Brazilian caregiver version of the Apathy Scale

Guimarães, Henrique Cerqueira; Fialho, Patricia Paes Araujo; Carvalho, Viviane Amaral; Santos, Etelvina Lucas dos; Caramelli, Paulo

doi:10.1590/S1980-57642009DN30400010

Abstract

No Brazilian version of a specific scale for evaluating apathy in dementia is available.

Objectives:

To introduce a translated version of the Apathy Scale (AS) for use with caregivers.

Methods:

The instrument was formally translated and then administered to the caregivers of a small sample of dementia patients, in order to assess scale comprehensibility and make final adjustments. The scale was subsequently administered to the caregivers of a second, independent sample of Alzheimer's disease (AD) patients. The content validity of the scale was tested by correlating the AS scores with the Neuropsychiatric Inventory (NPI) - apathy sub-score and Disability Assessment in Dementia (DAD) total scores.

Results:

The first sample consisted of eleven subjects with dementia, most of whom had AD. The second sample comprised twenty patients with probable or possible AD (10 with mild dementia), a mean age of 84.1±5.8 years, and 2.2±1.6 years of schooling. The AS scores correlated with both NPI-apathy sub-score (r=0.756, p=0.001) and DAD total scores (r=-0.793, p=0.0005).

Conclusions:

The final version had good comprehensibility and correlated strongly with standardized apathy and functional activities of daily living measures.

Key words:
apathy; diagnosis; evaluation; dementia; Alzheimer's disease.

Resumo

Não há versão brasileira de qualquer escala especificamente dedicada à avaliação de apatia nas demências.

Objetivos:

Apresentar uma versão traduzida da Escala de Apatia direcionada ao cuidador.

Métodos:

O instrumento foi formalmente traduzido e administrado aos cuidadores de uma pequena amostra de pacientes com demência, para avaliar a compreensibilidade da versão e realizar ajustes finais. Em seguida a escala foi administrada aos cuidadores de uma segunda amostra independente de pacientes com doença de Alzheimer (DA). A validade de conteúdo da escala foi testada correlacionando-se os escores da Escala de Apatia com os subescores de apatia do Inventário Neuropsiquiátrico (NPI) e com os escores totais da escala DAD de incapacidade na demência.

Resultados:

A primeira amostra consistia de onze pacientes com demência, a maioria com doença de Alzheimer (DA). A segunda amostra possuía vinte pacientes com DA provável ou possível (10 com demência leve), média de idade de 84,1±5,8 anos e escolaridade média de 2,2±1,6 anos. Os escores na Escala de Apatia correlacionaram-se com o subescore apatia do NPI (r=0,756; p=0,001) e com os escores totais da DAD (r=-0,793; p=0,0005).

Conclusões:

A versão final apresentou boa compreensibilidade e correlacionou-se fortemente com medidas padronizadas de apatia e atividades de vida diária.

