Encyclopedia of Clinical Neuropsychology

2018 Edition
| Editors: Jeffrey S. Kreutzer, John DeLuca, Bruce Caplan

Apathy

  • Laura L. FrakeyEmail author
Reference work entry
DOI: https://doi.org/10.1007/978-3-319-57111-9_1879

Synonyms

Abulia; Amotivational; Anhedonia; Negative symptom

Short Description or Definition

In the vernacular, the word apathy generally refers to indifference or a lack of feeling or concern. In clinical settings, “apathy” is often conceptualized as a lack of drive or motivation, a lack of responsiveness (behavioral or emotional) to stimuli or a lack of initiation, or a reduction in self-generated, purposeful behavior.

Epidemiology

Apathy has been described in a variety of psychiatric, neurological, and medical conditions including depression, schizophrenia, Alzheimer’s disease, frontotemporal dementia, mild cognitive impairment (MCI), Parkinson’s disease, progressive supranuclear palsy, Huntington’s disease, cortical basal degeneration, dementia with Lewy bodies, stroke, vascular dementia, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), traumatic brain injury (TBI), anoxic encephalopathy, Wernicke-Korsakoff syndrome,...

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Further Reading

  1. Aarsland, D., Bronnick, K., Ehrt, U., De Deyn, P. P., Tekin, S., Emre, M., & Cummings, J. L. (2007). Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: Frequency, profile and associated care giver stress. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 36–42.PubMedCrossRefGoogle Scholar
  2. Albert, S. M., Del Castillo-Castaneda, C., Sano, M., Jacobs, D. M., Marder, K., Bell, K., et al. (1996). Quality of life in patients with Alzheimer’s disease as reported by patient proxies. Journal of the American Geriatrics Society, 44(11), 1342–1347.PubMedCrossRefGoogle Scholar
  3. Andersson, S., & Bergedalen, A. M. (2002). Cognitive correlates of apathy in traumatic brain injury. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 15(3), 184–191.PubMedGoogle Scholar
  4. Apostolova, L. G., & Cummings, J. L. (2008). Neuropsychiatric manifestations in mild cognitive impairment: A systematic review of the literature. Dementia and Geriatric Cognitive Disorders, 25(2), 115–126.PubMedCrossRefGoogle Scholar
  5. Benoit, M., Dygai, I., Migneco, O., Robert, P. H., Bertogliati, C., Darcourt, J., et al. (1999). Behavioral and psychological symptoms in Alzheimer’s disease. Relation between apathy and regional cerebral perfusion. Dementia and Geriatric Cognitive Disorders, 10(6), 511–517.PubMedCrossRefGoogle Scholar
  6. Boyle, P. A., Malloy, P. F., Salloway, S., Cahn-Weiner, D. A., Cohen, R., & Cummings, J. L. (2003). Executive dysfunction and apathy predict functional impairment in Alzheimer disease. The American Journal of Geriatric Psychiatry, 11(2), 214–221.PubMedCrossRefGoogle Scholar
  7. Castellon, S. A., Hinkin, C. H., & Myers, H. F. (2000). Neuropsychiatric disturbance is associated with executive dysfunction in hiv-1 infection. Journal of the International Neuropsychological Society, 6(3), 336–347.PubMedCrossRefGoogle Scholar
  8. Chatterjee, A., & Fahn, S. (2002). Methylphenidate treats apathy in Parkinson’s disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 14(4), 461–462.PubMedCrossRefGoogle Scholar
