecoefficient of determination of the regression equation R2was0.600, which showedthat the fitting degree of the equation is good.Conclusion: Apathy evaluation (AES-C) had a good reliability and validity, and thus,could be used to assess apathy symptom in Alzheimer’s disease. Apathy was commonin AD and the severity of apathy was correlated with the degree of cognitivedysfunction, which meant the more obvious symptom of apathy, the more seriousdamages of cognitive function. The presence of apathy might be related to cognitiveimpairment, age, depressive symptoms and so on, among which the cognitiveimpairment had a greater impact.