Palavras-chave:
apatia; diagnóstico; avaliação; demência; doença de Alzheimer.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Marin RS. Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 1991;3:243-254.
²
Starkstein SE, Petracca G, Chemerinski E, Kremer J. Syndromic validity of apathy in Alzheimer's disease. Am J Psychiatry 2001;158:872-877.
³
Guimaraes HC, Levy R, Teixeira AL, Beato RG, Caramelli P. Neurobiology of apathy in Alzheimer's disease. Arq Neuropsiquiatr 2008;66:436-443
⁴
Aalten P, Verhey FR, Boziki M, et al. Neuropsychiatric syndromes in dementia Results from the European Alzheimer Disease Consortium: part1. Dement Geriatr Cogn Disord 2007;24:457-463.
⁵
Craig D, Mirakhur A, Hart DJ, McIlroy SP, Passmore AP. A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease. Am J Geriatr Psychiatry 2005;13:460-468.
⁶
Kuzis G, Sabe L, Tiberti C, Dorrego F, Starkstein SE. Neuropsychological correlates of apathy and depression in patients with dementia. Neurology 1999;52:1403-1407
⁷
McPherson S, Fairbanks L, Tekin S, Cummings JL, Back-Madruga C. Apathy and executive function in Alzheimer's disease. J Int Neuropsychol Soc 2002;8:373-381.
⁸
Starkstein SE, Sabe L, Vázquez S, et al. Neuropsychological, psychiatry, and cerebral perfusion correlates of leucoaraiosis in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1997; 63:66-73.
⁹
Starkstein SE, Jorge R, Mizrahi R, Robinson RG. A prospective longitudinal study of apathy in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2006;77:8-11.10.
¹⁰
Levy ML, Cummings JL, Fairbanks LA, et al. Apathy is not depression. J Neuropsychiatry Clin Neurosci1998;10:314-9.
¹¹
Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the apathy evaluation scale. Psychiatry Research 1991;38:143-162.
¹²
Starkstein SE, Mayberg HS, Preziosi TJ, Andrezejewski P, Leiguarda R, Robinson RG. Reliability, validity and clinical correlate of apathy in Parkinsons's disease. J Neuropsychiatry Cli Neurosci 1992;4;134-139.
¹³
Robert PH, Clairet S, Benoit M, et al. The Apathy Inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment. Int J Geriatr Psychiatry 2002;17:1099-1105
¹⁴
Sockeel P, Dujardin K, Devos D, Deneve C, Destee A, Defebvre L. The Lille apathy rating scale (LARS), a new instrument for detecting and quantifying apathy: validation in Parkinson's disease. J Neurol Neurosurg Psychiatry 2006;77:579-584.
¹⁵
Dujardin K, Sockeel P, Delliaux M, Destee A, Defebvre L. The Lille Apathy Rating Scale: validation of a caregiver-based version. Mov Disord 2008;23:845-849.
¹⁶
Lueken U, Seidl U, Völker L, Schweiger E, Kruse A, Schröder J. Development of a short version of the Apathy Evaluation Scale specifically adapted for demented nursing home residents. Am J Geriatr Psyhciatry 2007;15:376-385.
¹⁷
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessments of psychopathology in dementia. Neurology 1994;44:2308-2313.
¹⁸
Camozzato AL, Kochhann R, Simeoni C, et al. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychogeriatr 2008;20:383-393
¹⁹
Caramelli P, Teixeira Al, Barbosa MT, et al. Prevalence of cognitive impairment and dementia in a cohort of oldest-old in Brazil: The Pietà study.(Abstr) Alzheimers Dement. 2009;5: P391-P392.
²⁰
Reisberg B. Functional assessment staging (FAST). Psychopharmacol Bull 1988;24:653-659.
²¹
Folstein MF, Folstein SE, McHugh, PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.22.
²²
Gélinas I, Gauthier L, McIntyre M, Gauthier S. Development of a functional measure for persons with Alzheimer´s disease: the disability assessment for dementia. Am J Occup Ther 1999;53:471-481.
²³
Cathery-Goulart MT, Areza-Fegyveres R, Schultz RR, et al. Cross-cultural adaptation for the Disability Assessment for Dementia (DAD). Arq Neuropsiquiatr 2007;65:916-919.
²⁴
Diagnostic and Statistical Manual of Mental Disorders (DSM). 4th ed. Washington, DC: American Psychiatric Association, 1994.
²⁵
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical Diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.
²⁶
Knibb JA, Kipps CM, Hodges JR. Frontotemporal dementia. Curr Opin Neurol. 2006;19:565-571.
²⁷
Connor DJ, Sabbagh MN, Cummings JL. Comment on administration and scoring of the Neuropsychiatric Inventory in clinical trials. Alzheimers Dement 2008;4:390-394.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
20 Sept 2009
Accepted
03 Nov 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Marin RS. Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 1991;3:243-254.

[2] ²
Starkstein SE, Petracca G, Chemerinski E, Kremer J. Syndromic validity of apathy in Alzheimer's disease. Am J Psychiatry 2001;158:872-877.

[3] ³
Guimaraes HC, Levy R, Teixeira AL, Beato RG, Caramelli P. Neurobiology of apathy in Alzheimer's disease. Arq Neuropsiquiatr 2008;66:436-443

[4] ⁴
Aalten P, Verhey FR, Boziki M, et al. Neuropsychiatric syndromes in dementia Results from the European Alzheimer Disease Consortium: part1. Dement Geriatr Cogn Disord 2007;24:457-463.