  9. Clarke, D. E., Reekum, R., Simard, M., Streiner, D. L., Freedman, M., & Conn, D. (2007a). Apathy in dementia: An examination of the psychometric properties of the apathy evaluation scale. The Journal of Neuropsychiatry and Clinical Neurosciences, 19(1), 57–64.PubMedCrossRefGoogle Scholar
  10. Clarke, D. E., Van Reekum, R., Patel, J., Simard, M., Gomez, E., & Streiner, D. L. (2007b). An appraisal of the psychometric properties of the clinician version of the apathy evaluation scale (aes-c). International Journal of Methods in Psychiatric Research, 16(2), 97–110.PubMedCrossRefGoogle Scholar
  11. Craig, A. H., Cummings, J. L., Fairbanks, L., Itti, L., Miller, B. L., Li, J., et al. (1996). Cerebral blood flow correlates of apathy in Alzheimer disease. Archives of Neurology, 53(11), 1116–1120.PubMedCrossRefGoogle Scholar
  12. Cummings, J. L. (1997). The neuropsychiatric inventory: Assessing psychopathology in dementia patients. Neurology, 48(5 Suppl 6), S10–S16.PubMedCrossRefGoogle Scholar
  13. Cummings, J. L. (2000). The role of cholinergic agents in the management of behavioural disturbances in Alzheimer’s disease. The International Journal of Neuropsychopharmacology, 3(7), 21–29.PubMedCrossRefGoogle Scholar
  14. Cummings, J., Friedman, J. H., Garibaldi, G., Jones, M., Macfadden, W., Marsh, L., & Robert, P. H. (2015). Apathy in neurodegenerative diseases: Recommendations on the design of clinical trials. Journal of Geriatric Psychiatry and Neurology, 28(3), 159–173.PubMedCrossRefGoogle Scholar
  15. Damsio, A. R., & Van Hosen, G. W. (1983). Emotional disturbances associated with focal lesions of the frontal lobe. In K. M. Heilman & P. Satz (Eds.), Neuropsychology of human emotion. New York: Guilford Press.Google Scholar
  16. David, R., Koulibaly, M., Benoit, M., Garcia, R., Caci, H., Darcourt, J., et al. (2008). Striatal dopamine transporter levels correlate with apathy in neurodegenerative diseases a spect study with partial volume effect correction. Clinical Neurology and Neurosurgery, 110(1), 19–24.PubMedCrossRefGoogle Scholar
  17. Dimidjian, S., & Davis, K. J. (2009). Newer variations of cognitive-behavioral therapy: Behavioral activation and mindfulness-based cognitive therapy. Current Psychiatry Reports, 11(6), 453–458.PubMedCrossRefGoogle Scholar
  18. Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658–670.PubMedCrossRefGoogle Scholar
  19. Finset, A., & Andersson, S. (2000). Coping strategies in patients with acquired brain injury: Relationships between coping, apathy, depression and lesion location. Brain Injury, 14(10), 887–905.PubMedCrossRefGoogle Scholar
  20. Frakey, L. L., Salloway, S., Buelow, M., & Malloy, P. F. (2012). A randomized, double-blind, placebo-controlled trial of modafinil for the treatment of apathy in individuals with mild-to-moderate stage Alzheimer’s disease. The Journal of Clinical Psychiatry, 73(6), 796–801.PubMedCrossRefGoogle Scholar
  21. Franceschi, M., Anchisi, D., Pelati, O., Zuffi, M., Matarrese, M., Moresco, R. M., et al. (2005). Glucose metabolism and serotonin receptors in the frontotemporal lobe degeneration. Annals of Neurology, 57(2), 216–225.PubMedCrossRefGoogle Scholar
  22. Gauthier, S., Feldman, H., Hecker, J., Vellas, B., Ames, D., Subbiah, P., et al. (2002). Efficacy of donepezil on behavioral symptoms in patients with moderate to severe Alzheimer’s disease. International Psychogeriatrics, 14(4), 389–404.PubMedCrossRefGoogle Scholar
