UNASSIGNED: Apathy is a frequent and debilitating condition among subarachnoid hemorrhage (SAH) survivors. Few studies have evaluated apathy in SAH, and none have examined the course of the condition, predictors of persistent apathy, or its impact on functional outcomes. The proposed study will examine, for the first time, the 12-month course of apathy and its impact on functional outcomes in the largest cohort of SAH survivors to date.
UNASSIGNED: The current study is designed as a prospective cohort study with a duration of 36 months. We will recruit 240 participants. A trained research assistant will assess apathy using the Apathy Evaluation Scale 3 months after SAH. Patients\' level of functioning, comorbidity, global cognitive functioning, and depressive symptoms will be assessed. All SAH patients will participate in follow-up assessments of apathy and functioning at 9 (T2) and 15 months (T3) post-SAH or at 6 and 12 months after the first assessment. Predictors of persistent apathy and the impact of apathy on functional outcomes will be examined.
UNASSIGNED: This will be the first large-scale 1-year follow-up study of apathy in SAH survivors. The findings will provide valuable data to advance our understanding of the clinical course of apathy in this population. Moreover, the results will have clinical relevance by providing essential information to patients, caregivers, and clinicians; promoting the evaluation of apathy; and facilitating the development of prevention strategies, rehabilitation programs, and therapeutic options.
UNASSIGNED: Ethical approval for this study was obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No.: 2023.339) on 3 October 2023. The findings of this study will be shared through publication in a peer-reviewed journal, presentations at relevant conferences, and dissemination through social media platforms.

OBJECTIVE: Alzheimer\'s disease is a progressive neurodegenerative disorder characterized by cognitive decline, behavioral changes, and functional impairments. Apathy, a common symptom in Alzheimer\'s disease, refers to a lack of motivation, interest, and emotional responsiveness. It can significantly impact patients\' quality of life and increase caregiver burden. This study aimed to determine the effects of a diversified rehabilitation program combined with donepezil on apathy, cognitive function, and family caregiver burden of Alzheimer\'s disease patients.
METHODS: A total of 105 Alzheimer\'s disease patients treated at our hospital between January 2020 and January 2023 were selected and analyzed retrospectively. They were assigned to the control group (n = 50) or the observation group (n = 55). The two groups did not differ in terms of general data such as age and sex. All patients were treated with donepezil orally. The control group was given routine nursing, whereas the observation group was given a diversified rehabilitation program intervention, including cognitive training and emotional support. The Hasegawa\'s dementia scale, mini-mental state examination, and Montreal cognitive assessment scale were adopted to evaluate the cognitive function of the two groups before and after treatment. A caregiver burden scale, the Zarit Burden Interview (ZBI) and the Apathy Evaluation Scale Informant version (AES-I) were used to evaluate the caregiver burden and apathy of the two groups.
RESULTS: A significantly higher overall response rate to treatment was found in the observation group (94.55%) than in the control group (80.00%) (p = 0.024). After treatment, scores on the Hasegawa\'s dementia scale, mini-mental state examination, and Montreal cognitive assessment scale of the two groups increased to varying degrees, with greater increases in the observation group than in the control group (p < 0.05). The ZBI and AES-I scores of the two groups decreased to different degrees after treatment, with greater decreases in the observation group than in the control group (p < 0.05).
CONCLUSIONS: A diversified rehabilitation program combined with donepezil can substantially alleviate the apathy of Alzheimer\'s disease patients, improve their cognitive function, and reduce the burden on their families.

