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1.
Rev Med Suisse ; 17(751): 1614-1616, 2021 Sep 22.
Artigo em Francês | MEDLINE | ID: mdl-34550655

RESUMO

Progress in research methodology allows for better characterizing biological processes of brain aging, and therefore to detect dementia or Alzheimer's disease (AD) at a very early stage. Clinically, AD is characterized by progressive memory loss. Moreover, psychiatric symptoms such as anxiety, apathy or depression are frequently present, and may overlay cognitive dysfunction in early AD. There is a broad consensus in the research community that early stages of AD offer a promising window of opportunity for potential therapeutic intervention. Recent studies also suggest that a healthy and active lifestyle has a significant preventive effect. By supporting the patient in lifestyle and health management, the treating physician can make a relevant contribution to the prevention of AD.


Assuntos
Doença de Alzheimer , Apatia , Disfunção Cognitiva , Doença de Alzheimer/prevenção & controle , Encéfalo , Humanos , Estilo de Vida
2.
Zhonghua Yi Xue Za Zhi ; 101(35): 2792-2797, 2021 Sep 21.
Artigo em Chinês | MEDLINE | ID: mdl-34551496

RESUMO

Objective: To study the relationship between emotional apathy and motor symptoms, sleep, and cognitive function in patients with early Parkinson's disease (PD). Methods: One hundred and twenty-nine early PD patients who were treated in the Second Affiliated Hospital of Soochow University from June to October 2020 were included, including 82 male and 47 female patients. The emotional apathy was assessed by modified apathy rating scale (MAES). The above 129 patients were divided into 67 patients in the PD with emotional apathy group (MAES>14 points) and 62 patients in the PD without emotional apathy group (MAES≤ 14 points). Age, gender, course of disease and levodopa equivalent dose were also collected. Hoehn-Yahr stage and unified Parkinson's disease rating scale PartⅢ(UPDRS-Ⅲ), Pittsburgh Sleep Quality Index (PSQI), polysomnography, and Montreal Cognitive Assessment Scale (MoCA) were used to evaluate the motor symptoms, sleep and cognitive functions of patients with early PD, and the clinical characteristics of patients with early PD with apathywere determined. Results: Compared with PD patients without apathy, those with apathy had longer disease duration [M(Q1,Q3)][5.0 (3.0, 7.0) years vs 3.0 (2.0, 5.0) years, P=0.006] and severer motor symptoms [20.0 (10.0, 28.0) vs 14.0 (8.5, 23.0), P=0.047]. There was no significant difference in PSQI score between the two groups. Among the 33 patients who completed polysomnography, compared with PD patients without apathy (n=16), those with apathy (n=17) had a longer rapid eye movement (REM) sleep latency [150 (124, 184) min vs 87 (57, 133) min, P=0.035)] and more frequent periodic limb movements in the REM phase(P=0.042).The REM sleep ratio (r=0.373, P=0.042), apnea-hypopena index (AHI)(r=0.374, P=0.046) and oxygen deficit index (r=0.409, P=0.025) were positively correlated with the degree of apathy in PD patients. PD patients with apathy had relatively poorer performance in cognition assessment than those without apathy and total MoCA score was inversely correlated with the degree of apathy (r=-0.231, P=0.017). Conclusion: Early PD patients with apathy have objective sleep disorders dominated by REM sleep disorders, which can have a negative impact on cognitive function.


