Apathy, cognitive function and motor function in Alzheimer's disease

Hernandez, Salma S. Soleman; Vital, Thays Martins; Garuffi, Marcelo; Stein, Angélica Miki; Teixeira, Camila Vieira Ligo; Costa, José Luiz Riani; Stella, Florindo

doi:10.1590/S1980-57642012DN06040007

Abstract

The aims of this study were to characterize the presence of apathy in patients with AD, determine the relationship between apathy, motor function and cognitive function, and to verify differences among patients stratified by level of apathy in relation to cognitive and motor abilities.

Methods:

A cross-sectional study was conducted of 37 patients with AD. The following tests were used: MoCA, the Frontal Assessment Battery, Verbal Fluency, Clock Drawing Test, Andreotti & Okuma Battery Tests, Sit and Reach, Resistance of Upper Limbs - AAHPERD Battery Test, Sit and Lift Chair and the Apathy domain of the Neuropsychiatric Inventory. After verifying the normality of the data distribution, comparisons were made using Student's t-test and the U Mann Whitney test; relationships were also assessed using Pearson's and Spearman's correlation coefficients. All analyses were considered to be statistically significant at a p-value of 0.05.

Results:

46% of participants in this study showed mild symptoms of apathy. Significant and weak associations were found (p=0.04) between apathy and the attention domain on the MoCA and between apathy and the Walk Test. Analysis of differences in cognitive and motor functions according to participants' level of apathy revealed no significant differences for any of the variables.

Conclusion:

Apathy was reflected in attention and the Walk Test, suggesting these variables may be related to cognitive and functional decline in AD patients.

Key words:
Alzheimer's disease; apathy; cognition; motor activity

RESUMO

Os objetivos deste estudo compreendem: caracterizar a presença de apatia em pacientes com doença de Alzheimer (DA); verificar se há relação entre apatia, funções cognitivas e funcionalidade motora dos mesmos e analisar se há diferenças entre os pacientes, separados por nível de apatia, em relação às suas funções cognitivas e funcionalidade motora.

Métodos:

Trata-se de um estudo com delineamento transversal. Ao todo 37 pacientes com DA compuseram a amostra. Foram utilizados os seguintes testes: Mini-Exame de Estado Mental, Montreal Cognitive Assessment (MoCA), Bateria de Avaliação Frontal, Teste de Fluência Verbal Semântica, Teste do Desenho do Relógio, Bateria de Testes de Andreotti & Okuma, Teste de Sentar e Alcançar, Resistência de Membros Superiores da AAHPERD, Teste Sentar-se e Levantar-se da Cadeira e o domínio Apatia do Inventário Neuropsiquiátrico. Após verificar a distribuição dos dados as comparações seguiram através dos testes t student e U Mann Whitney e as relações, através das correlações de Pearson e Spearman. Todas as análises admitiram nível de significância de 5%.

Resultados:

46% dos participantes deste estudo apresentam sintomatologia para apatia em nível leve. Foram verificadas relações significativas e fracas (p=0,04) entre apatia e o domínio atenção do MoCA e entre apatia e o Teste de Caminhar. Ao verificar a diferença nas funções cognitivas e funcionalidade motora segundo o nível de apatia dos participantes não foram encontradas diferenças significativas para nenhuma das variáveis analisadas.

Conclusão:

Apatia relaciona-se com a atenção e o Teste de Caminhar sugerindo que estas variáveis podem estar relacionadas com o declínio cognitivo e funcional dos pacientes com esta patologia.

