Objectives
Apathy is a frequent neuropsychiatric consequence of stroke. In the under-researched
population of institutionalized stroke patients, we aimed to explore the prevalence
of apathy, its clinical correlates, and the relation to the amount of stimulating
activities in the nursing home (NH).
Design
A cross-sectional, observational study.
Setting
Dutch NHs.
Participants
274 chronic stroke patients.
Measurements
Data were collected through observation lists that were filled out in structured interviews
with qualified nurse assistants who knew the residents well. The lists comprised the
NH-version of the Apathy Evaluation Scale (AES10), the Barthel Index, the Neuropsychiatric
Inventory Questionnaire, and sections of the Resident Assessment Instrument for Long-Term
Care Facilities. Attending physicians and therapists provided additional information.
Results
Apathy (AES10 score ≥30) was present in 28% of residents. Multilevel regression analyses
revealed that this apathy was independently related to (moderate, severe) cognitive
impairment (odds ratio [OR] 11.30 [95% confidence interval (CI): 4.96–25.74], OR 5.54
[95% CI: 2.48–12.40]), very severe ADL-dependency (OR 12.10 [95% CI: 1.35–108.66]),
and being >12 hours per day in bed (OR 2.10 [95% CI: 1.07–4.13]). It was not related
to depressive mood symptoms (OR 1.75 [95% CI: 0.91–3.37]). Only in residents aged
less than 80 years were a higher amount of activities independently related to a lower
AES10 score (−0.70 [95% CI: −1.18 to −0.20] points per four extra activities in a
4-week period).
Conclusions
Apathy is prevalent in largely one-quarter of institutionalized stroke patients, and
that is most strongly related to cognitive impairment in this explorative study. We
discuss the need for research on the relation with distinct dimensions of depression
and fatigue as partly overlapping constructs, and on (individualized) stimulating
activities as a possible intervention method.
Key Words
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References
- Evolving research in the geriatric neuropsychiatry of stroke.Am J Geriatr Psychiatry. 2013; 21: 817-820
- Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders.Eur Psychiatry. 2009; 24: 98-104
- The nosological position of apathy in clinical practice.J Neurol Neurosurg Psychiatry. 2008; 79: 1088-1092
- Apathy secondary to stroke: a systematic review and meta-analysis.Cerebrovasc Dis. 2013; 35: 23-39
- Poststroke apathy.Stroke. 2013; 44: 851-860
- Influence of premorbid psychopathology and lesion location on affective and behavioral disorders after ischemic stroke.J Neuropsychiatry Clin Neurosci. 2011; 23: 340-347
- A longitudinal view of apathy and its impact after stroke.Stroke. 2009; 40: 3299-3307
- A longitudinal study examining the independence of apathy and depression after stroke: the Sydney Stroke Study.Int Psychogeriatr. 2011; 23: 264-273
- Apathy: a common psychiatric syndrome in the elderly.J Am Med Dir Assoc. 2009; 10: 381-393
- Apathy: why care?.J Neuropsychiatry Clin Neurosci. 2005; 17: 7-19
- Institutionalized stroke patients: status of functioning of an under researched population.J Am Med Dir Assoc. 2012; 13: 634-639
- Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer's disease: a randomized controlled trial.Clin Rehabil. 2010; 24: 1102-1111
- A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care.Int J Geriatr Psychiatry. 2004; 19: 1087-1094
- The effects of psychosocial methods on depressed, aggressive and apathetic behaviors of people with dementia: a systematic review.Int J Geriatr Psychiatry. 2005; 20: 301-314
- Incident apathy during the first year after stroke and its effect on physical and cognitive recovery.Am J Geriatr Psychiatry. 2013; 21: 848-854
- Apathy and functional recovery following first-ever stroke.Int J Rehabil Res. 2008; 31: 321-326
- Apathy and weight loss in nursing home residents: longitudinal study.J Am Med Dir Assoc. 2013; 14: 417-420
- Development of a short version of the Apathy Evaluation Scale specifically adapted for demented nursing home residents.Am J Geriatr Psychiatry. 2007; 15: 376-385
- Are the available apathy measures reliable and valid? A review of the psychometric evidence.J Psychosom Res. 2011; 70: 73-97
- A comparative validation of the Abbreviated Apathy Evaluation Scale (AES-10) with the Neuropsychiatric Inventory Apathy subscale against Diagnostic Criteria of Apathy.J Am Med Dir Assoc. 2012; 13: 308.e1-308.e6
- [Clinimetric evaluation of the Barthel Index, a measure of limitations in daily activities].Ned Tijdschr Geneeskd. 1993; 137: 917-921
- Use of the Barthel index and modified Rankin scale in acute stroke trials.Stroke. 1999; 30: 1538-1541
- Pain in U.S. nursing homes: validating a pain scale for the minimum data set.Gerontologist. 2001; 41: 173-179
- The implementation of the serial trial intervention for pain and challenging behaviour in advanced dementia patients (STA OP!): a clustered randomized controlled trial.BMC Geriatr. 2011; 11: 12
- Fatigue after stroke: the development and evaluation of a case definition.J Psychosom Res. 2007; 63: 539-544
- Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents.Int J Geriatr Psychiatry. 2007; 22: 286-293
- [Neuropsychiatric inventory questionnaire (NPI-Q): A validity study of the Dutch form].Tijdschr Gerontol Geriatr. 2003; 34: 74-77
- InterRAI Long-Term Care Facilities (LTCF) Assessment Form and User's Manual, 9.1.interRAI, Washington, DC2006
- Applied Multilevel Analysis. A Practical Guide.Cambridge University Press, Cambridge2006
- Differential diagnosis and classification of apathy.Am J Psychiatry. 1990; 147: 22-30
- Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke—the Sydney Stroke Study.Psychol Med. 2005; 35: 1707-1716
- Post-stroke depression and apathy: interactions between functional recovery, lesion location, and emotional response.Psychogeriatrics. 2011; 11: 68-76
- SSRI-induced apathy syndrome: a clinical review.J Psychiatr Pract. 2004; 10: 196-199
- Neuroanatomic pathways associated with poststroke affective and apathetic depression.Am J Geriatr Psychiatry. 2013; 21: 840-847
- Poststroke fatigue: a 2-year follow-up study of stroke patients in Sweden.Stroke. 2002; 33: 1327-1333
- Frequency and natural history of fatigue after stroke: a systematic review of longitudinal studies.J Psychosom Res. 2012; 73: 18-27
- The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue.J Psychosom Res. 1995; 39: 315-325
- The effects of a nursing guideline on depression in psychogeriatric nursing home residents with dementia.Int J Geriatr Psychiatry. 2011; 26: 723-732
- [The Pleasant-Events-Method after a stroke].TvZ. 2013; 3: 48-51
- Apathy due to cerebrovascular accidents successfully treated with methylphenidate: a case series.J Neuropsychiatry Clin Neurosci. 2009; 21: 216-219
Article info
Publication history
Published online: March 31, 2014
Accepted:
March 26,
2014
Received in revised form:
March 25,
2014
Received:
September 18,
2013
Identification
Copyright
© 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
