تشخیص و ارزیابی بی تفاوتی در بیماران چینی بیماری آلزایمر

Background Apathy is a major component of the behavioral and psychological symptoms of Alzheimer's Disease (AD) and other types of dementia. Most researchers have reached a consensus on a new set of diagnostic criteria for apathy (DCA) recently. However, no relevant reports on apathy exist for AD patients in Asian countries yet. Objectives To estimate the prevalence of apathy in Chinese AD patients. Methods 83 AD patients were recruited for a cross-sectional observational study. Following the new diagnostic criteria for apathy (DCA) and DSM-IV criteria for Major Depressive Disorder (MDD), each patient was assessed successively by Mini Mental State Examination (MMSE), the Neuropsychiatric Inventory-apathy subscale (NPI-apathy), the Geriatric Depression Screening scale (GDS), and the Caregiver Burden Scale (CBS). Results According to the DCA, we found that the frequency of apathy in Chinese AD patients reached 61.4%. The DCA had very good standard validity and internal consistency. The frequency of apathy was not significantly associated with that of depression, whereas there was a significant association between apathy and more severe cognitive deficits. Caregiver burden was significantly associated with severity of apathy. Conclusions From the symptoms of a group of Chinese AD patients, we summarized a set of effective methods for the diagnosis and assessment of apathy.

The term, apathy, originally signified a virtuous state of indifference. Although frequently used in the neuropsychiatric literature, apathy is not included in current nosological classifications such as the DSM-IV [1] or ICD-10 [2] as an independent term. More recently, an advanced draft was discussed at a consensus meeting (during the EPA conference on April 7th 2008) and a unanimous agreement was reached on the diagnostic and assessment of apathy. Then, DCA were proposed by the French Association for Biological Psychiatry, the European Psychiatric Association, and the European Alzheimer's Disease Consortium [3]. The frequency of apathy in AD patients differed depending on the methods adopted to measure apathy. By using Apathy Evaluating Scale (AES), Clark et al. [4] showed that apathy was present in 43% of patients with AD. However, by using the Apathy Scale (AS) Starkstein et al. [5] reported that the frequency of apathy ranged from 19% to 76%. One possible reason is that standardized methods to diagnose apathy were not available until 2008, and apathy was mostly diagnosed using arbitrary cut-off scores on severity rating scales [6]. The NPI-apathy subscale is one of the most authoritative and commonly used scales [7]. It was developed by Cummings et al. [8] to assess and quantify neurobehavioral disturbances in dementia patients and to quantify caregiver distress caused by such behaviors. NPI includes an apathy subscale, by which the overall frequency (1–4) and severity (1–3) of apathy are rated. Scores on the NPI apathy subscale range from 0 to 12, with higher scores indicating more severe apathy and an ordinary cut-off score of 4.0. Severity of apathy correlated closely with cognitive function. Robert et al. [9] assessed 251 patients who met the criteria of amnestic Mild Cognitive Impairment (MCI) by using Apathy Inventory (IA), and checked the incidence of AD one year later. The results showed that cognitive function of MCI patients accompanied by apathy declined in the following years. One example of unresolved nosological questions in behavioral neuroscience is that depression and apathy are difficult to distinguish from one another, despite the fact that many researchers have found clear-cut differences between apathy and depression. Levy et al. [11] performed a cross-sectional comparison of neuropsychiatric symptoms. They found that apathy did not correlate with depression in the combined sample and that apathy as measured by NPI, but not depression, correlated with lower cognitive function as measured by the MMSE. They concluded that apathy was a specific neuropsychiatric syndrome distinct from depression. Similarly, Starkstein et al. [9] reported that apathy was significantly associated with more severe cognitive deficits independent of depression.