Palavras-chave:
doença de Alzheimer; apatia; cognição; atividade motora

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REFERENCES

Mckhann GM, Knopaman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging and the Alzheimer's Association workgroup. Alzheimers dememt 2011;7:263-269.
Starkstein SE, Jorge R, Mizrahi R, et al. A prospective longitudinal study of apathy in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2006;77:8-11.
Aalten P, Verhey FRJ, Boziki M, et al. Consistency of Neuropsychiatric Syndromes across Dementias: Results from the European Alzheimer Disease Consortium. Dement Geriatr Cogn Disord 2007;24:457- 463.
Guimarães HC, Levy R, Teixeira AL, et al. Neurobiology of apathy in Alzheimer's disease. Arq Neuropsiquiatr 2008;66:436-443.
Ishii S, Weintraub N, Mervis JR. Apathy: A Common Psychiatric Syndrome in the Elderly. J Am Med Dir Assoc 2009;10:381-393.
Chow TW, Binns MA, Cummings JL, et al. Apathy Symptom Profile and Behavioral Associations in Frontotemporal Dementia vs Dementia of Alzheimer Type. Arch Neurol 2009;66:888-893.
Esposito F, Rochat L, Van der Linden ACJ, et al. Apathy and executive dysfunction in Alzheimer disease. Alzheimer Dis Assoc Disord 2010;24:131-137.
Van Reekum R, Stuss DT, Ostrander R. Apathy: Why care? J Neuropsychiatry Clin Neurosci 2005;17:7-19.
Mega MS, Cummings JL, Fiorello T, et al. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996;46:130-135.
Gonfrier S, Andrieu S, David R, et al. Course of neuropsychiatric symptoms during a four year follow-up in the REAL-FR cohort. Alzheimers Dement 2008;4(4 Suppl 2):135.
Boyle PA, Malloy PF. Treating apathy in Alzheimer's disease. Dement Geriatr Cogn Disord 2004;17:91-99.
Lechowski L, Benoit M, Chassagne P, et al. Persistent apathy in Alzheimer's disease as an independent factor of rapid functional decline: The REAL longitudinal cohort study. Int J Geriatri Psychiatry 2009;24: 341-346.
Tunnard C, Whitehead D, Hurt C, et al. Apathy and cortical atrophy in Alzheimer's disease. Geriatric Psychiatry 2011;26:741-748.
Weiner MF, Hynan LS, Bret ME, et al. Early behavioral symptoms and course of Alzheimer's disease. Acta Psychiatr Scand 2005;111:367-371.
Robbert PH, Mulin E, Malléa P, et al. Apathy diagnosis, assessment, and Treatment in Alzheimer's disease. CSN Neurosci Therap 2010;16:263-271.
Drijgers RL, Aalten P, Wionogrodzka A, et al. Pharmacological treatment of apathy in neurodegenerative diseases: A systematic review. Dement Geriatr Cogn Disord 2009;28:13-22.
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. Washington: DC, APA, 2000.
Morris J. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
Montaño MBMM, Ramos LR. Validade da versão em português da Clinical Dementia Rating (CDR). Rev Saude Publica 2005;39:912-917.
Brucki SMD, Nitrini R, Caramelli P, et al. Suggestions for the utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61:777-781.
Folstein MF, Folstein SE, Mchugh PR. Mini-mental state. A practical method for grading the cognitive patients for the clinician. J Psychiatr Res 1975;12:189-198.
Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: Validity an Utility in a Memory Clinic Setting. Can J Psychiatry 2007;52: 329-332.
Bertolucci PH, et al. Brazilian Portuguese version for the Montreal Cognitive Assessment (MoCA) and the preliminary results. Presented at Alzheimer's Association International Conference on Alzheimer's Disease. Alzheimer's Dement 2008;4:T686.
Dubois B, Slachevsky A, Litvan I, et al. The BAF: A Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626.
Beato RG, Nitrini R, Formigoni AP, et al. Brazilian version of the Frontal Assessment Battery (FAB). Dement Neuropsychol 2007;1:59-65.
Lezak MD. Neuropsychological Assessment. New York: Oxford Press; 1995.
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.
Cummings JL, Mega M, Gary K, et al. The Neuropsychiatric Iventory: Comprehensive assessment of psychopathology in dementia. Neurology 1997;44:2308-2314.
Andreotti RA, Okuma SS. Validação de uma bateria de testes de atividades da vida diária para idosos fisicamente independentes. Rev Paul Educ Fís 1999;3:46-66.
Wells KF, Dillon EK. The Sit and Reach - A test of Back and Leg Flexibility. Res Q Exerc Sport 1952;23:115-118.
Osness WH, Adrian M, Clark B, et al. Functional Fitness Assessment for Adults Over 60 Years. The American Alliance for Health, Physical Education, Recreation and Dance. Association For Research Administration, Professional Councils, and Societies. Council On Aging and Adult Development. Association Drive. Reston 1990;VA:22091.
Rikli RE, Jones CJ. Development and validation of a functional fitnesstest for community residing older adults. J Aging Phys Act 1999;7: 129-161.
Tatsch MF, Bottino CMC, Azevedo D, et al. Neuropsychiatric Symptoms in Alzheimer Disease and Cognitively Impaired, Nondemented Elderly From a Community-Based Sample in Brazil: Prevalence and Relationship With Dementia Severity. Am J Geriatr Psychiatr 2006;14(5): 438-445.
Starkstein SE, Ingram L, Garau ML, et al. On overlap between apathy and depression in dementia. J Neurol Neurosurg Psychiatry 2005;76: 1070-1074.
Kartunnen K, Karppi P, Hiltunen A, et al. Neuropsychiatric symptons and Quality of life in patients with very mild and mild Alzheimer's disease. Int J Geriatr Psychiatry 2011;26:473-482.
Rockwood K. Should We Listen to People Affected by Dementia? CNS Neurosci Therapeut 2011;17:1-3.
Medeiros, K, Robert R, Gauthier S, et al. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. Int Psychogeriatr 2010;22:984-994.
Perry RJ, Hodges JR. Attention and executive deficits in Alzheimer's disease. Brain 1999;122:383-404.
Levy R, Dubois B. Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex 2006;16:916-928.
Bottino CM, Laks J, Blay SL. Demência e transtornos cognitivos em idosos: Diagnóstico clínico na doença de Alzheimer. Rio de Janeiro: Guanabara Koogan, 2006,173-176.
Freitas EV. Tratado de geriatria e gerontologia. Rio de Janeiro: Guanabara Koogan , 2006.

