SciELO - Scientific Electronic Library Online

vol.3 issue4Semantic Verbal Fluency test in dementia: Preliminary retrospective analysisThe abbreviated form of the Brief Cognitive Battery in the diagnosis of dementia in Alzheimer's disease author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links


Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.3 no.4 São Paulo Oct./Dec. 2009 

Original Articles

Brazilian caregiver version of the Apathy Scale

Versão brasileira direcionada ao cuidador da Escala de Apatia

Henrique Cerqueira Guimarães1  2 

Patricia Paes Araujo Fialho1 

Viviane Amaral Carvalho1 

Etelvina Lucas dos Santos1 

Paulo Caramelli1  2 

1Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Faculty of Medicine of the Federal University of Minas Gerais, Belo Horizonte MG, Brazil.

2Post-graduate Program in Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil.


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


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


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.


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).


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.


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


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


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.


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).


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.


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

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

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

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. [ Links ]

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. [ Links ]

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 [ Links ]

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. [ Links ]

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. [ Links ]

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. [ Links ]

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

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

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. [ Links ]

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 [ Links ]

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. [ Links ]

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. [ Links ]

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. [ Links ]

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. [ Links ]

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 [ Links ]

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. [ Links ]

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

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. [ Links ]

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. [ Links ]

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. [ Links ]

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

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. [ Links ]

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

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. [ Links ]

Received: September 20, 2009; Accepted: November 03, 2009

Henrique Cerqueira Guimarães - Rua Orenoco 137 / apto 101 - 30310-060 Belo Horizonte MG - Brazil. E-mail:

Disclosure: The authors report no conflicts of interest.

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