BACKGROUND: Apathy, defined as a lack of motivation towards goal-directed behavior, is a common neuropsychiatric symptom in Alzheimer\'s (AD) and Parkinson\'s (PD) disease. However, the mechanism underlying apathy is still unclear. Studies have postulated that the degeneration of frontal cortical and subcortical structures may play a major role in the mechanism of apathy. This study investigates whether associations between degeneration in structural and functional connectivity between frontal and subcortical regions contributes to the development of apathetic behavior and whether these associations differ by diseases.
METHODS: Forty-four patients, 8 with AD, 14 amnestic mild cognitive impairment (aMCI), and 22 PD, received MRI brain scans, a decision-making behavioral task, cognitive and psychosocial assessments including the dimensional apathy scale (DAS). We quantified functional connectivity and white matter tract integrity for a set of frontal and subcortical regions of interest, and examined the associations among fronto-subcortical connectivity, behavioral measures, and the DAS. These associations were tested for patient group interactions.
RESULTS: Combining AD and aMCI into one patient group, the AD/aMCI group showed worse apathy than PD in terms of the total, the executive, and the behavioral/cognitive subscores (see Table 1), while the DAS emotional subscore was not different between the two groups. For the decision-making task, the proportion of trial acceptance was similar between the groups, but AD/aMCI had slower decision latency than PD. Group interaction with brain measures was observed in the association between DAS total score and the functional connectivity between the right pars triangularis in the inferior frontal gyrus and the caudate (See Figure 1; interaction effect: beta = -.367, p = .0422 FDR corrected). The white matter tract connecting the right pars triangularis to subcortical regions also showed a group interaction with DAS total score but at an uncorrected statistical level (Figure 2; beta = 3.61, p = .0454, uncorrected).
CONCLUSIONS: Our preliminary analyses exposed phenotypic differences in apathy profiles and decision-making behavior between AD and PD. Furthermore, the observed functional and structural neurodegenerative changes associated with higher apathy severity may also differ between the two diseases. Future analyses in a larger cohort will examine distinct neurodegeneration patterns between the two diseases.

OBJECTIVE: This study evaluated the factorial structure, psychometric properties, and diagnostic accuracy of the Persian version of the Lille Apathy Rating Scale-Patient version (LARS-P) in stroke survivors.
METHODS: This study comprised 105 stroke survivors and 41 healthy controls.
METHODS: Exploratory factor analysis was used to determine the factors of the LARS-P. The acceptability, reliability, and validity of the LARS-P were also assessed. Agreement between the LARS-P and the Lille Apathy Rating Scale-informed version (LARS-I) was evaluated using the Bland-Altman plot. The diagnostic accuracy of the LARS-P was determined by categorizing stroke survivors into apathetic and nonapathetic groups based on the \"diagnostic criteria of apathy.\"
RESULTS: The exploratory factor analysis showed 3 factors (action initiation and social life; novelty and motivation; and emotional and self-awareness), explaining 67.35% of the variance. Cronbach\'s alpha was 0.85 for between-items and 0.74 for between-subscales. Intra-class correlation coefficient (ICC)2,1 was >0.88 for test-retest and inter-rater reliability. The LARS-P showed moderate to strong correlations with the LARS-I and Neuropsychiatric Inventory-Apathy subscale (r = 0.70-0.82). In addition, the LARS-P had significant moderate correlations with 2 subscales of the Hospital Anxiety and Depression Scale, modified Rankin Scale, Barthel Index, and Lawton Instrumental Activities of Daily Living (r or ƿ = 0.47-0.63). There was a 96.19% agreement between LARS-P and LARS-I. The identified cutoff point (>17) for LARS-P exhibited 77.14% sensitivity and 90% specificity in diagnosing apathetic and nonapathetic stroke survivors.
CONCLUSIONS: The LARS-P exhibits acceptable psychometric properties in stroke survivors, presenting a promising instrument for assessing apathy through a multidimensional framework.