Publication Dates

Publication in this collection
Oct-Dec 2012

History

Received
19 June 2012
Accepted
09 Sept 2012

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

[1] Mckhann GM, Knopaman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging and the Alzheimer's Association workgroup. Alzheimers dememt 2011;7:263-269.

[2] Starkstein SE, Jorge R, Mizrahi R, et al. A prospective longitudinal study of apathy in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2006;77:8-11.

[3] Aalten P, Verhey FRJ, Boziki M, et al. Consistency of Neuropsychiatric Syndromes across Dementias: Results from the European Alzheimer Disease Consortium. Dement Geriatr Cogn Disord 2007;24:457- 463.

[4] Guimarães HC, Levy R, Teixeira AL, et al. Neurobiology of apathy in Alzheimer's disease. Arq Neuropsiquiatr 2008;66:436-443.

[5] Ishii S, Weintraub N, Mervis JR. Apathy: A Common Psychiatric Syndrome in the Elderly. J Am Med Dir Assoc 2009;10:381-393.

[6] Chow TW, Binns MA, Cummings JL, et al. Apathy Symptom Profile and Behavioral Associations in Frontotemporal Dementia vs Dementia of Alzheimer Type. Arch Neurol 2009;66:888-893.

[7] Esposito F, Rochat L, Van der Linden ACJ, et al. Apathy and executive dysfunction in Alzheimer disease. Alzheimer Dis Assoc Disord 2010;24:131-137.

[8] Van Reekum R, Stuss DT, Ostrander R. Apathy: Why care? J Neuropsychiatry Clin Neurosci 2005;17:7-19.

[9] Mega MS, Cummings JL, Fiorello T, et al. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996;46:130-135.

[10] Gonfrier S, Andrieu S, David R, et al. Course of neuropsychiatric symptoms during a four year follow-up in the REAL-FR cohort. Alzheimers Dement 2008;4(4 Suppl 2):135.

[11] Boyle PA, Malloy PF. Treating apathy in Alzheimer's disease. Dement Geriatr Cogn Disord 2004;17:91-99.

[12] Lechowski L, Benoit M, Chassagne P, et al. Persistent apathy in Alzheimer's disease as an independent factor of rapid functional decline: The REAL longitudinal cohort study. Int J Geriatri Psychiatry 2009;24: 341-346.

[13] Tunnard C, Whitehead D, Hurt C, et al. Apathy and cortical atrophy in Alzheimer's disease. Geriatric Psychiatry 2011;26:741-748.

[14] Weiner MF, Hynan LS, Bret ME, et al. Early behavioral symptoms and course of Alzheimer's disease. Acta Psychiatr Scand 2005;111:367-371.

