Apathy in Dementia with Lewy Bodies: Frequency and Impact on Patient and Caregiver Experiences
Anastasia Barnes1, Tingchang Wang2, Alfonso Enrique Martinez-Nunez1, Zhigang Li2, Melissa Armstrong1
1Neurology, 2Biostatistics, University of Florida
Objective:

To determine frequency and correlates of apathy in dementia with Lewy bodies (DLB).

Background:

Apathy is a common behavioral symptom in parkinsonian syndromes. Limited prior research investigates the frequency and impact of apathy in DLB.

Design/Methods:

A retrospective review of two databases was conducted: (1) a University of Florida clinical database and (2) the Predicting Accurately End-of-Life in DLB and Promoting Quality End-of-Life Experiences (PACE-DLB) study in moderate-advanced DLB. Apathy was assessed via the Starkstein Apathy Scale in the former and the Neuropsychiatric Inventory–Questionnaire (NPI-Q) in the latter. Apathy was correlated with other available measures in each database including the Beck Depression Inventory (BDI-II), Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), NPI-Q, motor Unified Parkinson's Disease Rating Scale (UDPRS), cognitive screens (MMSE, MOCA), Quick Dementia Rating System (QDRS), and quality of life (Quality of Life-Alzheimer's Disease Scale, QoL-AD). For correlations, strength was assessed as weak if <0.4, moderate if 0.4 to 0.59, and strong if >0.59.

Results:

For individuals with DLB in the clinical database (76% men, mean age 73, mean disease duration 2.18y), 80% had apathy. Apathy correlated with depression (BDI-II: r=0.562, p<0.001; GDS: r=0.773, p=0.042), anxiety (BAI: r=0.478, p=0.002), and motor symptoms (r=0.248; p=0.013) but not cognitive screening (performed in a subset). In PACE-DLB (78% men, mean age 75, mean disease duration 3.24y), 78% had apathy. Apathy correlated with cognitive severity (QDRS; r=0.162, p=0.026), depression (NPI-Q: r=0.263, p<0.001), anxiety (NPI-Q: r=0.155, p=0.034) and participant quality of life (QoL-AD: r=-0.319, p=0.006) but not hallucinations or delusions. Apathy correlated with caregiver quality of life (QoL-AD: r=-0.149, p=0.005) but not depression or burden.

Conclusions:
Apathy is highly prevalent in DLB and correlates with cognitive severity, anxiety, depression and quality of life. This study underscores the importance of screening for apathy. Additional research is needed to identify pharmacologic and non-pharmacologic treatments.
10.1212/WNL.0000000000213124
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