Assuntos
Apatia , Doença de Parkinson , Transtorno do Comportamento do Sono REM , Cognição , Feminino , Humanos , Masculino , Doença de Parkinson/complicações , Sono
3.
Artigo em Inglês | MEDLINE | ID: mdl-34360133

RESUMO

Apathy, a common neuropsychiatric symptom associated with dementia, has a strong impact on patients' and caregivers' quality of life. However, it is still poorly understood and hard to define. The main objective of the ECOCAPTURE programme is to define a behavioural signature of apathy using an ecological approach. Within this program, ECOCAPTURE@HOME is an observational study which aims to validate a method based on new technologies for the remote monitoring of apathy in real life. For this study, we plan to recruit 60 couples: 20 patient-caregiver dyads in which patients suffer from behavioral variant Fronto-Temporal Dementia, 20 patient-caregiver dyads in which patients suffer from Alzheimer Disease and 20 healthy control couples. These dyads will be followed for 28 consecutive days via multi-sensor bracelets collecting passive data (acceleration, electrodermal activity, blood volume pulse). Active data will also be collected by questionnaires on a smartphone application. Using a pool of metrics extracted from these passive and active data, we will validate a measurement model for three behavioural markers of apathy (i.e., daytime activity, quality of sleep, and emotional arousal). The final purpose is to facilitate the follow-up and precise diagnosis of apathy, towards a personalised treatment of this condition within everyday life.


Assuntos
Doença de Alzheimer , Apatia , Doença de Alzheimer/diagnóstico , Cuidadores , Humanos , Estudos Observacionais como Assunto , Qualidade de Vida , Inquéritos e Questionários
4.
Behav Neurol ; 2021: 6319826, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394772

RESUMO

Apathy is a neurobehavioral syndrome characterized by impaired motivation for goal-directed behaviors and cognitive activity, alongside blunted affect. Apathy is a common neuropsychiatric syndrome in Alzheimer's disease (AD), with a 5-year prevalence over 70%. Apathy also serves as a prognostic indicator, correlating with the progression of AD. Despite advances in its conceptualization and understanding of its neural basis, there is very limited empirical evidence to support the available strategies for the treatment of apathy in AD. Given its complex pathophysiology, including distinct substrates for different apathy dimensions (affective, cognitive, and behavioral), it is unlikely that a single pharmacological or nonpharmacological strategy will be effective for all cases of apathy in AD. High-quality evidence research is needed to better understand the role of specific strategies aiming at a personalized approach.


Assuntos
Doença de Alzheimer , Apatia , Doença de Alzheimer/terapia , Formação de Conceito , Humanos , Transtornos do Humor , Motivação
5.
Brain Inj ; 35(9): 1043-1053, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34357825

RESUMO

PRIMARY OBJECTIVE: The aim of the study was twofold. First, to study the relationship among apathy in the long term, initial clinical measures, and standard outcome scores after traumatic brain injury (TBI). Second, to describe white matter integrity correlates of apathy symptoms. RESEARCH DESIGN: Correlational study. Methods and Procedures: Correlation and Bayesian networks analyses were performed in a sample of 40 patients with moderate to severe TBI in order to identify the relationship among clinical variables, functionality, and apathy. A diffusion tensor imaging study was developed in 25 participants to describe correlations between fractional anisotropy (FA) measures and apathetic symptoms. MAIN OUTCOMES AND RESULTS: Correlation analysis revealed associations between pairs of variables as apathy in the long term and functional score at discharge from hospital. Bayesian network illustrated the relevant role of axonal injury mediating the relationship between apathy and initial clinical variables. FA in the superior longitudinal fasciculus, the inferior longitudinal fasciculus, and the internal capsule were negatively correlated with apathy measures. Widespread brain areas showed positive correlations between FA and apathy. CONCLUSIONS: These results highlight the relevance of white matter integrity measures in initial assessment after TBI and its relationship with apathetic manifestations in the chronic phase.


