The Apathy Evaluation Scale: A Comparison of Subject, Informant, and Clinician Report in Cognitively Normal Elderly and Mild Cognitive Impairment

Article type: Research Article

Authors: Guercio, Brendan J.^{a; b} | Donovan, Nancy J.^{a; b; c; d} | Munro, Catherine E.^e | Aghjayan, Sarah L.^{b; c; e} | Wigman, Sarah E.^{c; e} | Locascio, Joseph J.^e | Amariglio, Rebecca E.^{a; b; c; d; e} | Rentz, Dorene M.^{a; b; c; d; e} | Johnson, Keith A.^{a; b; c; f} | Sperling, Reisa A.^{a; b; c; e} | Marshall, Gad A.^{a; b; c; e; *}

Affiliations: [a] Harvard Medical School, Boston, MA, USA | [b] Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Boston, MA, USA | [c] Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA | [d] Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA | [e] Department of Neurology, Massachusetts General Hospital, Boston, MA, USA | [f] Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

Correspondence: [*] Correspondence to: Gad A. Marshall, MD, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, 221Longwood Avenue, BL-104H, Boston, MA 02115, USA. Tel.:+1 617 732 8085; Fax: +1 617 264 5212; gamarshall@partners.org

Abstract: Background: Apathy is a common neuropsychiatric symptom in Alzheimer’s disease (AD) dementia and mild cognitive impairment (MCI). Detecting apathy accurately may facilitate earlier diagnosis of AD. The Apathy Evaluation Scale (AES) is a promising tool for measurement of apathy in prodromal and possibly preclinical AD. Objective: To compare the three AES sub-scales— subject-reported (AES-S), informant-reported (AES-I), and clinician-reported (AES-C)— over time in individuals at risk for AD due to MCI and advanced age (cognitively normal [CN] elderly). Methods: Mixed effects longitudinal models were used to assess predictors of score for each AES sub-scale. Cox proportional hazards models were used to assess which AES sub-scales predict progression from MCI to AD dementia. Results: Fifty-seven MCI and 18 CN subjects (ages 53–86) were followed for 1.4 ± 1.2 years and 0.7 ± 0.7 years, respectively. Across the three mixed effects longitudinal models, the common findings were associations between greater apathy and greater years in study, a baseline diagnosis of MCI (compared to CN), and male gender. CN elderly self-reported greater apathy compared to that reported by informants and clinicians, while individuals with MCI under-reported their apathy compared to informants and clinicians. Of the three sub-scales, the AES-C best predicted transition from MCI to AD dementia. Conclusion: In a sample of CN elderly and elderly with MCI, apathy increased over time, particularly in men and those with MCI. AES-S scores may be more sensitive than AES-I and AES-C scores in CN elderly, but less reliable if subjects have MCI. Moreover, the AES-C sub-scale predicted progression from MCI to AD dementia.

Keywords: Aged, Alzheimer’s disease, apathy, mild cognitive impairment, symptom assessment

DOI: 10.3233/JAD-150146

Journal: Journal of Alzheimer's Disease, vol. 47, no. 2, pp. 421-432, 2015