OBJECTIVE: To evaluate the frequency and severity of various clinical symptoms of Parkinson\'s disease (PD) depending on the BDNF rs6265 polymorphism.
METHODS: The study included 533 patients with PD. The stage of PD was assessed using the Hoehn and Yahr scale (1967), motor symptoms were evaluated with MDS-UPDRS. Assessment of non-motor symptoms (NMS) in PD was conducted using the Beck Depression Inventory II (BDI-II); the Hospital Anxiety and Depression Scale (HADS); the Apathy Scale; the Montreal Cognitive Assessment (MoCA test); the Questionnaire for Impulsive-Compulsive Disorders in PD -Rating Scale (QUIP-RS). Genotyping of the BDNF variant (rs6265) was performed using real-time PCR with TaqMan probes.
RESULTS: Most PD patients have a combination of NMS increasing as the disease progresses and is determined by molecular-genetic individual characteristics. There are significant differences in the severity of motor symptoms and NMS: individuals with the AA genotype showed significantly pronounced motor symptoms (p<0.0001); emotional-affective symptoms (p<0.0001); cognitive and impulsive behavioral disorders (p<0.0001).
CONCLUSIONS: The rs6265 BDNF allele A is associated with a wide range of NMS, increasing the risk of their development in patients with PD, thus playing the important role in the etiopathogenesis of this pathology.
UNASSIGNED: Оценить частоту и степень выраженности различных клинических проявлений болезни Паркинсона (БП) в зависимости от полиморфизма rs6265 гена BDNF.
UNASSIGNED: В исследовании приняли участие 533 пациента с БП. Стадию БП оценивали по шкале Хен и Яра, степень двигательных нарушений — по шкале MDS-UPDRS. Оценка немоторных нарушений БП проводилась с использованием валидизированных опросников и шкал: шкала оценки депрессии Бека II, госпитальная шкала оценки тревоги и депрессии, шкала апатии, Монреальская шкала оценки когнитивных функций, анкета для оценки импульсивно-компульсивных расстройств при БП с оценочной шкалой. Генотипирование полиморфного варианта гена BDNF (rs6265) выполнено методом ПЦР в режиме реального времени с использованием зондов TaqMan.
UNASSIGNED: У большинства пациентов с БП встречается сочетание немоторных симптомов, количество которых увеличивается по мере прогрессирования заболевания и определяется молекулярно-генетическими особенностями индивидуума. Установлены статистически значимые различия в выраженности моторных и немоторных нарушений: у индивидов с генотипом AA были выявлены достоверно выраженные двигательные нарушения (p<0,0001), эмоционально-аффективные (p<0,0001), когнитивные и импульсивные поведенческие расстройства (p<0,0001).
UNASSIGNED: Исследование показало, что аллель rs6265 BDNF (A) ассоциирован с широким спектром немоторных симптомов, увеличивая риск их развития у пациентов с БП, таким образом, играя важную роль в патогенезе данной патологии.

BACKGROUND: Apathy is defined as the lack of motivation and has been found to be associated with incident dementia in western populations (Dalen, 2018). Little is known about the impact of apathy in Asians. Apathy is a prevalent behavioural symptom of pre dementia and current literature shows that apathy increases the risk of dementia (Bock, 2020). Apathy is also linked to an increased risk of frailty(Ayers, 2018) and found to impair executive function and processing speed(Lohner, 2017). We aim to evaluate the association of apathy with cognitive function, frailty and lifestyle factors in a pre-dementia community population in Singapore.
METHODS: We recruited 534 participants from the community who completed a detailed neuropsychological assessment. Apathy was measured using the mild behavioural impairment checklist (MBI-C). To test for the association of apathy with the different variables, we performed a multiple generalized linear model controlling for covariates age, sex and education.
RESULTS: The study population included 186 participants with subjective cognitive decline and 348 mild cognitive impairment participants from Dementia Research Centre (Singapore). Mean age of the cohort was 62.55, SD = 9.55, mean education years was 13.97, SD = 3.45 and majority were women (57.1%). The prevalence of apathy among our cohort was 23.5%. Compared to participants without apathy, those with apathy had poorer cognitive scores in processing speed (test of coding) (β = -4.60, p<0.001), executive function (colour trails 2) (β = 9.71, p = 0.020), episodic memory on the RAVLT Delayed (β = -0.738, p = 0.026), RCFT Delayed (β = -1.941, p = 0.009) and FCSRT delayed (β = -0.616, p = 0.030). Participants with apathy were also more frail (β = 0.316, p<0.001) on the Fried Phenotype frailty assessment test and had poorer quality of life (β = -12.49, p<0.001), had lower levels of physical activity (β = 0.163, p = 0.017), and had poorer sleep (β = 2.25, p<0.001).
CONCLUSIONS: Apathy is associated with worse cognitive performance, higher frailty, lower physical performance and poorer sleep in an Asian pre-dementia community cohort. Screening for apathy and appropriate early intervention could reduce incidence of dementia and frailty.