  23. Grace, J., & Malloy, P. F. (2001). Frontal systems behavior scale. Professional manual. Lutz: Psychological Assessment Resources.Google Scholar
  24. Grace, J., Stout, J. C., & Malloy, P. F. (1999). Assessing frontal lobe behavioral syndromes with the frontal lobe personality scale. Assessment, 6(3), 269–284.CrossRefGoogle Scholar
  25. Hama, S., Yamashita, H., Shigenobu, M., Watanabe, A., Hiramoto, K., Kurisu, K., et al. (2007). Depression or apathy and functional recovery after stroke. International Journal of Geriatric Psychiatry, 22(10), 1046–1051.PubMedCrossRefGoogle Scholar
  26. Hoehn-Saric, R., Lipsey, J. R., & McLeod, D. R. (1990). Apathy and indifference in patients on fluvoxamine and fluoxetine. Journal of Clinical Psychopharmacology, 10(5), 343–345.PubMedCrossRefGoogle Scholar
  27. Ishii, S., Weintraub, N., & Mervis, J. R. (2009). Apathy: A common psychiatric syndrome in the elderly. Journal of the American Medical Directors Association, 10(6), 381–393.PubMedCrossRefGoogle Scholar
  28. Jansen, I. H., Olde Rikkert, M. G., Hulsbos, H. A., & Hoefnagels, W. H. (2001). Toward individualized evidence-based medicine: Five “n of 1” trials of methylphenidate in geriatric patients. Journal of the American Geriatrics Society, 49(4), 474–476.PubMedCrossRefGoogle Scholar
  29. Kaufer, D. I., Cummings, J. L., Christine, D., Bray, T., Castellon, S., Masterman, D., et al. (1998). Assessing the impact of neuropsychiatric symptoms in Alzheimer’s disease: The neuropsychiatric inventory caregiver distress scale. Journal of the American Geriatrics Society, 46(2), 210–215.PubMedCrossRefGoogle Scholar
  30. Kaufer, D. I., Cummings, J. L., Ketchel, P., Smith, V., MacMillan, A., Shelley, T., et al. (2000). Validation of the npi-q, a brief clinical form of the neuropsychiatric inventory. The Journal of Neuropsychiatry and Clinical Neurosciences, 12(2), 233–239.PubMedCrossRefGoogle Scholar
  31. Keenan, S., Mavaddat, N., Iddon, J., Pickard, J. D., & Sahakian, B. J. (2005). Effects of methylphenidate on cognition and apathy in normal pressure hydrocephalus: A case study and review. British Journal of Neurosurgery, 19(1), 46–50.PubMedCrossRefGoogle Scholar
  32. Kipps, C. M., Mioshi, E., & Hodges, J. R. (2009). Emotion, social functioning and activities of daily living in frontotemporal dementia. Neurocase, 1–8.Google Scholar
  33. Kuzis, G., Sabe, L., Tiberti, C., Dorrego, F., & Starkstein, S. E. (1999). Neuropsychological correlates of apathy and depression in patients with dementia. Neurology, 52(7), 1403–1407.PubMedCrossRefGoogle Scholar
  34. Lam, L. C., Lui, V. W., Luk, D. N., Chau, R., So, C., Poon, V., et al. (2009). Effectiveness of an individualized functional training program on affective disturbances and functional skills in mild and moderate dementia-a randomized control trial. International Journal of Geriatric Psychiatry, 25(2), 133–141.PubMedCrossRefGoogle Scholar
  35. Landes, A. M., Sperry, S. D., Strauss, M. E., & Geldmacher, D. S. (2001). Apathy in Alzheimer’s disease. Journal of the American Geriatrics Society, 49(12), 1700–1707.PubMedCrossRefGoogle Scholar
  36. Lane-Brown, A. T., & Tate, R. L. (2009). Measuring apathy after traumatic brain injury: Psychometric properties of the apathy evaluation scale and the frontal systems behavior scale. Brain Injury, 23(13–14), 999–1007.PubMedCrossRefGoogle Scholar
