Psychometric Properties of Apathy Scales in Dementia: A Systematic Review

Article type: Research Article

Authors: Mohammad, Dana^{a; b} | Ellis, Courtney^c | Rau, Allison^b | Rosenberg, Paul B.^d | Mintzer, Jacobo^e | Ruthirakuhan, Myuri^{a; b} | Herrmann, Nathan^{a; f} | Lanctôt, Krista L.^{a; b; f; *}

Affiliations: [a] Sunnybrook Research Institute, Toronto, ON, Canada | [b] Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada | [c] Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada | [d] Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA | [e] Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA | [f] Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Correspondence: [*] Correspondence to: Krista L. Lanctôt, Sunnybrook Hospital, FG 21, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Tel.: +1 416 480 6100/Ext.2241; E-mail: Krista.Lanctot@sunnybrook.ca.

Abstract: Apathy is a prevalent and problematic neuropsychiatric symptom in those with dementia that is emerging as a treatment target, necessitating accurate assessment. While many apathy scales are available, not all have been developed for use exclusively in dementia, and psychometric properties may vary across different populations. This systematic review aimed to provide an overview of the psychometric properties of apathy scales used in Alzheimer’s disease (AD) and related dementias, as well as rate the methodological quality of supporting studies. In addition, for those scales identified, performance in clinical trials was reviewed. A search was conducted through Medline, Psychinfo, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Articles that reported psychometric properties of an apathy scale in an AD or mixed dementia population were included. Of 15 articles, the methodological quality ratings of the studies ranged from adequate to excellent. Three clinical trials and two pooled analyses of clinical trials were included that used apathy scales evaluated in this review. Three scales emerged. The Neuropsychiatric Inventory apathy subscale (NPI-apathy) and the Apathy Evaluation Scale (AES) had the greatest number of studies evaluating psychometric properties and were also used in the clinical trials and have shown sensitivity to change. The Dementia Apathy Interview and Rating demonstrated excellent values of internal consistency, validity, and reliability for use in an AD population. Future research should address comparative scale performance and assess ability to distinguish subtypes of apathy. Validation may include evaluation of performance against specific imaging defined deficits.

Keywords: Alzheimer’s disease, apathy, dementia, diagnosis, psychometrics

DOI: 10.3233/JAD-180485

Journal: Journal of Alzheimer's Disease, vol. 66, no. 3, pp. 1065-1082, 2018