Assuntos
Apatia , Lesões Encefálicas Traumáticas , Substância Branca , Anisotropia , Teorema de Bayes , Encéfalo , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Imagem de Tensor de Difusão , Humanos , Substância Branca/diagnóstico por imagem
6.
Eur J Neurosci ; 54(6): 6267-6280, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34449938

RESUMO

Patients with Parkinson's disease (PD) experience motor and non-motor symptoms, suggesting alterations of the motor and/or limbic system or more probably of their communications. We hypothesized that the communication between the insula (part of the limbic system) and sensorimotor cortex in PD is altered and hemispheric asymmetric. Furthermore, that this asymmetry relates to non-motor symptoms, and specifically, that apathy-related asymmetry is unique to PD. To test these hypotheses, we used a novel multivariate time-frequency analysis method applied to resting-state functional magnetic resonance imaging (MRI) data of 28 controls and 25 participants with PD measured in their OFF medication state. The analysis infers directionality of coupling, that is, afferent or efferent, among four anatomical regions, thus defining directed pathways of information flow, which enables the extension of symmetry measures to include directionality. A major right asymmetry reduction of the dorsal-posterior insula efferent and a slight bilateral increase of insula afferent pathways were observed in participants with PD versus controls. Between-group pathways that correlated with mild cognitive impairments combined the central-executive and default-mode networks through the right insula. Apathy-correlated pathways of the posterior insula in participants with PD versus controls exhibited reduced right efferent and increased left afferent. Because apathy scores were comparable between the groups and effects of the other motor and non-motor symptoms were statistically removed by the analysis, the differences in apathy-correlated pathways were suggested as unique to PD. These pathways could be predictors in the pre-symptomatic phase in patients with apathy.


Assuntos
Apatia , Disfunção Cognitiva , Doença de Parkinson , Córtex Sensório-Motor , Humanos , Imageamento por Ressonância Magnética , Doença de Parkinson/diagnóstico por imagem
7.
Artigo em Inglês | MEDLINE | ID: mdl-34207955

RESUMO

Apathy, defined as a lack of motivation, is a prevalent and persistent behavioural and psychological symptom of dementia. Limited research suggests that apathy is associated with increased carer burden, but there are no studies investigating carers' subjective experiences of apathy. This study aimed to fill this gap and explore the lived experience of apathy in dementia from the perspectives of the people with dementia and their carers. This article reports on the carers' perspectives. Six dyads of people with dementia and carers participated in semi-structured interviews, which were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (1) achieving a balance of conflicting emotions-the challenges of apathy led to feelings of guilt, acceptance, and frustration; (2) new roles imposed by caring, which involved taking on new responsibilities and promoting remaining interests of person with dementia; and (3) having a life of one's own-coping with apathy by talking to others, and spending time away from the caring role. This study highlighted that carers are caught in a struggle between wanting to involve the person with dementia in decisions and finding that they cannot if they want to overcome the hurdle of apathy. Implications of this study suggest that a wider understanding of apathy at a societal level could lead to the provision of a helpful forum for carers to share their experiences.


Assuntos
Apatia , Demência , Cuidadores , Humanos , Masculino , Motivação , Pesquisa Qualitativa
8.
Psychogeriatrics ; 21(5): 773-782, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34216181

RESUMO

BACKGROUND: Cognitive decline and neuropsychiatric symptoms (NPS) are main clinical manifestations in Alzheimer disease (AD). It is unclear whether the link between specific NPS and cognitive domains exists in AD or mild cognitive impairment (MCI). Our study aimed to examine the association between specific cognitive domain and NPS in AD and MCI, and to evaluate whether this association showed variety in different stages of cognitive impairment. METHODS: A total of 458 patients diagnosed as AD or MCI were included in this study. Neuropsychological batteries were applied in the study. The association between NPS and cognitive function were evaluated by multiple linear regression, and its correlation was evaluated by Spearman correlation coefficient. RESULTS: The prevalence of NPS increased with the severity of cognitive impairment, and there were significant differences between MCI and AD. NPS were predominantly associated with cognitive domains, including memory, language, attention, and executive function. Both regression liner analysis and correlation analysis showed delusion, hallucination, and aberrant motor behaviour (AMB) were linked to language and attention. In addition, regression liner analysis illustrated depression, anxiety, and apathy were related to learning and episodic memory. Generally, the delusion, hallucination, and AMB have the broadest impact on cognition. CONCLUSION: Specific NPS was predominantly associated with different cognitive domains. Symptoms of agitation, delusion and irritability indicate worse cognitive performance. Therefore, cognitive improvement should be a therapeutic strategy in managing NPS in AD.


