Apathy and Depression in Mild Alzheimer's Disease: A Cross-Sectional Study Using Diagnostic Criteria

Article type: Research Article

Authors: Benoit, Michel^{a; *} | Berrut, Gilles^b | Doussaint, Johanna^c | Bakchine, Serge^d | Bonin-Guillaume, Sylvie^e | Frémont, Patrick^f | Gallarda, Thierry^g | Krolak-Salmon, Pierre^h | Marquet, Thierryⁱ | Mékiès, Claude^j | Sellal, François^k | Schuck, Stéphane^c | David, Renaud^l | Robert, Philippe^l

Affiliations: [a] Clinique de Psychiatrie et de Psychologie Médicale, Pole des Neurosciences Cliniques, CHU Nice, France | [b] Pôle de Gérontologie clinique, Hôpital Bellier, Nantes, France | [c] Kappa Santé, Paris, France | [d] Service de Neurologie et CMRR, CHU de Reims, France | [e] Assistance Publique des Hôpitaux de Marseille, Institut des Neurosciences de la Timone, Université Aix Marseille, France | [f] Service de Psychiatrie, C.H. Lagny – Marne La Vallée, France | [g] Université Paris-Descartes, Inserm, UMR 894, Laboratoire de physiopathologie des maladies psychiatriques, Centre de Psychiatrie et Neurosciences, Service Hospitalo-Universitaire, Centre Hospitalier Sainte-Anne, Paris, France | [h] CMRR – Hospices Civils de Lyon, Inserm U1028, CNRS UMR5292, Université Lyon 1, France | [i] Eisai France – Région Europe du Sud, Paris, France | [j] Polyclinique du Parc, Toulouse et clinique des Cèdres, Cornebarrieu, France, Representing the ANLLF | [k] CMRR – Hôpitaux Civils de Colmar et INSERM U-692, Université de Strasbourg, France | [l] CMRR – EA CoBTeK- CHU – Université de Nice Sophia Antipolis, France

Correspondence: [*] Correspondence to: Dr. Michel Benoit, Clinique de Psychiatrie et de Psychologie Médicale, Pole des Neurosciences Cliniques, Hôpital Pasteur, BP 69, 06002 Nice Cédex 1, France. Tel.: +33 492 037 753; Fax: +33 492 038 011; E-mail: [email protected].

Abstract: Apathy and depression are the most frequent neuropsychiatric symptoms in Alzheimer's disease (AD). In a cross-sectional observational study of 734 subjects with probable mild AD, we evaluated the prevalence of apathy and depression. After the use of specific diagnostic criteria, we tested the interaction between the two syndromes and their relation with specific comorbidities, and different functional outcomes. Depression was diagnosed using the diagnostic criteria for depression in AD, and apathy with the diagnostic criteria for apathy in neuropsychiatric disorders. According to the specific diagnostic criteria, depression had a 47.9% prevalence, while apathy prevalence was 41.6%. Apathy and depression were associated in 32.4% of patients (n = 225). 9.4% (n = 65) had only apathy, 15.4% (n = 107) had only depression, and 42.9% had no apathy and no depression (n = 298). The three most frequent depressive symptoms were fatigue or loss of energy (59.4%), decreased positive affect or pleasure in response to social contacts and activities (46.2%), and psychomotor agitation or retardation (36.9%). Concerning apathy, loss of goal-directed cognition was the most frequently altered (63.6%), followed by loss of goal-directed action (60.6%) and loss of goal-directed emotion (43.8%). Patients with both apathy and depression more frequently required a resource allowance for dependency. Neurological comorbidities were more frequent in the “apathy and depression” and “depression alone” groups (p < 0.001). Apathy and depression overlap considerably, and this might be explained by the presence of some non-specific symptoms in both diagnostic criteria. The need for social support is higher when a patient fulfills the two diagnostic criteria.

Keywords: Alzheimer's disease, apathy, depressive symptoms, dementia

DOI: 10.3233/JAD-2012-112003

Journal: Journal of Alzheimer's Disease, vol. 31, no. 2, pp. 325-334, 2012