Whitney Fitts1, Daniel Weintraub2, Lauren Massimo1, Lama Chahine1, Alice Chen-Plotkin1, John E Duda3, Howard I Hurtig1, Jacqueline Rick1, John Q Trojanowski4, Nabila Dahodwala5. 1. Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 2. Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Parkinson Disease Research, Education and Clinical Center, Veterans Affairs, Philadelphia, PA, USA. 4. Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: nabila.dahodwala@uphs.upenn.edu.
Abstract
INTRODUCTION: Apathy is a common, troublesome symptom in Parkinson's disease (PD). However, little is known about its relationship with long-term cognition. We sought to determine if a caregiver-reported apathy measure predicts the development of PD dementia. METHODS: Non-demented PD patients were recruited as part of a longitudinal study of cognition. Demographics, medications, Dementia Rating Scale-2, Unified Parkinson's Disease Rating Scale, Geriatric Depression Scale and the Neuropsychiatric Inventory-Questionnaire (NPI-Q) ratings were obtained. Apathy was defined as an NPI-Q apathy score ≥1. Participants were evaluated annually with cognitive and functional assessments until the end of the study period or a physician consensus diagnosis of dementia was assigned. Cox proportional hazard models were used to assess the effects of baseline apathy on dementia development while controlling for other clinical and demographic factors. RESULTS: Of 132 PD patients 12.1% (N = 16) scored in the apathetic range at baseline. A total of 19.6% (N = 26) individuals developed dementia over the course of the study, 8 of whom (30.8% of future dementia patients) had baseline apathy. In bivariate analyses baseline apathy, older age, and worse cognitive, motor, and depressive symptom scores predicted the development of dementia. In a multivariate analysis the predictive effects of baseline apathy were still significant (HR = 3.56; 95% CI = 1.09-11.62; p = 0.04). CONCLUSIONS: A simple, caregiver-reported measure of apathy is an independent predictor of progression to dementia in PD. This highlights the importance of apathy as a clinical characteristic of PD and could prove useful for the prediction of future dementia.
INTRODUCTION: Apathy is a common, troublesome symptom in Parkinson's disease (PD). However, little is known about its relationship with long-term cognition. We sought to determine if a caregiver-reported apathy measure predicts the development of PD dementia. METHODS: Non-demented PDpatients were recruited as part of a longitudinal study of cognition. Demographics, medications, Dementia Rating Scale-2, Unified Parkinson's Disease Rating Scale, Geriatric Depression Scale and the Neuropsychiatric Inventory-Questionnaire (NPI-Q) ratings were obtained. Apathy was defined as an NPI-Q apathy score ≥1. Participants were evaluated annually with cognitive and functional assessments until the end of the study period or a physician consensus diagnosis of dementia was assigned. Cox proportional hazard models were used to assess the effects of baseline apathy on dementia development while controlling for other clinical and demographic factors. RESULTS: Of 132 PDpatients 12.1% (N = 16) scored in the apathetic range at baseline. A total of 19.6% (N = 26) individuals developed dementia over the course of the study, 8 of whom (30.8% of future dementiapatients) had baseline apathy. In bivariate analyses baseline apathy, older age, and worse cognitive, motor, and depressive symptom scores predicted the development of dementia. In a multivariate analysis the predictive effects of baseline apathy were still significant (HR = 3.56; 95% CI = 1.09-11.62; p = 0.04). CONCLUSIONS: A simple, caregiver-reported measure of apathy is an independent predictor of progression to dementia in PD. This highlights the importance of apathy as a clinical characteristic of PD and could prove useful for the prediction of future dementia.
Authors: S E Starkstein; H S Mayberg; T J Preziosi; P Andrezejewski; R Leiguarda; R G Robinson Journal: J Neuropsychiatry Clin Neurosci Date: 1992 Impact factor: 2.198
Authors: Audrey McKinlay; Randolph C Grace; John C Dalrymple-Alford; Timothy J Anderson; John Fink; Derek Roger Journal: Aging Ment Health Date: 2008-09 Impact factor: 3.658
Authors: Albert F G Leentjens; Kathy Dujardin; Laura Marsh; Pablo Martinez-Martin; Irene H Richard; Sergio E Starkstein; Daniel Weintraub; Cristina Sampaio; Werner Poewe; Oliver Rascol; Glenn T Stebbins; Christopher G Goetz Journal: Mov Disord Date: 2008-10-30 Impact factor: 10.338
Authors: Dawn M Schiehser; Lin Liu; Stephanie L Lessig; David D Song; Kristalyn M Obtera; Mathes M Burke Iii; Shannon R Earl; J Vincent Filoteo Journal: J Int Neuropsychol Soc Date: 2013-01-28 Impact factor: 2.892
Authors: Rachael Purri; Laura Brennan; Jacqueline Rick; Sharon X Xie; Benjamin L Deck; Lana M Chahine; Nabila Dahodwala; Alice Chen-Plotkin; John E Duda; James F Morley; Rizwan S Akhtar; John Q Trojanowski; Andrew Siderowf; Daniel Weintraub Journal: Mov Disord Date: 2020-06-10 Impact factor: 10.338
Authors: Ulrike Lueken; Ricarda Evens; Monika Balzer-Geldsetzer; Simon Baudrexel; Richard Dodel; Susanne Gräber-Sultan; Rüdiger Hilker-Roggendorf; Elke Kalbe; Oliver Kaut; Brit Mollenhauer; Kathrin Reetz; Eva Schäffer; Nele Schmidt; Jörg B Schulz; Annika Spottke; Karsten Witt; Katharina Linse; Alexander Storch; Oliver Riedel Journal: Int J Methods Psychiatr Res Date: 2017-04-18 Impact factor: 4.035
Authors: Kyla-Louise Horne; Michael R MacAskill; Daniel J Myall; Leslie Livingston; Sophie Grenfell; Maddie J Pascoe; Bob Young; Reza Shoorangiz; Tracy R Melzer; Toni L Pitcher; Tim J Anderson; John C Dalrymple-Alford Journal: Mov Disord Clin Pract Date: 2021-02-18
Authors: Jennifer A Foley; Tom Foltynie; Ludvic Zrinzo; Jonathan A Hyam; Patricia Limousin; Lisa Cipolotti Journal: Behav Neurol Date: 2017-03-20 Impact factor: 3.342