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. 2023 Jun;13(6):e2862.
doi: 10.1002/brb3.2862. Epub 2023 May 18.

Dimensions of apathy in Parkinson's disease

Nasya Thompson  1   2 , Michael MacAskill  1   2 , Maddie Pascoe  1 , Tim Anderson  1   2   3 , Campbell Le Heron  1   2   3
Affiliations

Dimensions of apathy in Parkinson's disease

Nasya Thompson et al. Brain Behav. 2023 Jun.

Abstract

Introduction: Apathy is one of the most common neuropsychiatric manifestations in Parkinson's disease (PD). Recent proposals consider apathy as a multidimensional construct, which can manifest in behavioral, cognitive, emotional, and/or social dimensions. Apathy also overlaps conceptually and clinically with other non-motor comorbidities, particularly depression. Whether all of these dimensions are applicable to the apathetic syndrome experienced by people with PD is unclear. In the present study, we investigated the multidimensional pattern of apathy associated with PD, using the recently developed Apathy Motivation Index (AMI) which probes behavioral, emotional, and social apathy dimensions. We then examined the relationship between these dimensions and other features of PD commonly associated with apathy, including depression, anxiety, cognition, and motor state.

Methods: A total of 211 participants were identified from the New Zealand Brain Research Institute (NZBRI) longitudinal PD cohort. One hundred eight patients and 45 controls completed the AMI, administered as an online questionnaire, and additional assessments including neuropsychiatric, neuropsychological, and motor scores. The pattern of dimensional apathy in PD was assessed using a repeated-measured analysis of variance, while simple linear regressions were performed to evaluate relationships between these dimensions and other variables.

Results: We found a significant interaction between group (PD versus control) and apathy subscale, driven mainly by higher levels of social and behavioral-but not emotional-apathy in those with PD. This result was strikingly similar to a previous study investigating social apathy in PD. Distinct patterns of dimensional apathy were associated with depression and anxiety, with social and behavioral apathy positively associated with depression, and emotional apathy negatively associated with anxiety.

Conclusion: This work provides further evidence for a distinct pattern of apathy in people with PD in which deficits manifest in some-but not all-dimensions of motivated behavior. It emphasizes the importance of considering apathy as a multidimensional construct in clinical and research settings.

Keywords: Parkinson's disease; apathy; dimensional apathy; non-motor symptoms.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
CONSORT trial flow diagram
FIGURE 2
FIGURE 2
Comparison of apathy dimensions between people with Parkinson's disease (PD) and controls. The left panel shows the current cohort (NZBRI), while the right panel shows results from a previous study (Ang et al., 2018) for comparison. In the NZBRI cohort, there was a significant interaction between group and subscale, driven mainly by participants with PD having significantly greater levels of social apathy, and a trend toward greater levels of behavioral apathy. Emotional apathy levels were very similar between the two groups. The NZBRI results demonstrate a very similar pattern to those obtained in the prior Oxford study. Graph represents the mean sub score ± SE. significance was assessed using a mixed model analysis of variance. *p <.05
FIGURE 3
FIGURE 3
Higher Apathy Motivation Index (AMI) scores in those classified as apathetic by Neuropsychiatric Inventory
FIGURE 4
FIGURE 4
Differential association of Apathy Motivation Index (AMI) subdomains with depression and anxiety in Parkinson's disease (PD). Higher levels of behavioral and social apathy were associated with higher levels of depression, whereas higher levels of emotional apathy were associated with lower levels of anxiety.
FIGURE 5
FIGURE 5
Relationship between dimensional apathy and motor severity (top panels) and cognition (bottom panels)
See this image and copyright information in PMC

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