  37. Levy, M. L., Cummings, J. L., Fairbanks, L. A., Masterman, D., Miller, B. L., Craig, A. H., et al. (1998). Apathy is not depression. The Journal of Neuropsychiatry and Clinical Neurosciences, 10(3), 314–319.PubMedCrossRefGoogle Scholar
  38. Litvan, I., Cummings, J. L., & Mega, M. (1998). Neuropsychiatric features of corticobasal degeneration. Journal of Neurology, Neurosurgery, and Psychiatry, 65(5), 717–721.PubMedPubMedCentralCrossRefGoogle Scholar
  39. Marin, R. S. (1990). Apathy: A neuropsychiatric syndrome. The Journal of Neuropsychiatry and Clinical Neurosciences, 3(3), 243–254.Google Scholar
  40. Marin, R. S., Biedrzycki, R. C., & Firinciogullari, S. (1991). Reliability and validity of the apathy evaluation scale. Psychiatry Research, 38(2), 143–162.PubMedCrossRefGoogle Scholar
  41. Mayo, N. E., Fellows, L. K., Scott, S. C., Cameron, J., & Wood-Dauphinee, S. (2009). A longitudinal view of apathy and its impact after stroke. Stroke, 40(10), 3299–3307.PubMedCrossRefGoogle Scholar
  42. McPherson, S., Fairbanks, L., Tiken, S., Cummings, J. L., & Back-Madruga, C. (2002). Apathy and executive function in Alzheimer’s disease. Journal of the International Neuropsychological Society, 8(3), 373–381.PubMedCrossRefGoogle Scholar
  43. Mega, M. S., & Cummings, J. L. (1994). Frontal-subcortical circuits and neuropsychiatric disorders. The Journal of Neuropsychiatry and Clinical Neurosciences, 6(4), 358–370.PubMedCrossRefGoogle Scholar
  44. Mega, M. S., Masterman, D. M., O’Connor, S. M., Barclay, T. R., & Cummings, J. L. (1999). The spectrum of behavioral responses to cholinesterase inhibitor therapy in Alzheimer disease. Archives of Neurology, 56(11), 1388–1393.PubMedCrossRefGoogle Scholar
  45. Migneco, O., Benoit, M., Koulibaly, P. M., Dygai, I., Bertogliati, C., Desvignes, P., et al. (2001). Perfusion brain spect and statistical parametric mapping analysis indicate that apathy is a cingulate syndrome: A study in Alzheimer’s disease and nondemented patients. NeuroImage, 13(5), 896–902.PubMedCrossRefGoogle Scholar
  46. Newburn, G., & Newburn, D. (2005). Selegiline in the management of apathy following traumatic brain injury. Brain Injury, 19(2), 149–154.PubMedCrossRefGoogle Scholar
  47. Okada, K., Kobayashi, S., Yamagata, S., Takahashi, K., & Yamaguchi, S. (1997). Poststroke apathy and regional cerebral blood flow. Stroke, 28(12), 2437–2441.PubMedCrossRefGoogle Scholar
  48. Onyike, C. U., Sheppard, J. M., Tschanz, J. T., Norton, M. C., Green, R. C., Steinberg, M., et al. (2007). Epidemiology of apathy in older adults: The cache county study. The American Journal of Geriatric Psychiatry, 15(5), 365–375.PubMedCrossRefGoogle Scholar
  49. Padala, P. R., Burke, W. J., & Bhatia, S. C. (2007a). Modafinil therapy for apathy in an elderly patient. The Annals of Pharmacotherapy, 41(2), 346–349.PubMedCrossRefGoogle Scholar
  50. Padala, P. R., Burke, W. J., Bhatia, S. C., & Petty, F. (2007b). Treatment of apathy with methylphenidate. The Journal of Neuropsychiatry and Clinical Neurosciences, 19(1), 81–83.PubMedCrossRefGoogle Scholar
  51. Pedersen, K. F., Larsen, J. P., Alves, G., & Aarsland, D. (2009). Prevalence and clinical correlates of apathy in Parkinson’s disease: A community-based study. Parkinsonism & Related Disorders, 15(4), 295–299.CrossRefGoogle Scholar
