Conversely, the ES subscale correlated negatively with these MFIS domains. (* p < 0.05, ** p < 0.01, *** p < 0.001). 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. [ ] proposed the apathy evaluation scale (AES) based on his No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0169938. For more information about PLOS Subject Areas, click Robert PH, Schuck S, Dubois B, Lépine JP, Gallarda T, Olié JP, Goni S, Troy S. Encephale. Sheelakumari R, Bineesh C, Varghese T, Kesavadas C, Verghese J, Mathuranath PS. https://doi.org/10.1371/journal.pone.0169938.g003. 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. 2006 Mar;21(3):259-65. doi: 10.1002/gps.1457. 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 … ANOVA was used to examine differences among the four apathy-motivation subtypes on independent measures of depression, anhedonia and fatigue (Fig 4). Apathy is a disorder of motivation characterised by reduced action initiation and goal-directed behaviour [1, 2]. 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 … An exploratory factor analysis (EFA) with promax rotation was conducted in MPlus [22] to examine the latent structure of this 51-item apathy questionnaire. Patricia Lockwood, Affiliation This gave rise to a preliminary 51-item scale [21]. 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. Table 3 shows higher scores on the Initiation and Executive apathy subscales. We observed that the AMI SM was correlated with both the BA and ES subscales. Conclusions: The scores in the patient-based evaluations were only higher for the PD group versus the control subjects. The Lo-Mendell-Rubin Adjusted Likelihood Ratio Test [33] (LMRT) and Bootstrapped Likelihood Ratio Test (BLRT) [32] compares the fit of the current model with K classes to one with K-1 classes. The generally motivated class also experienced greater fatigue than the emotionally apathetic class (Fig 4A and 4C). No, Is the Subject Area "Material fatigue" applicable to this article? 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). 2012 Aug-Sep;168(8-9):598-604. doi: 10.1016/j.neurol.2012.05.002. There are a host of standardized measures of frontal cognitive changes, such as the Wisconsin Card Sorting Test and the Stroop Test. 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). Furthermore, are these different symptoms associated with distinct profiles of apathy in healthy people? Two hand-scorable, carbonless test booklets (self and family) are available. In this study we used the CAS3, the scale for assessment of spontaneity about patients’ ADL. 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. 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. The SM subscale contained items that examine a person’s engagement in social interactions. USA.gov. For more information about PLOS Subject Areas, click 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. It was also positively associated with the BDI (ρ = 0.26, p < 0.01) and MFIS total (r = 0.19, p < 0.01). 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). Key Descriptions. [Apathy in Parkinson's disease: clinical features, mechanisms and assessment]. Most people (60.8%) were identified as ‘generally motivated’ with their group average on each AMI subscale being lower than the overall mean. These results indicated that the four apathy subtypes were distinct and overlapped differently with the closely related outcomes of depression, anhedonia and fatigue. As expected, the AMI correlated with established assessments of apathy, depression, anhedonia and fatigue, providing evidence of good construct validity (Table 5). Given this relationship between motivation and reward, we predicted that anhedonia and apathy would be linked. The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. Yes 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]). After the EFA, twenty-one items were excluded, as their loadings were less than 0.40. 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. e0169938. The DAS is a 24-item scale that assesses apathy on three different subscales, namely executive, emotional and behavioural/cognitive initiation. 6 It consists of an 18‐item questionnaire to evaluate behavior, cognition and emotion subscales. A small p-value (< 0.05) indicates that the solution with K classes fit better. We propose cut-offs for moderate and severe apathy on the AMI to be respectively > 1 S.D. (B) Conditional response mean value greater than overall sample means (black line) indicates apathy on that AMI subscale. By contrast, the ES subscale contained items that probe an individual’s feelings of positive and negative affection, which seems similar to the emotional blunting often observed in some patients with apathy [37]. Competing interests: The authors have declared that no competing interests exist. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Includes a total score as well as scores on three subscales that correspond to the three frontal systems behavioral syndromes. Intriguingly, these different apathy subtypes were predictive of different associations with depression, anhedonia and fatigue. Apathy Evaluation Scale, and the Geriatric Depression Scale- Short form. Every subscale contains 6 items that is each scored from 0–4, with a higher mean score indicating greater apathy. with the LMRT and BLRT p-values, we found the 4-class model had the best fit. Yes 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. No, Is the Subject Area "Depression" applicable to this article? No, Is the Subject Area "Behavior" applicable to this article? 2019 Feb 6;19(1):35. doi: 10.1186/s12877-019-1046-x. The scale includes a compre- Robert P, Manera V, Derreumaux A, Ferrandez Y Montesino M, Leone E, Fabre R, Bourgeois J. J Med Internet Res. Results: 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. The PEAR-Environment subscale was validated using the Ambiance Scale and the Crowding Index. This appears to relate closely to Stuss's [36] executive process of ‘energization’ or the initiating and maintaining of task-relevant responses. Here we developed the Apathy-Motivation Index (AMI), a brief self-report index of apathy and motivation. 