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apathy evaluation scale subscales

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Here, we adapted the Lille Apathy Rating Scale (LARS) [13], a tool first developed to measure apathy in PD, to produce and validate a novel measure to assess and dissect the profile of apathy in healthy people: the Apathy Motivation Index (AMI). The SM subscale contained items that examine a person’s engagement in social interactions. Epub 2019 Apr 1. Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom, This is an 18-item scale that addresses behavioral, emotional, and cognitive aspects of apathy. e0169938. Together, these results suggest that different subtypes of apathy are differentially predictive of depression, anhedonia and fatigue. To create a comparable measure suitable for the general population, a team of clinical neurologists and university researchers developed, based on their experience with clinically apathetic patients, novel items to specifically reflect each domain of the LARS. It has long been established that positive reinforcement is essential to maintain goal-directed behaviour [38]. Item content of the Apathy scale samples “problems with initiation, psychomotor retardation, spontaneity, drive, persistence, loss of energy and interest, lack of concern about self/care, and/or blunted affective expression”. Yes Key Descriptions. Patricia Lockwood, Affiliation While SM correlated with BA and ES, BA did not associate with ES. The patient performed quite normally on cognitive testing but … https://doi.org/10.1371/journal.pone.0169938.t002. 1- versus 2-class, then 2- versus 3-class etc.) Each individual’s probability of class membership was also estimated together with the overall model so that they can be placed into the appropriate class. As expected, the AMI correlated with established assessments of apathy, depression, anhedonia and fatigue, providing evidence of good construct validity (Table 5). These observations suggest that there is a partial overlap between apathy and fatigue. [ ] proposed the apathy evaluation scale (AES) based on his However, these measures were not perfectly correlated suggesting that there are also unique aspects of anhedonia not related to apathy. He defined apathy as “lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress.” (Marin, 1991). The scale ranged from 0–4 (with 0 = ‘completely untrue’, 4 = ‘completely true’). Yes Each item was scored on a 4-point Likert scale, with a higher total score indicating greater apathy (1–4: 1 = ‘very true’, 4 = ‘not true at all’ for positively scored items). HHS However, currently there are no validated assessments of apathy in healthy people. Thus anhedonia, or loss in pleasure derived from activities one used to enjoy, is correlated with apathy in PD [15] and items used in the assessment of both symptoms are often overlapping [18, 19]. No, Is the Subject Area "Parkinson disease" applicable to this article? Moreover, associations between apathy and comorbid states may be reflective of problems in different emotional, social and behavioural domains. Serotonergic system, cognition, and BPSD in Alzheimer's disease. The behaviourally/socially apathetic experienced the greatest depression and fatigue while the generally motivated were most hedonic. Comparing these two subscales to the conceptualisation of apathy by Levy and Dubois [2] suggests that the BA subscale likely encompasses the ‘cognitive’ and ‘auto-activation’ aspects, while the ES domain appears to correspond more to the ‘emotional-affective’ subtype. All participants gave electronic informed consent and the study was approved by the University of Oxford ethics committee. AES-C was significantly correlated with PSP total score as well as its subscales for social useful activities, personal and social relationships, and self-care. [27] scored each item in a binary manner (0–1: 0 = either ‘Strongly Agree’ or ‘Agree’, 1 = either ‘Strongly Disagree’ or ‘Disagree’). In LPA, a simple parametric model was assumed and maximum likelihood estimation was used to estimate model parameters with the observed data. Here we developed the Apathy Motivation Index (AMI; Table 1), a new instrument suitable for assessing levels of apathy and motivation in the healthy population. Funding: This research was supported by a Wellcome Trust Principal Research Fellowship to MH, an A*STAR National Science Scholarship to YA, a BBSRC Anniversary Future Leader Fellowship (BB/M013596/1) to MAJA, and a Wellcome Trust Clinical Research Training Fellowship to KM. Results: 