Assuntos
Doença de Alzheimer , Apatia , Disfunção Cognitiva , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Humanos , Testes Neuropsicológicos
9.
Handb Clin Neurol ; 180: 417-431, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34225945

RESUMO

The subthalamic nucleus (STN) is a subcortical, glutamatergic, excitatory, relay nucleus that increases the inhibitory drive of the basal ganglia and suppresses action. It is of central relevance to the neuropsychological construct of inhibition, as well as the pathophysiology of Parkinson's disease (PD). Deep brain stimulation (DBS) of the STN (STN-DBS) is an established surgical treatment for PD that can be complicated by adverse neuropsychiatric side effects, most commonly characterized by impulsivity and mood elevation, although depression, anxiety, apathy, and cognitive changes have also been reported. Notwithstanding these adverse neuropsychiatric effects in PD, STN-DBS may also have a role in the treatment of refractory psychiatric disorders, as more is understood about the physiology of this nucleus and techniques in neuromodulation are refined. In this chapter, we link neuropsychiatric symptoms after STN-DBS for PD to the biological effects of electrode implantation, neurostimulation, and adjustments to dopaminergic medication, in the setting of neurodegeneration affecting cortico-striatal connectivity. We then provide an overview of clinical trials that have employed STN-DBS to treat obsessive-compulsive disorder and discuss future directions for subthalamic neuromodulation in psychiatry.


Assuntos
Apatia , Estimulação Encefálica Profunda , Transtorno Obsessivo-Compulsivo , Doença de Parkinson , Núcleo Subtalâmico , Humanos , Transtorno Obsessivo-Compulsivo/terapia , Doença de Parkinson/terapia
10.
Psychogeriatrics ; 21(4): 636-649, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34060188

RESUMO

BACKGROUND: Apathy is common in normal ageing and widely recognized as a predictor of cognitive decline, especially in executive functions. Much less characterized than apathy in the elderly is impulsivity, which increases with ageing. It is also frequently described in comorbidity with apathy in various clinical populations, in whom it is associated with poorer executive functioning. In the present study, by capitalizing on a multidimensional approach, we explore the mediating role of facets of impulsivity on the bidirectional relationships between apathy dimensions and executive functioning in non-demented community-dwelling elderly individuals in daily life. METHODS: A sample of non-demented community-dwelling older adults (n = 101) completed self-rated questionnaires. Apathy was measured by the Apathy Evaluation Scale; impulsivity was examined through the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency (UPPS-P) Impulsive Behaviour Scale; and executive functioning in daily life was assessed by the Behaviour Rating Inventory of Executive Function-Adult (BRIEF-A). Two models positing mediation were tested using conditional process modelling. RESULTS: Hierarchical regressions controlling for depressive symptoms indicated that the cognitive apathy dimension was associated with the UPPS-P facets sensation seeking, lack of perseverance, and premeditation. Among the UPPS-P facets, lack of perseverance and negative urgency were found to contribute significantly to BRIEF-A Metacognitive index variance. Finally, in both models, lack of perseverance was found to totally mediate the relationship between cognitive apathy and the BRIEF-A Metacognitive index. CONCLUSIONS: These preliminary findings suggest that, in normal ageing, apathy may share an overlap with impulsivity, contradicting the notion they represent opposite ends of a single behavioural spectrum. Our results argue for bidirectional relationship between a specific apathy dimension (i.e. cognitive apathy) and executive functioning. Moreover, they shed new light on the underlying psychological process implicated (i.e. lack of perseverance) among older adults without dementia and represent an interesting prospect for psychological interventions.


