Assessment of Dementia Related Apathy: Cognitive Debriefing for the Neuropsychiatric Inventory Clinician Apathy Domain
Betsy Williams1, Karli Heuer1, Rahul Sasane2, Jianbin Mao2, Jennifer N. Hill1, Gary Globe2, Emily Ruzich1, Stella Karantzoulis1
1IQVIA Inc., 2Cerevel Therapeutics
Objective:
To assess content validity of the Neuropsychiatric Inventory Clinician (NPI-C) Apathy domain for use in clinical trials for dementia-related apathy (DRA).
Background:
Diagnostic criteria for apathy were published in May 2021, but there is no accepted standard assessment for evaluation of treatment benefit for DRA.
Design/Methods:
Clinicians with research/clinical experience with patients with DRA and caregivers caring for a patient with current DRA in the home-setting were recruited. Interviews were conducted by trained moderators using semi-structured discussion guides and were recorded with permission. Audiofiles were transcribed; transcripts were coded and analyzed to assess debriefed instructions, domain items, responses, and recall period.
Results:
Five clinicians (6-33-years’ dementia experience) and 10 caregivers (50% female; mean age=56.5 years; 50% spouses) of patients with DRA (50% female; mean age=74.2 years; 50% moderate, 50% mild dementia) were interviewed. Clinicians agreed that 10/11 NPI-C Apathy domain items were relevant; one felt Item 8 could be related to cognitive impairment. Instructions and response options were understandable, although clinicians indicated that severity would be more reliable than frequency. Clinicians considered the four-week recall as long and that caregivers would mainly describe most bothersome events in the past one-two weeks. Clinicians reported being dependent on caregiver responses regarding patient experiences because patients with DRA are unable to reliably report. Caregivers indicated that instructions were clear (n=10), response options were clear and relevant (n=9), and overall the NPI-C Apathy domain was relevant to their experience (n=10), with most caregivers (≥75%) able to easily understand and respond to each item.
Conclusions:
Based on clinician and caregiver concept elicitation (reported elsewhere) and current debriefing interviews, the NPI-C Apathy domain covers the most important concepts in DRA. A shorter recall period is recommended for clinical trials. Further research is warranted to assess the psychometric properties in this context of use.