  52. Politis, A. M., Vozzella, S., Mayer, L. S., Onyike, C. U., Baker, A. S., & Lyketsos, C. G. (2004). A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. International Journal of Geriatric Psychiatry, 19(11), 1087–1094.PubMedCrossRefGoogle Scholar
  53. Powell, J. H., al-Adawi, S., Morgan, J., & Greenwood, R. J. (1996). Motivational deficits after brain injury: Effects of bromocriptine in 11 patients. Journal of Neurology, Neurosurgery, and Psychiatry, 60(4), 416–421.PubMedPubMedCentralCrossRefGoogle Scholar
  54. Rabkin, J. G., Ferrando, S. J., van Gorp, W., Rieppi, R., McElhiney, M., & Sewell, M. (2000). Relationships among apathy, depression, and cognitive impairment in hiv/aids. The Journal of Neuropsychiatry and Clinical Neurosciences, 12(4), 451–457.PubMedCrossRefGoogle Scholar
  55. Radakovic, R., Harley, C., Abrahams, S., & Starr (2015). A systematic review of the validity and reliability of apathy scales in neurodegenerative conditions. International Psychogeriatrics, 27(6), 903–923.PubMedCrossRefGoogle Scholar
  56. Rea, R., Carotenuto, A., Traini, E., Fasananro, M., & Amenta, F. (2015). Apathy treatment in Alzheimer’s disease: Interim results of the ascomalva trial. Journal of Alzheimer’s Disease, 48, 377–383.PubMedCrossRefGoogle Scholar
  57. Ready, R. E., Ott, B. R., Grace, J., & Cahn-Weiner, D. A. (2003). Apathy and executive dysfunction in mild cognitive impairment and Alzheimer disease. The American Journal of Geriatric Psychiatry, 11(2), 222–228.PubMedCrossRefGoogle Scholar
  58. van Reekum, R., Stuss, D. T., & Ostrander, L. (2005). Apathy: Why care? The Journal of Neuropsychiatry and Clinical Neurosciences, 17(1), 7–19.PubMedCrossRefGoogle Scholar
  59. Reyes, S., Viswanathan, A., Godin, O., Dufouil, C., Benisty, S., Hernandez, K., et al. (2009). Apathy: A major symptom in cadasil. Neurology, 72(10), 905–910.PubMedCrossRefGoogle Scholar
  60. Ricci, M., Guidoni, S. V., Sepe-Monti, M., Bomboi, G., Antonini, G., Blundo, C., et al. (2009). Clinical findings, functional abilities and caregiver distress in the early stage of dementia with lewy bodies (dlb) and Alzheimer’s disease (ad). Archives of Gerontology and Geriatrics, 49(2), e101–e104.PubMedCrossRefGoogle Scholar
  61. Robert, P. H., Berr, C., Volteau, M., Bertogliati, C., Benoit, M., Sarazin, M., et al. (2006). Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer’s disease: A one-year follow-up study. Clinical Neurology and Neurosurgery, 108(8), 733–736.PubMedCrossRefGoogle Scholar
  62. Robert, P., Onyike, C. U., Leentjens, A. F. G., Dujardin, K., Aalten, P., Starkstein, S., Verhey, F. R. J., Yessavage, J., Clement, J. P., Drapier, D., Bayle, F., Benoit, M., Boyer, P., Lorca, P. M., Thibaut, F., Gauthier, S., Grossberg, G., Vellas, B., & Byrne, J. (2009). Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. European Psychiatry, 24, 98–104.PubMedCrossRefGoogle Scholar
  63. Rodda, J., Morgan, S., & Walker, Z. (2009). Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer’s disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine. International Psychogeriatrics, 21(5), 813–824.PubMedCrossRefGoogle Scholar
  64. Scott, W. K., Edwards, K. B., Davis, D. R., Cornman, C. B., & Macera, C. A. (1997). Risk of institutionalization among community long-term care clients with dementia. Gerontologist, 37(1), 46–51.PubMedCrossRefGoogle Scholar