[15] Robbert PH, Mulin E, Malléa P, et al. Apathy diagnosis, assessment, and Treatment in Alzheimer's disease. CSN Neurosci Therap 2010;16:263-271.

[16] Drijgers RL, Aalten P, Wionogrodzka A, et al. Pharmacological treatment of apathy in neurodegenerative diseases: A systematic review. Dement Geriatr Cogn Disord 2009;28:13-22.

[17] American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. Washington: DC, APA, 2000.

[18] Morris J. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.

[19] Montaño MBMM, Ramos LR. Validade da versão em português da Clinical Dementia Rating (CDR). Rev Saude Publica 2005;39:912-917.

[20] Brucki SMD, Nitrini R, Caramelli P, et al. Suggestions for the utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61:777-781.

[21] Folstein MF, Folstein SE, Mchugh PR. Mini-mental state. A practical method for grading the cognitive patients for the clinician. J Psychiatr Res 1975;12:189-198.

[22] Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: Validity an Utility in a Memory Clinic Setting. Can J Psychiatry 2007;52: 329-332.

[23] Bertolucci PH, et al. Brazilian Portuguese version for the Montreal Cognitive Assessment (MoCA) and the preliminary results. Presented at Alzheimer's Association International Conference on Alzheimer's Disease. Alzheimer's Dement 2008;4:T686.

[24] Dubois B, Slachevsky A, Litvan I, et al. The BAF: A Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626.

[25] Beato RG, Nitrini R, Formigoni AP, et al. Brazilian version of the Frontal Assessment Battery (FAB). Dement Neuropsychol 2007;1:59-65.

[26] Lezak MD. Neuropsychological Assessment. New York: Oxford Press; 1995.

[27] Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease. A novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.

[28] Cummings JL, Mega M, Gary K, et al. The Neuropsychiatric Iventory: Comprehensive assessment of psychopathology in dementia. Neurology 1997;44:2308-2314.

[29] Andreotti RA, Okuma SS. Validação de uma bateria de testes de atividades da vida diária para idosos fisicamente independentes. Rev Paul Educ Fís 1999;3:46-66.

[30] Wells KF, Dillon EK. The Sit and Reach - A test of Back and Leg Flexibility. Res Q Exerc Sport 1952;23:115-118.

[31] Osness WH, Adrian M, Clark B, et al. Functional Fitness Assessment for Adults Over 60 Years. The American Alliance for Health, Physical Education, Recreation and Dance. Association For Research Administration, Professional Councils, and Societies. Council On Aging and Adult Development. Association Drive. Reston 1990;VA:22091.

[32] Rikli RE, Jones CJ. Development and validation of a functional fitnesstest for community residing older adults. J Aging Phys Act 1999;7: 129-161.

[33] Tatsch MF, Bottino CMC, Azevedo D, et al. Neuropsychiatric Symptoms in Alzheimer Disease and Cognitively Impaired, Nondemented Elderly From a Community-Based Sample in Brazil: Prevalence and Relationship With Dementia Severity. Am J Geriatr Psychiatr 2006;14(5): 438-445.

[34] Starkstein SE, Ingram L, Garau ML, et al. On overlap between apathy and depression in dementia. J Neurol Neurosurg Psychiatry 2005;76: 1070-1074.

[35] Kartunnen K, Karppi P, Hiltunen A, et al. Neuropsychiatric symptons and Quality of life in patients with very mild and mild Alzheimer's disease. Int J Geriatr Psychiatry 2011;26:473-482.

[36] Rockwood K. Should We Listen to People Affected by Dementia? CNS Neurosci Therapeut 2011;17:1-3.

[37] Medeiros, K, Robert R, Gauthier S, et al. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. Int Psychogeriatr 2010;22:984-994.

[38] Perry RJ, Hodges JR. Attention and executive deficits in Alzheimer's disease. Brain 1999;122:383-404.

[39] Levy R, Dubois B. Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex 2006;16:916-928.

[40] Bottino CM, Laks J, Blay SL. Demência e transtornos cognitivos em idosos: Diagnóstico clínico na doença de Alzheimer. Rio de Janeiro: Guanabara Koogan, 2006,173-176.

[41] Freitas EV. Tratado de geriatria e gerontologia. Rio de Janeiro: Guanabara Koogan , 2006.

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