Convergence and divergence of apathy and depression

Apathy and depression can occur as independent constructs in various diseases, however, they have also been shown to overlap in certain features. It is not always clear as to how these two constructs are practically and theoretically different (divergent) or similar (convergent). Therefore, this article aims to discuss how the relevant literature has attempted to explain the issue of divergence and convergence of these constructs and to clarify this important, albeit complex, relationship between features of apathy and depression. Finally, important considerations are outlined so that apathy and depression can be assessed and researched while taking in to account these divergent and convergent features

Multidimensional apathy: evidence from neurodegenerative disease

Apathy is a demotivation syndrome common in neurodegenerative diseases and is fundamentally multidimensional in nature. Different methodologies have been used to identify and quantify these dimensions, which has resulted in multifarious concepts, ranging in the number and characteristics of apathy subtypes. This has created an ambiguity over the fundamental substructure of apathy. Here we review the multidimensional concepts of apathy and demonstrate that overlapping elements exist, pointing towards commonalities in apathy subtypes. These can be subsumed under a unified Dimensional Apathy Framework: a triadic structure of Initiation, Executive and Emotional apathy. Distinct cognitive processes may underlie these domains, while self-awareness interplays with all subtypes. Evidence from neurodegenerative diseases supports this distinction with differing apathy profiles in amyotrophic lateral sclerosis, Parkinson's disease and Alzheimer's disease

Developing a New Apathy Measurement Scale

Apathy is both a symptom and syndrome prevalent in many pathological populations that affects motivation to display goal directed functions. Apathy has been established as having a triadic substructure by various researchers but has never been directly detected in normative and non- normative populations. Levy and Dubois (2006) proposed three apathetic subtypes, Cognitive, Emotional- Affective and Auto Activation, all with particular neural correlates and functional impairments. The aim of this study was to create and begin the validation process of a new apathy measure called the Dimensional Apathy Scale (DAS), which assesses the three previously mentioned apathetic subtypes. There were 311 participants (mean = 37.4, SD = 15.0) ranging from 18 to 70 years old .Upon performing an Horn’s parallel analysis of principal factors and Exploratory Factor Analysis, 4 factors (labelled Executive, Emotional, Cognitive Initiation and Behavioural Initiation) were extracted accounting for 28.9% of the total variance. The factors and their meanings fitted Levy and Dubois’ definitions of the three apathetic subtypes with the exception of the Auto Activation apathy. Upon closer examination thematically the Auto Activation apathy subtype definition accounted for Behavioural Initiation and Cognitive Initiation factors. These were found to be thematically intertwined and therefore were labelled as Behavioural/Cognitive Initiation. The 24 item DAS contained 3 subscales – Executive, Emotional and Behavioural/Cognitive Initiation, each composed of 8 items. The DAS items for each subscale showed good reliability and validity against depression based on a normally ageing population. Preliminarily, this serves as evidence for further research using this robust scale and should be further validated in various pathological populations. Research into apathetic subtypes, the DAS scale and implications for eventual clinical use are discussed

Psychedelics and mindfulness: A systematic review and meta-analysis

Background and aims: The benefits of classic serotonergic psychedelics (e.g. psilocybin, LSD, DMT, ayahuasca) are becoming more widely known with the resurgence in research in the past decade. Furthermore, the benefits of mindfulness are well documented. However, no systematic reviews have examined linkage of mindfulness and psychedelics use. The aim of this systematic review is to explore the link between psychedelics and characteristics of mindfulness. Methods: We conducted a systematic search across multiple databases, inclusive of grey literature and backwards/forward-citation tracking, on the 18 January 2021. The search strategy included terms relating to mindfulness and psychedelics, with no restriction on clinical or non-clinical conditions. Study quality was assessed. An exploratory random-effects meta-analysis was conducted on pre-post mindfulness data relative to psychedelic ingestion. Results: Of 1805 studies screened, 13 were included in the systematic review. There was substantial variability in participant characteristics, psychedelic administration method and measurement of mindfulness. The ingestion of psychedelics is associated with an increase in mindfulness, specifically relating to domains of acceptance, which encompasses non-judgement of inner experience and non-reactivity. The meta-analysis of a subset of studies (N = 6) showed small effects overall relative to ayahuasca ingestion, increasing mindfulness facets of non-judgement of inner experience and non-reactivity, as well as acting with awareness. Conclusions: Further methodologically robust research is needed to elucidate the relationship between psychedelics and mindfulness. However, mindfulness and specific facets relating to acceptance have been shown to increase following ingestion of psychedelics in a number of studies

Multidimensional apathy in ALS:validation of the Dimensional Apathy Scale

AIM: Apathy is a prominent symptom of amyotrophic lateral sclerosis (ALS), but measurement is confounded by physical disability. Furthermore, it has been traditionally measured as a unidimensional symptom despite research demonstrating a multifaceted construct. 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. We aimed to explore this behavioural symptom by examining the substructure of apathy in ALS and to determine the reliability and validity of the DAS in patients and their carers.  METHOD: Patients and carers were recruited through the national Scottish Motor Neurone Disease Register and were asked to complete the DAS, the standardised Apathy Evaluation Scale, and the Geriatric Depression Scale-Short Form. 83 patients with ALS, 75 carers and 83 sex-matched, age-matched and education-matched controls participated.  RESULTS: When compared with healthy controls, patients showed a significant increase in apathy on the Initiation subscale, and were significantly less apathetic on the Emotional subscale. Scores on the DAS patient and carer versions did not significantly differ. Internal consistency reliability, convergent and discriminant validity were found to be good for the DAS subscales. There was no association between the DAS and functional disability using the ALS Functional Rating Scale.  CONCLUSIONS: Apathy in ALS is characterised by a specific profile of increased initiation apathy and reduced emotional apathy. The DAS is a reliable and valid measure for the assessment of multidimensional apathy in ALS

