Properties of the Apathy Scale(AS)for use on Parkinson’s patients

Parkinson’s disease is a neurodegenerative disorder characterized by motor, autonomic, and neuropsychiatric symptoms, among the latter, apathy has been found to be present in up to 70% of patients. The main objective of the present study was to assess the psychometric properties of the Apathy Scale for evaluation of Ecuadorian patients with Parkinson’s. This was a cross sectional study, with re-test. There were 73 women (34.5%) in the final sample of 211 patients. Mean age was 67.5 ± 10.2 years, mean length of illness was 7.1 ± 5.5 years, and the mean ldopa dose was 656.1 ± 292.7 mg/day. The mean Apathy Scale score was 12.7 ± 7.1. Reliability: The Guttman’s λ obtained was 0.89. The SEM was 2.34 for the AS. The ICC using an absolute agreement definition was: ICC = 0.78 [(95% IC 0.73?- 0.82) f = 4.96;p ≤ 0.000]. Discriminative validity, analyzed with the Kruskal-Wallis statistic and using H&Y stages as segmentation variable registered an X(2) value of p 0.0001. In conclusion the Apathy Scale proved to have suitable metric attributes in this specific PD patient sample: internal consistency, reliability, stability, and convergent and known-groups validity.

Efficacy of Pramipexole for Treatment of Apathy in Parkinson’s Disease

Background: Apathy occurs frequently in patients with Parkinson’s disease (PD), and has a negative impact on activities of daily living through loss of motivation. Pramipexole (PPX), which shows preferential affinity for D3 dopamine receptor in the mesolimbic system, is thought to influence mood and motivation. Therefore, we conducted an open-label case-control study to examine the effect of PPX on apathy in PD. Methods: We studied 36 PD patients (mean age, 70.4 ± 8.1 years), who had been treated only with L-DOPA. PPX was added to L-DOPA treatment in 24 patients (PPX group) and other 12 patients continued with L-DOPA alone (non-PPX group). The study period was 8 weeks. Apathy was assessed using the revised apathy scale for Japanese. Motor function was assessed with part III of the Unified Parkinson’s Disease Rating Scale (UPDRS). Results: Seventeen of 36 patients (47%) were diagnosed as having apathy. In the PPX group, apathy scale significantly improved from 17.3 to 13.8 at week 8 (p < 0.05). Motor function also improved significantly from 16.1 to 7.6 at week 8 (p < 0.0001). In the non-PPX group, apathy scale and UPDRS both showed no change during the study period. There was no correlation between changes in apathy scale and UPDRS in either the PPX or non-PPX group. Conclusion: PPX may be effective for treating apathy as well as motor dysfunction in PD.

Low Frequency of Leisure-Time Activities Correlates with Cognitive Decline and Apathy in Patients with Parkinson’s Disease

Objective: The purpose of this study is to investigate habitual leisure-time activities (physical and non-physical leisure activities) in patients with Parkinson’s disease (PD), and to determine any potential benefits of these activities on cognitive functions and emotional symptoms. Methods: Thirty-two patients with PD and 25 demographically-matched healthy controls participated in the present study. Neuropsychological tests (Wisconsin Card Sorting Test, Trail Making Test, Digit Span Test, Verbal Fluency Test, and Japanese Verbal Learning Test), assessment of emotional sym- ptoms, and interviews for confirmation of habitual leisure-time activities were conducted for all participants. Results: Patients with PD significantly showed the lower frequency of both physical and non-physical leisure activities than healthy controls. Compared to patients who engaged in physical leisure activities, patients who did not engage in such activities performed worse on the Trail Making Test (TMT-B, and TMT-B minus A). Moreover, patients who engaged in non-physical leisure activities were less apathetic than patients who did not engage in such activities. Conclusions: Our preliminary study shows that habitual leisure-time activities correlate with cognitive function and emotions in patients with PD. Reducing sedentary lifestyles and promoting habitual leisure-time activities may be helpful for preventing cognitive decline and apathy.

