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. 2018 Mar;25(3):469-e32.
doi: 10.1111/ene.13515. Epub 2017 Dec 14.

Apathy in rapid eye movement sleep behaviour disorder is common and under-recognized

T R Barber  1   2 , K Muhammed  1   3 , D Drew  1 , M Lawton  4 , M Crabbe  1   2 , M Rolinski  1   2   5 , T Quinnell  6 , Z Zaiwalla  7 , Y Ben-Shlomo  4 , M Husain  1   3 , M T M Hu  1   2
Affiliations

Apathy in rapid eye movement sleep behaviour disorder is common and under-recognized

T R Barber et al. Eur J Neurol. 2018 Mar.

Abstract

Background and purpose: Apathy is an important neuropsychiatric feature of Parkinson's disease (PD), which often emerges before the onset of motor symptoms. Patients with rapid eye movement sleep behaviour disorder (RBD) have a high probability of developing PD in future. Neuropsychiatric problems are common in RBD, but apathy has not previously been detailed in this key prodromal population.

Methods: Eighty-eight patients with polysomnographically proven RBD, 65 patients with PD and 33 controls were assessed for apathy using the Lille Apathy Rating Scale. Cognition and depression were also quantified. The sensitivity of the Unified Parkinson's Disease Rating Scale screening questions for apathy and depression was calculated.

Results: A total of 46% of patients with RBD were apathetic, compared with 31% of patients with PD in our sample. Most patients with RBD with depression were apathetic but more than half of apathetic patients were not depressed. The sensitivity of the single Unified Parkinson's Disease Rating Scale screening question was only 33% for mild apathy and 50% for severe apathy.

Conclusions: Apathy is common in RBD and is underestimated by a single self-report question. Recognition of apathy as a distinct neuropsychiatric feature in RBD could aid targeted treatment interventions and might contribute to the understanding of prodromal PD.

Keywords: Parkinson's disease; apathy; prodromal; rapid eye movement sleep behaviour disorder.

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Figures

Figure 1
Figure 1
Overlap between apathy, depression and mild cognitive impairment (MCI) in patients with (a) rapid eye movement sleep behaviour disorder (n = 88) and (b) Parkinson's disease (n = 65). Apathy is defined as Lille Apathy Rating Scale score ≥−21, cognitive impairment as Montreal Cognitive Assessment score <24 and depression as Beck Depression Inventory score >13.
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References

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