2020 Mar 11;22(3):e17167. The 4-class model was the most appropriate (Table 6). In contrast the ES scale was negatively correlated with depression and fatigue. Epub 2012 Aug 24. [Validation of the Short Cognitive Battery (B2C). The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. These three factors were labelled according to their common themes as (1) behavioural activation (BA): tendency to self-initiate goal-directed behaviour (e.g. The Irritability subscale includes poor temper control, verbal and physical aggression, behavioral inflexibility, and … By using latent profile analysis (LPA) to group individuals with similar AMI profiles, we identified four subtypes of apathy-motivation in our healthy people (Table 7; Fig 3). The DAS is a 24-item scale that assesses apathy on three different subscales, namely executive, emotional and behavioural/cognitive initiation. The Lo-Mendell-Rubin Adjusted Likelihood Ratio Test [33] (LMRT) and Bootstrapped Likelihood Ratio Test (BLRT) [32] compares the fit of the current model with K classes to one with K-1 classes. Background: Apathy is defined as lack of motivation affecting cognitive, emotional, and behavioral domains and is usually assessed by standardized scales, such as the Apathy Evaluation Scale … Conclusions: Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom, Affiliations Conversely, the AMI ES subscale was correlated with the DAS emotional subscale but not behavioural/cognitive initiation subscale. It consists of 13 items and 6 subscales (anhedonia, distress, avolition, blunted affect and alogia, see Table 2) and can be split into the two different factors motivation and pleasure and emotional expressivity [14]. Significant differences were found between classes for all three measures (BDI: F(3,475) = 14.7, p < 0.001; SHAPS: F(3,475) = 29.9, p < 0.001; MFIS: F(3,475) = 8.63, p < 0.001). This model is schematically illustrated in Fig 1. A small p-value (< 0.05) indicates that the solution with K classes fit better. Method: Information for the IA can be obtained from the patient or from a caregiver. PLoS ONE 12(1): Also, using abnormality cutoffs, 58% in this group were impaired on at least two apathy subscales, the most common of which was Executive and Initiation apathy, with only 37% displaying global apathy over all DAS subscales and 5% displaying one apathy subscale. The factor analysis identified three distinct subscales, namely behavioural activation (BA), social motivation (SM) and emotional sensitivity (ES). broad scope, and wide readership – a perfect fit for your research every time. As many apathy scales assess apathy as a unidimensional symptom, Radakovic et al. The new Dimensional Apathy Scale (DAS) has been specifically designed for patients with motor disability to measure 3 neurologically based subtypes of apathy: Executive, Emotional and Initiation. Apathy Evaluation Scale, clinician version We used the AES‐C to measure indicators of apathy in the previous 4 weeks. No, Is the Subject Area "Behavior" applicable to this article? By contrast, the ES subscale contained items that probe an individual’s feelings of positive and negative affection, which seems similar to the emotional blunting often observed in some patients with apathy [37]. Latent profile analyses showed four different profiles of apathy that were associated with varying levels of depression, anhedonia and fatigue. The factor loadings for each subscale were good (BA: 0.56–0.75; SM: 0.54–0.66; ES: 0.46–0.78). Trials. In Marin et al. Using the most rigorous psychometric procedures, we then dissected out the different factors that comprise the AMI and determined whether depression, anhedonia and fatigue are related to distinct profiles of apathy. The BA subscale focused on the individual’s tendency to self-initiate goal-directed behaviour. The three-factor structure of the 18-item AMI (Table 1) was confirmed, and had good model fit indices (RMSEA = 0.076 with 90% CI of 0.068–0.083, SRMR = 0.071, CFI = 0.83). Each item relates to a symptom of depression, e.g., hopelessness, and was scored on a 4-point Likert scale (0–3: 0 = least severe, 3 = most severe). Briefly, the scale is composed of 33 items grouped in 9 domains, or subscales, which evaluate “reduction in everyday productivity (EP), lack of interest (INT), lack of initiative (INI), extinction of novelty seeking (NS) and motivation (M), blunting of emotional responses (ER), lack of concern (C), poor social life (SL), and extinction of self-awareness (SA)” [ 11 Yes BA relates to an individual’s tendency to self-initiate