Assuntos
Apatia , Função Executiva , Idoso , Humanos , Comportamento Impulsivo , Vida Independente , Inventário de Personalidade
12.
Artigo em Inglês | MEDLINE | ID: mdl-34065843

RESUMO

Changes in the daily lives and mental health of people with disabilities due to the coronavirus disease (COVID-19) pandemic have not been reported. The Japanese government closed public facilities, including swimming pools, during the first wave of COVID-19, and many competitive swimmers lost their places of activities. This study aimed to investigate the impact of the COVID-19 pandemic on life space and apathy among swimmers and investigated differences in the impact on swimmers with and without disabilities. A total of 39 competitive swimmers participated in this study, including 11 male and nine female swimmers with disabilities (swimmers with disabilities = para-swimmers), and e11 male and eight female swimmers without disabilities. Baseline and follow-up web-based questionnaire surveys were conducted, and changes in life space and apathy scale (AS) were assessed. Female para-swimmers showed significantly lower apathy than female able-bodied subjects (para, during; 16.0 ± 1.9; after, 12.8 ± 3.2; non-disabled; during, 10.5 ± 4.4; after, 10.6 ± 4.8; p < 0.05). Female swimmers with disabilities may be more likely to experience worsening mental health due to changes in their lifestyle.


Assuntos
Apatia , COVID-19 , Pessoas com Deficiência , Esportes para Pessoas com Deficiência , Feminino , Humanos , Japão/epidemiologia , Masculino , Pandemias , SARS-CoV-2 , Natação
13.
J Alzheimers Dis ; 82(1): 381-390, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34024833

RESUMO

BACKGROUND: Behavioral variant frontotemporal dementia (bvFTD) is generally considered a young-onset dementia, although age at onset is highly variable. While several studies indicate clinical differences regarding age at onset, no biomarker validated cohort studies with updated clinical criteria have been performed. OBJECTIVE: We aimed to examine behavior, cognition, and mortality over the full age spectrum in a cohort of bvFTD patients with neuroimaging, genetic, or histopathological confirmation and exclusion of positive Alzheimer's disease biomarkers or severe cerebrovascular damage. METHODS: In total, 315 patients with a clinical diagnosis of probable or definite bvFTD were included from the Amsterdam Dementia Cohort and grouped into quartiles by age-at-diagnosis. Neuropsychiatric symptoms and cognitive functioning were assessed with the neuropsychiatric inventory, the geriatric depression scale and a neuropsychological test battery. Data on mortality was obtained from the Dutch municipal register. Associations between age-at-diagnosis and clinical features and mortality risk were examined. RESULTS: Age-at-diagnosis ranged from 26 to 85 years and established quartiles with mean ages of 52±6, 61±2, 66±2, and 74±3 years. In the total sample, 44.4%exceeded an age of 65 years at time of diagnosis. Earlier age-at-diagnosis was associated with more severe behavioral symptoms, while later age-at-diagnosis was associated with more severe memory impairment. Unexpectedly, mortality risk was not associated with age-at-diagnosis. CONCLUSION: In bvFTD, symptom profile is associated with age-at-diagnosis. This should be taken into account with regard to diagnostics, patient management, and trial design. Additionally, based on our sample, the prevalence of late-onset bvFTD is higher than generally thought.


Assuntos
Demência Frontotemporal/fisiopatologia , Mortalidade , Testes Neuropsicológicos , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Ansiedade/fisiopatologia , Ansiedade/psicologia , Apatia/fisiologia , Delusões/fisiopatologia , Delusões/psicologia , Feminino , Demência Frontotemporal/psicologia , Alucinações/fisiopatologia , Alucinações/psicologia , Humanos , Inibição Psicológica , Humor Irritável/fisiologia , Masculino , Transtornos da Memória/fisiopatologia , Transtornos da Memória/psicologia , Pessoa de Meia-Idade , Transtornos do Humor/fisiopatologia , Transtornos do Humor/psicologia , Fenótipo , Índice de Gravidade de Doença
14.
Mov Disord ; 36(9): 2162-2172, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33998063

