Apathy and persons living with Parkinson's disease
Transcript of Apathy and persons living with Parkinson's disease
Apathy and persons living with Parkinson’s disease: a mul9dimensional
conceptualisa9on and approach
Ratko Radakovic Email: [email protected]
Outline • History of apathy • Defini=on of apathy
– Apathy and Depression • Mul=dimensional apathy • Dimensional Apathy Scale • Study
– Background & Aims – Method – Results – Conclusions
• Summary • Future direc=ons
History of apathy • Greek stoic philosophy
• Apatheia a-‐ (without) -‐pathos (passion)
• Apatheia considered a virtue, impar=ng more objec=vity
• The defini=on has transformed vastly from its original, philosophical roots
Zeno of Ci=um
What is apathy
History of apathy
• Greek Monk Evagrius Pon=cus – Acedia A state of dejec=on leading to loss of interest in
aspects of life
“Spiritual Apathy”
History of apathy
• Hippocrates’ The Sacred disease (from Marin, 1991):
“Those who are mad through phlegm are quiet, and neither shout nor make a disturbance; those maddened through bile are noisy, evildoers, and restless, doing something
inopportune”
Defini9on of apathy • We all feel apathe=c/demo=vated à selec=ve apathy!
• Defined as:
– “a state of primary mo=va=onal impairment” Marin (1990)
• Marin (1996) expanded further to include the defini=on as reduced mo=va=on towards goal-‐directed behaviours – e.g. “I have no plans to do things”, “I don’t want to do anything today”, “Emo=onally indifferent to things”
What is apathy
Apathy and Depression
Emo=onal neutrality Indifference
Emo=onality
Low Mood Interest
Apathy Depression
Mul9dimensional apathy
• Apathy is commonly regarded as one-‐dimensional BUT is in fact mul=dimensional
Mul9dimensional Apathy
• Marin – Behavioural, Cogni=ve, Emo=onal
• Cummings et al. – Emo=on, Ini=a=ve, Enthusiasm
• Stuss et al. – Affec=ve, Behavioural, Cogni=ve, “Social apathy”
• Robert et al. – Emo=onal Blun=ng, Lack of Ini=a=ve, Lack of Interest
• Sockeel et al. – Intellectual Curiosity, Ac=on Ini=a=on, Emo=onal, Self Awareness
• Starkstein and Leetjens – Goal directed behaviour, goal directed cogni=on
• Levy and Dubois – Auto Ac=va=on, Emo=onal Affec=ve, Cogni=ve Iner=a
Mul9dimensional apathy
Mul9dimensional apathy Mul9dimensional Apathy
One Dimension
Four Dimensions
Three Dimensions
? ??
???
Mul9dimensional apathy
• Lille Apathy Ra=ng Scale (Sockeel et al., 2006) – Not an adequate measure of mul=dimensional apathy (Radakovic et al., 2015)
Caveats uncorroborated apathy domains and not
comprehensive measurement
Mul9dimensional Apathy
Mul9dimensional apathy Dimensional Apathy Scale (DAS)
Radakovic & Abrahams (2014), Radakovic et al. (2015)
Executive Apathy
Emotional Apathy
Initiation Apathy
I can’t finish things
I don’t care I can’t think of new things
Mul9dimensional apathy Mul9dimensional Apathy
Mul9dimensional apathy Motor neurone disease
• DAS measures apathy independent of motor symptoms in motor neurone disease
• Motor neurone disease is characterised by
Initiation Apathy
Radakovic et al. (2015)
Background
• Parkinson’s disease (PD) – Apathy is observed between 30% and 51% (Kirsch-‐Darrow et al., 2006; Dujardin et al., 2007; Pedersen et al., 2009)
• Theorised three dimensional substructure of apathy (Pagonabarraga et al., 2015) – Can be measured by the Dimensional Apathy Scale
Aims
• To explore the mul=dimensional apathy in persons living with PD (PwPD) and their caregivers/rela=ves/friends (CRFPD)
• To determine the rela=onship of mul=dimensional apathy with clinical variables, motor dysfunc=on and ac=vi=es of daily living in PwPD
Radakovic et al. (In Prep)
Methods • Postal ques=onnaire study
• 54 PwPD recruited in to study, response rate of 72.2%
• Total of 34 PwPD and of their 30 PDCRFs par=cipated
• 34 gender-‐age-‐educa=on matched healthy controls and of their 30 informants par=cipated
Methods
• Ques=onnaires – Apathy Evalua=on Scale (AES) – Geriatric Depression Scale-‐ Short form (GDS15) – Dimensional Apathy Scale (DAS) – Execu=ve, Emo=onal and Ini=a=on Subscales
• Addi=onal measures – Lawton Instrumental Ac=vi=es of Daily Living – Hoehn & Yahr scale
Results-‐ Mul9dimensional apathy PwPDs vs CRFPDs
• Comparing PwPDs’ and CRFPDs’ ra=ngs on apathy subtypes (DAS) – No significant difference observed
• Comparing Controls and Informants ra=ngs on apathy subtypes (DAS) – No significate difference observed
Results-‐ Mul9dimensional apathy PwPD vs Control
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Execu=ve Emo=onal Ini=a=on
Control
PwPD
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Executive Apathy
Initiation Apathy
Results-‐ Mul9dimensional apathy CRFPD vs Informant
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Execu=ve Emo=onal Ini=a=on
Informant
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Executive Apathy
Results-‐ Mul9dimensional apathy Other variables
• Most common were Executive Apathy
Initiation Apathy
Results-‐ Mul9dimensional apathy Comparison to other diseases
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Conclusions
• Persons living with PD showed a lack of mo=va=on for planning, organising and anending (Execu9ve apathy) – With a self reported lack of mo=va=on to self generate thoughts or ac=ons (Ini9a9on apathy)
– No awareness problems observed in rela=on to demo=va=on
• Slightly reduced everyday func=oning when apathy is present
Summary
• Apathy is complex and mul=dimensional, with impact on everyday func=oning
• Three dimensional apathy is well-‐established and measurable
• Characteris=c apathy profiles dependent on disease
Future
• Increase recogni=on of apathy as complex and mul=dimensional
• Bener detec=on of apathy subtypes can lead to improved design of interven=ons or management
• Underlying neural substrates of apathy subtypes and how they relate to func=oning
Thank you for listening! And a great thanks to all who par=cipated in the study.
@ratkorad
Special thanks to: Prof. Sharon Abrahams Prof. John M. Starr Dr Richard Davenport Anne Rowling Regenera=ve Neurology Clinic
References Marin, R. (1990). Differen=al diagnosis and classifica=on of apathy. American Journal of Psychiatry, 147(7), 22–30. Radakovic, R., & Abrahams, S. (2014). Developing a new apathy measurement scale: Dimensional Apathy Scale. Psychiatry research, 219(3), 658–663. Radakovic, R., Stephenson, L., Colville, S., Swingler, R., Chandran, S., & Abrahams, S. (2015). Mul=dimensional apathy in ALS: valida=on of the Dimensional Apathy Scale. Journal of Neurology, Neurosurgery & Psychiatry. Advanced online publica=on. Levy, R. (2012). Apathy: A pathology of goal-‐directed behaviour. A new concept of the clinic and pathophysiology of apathy. Revue neurologique, 168(8), 585–597. Levy, R., & Dubois, B. (2006). Apathy and the func=onal anatomy of the prefrontal cortex-‐basal ganglia circuits. Cerebral Cortex, 16, 916–928.