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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.4 no.3 São Paulo July/Sept. 2010 

Original Articles

Apathy in Alzheimer's disease: Contribution to a clinical view on progression of dementia

Apatia na doença de Alzheimer: contribuição para uma visão clínica da progressão da demência

Florindo Stella1  2 

Larissa Pires de Andrade1 

Thays Martins Vital1 

Flávia Gomes de Melo Coelho1 

Carla Manuela Crispim Nascimento1 

Salma Stephany Soleman Hernández1 

1UNESP, Universidade Estadual Paulista, Biosciences Institute, Campus of Rio Claro, Aging and Physical Activity Laboratory, São Paulo SP, Brazil.

2Geriatric Psychiatry Clinic, State University of Campinas, CRUESP Cooperation Program, Campinas SP, Brazil.


In addition to cognitive impairment, apathy is increasingly recognized as an important neuropsychiatric syndrome in Alzheimer's disease (AD).


To identify the relationship between dementia severity and apathy levels, and to discuss the association of this condition with other psychopathological manifestations in AD patients.


This study involved 15 AD patients (mean age: 77 years; schooling: 4.9 years), with mild, moderate and severe dementia, living in Rio Claro SP, Brazil. Procedures included evaluation of cognitive status by the Mini-Mental State Examination, Clinical Dementia Rating, and Global Deterioration Scale. Apathy syndrome was assessed by the Apathy Evaluation Scale and Neuropsychiatric Inventory (NPI-apathy domain). Other psychopathological manifestations such as depression were also considered.


Patients with more severe dementia presented higher levels of apathy, reinforcing the hypothesis that apathy severity aggravates as the disease progresses. Using the Spearman coefficient correlation an association was identified between the MMSE and Apathy Evaluation Scale (r=0.63; p=0.01), and also between the MMSE and NPI-apathy domain (r=0.81; p=0.01). Associations were also found between the Global Deterioration Scale and Apathy Evaluation Scale (r=0.58; p=0.02), and between the Global Deterioration Scale and NPI-apathy domain (r=0.81; p=0.01).


Apathy is a distinct syndrome among patients with AD and increases with global deterioration.

Key words: apathy; Alzheimer's disease; disease progression


A apatia tem sido reconhecida como uma importante síndrome na doença de Alzheimer (DA), além do comprometimento cognitivo.


Avaliar a relação entre gravidade da demência e níveis de apatia e discutir a associação de apatia com outras manifestações psicopatológicas em pacientes com DA.


15 pacientes com DA com demência leve, moderada e avançada, residentes em Rio Claro SP, Brasil.


Avaliação do status cognitivo por meio do Mini-Exame do Estado Mental, Escore Clínico de Demência e Escala de Deterioração Global. A avaliação da apatia incluiu a Escala de Avaliação de Apatia e o Inventário Neuropsiquiátrico (NPI-domínio apatia). Depressão também foi aferida.


Os pacientes com demência avançada apresentaram níveis mais elevados de apatia, o que reforça a hipótese de que ela se agrava na medida em que a doença progride. Por meio do coeficiente de correlação de Spearman, verificou-se associação do Mini-Exame do Estado Mental com a Escala de Avaliação de Apatia (r=0,63; p=0,01) e com o NPI-domínio apatia (r=0,81; p=0,01); também se constatou associação da Escala de Deterioração Global com a Escala de Avaliação de Apatia (r=0,58; p=0,02) e com o NPI-domínio apatia (r=0,81; p=0,01).


A apatia é uma síndrome distinta em pacientes com DA e que se agrava com a deterioração global imposta pela doença.

Palavras-chave: apatia; doença de Alzheimer; progressão da doença

Texto completo disponível apenas em PDF.

Full text available only in PDF format.


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Received: May 28, 2010; Accepted: July 04, 2010

Florindo Stella - UNESP / Biosciences Institute - Caixa Postal: 199 - 13506-900 Rio Claro SP - Brazil. E-mail:

Disclosure: The authors report no conflicts of interest.

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