RESUMO

BACKGROUND: Apathy, a common neuropsychiatric disturbance in Huntington's disease (HD), is subserved by a complex neurobiological network. However, no study has yet employed a whole-brain approach to examine underlying regional vulnerabilities that may precipitate apathy changes over time. OBJECTIVES: To identify whole-brain gray matter volume (GMV) vulnerabilities that may predict longitudinal apathy development in HD. METHODS: Forty-five HD individuals (31 female) were scanned and evaluated for apathy and other neuropsychiatric features using the short-Problem Behavior Assessment for a maximum total of six longitudinal visits (including baseline). In order to identify regions where changes in GMV may describe changes in apathy, we performed longitudinal voxel-based morphometry (VBM) on those 33 participants with a magnetic resonance imaging (MRI) scan on their second visit at 18 ± 6 months follow-up (78 MRI datasets). We next employed a generalized linear mixed-effects model (N = 45) to elucidate whether initial and specific GMV may predict apathy development over time. RESULTS: Utilizing longitudinal VBM, we revealed a relationship between increases in apathy and specific GMV atrophy in the right middle cingulate cortex (MCC). Furthermore, vulnerability in the right MCC volume at baseline successfully predicted the severity and progression of apathy over time. CONCLUSIONS: This study highlights that individual differences in apathy in HD may be explained by variability in atrophy and initial vulnerabilities in the right MCC, a region implicated in action-initiation. These findings thus serve to facilitate the prediction of an apathetic profile, permitting targeted, time-sensitive interventions in neurodegenerative disease with potential implications in otherwise healthy populations. © 2021 International Parkinson and Movement Disorder Society.


Assuntos
Apatia , Doença de Huntington , Doenças Neurodegenerativas , Encéfalo/diagnóstico por imagem , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Doença de Huntington/diagnóstico por imagem , Imageamento por Ressonância Magnética
15.
Lancet Psychiatry ; 8(8): 732-738, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33865502

RESUMO

Predictive coding has played a transformative role in the study of psychosis, casting delusions and hallucinations as statistical inference in a system with abnormal precision. However, the negative symptoms of schizophrenia, such as affective blunting, avolition, and asociality, remain poorly understood. We propose a computational framework for emotional expression based on active inference-namely that affective behaviours such as smiling are driven by predictions about the social consequences of smiling. Similarly to how delusions and hallucinations can be explained by predictive uncertainty in sensory circuits, negative symptoms naturally arise from uncertainty in social prediction circuits. This perspective draws on computational principles to explain blunted facial expressiveness and apathy-anhedonia in schizophrenia. Its phenomenological consequences also shed light on the content of paranoid delusions and indistinctness of self-other boundaries. Close links are highlighted between social prediction, facial affect mirroring, and the fledgling study of interoception. Advances in automated analysis of facial expressions and acoustic speech patterns will allow empirical testing of these computational models of the negative symptoms of schizophrenia.


Assuntos
Anedonia/fisiologia , Apatia/fisiologia , Esquizofrenia/terapia , Simulação por Computador , Delusões , Expressão Facial , Alucinações , Humanos , Interocepção , Transtornos Psicóticos/terapia , Psicologia do Esquizofrênico
16.
Cortex ; 139: 73-85, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33836304