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. Each item on the AMI was scored from 0–4, with a higher score indicating greater apathy. Yes Maintenance of occupational therapy (OT) for dementia: protocol of a multi-center, randomized controlled and pragmatic trial. 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). doi: 10.2196/17167. The PEAR-Apathy subscale was validated using the Neuropsychiatric Inventory (NPI)-Apathy, Passivity in Dementia Scale (PDS), and NPI-Depression. Yes Fatigue can be a symptom of reduced motivation characterised by the lack of energy to perform actions. Introduction. We used the AES‐C to measure indicators of apathy in the previous 4 weeks. All participants gave electronic informed consent and the study was approved by the University of Oxford ethics committee. However, these measures were not perfectly correlated suggesting that there are also unique aspects of anhedonia not related to 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. The other subtypes were labelled ‘emotionally apathetic’ (11.9%) and ‘behaviourally/socially apathetic’ (25.3%) as they had a lower average score than overall only on that/those particular AMI subscale(s). Please enable it to take advantage of the complete set of features! Citation: Ang Y-S, Lockwood P, Apps MAJ, Muhammed K, Husain M (2017) Distinct Subtypes of Apathy Revealed by the Apathy Motivation Index. 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). Post-hoc comparisons showed that the behaviourally/socially apathetic class were significantly more depressed and fatigued than the emotionally apathetic and generally motivated classes. Contributed equally to this work with: Apathy Evaluation Scale, and the Geriatric Depression Scale- Short form. It has long been established that positive reinforcement is essential to maintain goal-directed behaviour [38]. 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. In Marin et al. 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. 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]. We briefly summarize key correlational results here in text (details in Table 5 and Fig 2). Participants completed the Spanish-translated DAS, Geriatric Depression Scale- Short form. Yes 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. Future longitudinal studies would benefit from investigating how particular profiles of apathy are risk factors for the development of depression, anhedonia and fatigue. The factor loadings for each subscale were good (BA: 0.56–0.75; SM: 0.54–0.66; ES: 0.46–0.78). Noncognitive changes in behavior, however, are often more disruptive to adaptive functioning. here. [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]. https://doi.org/10.1371/journal.pone.0169938.g001, https://doi.org/10.1371/journal.pone.0169938.t004. Exclusion criteria were self-reported neurological or psychiatric disorder. Thus anhedonia, or loss in pleasure derived from activities one used to enjoy, is correlated with apathy in PD [15] and items used in the assessment of both symptoms are often overlapping [18, 19]. 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. These classes showed different propensities for depression, anhedonia and fatigue. 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. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom, A higher total score indicates greater depression. Moreover, having high levels of behavioural and social apathy are more associated with other negative states, whereas experiencing emotional apathy on its own may not be associated with higher levels of depression and fatigue. COVID-19 is an emerging, rapidly evolving situation. 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. 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. We also found that these two subscales were not significantly correlated, suggesting some dissociation between behavioural and emotional aspects of apathy. The factor analysis identified three distinct subscales, namely behavioural activation (BA), social motivation (SM) and emotional sensitivity (ES). Is the Subject Area "Emotions" applicable to this article? background section, the scale allows a rapid and reliable assessment of negative symptoms. Yes 2008;14(3):183-6. doi: 10.1016/j.parkreldis.2007.07.015. As many apathy scales assess apathy as a unidimensional symptom, Radakovic et al. Method: For anhedonia, the generally motivated class experienced more pleasure than each of the other classes. This is an 18-item scale that addresses behavioral, emotional, and cognitive aspects of apathy. Mavioglu H, Gedizlioglu M, Akyel S, Aslaner T, Eser E. Int J Geriatr Psychiatry. Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom, Affiliations Conversely, lower scores indicated higher levels of anhedonia. To interpret each class, we compared the conditional response means with the overall sample means on each AMI subscale (Table 7, Fig 3). HHS This site needs JavaScript to work properly. Test structure. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom, Affiliations Each item was reverse-scored so that a higher rating indicated more apathy. Participants completed the AMI to confirm the proposed three-factor structure. However, currently there are no validated assessments of apathy in healthy people. Although similar in symptomology to apathy, few studies have investigated their relationship [16, 20]. (A) 3D scatterplot illustrating the distribution of each healthy individual’s mean rating along the three AMI subscales. 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. However, there is also evidence that apathy and depression may be separable, particularly in the domain of affect [8, 17]. Division of Psychology and Language Sciences, University College London, London, United Kingdom, Affiliation The 4-class model was the most appropriate (Table 6). Recently fatigue—the feeling of exhaustion caused by the exertion of effort, which is unrelated to actual exertion of energy by muscles—has also been shown to associate with apathy in clinical disorders such as PD and multiple sclerosis [16, 20]. This structure had good model fit (RMSEA = 0.051 with 90% CI of 0.048–0.053, SRMR = 0.05) and was supported by scree plot [23], which showed the characteristic “elbow” or plateau in eigenvalues after 3 factors.