Frontostriatal grey matter atrophy in amyotrophic lateral sclerosis A visual rating study

Background: Amyotrophic lateral sclerosis (ALS) is characterised by frontostriatal grey matter changes similar to those in frontotemporal dementia (FTD). However, these changes are usually detected at a group level, and simple visual magnetic resonance imaging (MRI) cortical atrophy scales may further elucidate frontostriatal changes in ALS. Objective: To investigate whether frontostriatal changes are detectable using simple visual MRI atrophy rating scales applied at an individual patient level in ALS. Methods: 21 ALS patients and 17 controls were recruited and underwent an MRI scan. Prefrontal cortex sub-regions of the medial orbitofrontal cortex (MOFC), lateral orbitofrontal cortex (LOFC) and anterior cingulate cortex (ACC), striatal sub-regions of the caudate nucleus (CN) and nucleus accumbens (NAcc) were rated using visual grey matter atrophy 5-point Likert scales. Results: Significantly higher atrophy ratings in the bilateral MOFC in ALS patients versus controls was only observed (p<.05). Patients with higher MOFC atrophy had significantly higher atrophy of the CN (p<.05) and LOFC (p<.05). Conclusions: Use of simple visual atrophy rating scales on an individual level reliably detects frontostriatal deficits specific to ALS, showing MOFC atrophy differences with associated CN and LOFC atrophy. This is an applicable method that could be used to support clinical diagnosis and management

Development of the MiNDToolkit for Management of Cognitive and Behavioural Impairment in Motor Neurone Disease

Aim : To develop structured guidance, recommendations and techniques for non-pharmacological management of cognitive and behavioural impairments in motor neurone disease (MND), called the MiNDToolkit. Methods : A 4-round modified-Delphi method was utilised (online and face-to-face meeting), supplemented by recent research, recommendations, expertise from allied health-professionals (AHP) clinicians, researchers and clients. Results : Round-1 (N=47) identified AHPs techniques. Round-2 (N=23) and -3 (N=19) used expert consensus, refining general focus, specific elements and techniques. Round-4 (N=8) applied personal, lived and occupational experience, finalising the general structure and content of specific techniques. Conclusion : The MiNDToolkit is composed of multiple tools to structure decision-making through flowcharts, decision-trees and checklists, provide information about impairments, assessment recommendations and techniques or strategies for non-pharmacological management cognitive or behavioural impairments in MND

Prevalence of pain in amyotrophic lateral sclerosis: A systematic review and meta-analysis

Objectives: Physical pain is a known symptom in amyotrophic lateral sclerosis (ALS), but no systematically derived prevalence estimate is available. The aim of this study was to determine the pooled prevalence of pain in ALS, relative to its method of measurement and pain characteristics. Methods: A systematic search across multiple databases was conducted on January 16, 2020. Random-effects meta-analyses of single proportions were performed on prevalence data. Heterogeneity was determined using the I2 statistic. Where available, pain location, intensity, and type or source were compared. Results: 2552 articles were identified. Twenty-one eligible studies were included. All studies used observational designs (14 cross-sectional, 6 cohort, 1 case-control). Pooled prevalence of pain in ALS across all studies was 60% (95% CI = 50–69%), with a high degree of heterogeneity (I2 = 94%, p < .001). Studies that used only validated measures had lower heterogeneity (I2 = 82%, p = 0.002), compared to those that used tailored measures, or tailored supplemented with validated measures (I2 = 90%, p < 0.001 and I2 = 83%, p < 0.001, respectively). In a subset of studies (N = 9), the most commonly reported pain location was the upper limbs including shoulders/extremities (41.5%). A further study subset (N = 7) showed moderate-severe intensity pain was most frequently reported. Type of pain was commonly related to cramp or spasm. Conclusions: Experiencing physical pain in ALS occurs with high prevalence. Deriving consensus on which specific tools should be used to assess, monitor and compare symptoms of pain in this population will reduce current heterogeneity in approaches and increase the likelihood of ameliorating distressing experiences more effectively

Multidimensional apathy in behavioural variant frontotemporal dementia, primary progressive aphasia and Alzheimer’s disease

Apathy is prevalent in dementia, such as behavioral variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD). As a multidimensional construct, it can be assessed and subsumed under a Dimensional Apathy Framework. A consistent apathy profile in bvFTD and PPA has yet to be established. The aim was to explore apathy profiles and awareness in bvFTD, PPA, and AD. A total of 12 patients with bvFTD, 12 patients with PPA, 28 patients with AD, and 20 matched controls, as well as their informants/carers, were recruited. All participants completed the Dimensional Apathy Scale (DAS), assessing executive, emotional, and initiation apathy subtypes, a 1-dimensional apathy measure, depression measure, and functional and cognitive screens. Apathy subtype awareness was determined through DAS informant/carer and self-rating discrepancy. Apathy profile comparison showed patients with bvFTD had significantly higher emotional apathy than patients with AD (P <.01) and significantly higher apathy over all subtypes than patients with PPA (Ps <.05). Additionally, patients with bvFTD had significantly lower awareness for emotional apathy (P <.01) when compared to patients with AD and PPA. All patient groups had significant global apathy over all subtypes compared to controls. The emergent apathy profile for bvFTD seems to be emotional apathy (indifference or emotional/affective neutrality), with lower self-awareness in this subtype. Further, lower self-awareness for executive apathy (lack of motivation for planning, organization, or attention) differentiates bvFTD from PPA. Future research should investigate the cognitive and neural correlates as well as the practical impact of apathy subtypes