[5] ⁵
Craig D, Mirakhur A, Hart DJ, McIlroy SP, Passmore AP. A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease. Am J Geriatr Psychiatry 2005;13:460-468.

[6] ⁶
Kuzis G, Sabe L, Tiberti C, Dorrego F, Starkstein SE. Neuropsychological correlates of apathy and depression in patients with dementia. Neurology 1999;52:1403-1407

[7] ⁷
McPherson S, Fairbanks L, Tekin S, Cummings JL, Back-Madruga C. Apathy and executive function in Alzheimer's disease. J Int Neuropsychol Soc 2002;8:373-381.

[8] ⁸
Starkstein SE, Sabe L, Vázquez S, et al. Neuropsychological, psychiatry, and cerebral perfusion correlates of leucoaraiosis in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1997; 63:66-73.

[9] ⁹
Starkstein SE, Jorge R, Mizrahi R, Robinson RG. A prospective longitudinal study of apathy in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2006;77:8-11.10.

[10] ¹⁰
Levy ML, Cummings JL, Fairbanks LA, et al. Apathy is not depression. J Neuropsychiatry Clin Neurosci1998;10:314-9.

[11] ¹¹
Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the apathy evaluation scale. Psychiatry Research 1991;38:143-162.

[12] ¹²
Starkstein SE, Mayberg HS, Preziosi TJ, Andrezejewski P, Leiguarda R, Robinson RG. Reliability, validity and clinical correlate of apathy in Parkinsons's disease. J Neuropsychiatry Cli Neurosci 1992;4;134-139.

[13] ¹³
Robert PH, Clairet S, Benoit M, et al. The Apathy Inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment. Int J Geriatr Psychiatry 2002;17:1099-1105

[14] ¹⁴
Sockeel P, Dujardin K, Devos D, Deneve C, Destee A, Defebvre L. The Lille apathy rating scale (LARS), a new instrument for detecting and quantifying apathy: validation in Parkinson's disease. J Neurol Neurosurg Psychiatry 2006;77:579-584.

[15] ¹⁵
Dujardin K, Sockeel P, Delliaux M, Destee A, Defebvre L. The Lille Apathy Rating Scale: validation of a caregiver-based version. Mov Disord 2008;23:845-849.

[16] ¹⁶
Lueken U, Seidl U, Völker L, Schweiger E, Kruse A, Schröder J. Development of a short version of the Apathy Evaluation Scale specifically adapted for demented nursing home residents. Am J Geriatr Psyhciatry 2007;15:376-385.

[17] ¹⁷
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessments of psychopathology in dementia. Neurology 1994;44:2308-2313.

[18] ¹⁸
Camozzato AL, Kochhann R, Simeoni C, et al. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychogeriatr 2008;20:383-393

[19] ¹⁹
Caramelli P, Teixeira Al, Barbosa MT, et al. Prevalence of cognitive impairment and dementia in a cohort of oldest-old in Brazil: The Pietà study.(Abstr) Alzheimers Dement. 2009;5: P391-P392.

[20] ²⁰
Reisberg B. Functional assessment staging (FAST). Psychopharmacol Bull 1988;24:653-659.

[21] ²¹
Folstein MF, Folstein SE, McHugh, PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.22.

[22] ²²
Gélinas I, Gauthier L, McIntyre M, Gauthier S. Development of a functional measure for persons with Alzheimer´s disease: the disability assessment for dementia. Am J Occup Ther 1999;53:471-481.

[23] ²³
Cathery-Goulart MT, Areza-Fegyveres R, Schultz RR, et al. Cross-cultural adaptation for the Disability Assessment for Dementia (DAD). Arq Neuropsiquiatr 2007;65:916-919.

[24] ²⁴
Diagnostic and Statistical Manual of Mental Disorders (DSM). 4th ed. Washington, DC: American Psychiatric Association, 1994.

[25] ²⁵
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical Diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.

[26] ²⁶
Knibb JA, Kipps CM, Hodges JR. Frontotemporal dementia. Curr Opin Neurol. 2006;19:565-571.

[27] ²⁷
Connor DJ, Sabbagh MN, Cummings JL. Comment on administration and scoring of the Neuropsychiatric Inventory in clinical trials. Alzheimers Dement 2008;4:390-394.

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