Apathy in Parkinson disease

Apathy is one of the least investigated symptom of Parkinson disease （PD）. In the article there are data of frequency, diagnostic features, pathophysiology and treatment of apathy in PD. The aim of the investigation was to evaluate the frequency of apathy in PD without dementia, evaluate the relationship with other neuropsychiatric and motor disorders, influence on the life quality. 115 patients （age-63.84±0.6 years, stage 2.6±0.3） with PD without dementia were included in the investigation. There were used the following scales： scale of evaluation stages of PD by Hoehn-Yahr, UPDRS （part 〈〈activity of daily living〉〉, 〈〈motor functions 〉〉）; Beck Depression Inventory, Spielberger State Trait Anxiety Inventory, Parkinson Disease Sleep Scale- PDSS, Epworth Sleepiness Scale, Parkinson Fatigue Scale-PFS- 16, SCOPA-Cog, Lilli Apathy Rating Scale LARS and Apathy Scale AS. Apathy was found in 25% of patients. The frequency and severity of apathy does not depend on stage and duration of PD. It was found positive correlation of apathy and hypokinesia. In different stages of PD there was variability of relationships of apathy with depression, executive functions and sleep disorders. We suppose the heterogeneity of apathy in PD because of the variability of the association with other neuropsychiatric （affective, cognitive, sleep） disorders. It was found the negative influence of apathy on daily activity, emotional and social aspects of life quality.

Apathy and neuropsychological characteristics of newly diagnosed Parkinson's disease patients

Objective To investigate the apathy and neuropsychological characteristics of newly diagnosed Parkinson’s disease(PD)patients.Methods Eighty-two newly diagnosed PD patients and 30 matched healthy controls by age,sex and education level were recruited in the present study.Apathy was assessed using Apathy Evaluation Scale(AES)and related factors,including age,sex,ed-

Agomelatine:a potential novel approach for the treatment of memory disorder in neurodegenerative disease

Agomelatine is a selective agonist of melatonin receptor 1A/melatonin receptor 1B(MT/MT)and antagonist of 5-hydroxytryptamine 2C receptors.It is used clinically to treat major depressive episodes in adults.The pro-chronobiological activity of agomelatine reconstructs sleep-wake rhythms and normalizes circadian disturbances via its agonistic effect of melatonin receptor 1A/melatonin receptor 1B,which work simultaneously to counteract depression and anxiety disorder.Moreover,by antagonizing neocortical postsynaptic 5-hydroxytryptamine 2C receptors,agomelatine enhances the release of dopamine and noradrenaline in the prefrontal cortex,increases the activity of dopamine and noradrenaline,and thereby reduces depression and anxiety disorder.The combination of these two effects means that agomelatine exhibits a unique pharmacological role in the treatment of depression,anxiety,and disturbance of the circadian rhythm.Emotion and sleep are closely related to memory and cognitive function.Memory disorder is defined as any forms of memory abnormality,which is typically evident in a broad range of neurodegenerative diseases,including Alzheimer’s disease.Memory impairment and cognitive impairment are common symptoms of neurodegenerative and psychiatric diseases.Therefore,whether agomelatine can improve memory and cognitive behaviors if used for alleviating depression and circadian-rhythm sleep disorders has become a research“hotspot”.This review presents the latest findings on the effects of agomelatine in the treatment of psychologic and circadian-rhythm sleep disorders in clinical trials and animal experiments.Our review evaluates recent studies on treatment of memory impairment and cognitive impairment in neurodegenerative and psychiatric diseases.

The Efficacy and Safety of Yokukansankachimpihange for Treating Behavioral and Psychological Symptoms of Dementia in Patients with Alzheimer’s Disease: An Open-Label Pilot Study

Previous clinical trials have demonstrated the efficacy of yokukansan, a traditional Japanese medicine, for the treatment of behavioral and psychological symptoms of dementia (BPSD). However, less evidence is available for the treatment of BPSD with yokukansankachimpihange (YKSCH), which consists of yokukansan and two additional herbal ingredients. The present study was conducted to investigate the efficacy and safety of YKSCH for treating BPSD in patients with Alzheimer’s disease (AD). We enrolled outpatients with mild-to-moderate AD who exhibited BPSD and obtained a Neuropsychiatric Inventory (NPI) score of >3 including subscale scores for “agitation”, “anxiety”, “irritability”, and “sleep and night-time behavior change”. A daily YKSCH dose of 7.5 g was administered for 12 weeks with concomitant administration of anti-dementia medication. BPSD was evaluated using the NPI at baseline and every 4 weeks during the intervention. We also examined apathy using the Japanese translation of the Apathy Scale, the short version of the Japanese version of the Zarit Caregiver Burden Interview, and the Modified Crichton Rating Scale for Predicting Activities of Daily Living. Cognitive dysfunction was evaluated using the Mini Mental State Examination and the AD Assessment Scale-Cognitive (Japanese version). Five participants were enrolled. The NPI total score tended to decrease between the baseline and 8-week evaluations during the YKSCH intervention (Wilcoxon signed rank test, P = 0.063). In terms of the NPI subscale scores, “apathy”, “agitation”, “delusions”, and “sleep and night-time behavior change” decreased after the intervention in those who exhibited each symptom at baseline. There were no significant differences in the other scores examined. No serious adverse events were observed. YKSCH could ameliorate BPSD in patients with mild-to-moderate AD with agitation, anxiety, irritability, and sleep and night-time behavior change, and it was well-tolerated.

Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia

BACKGROUND Neuropsychiatric symptoms(NPS)have been insufficiently examined in persons with aphasia(PWA)because most previous studies exclude participants with language and communication disorders.AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia.METHODS Study 1 reviewed articles obtained from PubMed,PsycINFO,Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders.Study 2 examined language deficits and activities of daily living in 20 PWA(median age:58,range:28-65 years;13 men)with the Western Aphasia Battery-Revised and the Barthel Index,respectively.Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales,including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale.In addition,an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves.This observational study is based on the baseline assessment of an intervention clinical trial(EudraCT:2017-002858-36;ClinicalTrials.gov identifier:NCT04134416).RESULTS The literature review revealed a broad spectrum of NPS in PWA,including depression,anxiety,apathy,agitation/aggression,eating and sleep disorders,psychosis,and hypomania/mania.These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA.Study 2 showed that the 20 participants had mild-to-moderate aphasia severity and were functionally independent.A wide range of comorbid NPS was found in the post-stroke aphasic population(median number of NPS:5,range:1-8).The majority of PWA(75%)had depressive symptoms,followed by agitation/aggression(70%),irritability(70%),anxiety(65%)and appetite/eating symptoms(65%).Half of them also presented symptoms of apathy,whereas euphoria and psychotic symptoms were rare(5%).Domain-specific scales revealed that 45%of participants had apathy and 30%were diagnosed with depression and anxiety.CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia.Therefore,further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.

The impact of a sense of belonging on lethargy and career maturity

In this study, the authors treated a combination of psychological apathy and decreased motivation as a tendency to lethargy, and implemented a survey into the tendency to lethargy demonstrated by students, in order to study the impact of a sense of belonging in the four relationships between the student and the people considered most likely to be interacted with during university life—those with family, friends at university, friends outside university and boyfriend/girlfriend. In addition, the authors implemented a survey and study that included additional categories relating to career maturity. The study was performed on 250 university students, using an anonymous questionnaire that graded responses using criteria to measure a sense of belonging, psychological apathy characteristics, areas of decreased motivation, and career maturity. The subjects were classified by the school year to which they belonged, their gender, and whether or not they had a boyfriend/girlfriend, and consideration was given to the relationship between psychological apathy, decreased motivation, career maturity and a sense of belonging. In terms of gender difference in regard to each of the criteria, partially, the study indicated that male students score significantly higher than female students in terms of a sense of belonging, females score significantly higher than males for decreased motivation in regard to classes, and males score significantly higher than females in relation to career maturity. No significant difference in scores was noted between males and females in relation to psychological apathy. The impact of a sense of belonging on psychological apathy, decreased motivation and career motivation was seen in the fact that across all categories, those students with a good relationship with friends at university had a suppressed level of decreased motivation in regard to university by the portions given in this document.

An analysis of 15 years of trends in children’s connection with nature and its relationship with residential environment

Intruduction:We assessed recent trends in children's connection with nature over the period of 2000-2015,using indices of wildlife awareness that focus on changes in wildlife abundance and the level of apathy among children.We used data from a survey conducted in 63 junior high school districts in the city of Sendai in Japan.In these surveys,children were asked whether they had seen 12 species groups within the past year.To examine changes in children's connection with nature,we used observed frequencies as an indicator of both the abundance of the species and children's apathy toward it.Results and Discussions:Results indicated an increase in children's apathy toward species that had low popularity regardless of residential environment.Our results suggest that regular exposure to wildlife would be effective in preventing the loss of children's connection with nature,particularly by reducing children's apathy toward less-popular species.