RESUMO

Primary progressive aphasia (PPA) is characterised by predominant language and communication impairment. However, behavioural changes, such as apathy, are increasingly recognised. Apathy is defined as a reduction in motivation and goal-directed behaviour. Recent theoretical models have suggested that apathy can be delineated into multiple dimensions: executive apathy (i.e., deficits in maintaining goals and organisation), emotional apathy (i.e., emotional blunting and indifference) and initiation apathy (i.e., reduced self-initiation). Whether the nature of apathy differs between clinical variants of PPA, and across early and late disease stages, remains to be established. Here, carers/informants of 20 semantic variant PPA (svPPA), 15 non-fluent variant PPA (nfvPPA), 16 logopenic variant PPA (lvPPA) and 25 healthy older controls completed the Dimensional Apathy Scale to quantify executive, emotional and initiation apathy. Voxel-based morphometry was used to identify associations between dimensions of apathy and regions of grey matter intensity decrease. Our behavioural results showed greater executive and initiation apathy in late svPPA than in late nfvPPA patients, while late svPPA had greater emotional apathy than both late nfvPPA and late lvPPA groups. Executive and initiation apathy were significantly higher than premorbid levels in all PPA subtypes, while elevated emotional apathy was only seen in early and late svPPA. Distinct neural correlates were identified across apathy dimensions. Executive apathy correlated with grey matter intensity of the left dorsolateral prefrontal and inferior parietal cortices; emotional apathy with the left medial prefrontal, insular and cerebellar regions; and initiation apathy with right parietal areas. Our findings are the first to reveal evidence of the dimensional nature of apathy in PPA, with different clinical signatures observed for each subtype. From a clinical standpoint, these results will inform the development of targeted interventions for specific aspects of apathy which emerge in PPA.


Assuntos
Apatia , Afasia Primária Progressiva , Transtornos do Desenvolvimento da Linguagem , Afasia Primária Progressiva/diagnóstico por imagem , Emoções , Substância Cinzenta , Humanos
17.
Behav Neurol ; 2021: 8810632, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33854650

RESUMO

Objective: To understand the extent to which apathy, cognition, and social support predict participation in activities with cognitive demands. Design: Prospective, quantitative correlational, cross-sectional study. Setting. Outpatient treatment centers and community stroke support groups located in St. Louis, MO, and Boston, MA. Participants. 81 community-dwelling individuals ≥ 6-month poststroke with and without aphasia. Measures. Participants completed the Activity Card Sort (ACS), Apathy Evaluation Scale (AES), Medical Outcomes Study Social Support Survey (MOS-SSS), and Delis-Kaplan Executive Function System (DKEFS) Design Fluency and Trail-Making subtests. Results: Cognitive deficits limit participation in activities with high cognitive demands. Apathy and positive social interaction influence participation, regardless of high or low cognitive demands. Poststroke aphasia did not impact return to participation in activities with high and low cognitive demands. Conclusions and Relevance. Cognitive deficits seen poststroke contribute to participation only for activities with high cognitive demands. Apathy has a significant and negative influence on participation overall. Social support is a modifiable contextual factor that can facilitate participation. Poststroke apathy can be detrimental to participation but is not well recognized. The availability of companionship from others to enjoy time with can facilitate participation.


Assuntos
Apatia , Disfunção Cognitiva , Acidente Vascular Cerebral , Disfunção Cognitiva/etiologia , Estudos Transversais , Humanos , Estudos Prospectivos , Apoio Social , Acidente Vascular Cerebral/complicações
18.
Int J Geriatr Psychiatry ; 36(9): 1330-1344, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33905138

RESUMO

OBJECTIVE: The present study aimed to resolve inconsistency in reported prevalence of affective symptoms by dementia stage. METHODS/DESIGN: We conducted a meta-analysis of studies with data on dementia stage and prevalence of depression, anxiety, or apathy assessed using validated tools. We performed random-effects meta-analysis and subgroup analysis on symptom prevalence by dementia stage, according to CDR. RESULTS: The meta-analysis included 5897 people with dementia from 20 studies. Prevalence rates of depression in mild, moderate, and severe dementia were 38% (95% CI 32%-45%), 41% (95% CI 33%-49%), and 37% (95% CI 17%-56%) respectively. The corresponding prevalence for anxiety was 38% (95% CI 31%-45%), 41% (95% CI 31%-52%), and 37% (95% CI -8%-82%); and 54% (95% CI 45%-62%), 59% (95% CI 44%-73%), and 43% (95% CI 10%-75%) for apathy. The prevalence of depression, anxiety, and apathy did not differ with regard to dementia stage and type. The prevalence of depression in Alzheimer's disease (AD) was significantly lower when it was assessed using diagnostic criteria compared to screening tools. The prevalence of depression in AD was lowest in America, while anxiety in vascular dementia was higher in Europe than Asia. CONCLUSIONS: Depression, anxiety, and apathy symptoms are highly prevalent across dementia stages. There is no evidence of any changes in prevalence of affective symptom as the illness progresses. Evaluation methods and cultural difference may explain some of the variance, suggesting further investigation of factors that may influence the report of symptoms, such as carer psychosocial characteristics, and more cross-cultural studies are needed.