  65. Spiegel, D. R., Kim, J., Greene, K., Conner, C., & Zamfir, D. (2009). Apathy due to cerebrovascular accidents successfully treated with methylphenidate: A case series. The Journal of Neuropsychiatry and Clinical Neurosciences, 21(2), 216–219.PubMedCrossRefGoogle Scholar
  66. Starkstein, S. E., Mayberg, H. S., Preziosi, T. J., Andrezejewski, P., Leiguarda, R., & Robinson, R. G. (1992). Reliability, validity, and clinical correlates of apathy in Parkinson’s disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 4(2), 134–139.PubMedCrossRefGoogle Scholar
  67. Starkstein, S. E., Fedoroff, J. P., Price, T. R., Leiguarda, R., & Robinson, R. G. (1993). Apathy following cerebrovascular lesions. Stroke, 24(11), 1625–1630.PubMedCrossRefGoogle Scholar
  68. Starkstein, S. E., Petracca, G., Chemerinski, E., & Kremer, J. (2001). Syndromic validity of apathy in Alzheimer’s disease. The American Journal of Psychiatry, 158(6), 872–877.PubMedCrossRefGoogle Scholar
  69. Starkstein, S. E., Jorge, R., Mizrahi, R., & Robinson, R. G. (2006). A prospective longitudinal study of apathy in Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77(1), 8–11.PubMedPubMedCentralCrossRefGoogle Scholar
  70. Steele, C., Rovner, B., Chase, G. A., & Folstein, M. (1990). Psychiatric symptoms and nursing home placement of patients with Alzheimer’s disease. The American Journal of Psychiatry, 147(8), 1049–1051.PubMedCrossRefGoogle Scholar
  71. Steffens, D. C., Hays, J. C., & Krishnan, K. R. (1999). Disability in geriatric depression. The American Journal of Geriatric Psychiatry, 7(1), 34–40.PubMedCrossRefGoogle Scholar
  72. Stout, J. C., Wyman, M. F., Johnson, S. A., Peavy, G. M., & Salmon, D. P. (2003). Frontal behavioral syndromes and functional status in probable Alzheimer disease. The American Journal of Geriatric Psychiatry, 11(6), 683–686.PubMedCrossRefGoogle Scholar
  73. Sturmey, P. (2009). Behavioral activation is an evidence-based treatment for depression. Behavior Modification, 33(6), 818–829.PubMedCrossRefGoogle Scholar
  74. Swanberg, M. M. (2007). Memantine for behavioral disturbances in frontotemporal dementia: A case series. Alzheimer Disease and Associated Disorders, 21(2), 164–166.PubMedCrossRefGoogle Scholar
  75. van Dijk, P. T., Dippel, D. W., & Habbema, J. D. (1994). A behavioral rating scale as a predictor for survival of demented nursing home patients. Archives of Gerontology and Geriatrics, 18(2), 101–113.PubMedCrossRefGoogle Scholar
  76. Van Reekum, R., Bayley, M., Garner, S., Burke, I. M., Fawcett, S., Hart, A., et al. (1995). N of 1 study: Amantadine for the amotivational syndrome in a patient with traumatic brain injury. Brain Injury, 9(1), 49–53.PubMedCrossRefGoogle Scholar
  77. Wood, S., Cummings, J. L., Hsu, M. A., Barclay, T., Wheatley, M. V., Yarema, K. T., et al. (2000). The use of the neuropsychiatric inventory in nursing home residents. Characterization and measurement. The American Journal of Geriatric Psychiatry, 8(1), 75–83.PubMedCrossRefGoogle Scholar
  78. Zawacki, T. M., Grace, J., Paul, R., Moser, D. J., Ott, B. R., Gordon, N., et al. (2002). Behavioral problems as predictors of functional abilities of vascular dementia patients. The Journal of Neuropsychiatry and Clinical Neurosciences, 14(3), 296–302.PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Memorial Hospital of Rhode Island and Alpert Medical School of Brown UniversityPawtucketUSA