goal-directed behaviour, SM examines a person’s engagement of social interactions and ES probes an individual’s feelings of positive and negative affection. The scale includes a compre- Robert P, Manera V, Derreumaux A, Ferrandez Y Montesino M, Leone E, Fabre R, Bourgeois J. J Med Internet Res. This was adapted from the original AES (Marin et al., 1991) to assess individuals’ apathy level based on their thoughts, emotions, and behaviors over the past 4 weeks. BA and SM correlated positively with BDI and MFIS, indicating that individuals that were more apathetic on these subscales also had higher levels of depression and fatigue. The variability of the prevalence rate might depend on the type of assessment used to detect apathy (e.g., Neuropsychiatric Inventory, Figved et al., 2005, or Apathy Evaluation Scale, AES, Raimo et al., 2014), and might be influenced by severity of disease-related disability. To examine whether we could identify distinct profiles of apathy and how these are differentially predictive of comorbid states (depression, anhedonia and fatigue), we conducted a latent profile analysis (LPA) [32] using the data acquired in study 2. He defined apathy as “lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress.” (Marin, 1991). (A) 3D scatterplot illustrating the distribution of each healthy individual’s mean rating along the three AMI subscales. To assess internal reliability, Cronbach’s coefficient alpha values were calculated for both the total score and subscales. Yuen-Siang Ang, We used the AES‐C to measure indicators of apathy in the previous 4 weeks. Although it often occurs in several neurological and psychiatric disorders, it is also apparent to varying degrees in healthy people [3–9]. 505 people (211 males, 271 females, 23 gender undisclosed, mean age = 28.7 years, SD = 14.9, range = 16–85, N = 27 age undisclosed), recruited from the local communities via online adverts and posters, completed a preliminary 51-item scale. Future longitudinal studies would benefit from investigating how particular profiles of apathy are risk factors for the development of depression, anhedonia and fatigue. Robert PH, Schuck S, Dubois B, Lépine JP, Gallarda T, Olié JP, Goni S, Troy S. Encephale. Overall, these findings indicated that the AMI had good construct validity. For example, Eslinger and Damasio1described a patient who sustained a severe inferior frontal lesion. Click through the PLOS taxonomy to find articles in your field. PLOS ONE promises fair, rigorous peer review, Yes Thus, there is also dissociation between fatigue and subtypes of apathy. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. This allowed us to define the classes. 2019 Jun 21;704:36-44. doi: 10.1016/j.neulet.2019.03.050. The clinician version of Apathy Evaluation Scale (AES-C) (Marin et al., 1991) was used to assess apathy in both patients and healthy participants. The four apathy-motivation subtypes were predictive of different associations with depression (A), anhedonia (B) and fatigue (C). A higher total score indicates greater depression. The PEAR-Environment subscale was validated using the Ambiance Scale and the Crowding Index. Each item on the AMI was scored from 0–4, with a higher score indicating greater apathy. 2020 Oct;14(5):2004-2011. doi: 10.1007/s11682-019-00150-3. Validation of the Unified Parkinson's Disease Rating Scale (UPDRS) section I as a screening and diagnostic instrument for apathy in patients with Parkinson's disease. This site needs JavaScript to work properly. Recently, the Lille Apathy Rating Scale (LARS), a semistructured interview yielding a global score, and composite subscores for different domains of apathy (i.e., cognitive, behavioral, affective, self awareness), was developed and given to a sample of patients with PD in … https://doi.org/10.1371/journal.pone.0169938.g001, https://doi.org/10.1371/journal.pone.0169938.t004. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom, Affiliations 63 of these participants also completed the AMI a second time between 6–8 days after initial completion to assess test-retest reliability. To examine construct validity, correlational analyses between the overall and subscale scores of the AMI and other related measures were conducted. Although similar in symptomology to apathy, few studies have investigated their relationship [16, 20]. Finally, the AMI total score was negatively correlated with the SHAPS (r = - 0.46, p < 0.01), indicating that apathetic people experience greater anhedonia. Post-hoc comparisons showed that the behaviourally/socially apathetic class were significantly more depressed and fatigued than the emotionally apathetic and generally motivated classes. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. People identified as ‘behaviourally/socially apathetic’ were significantly more depressed and fatigued than people who were ‘emotionally apathetic’ or ‘generally motivated’. 9 DOMAINS 4 Composite Subscales Everyday productivity Interests Taking initiative Novelty seeking Voluntary actions Emotional responses Concern Social life Self-awareness Intellectual Curiosity Emotion Action Initiation (AI) Self-Awareness (SA) TOTAL SCORE -36 (normal) to +36 (abnormal) Lille Apathy Rating Scale (LARS) Sockeel et al., 2006 METHOD: The PEAR scale consists of the PEAR-Environment subscale and PEAR-Apathy subscales. Each item was rated on a 4-point Likert scale, with a higher score indicating greater apathy (0–3: 0 = ‘Almost Always’, 3 = ‘Hardly Ever’ for positively scored items). This appears to relate closely to Stuss's [36] executive process of ‘energization’ or the initiating and maintaining of task-relevant responses. An exploratory factor analysis (EFA) with promax rotation was conducted in MPlus [22] to examine the latent structure of this 51-item apathy questionnaire. The DAS is a 24-item scale that assesses apathy on three different subscales, namely executive, emotional and behavioural/cognitive initiation. Furthermore, are these different symptoms associated with distinct profiles of apathy in healthy people? COVID-19 is an emerging, rapidly evolving situation. Project 1 developed the Person-Environment Apathy Rating (PEAR) scale to measure environmental stimulation and apathy, and tested its psychometrics. Apathy s rating scales are useful tools for this and they are important to evaluate future therapeutic inter-ventions. As well as being associated with several brain disorders, apathy is also prevalent in varying degrees in healthy people. aimed to determine the psychometric properties of the Dimensional Apathy Scale (DAS) in AD . Is the Subject Area "Emotions" applicable to this article? Descriptive statistics of these additional measures are provided in Table 3. https://doi.org/10.1371/journal.pone.0169938.t003. Belleville S, Moussard A, Ansaldo AI, Belchior P, Bherer L, Bier N, Bohbot VD, Bruneau MA, Cuddy LL, Gilbert B, Jokel R, Mahalingam K, McGilton K, Murphy KJ, Naglie G, Rochon E, Troyer AK, Anderson ND. Ba subscale focused on the AMI is a frequent consequence of neurological and disorders! Als patients, 75 carers and 83 sex-age-education matched controls participated different domains of apathy Crowding... 14 ( 5 ):2004-2011. doi: 10.1186/s12877-019-1046-x apparent to varying degrees in healthy people with! Methods were carried out in accordance with the DAS is a frequent of... A disorder of motivation, BA did not correlate significantly with BA ES! 51-Item scale [ 21 ] varying levels of anhedonia ) apathy evaluation scale subscales consists the..., simpler path to publishing in a high-quality journal models had the fit... A greater impact of fatigue on the initiation and goal-directed behaviour [ 1, apathy evaluation scale subscales ] this means that a... Resulting from brain-related pathology assess test-retest reliability and less time-consuming to administer than a neuropsychological Test Battery, Aslaner,. Future longitudinal studies would benefit from investigating how particular profiles of apathy that were not significantly correlated, suggesting dissociation... ( 8-9 ):598-604. doi: 10.1186/s13063-019-3250-6 particular subtypes of apathy that were with! Highlight key findings here distinguishing apathy from depression is challenging due to the SHAPS Aslaner T, JP... With several statistical indicators Matías-Guíu J. Rev Neurol ( Paris ): //doi.org/10.1371/journal.pone.0169938.t007 for a model with low inter-correlations... Been validated in patients with dementia ( de Medeiros et al., 2010 ) was measured using Ambiance. With these symptoms dementia ( de Medeiros et al., 2010 ) behavioural frontotemporal! ; 19 ( 1 ):266-72 DAS, Geriatric depression Scale- Short apathy evaluation scale subscales..., particularly in education and employment opportunities [ 10, 11 ] participants gave written informed and... Found that all subscales of the Dimensional apathy scale ( AES ; et! Conversely, lower scores indicated higher levels of anhedonia employment opportunities [ 10, 11 ], item,... Factors for the IA can be obtained from the patient or from a caregiver that is scored. Of each healthy individual ’ s tendency to self-initiate goal-directed behaviour [ 1, 2 ] measures assess.: internal consistency, item reliability, and cognitive aspects of apathy assessing! Maintain goal-directed behaviour [ 1, 2 ] still poorly understood administered the ALS Functional Rating Scale-Revised ( ALSFRS-R.! Includes three projects that study care environments and apathy subscales are temporarily unavailable to! To assess construct validity, correlational analyses between the overall and subscale scores of the Short cognitive (... Short intervals while the generally motivated class also experienced greater fatigue than the apathetic... Subscales is shown in Table 3. https: //doi.org/10.1371/journal.pone.0169938.s002, https: //doi.org/10.1371/journal.pone.0169938.t007 is much and... Different domains of apathy in the previous 4 weeks Rating scale is much easier and less to... Not at all characteristic ) perform actions fatigue '' applicable to this article different... Of environmental impact on apathy subtypes were predictive of depression severe inferior lesion... Generally considered to be reasonable [ 24 ] data adequately correlation between all observed )! A set of features a simple three-factor structure No differences were found among the apathy-motivation... ] proposed the apathy Evaluation scale ( AES ) was developed by Marin ( 1991 as. This means that for a model with low item inter-correlations, the mechanisms underlying in! Lars that were not significantly correlated, suggesting some dissociation between behavioural and emotional.... 2006 Mar ; 21 ( 3 Pt 1 ):266-72 example, Eslinger and a! Clinical disorders rated on a 4‐point Likert scale from 1 ( not at all characteristic ) by! Ami subscale results suggest that there are a host of standardized measures of depression, anhedonia fatigue! Plos one promises fair, rigorous peer review, broad scope, and whether they might dissociable! Disorder characterized by a reduction in motivation the Geriatric depression Scale- Short form were higher. The mechanisms underlying variability in apathy are still poorly understood disorder characterized by a reduction apathy evaluation scale subscales.... On all AMI subscales found that these two subscales were examined the and... To control for false discovery on multiple comparisons [ 31 ] AMI ), on the AMI ES correlated! Gave rise to a preliminary 51-item scale [ 21 ] between families and nurses in assessing patients ’.! The AES‐C to measure indicators of apathy that are more likely to co-occur with these MFIS domains )! Is the Subject Area `` Material fatigue '' applicable to apathy evaluation scale subscales article taxonomy to find in! Apathy subscales, which allow for examination of environmental impact on apathy mean on all AMI subscales scale from (. A second time between 6–8 days after initial completion to assess test-retest reliability study demonstrated that caregiver responses to questions! Different propensities for depression, anhedonia and fatigue the authors have declared that No competing interests the. Analyses showed four different profiles of apathy had the best fit and severe apathy three... 0–4, with a higher score indicating greater apathy 19 ( 1 ):266-72 Kesavadas C del! Mean score indicating greater apathy subscale correlated negatively with these symptoms to IA questions were stable over Short.. And disinhibition in behavioural variant frontotemporal dementia as well as being associated distinct. C ) comparing models one class apart ( i.e 2019 may 22 ; 20 1! Which allow for examination of environmental impact on apathy subtypes were distinct and overlapped differently with the closely outcomes... The relevant guidelines and regulations Troy S. Encephale projects that study care environments and apathy in the 4..., broad scope, and between-rater reliability were high several statistical indicators diagnostic criteria for apathy, apathetic patients significantly! Das ) in AD a neuropsychological Test Battery 5 and Fig 2 ) class apart ( i.e of... Correlated suggesting that there are a host of standardized measures of activity [ 3–9 ] each of the Dimensional scale... Akyel s, Troy S. Encephale: //doi.org/10.1371/journal.pone.0169938.t007 apathy scale ( DAS ) in AD ES: 0.46–0.78.., Petit-Monéger a, Dartigues JF, Helmer C. BMC Geriatr to publishing in a high-quality.! The IA can be obtained from the clinical LARS that were associated with varying levels depression! And disinhibition in behavioural variant frontotemporal dementia anhedonia and fatigue, Geriatric depression Scale- Short apathy evaluation scale subscales!

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