Assuntos
Doença de Alzheimer , Apatia , Demência , Ansiedade/epidemiologia , Demência/epidemiologia , Depressão/epidemiologia , Humanos , Testes Neuropsicológicos , Prevalência
19.
J Alzheimers Dis ; 81(2): 569-582, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814424

RESUMO

BACKGROUND: Social apathy, a reduction in initiative in proposing or engaging in social activities or interactions, is common in mild neurocognitive disorders (MND). Current apathy assessment relies on self-reports or clinical scales, but growing attention is devoted to defining more objective, measurable and non-invasive apathy proxies. OBJECTIVE: In the present study we investigated the interest of recording action kinematics in a social reach-to-grasp task for the assessment of social apathy. METHODS: Thirty participants took part in the study: 11 healthy controls (HC; 6 females, mean age = 68.3±10.5 years) and 19 subjects with MND (13 females, mean age = 75.7±6.3 years). Based on the Diagnostic Criteria for Apathy, MND subjects were classified as socially apathetic (A-MND, N = 9) versus non-apathetic (NA-MND, N = 10). SensRing, a ring-shaped wearable sensor, was placed on their index finger, and subjects were asked to reach and grasp a can to place it into a cup (individual condition) and pass it to a partner (social condition). RESULTS: In the reach-to-grasp phase of the action, HC and NA-MND showed different acceleration and velocity profiles in the social versus individual condition. No differences were found for A-MND. CONCLUSION: Previous studies showed the interest of recording patients' level of weekly motor activity for apathy assessment. Here we showed that a 10-min reach-to-grasp task may provide information to differentiate socially apathetic and non-apathetic subjects with MND, thus providing a tool easily usable in the clinical practice. Future studies with a bigger sample are needed to better characterize these findings.


Assuntos
Apatia/fisiologia , Fenômenos Biomecânicos/fisiologia , Disfunção Cognitiva/fisiopatologia , Força da Mão/fisiologia , Motivação/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Indian J Med Ethics ; VI(2): 1-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33908364

RESUMO

The Indian media's reportage of the Covid-19 pandemic has exposed the State's long-standing apathy towards low-income migrants and the structural neglect and violence faced by them in society. But how consistent were the country's print media in reporting on this population group before the crisis? This paper reports the findings of a study that examines the representation of migrants and refugees and their health in the Indian print media prior to the pandemic. A secondary objective was to examine any variations in their representation based on their social positions (for example, ethnicity, nationality, gender, religion). Using frame and content analyses, three English language newspapers were examined for the period January 1, 2017 to December 31, 2018. A total of 1,111 articles were retrieved. Analysis revealed that migrants were most frequently framed as "villains", posing a threat to the security, culture, health and economy in their destination states/cities, and less often as victims. On health coverage, the study found that the media frequently pathologised migrants and projected them as carriers of infection. Migrants' religion, ethnicity and class, and their proximity to the majoritarian population appeared most prominent in determining the frame imposed. The articles mostly relied on accounts of state officials and political leaders, whereas migrants' voices comprised less than a quarter of the sources of information. The media thus play a vital role in crystallising these disparities and, through acts of both omission and commission, end up vilifying migrants.


Assuntos
Apatia , COVID-19/epidemiologia , Nível de Saúde , Meios de Comunicação de Massa/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Fatores Socioeconômicos
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