BACKGROUND: The mild behavioral impairment checklist (MBI-C) designed to capture neuropsychiatric symptoms in the whole spectrum of elder with or without dementia, have been verified in mild behavioral impairment, mild cognitive impairment and Alzheimer\'s Disease, but never used in the behavioral variant of frontotemporal dementia (bvFTD).
METHODS: Fifty-two patients with bvFTD (mild, n = 30; moderate-severe, n = 22) and 82 community-dwelling elderly individuals (HCs) were enrolled. All subjects were assessed with a full neuropsychological scale including the MBI-C, Neuropsychiatric Inventory Questionnaire (NPI-Q), and Frontal Behavioral Inventory (FBI). Receiver operating characteristic curves were drawn to analyze the sensitivity and specificity of the MBI-C, NPI-Q, and FBI, and cutoff points were determined using the Youden index.
RESULTS: The MBI-C and domain scores in all patients with bvFTD were significantly higher than those in HCs. The most common symptoms of bvFTD were apathy (82.7%) and impulse dyscontrol (80.8%). The MBI-C score was positively correlated with the NPI-Q, FBI, and Activities of Daily Living. For differentiating patients with both bvFTD and mild bvFTD from HCs, the optimal MBI-C cutoff point was 5/6 with a sensitivity of 100% and specificity of 82%, and its sensitivity was higher than that of the NPI-Q and FBI.
CONCLUSIONS: The MBI-C is a sensitive tool for screening behavioral and psychological symptoms in patients with bvFTD, even in the early stages of the disease.

Late-life depression (LLD) is both common and disabling and doubles the risk of dementia onset. Apathy might constitute an additional risk of cognitive decline but clear understanding of its pathophysiology is lacking. While white matter (WM) alterations have been assessed using diffusion tensor imaging (DTI), this model cannot accurately represent WM microstructure. We hypothesized that a more complex multi-compartment model would provide new biomarkers of LLD and apathy. Fifty-six individuals (LLD n = 35, 26 females, 75.2 ± 6.4 years, apathy evaluation scale scores (41.8 ± 8.7) and Healthy controls, n = 21, 16 females, 74.7 ± 5.2 years) were included. In this article, a tract-based approach was conducted to investigate novel diffusion model biomarkers of LLD and apathy by interpolating microstructural metrics directly along the fiber bundle. We performed multivariate statistical analysis, combined with principal component analysis for dimensional data reduction. We then tested the utility of our framework by demonstrating classically reported from the literature modifications in LDD while reporting new results of biological-basis of apathy in LLD. Finally, we aimed to investigate the relationship between apathy and microstructure in different fiber bundles. Our study suggests that new fiber bundles, such as the striato-premotor tracts, may be involved in LLD and apathy, which bring new light of apathy mechanisms in major depression. We also identified statistical changes in diffusion MRI metrics in 5 different tracts, previously reported in major cognitive disorders dementia, suggesting that these alterations among these tracts are both involved in motivation and cognition and might explain how apathy is a prodromal phase of degenerative disorders.

Although one of the most prevalent and impactful features of Huntington\'s disease (HD), little is known about the impact of apathy on HD caregivers, although there is evidence it affects perceptions of distress and burden. Given the importance of the caregivers, we aimed to explore the lived experience of people supporting someone with HD and associated apathy. Semi-structured interviews were conducted with 11 caregivers and analysed using reflective thematic analysis, informed by a phenomenological framework. Five overarching themes were produced: (1) What even is apathy? (2) It makes my life harder: the practical impact of apathy, (3) They haven\'t forgotten me, but they have forgotten that they ever loved me, (4) I\'m grieving for someone who hasn\'t died yet, and (5) I need a safe space to say what I really feel without fear of judgement. Inter-woven between these themes were complex narratives about the unspoken nature of HD, the invisibility of caregivers who felt trapped and unheard, and the one-sided nature of loving someone with the disease. Findings are discussed in relation to theoretical frameworks of anticipatory grief and ambiguous loss, and situated within the wider literature on caregiving for people with a neurodegenerative condition.

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