Abstract
Depression is one of the most common psychiatric disorders in Alzheimer’s disease (AD), and depression is associated with poorer quality of life, greater disability in activities of daily living, faster cognitive decline, and higher frequency of depression and burden in caregivers. Depression in AD in usually underdiagnosed, which may be related to the lack of validated diagnostic criteria and specific instruments to assess depression in dementia. Left untreated, major depression in AD may last for about 12 months. Apathy is increasingly recognized as a major behavioral disorder in neuropsychiatric diseases, but confusion still exists as to its proper definition and assessment and whether apathy should be considered a symptom or a syndrome. Nevertheless, a variety of instruments have been developed to rate the severity of apathy in dementia, and a structured clinical interview has been recently validated. Moreover, there is now international consensus for a set of standardized diagnostic criteria to diagnose apathy in AD. Finally, apathy is a significant predictor of faster functional, mood, and motor decline.
Depression and apathy are among the most common behavioral and psychological disorders in AD. Both disorders have a strong negative impact on patients’ quality of life and are related to increased burden and stress among caregivers. One of the limitations in dealing with apathy and depression in dementia is that their respective diagnoses are not straightforward. Several scales to rate the severity of depression and apathy have been validated for use in AD, but standardized diagnostic criteria have only recently been proposed. This chapter addresses different strategies currently used to diagnose depression and apathy in AD and discusses the diagnostic criteria recently proposed. Another aim of this chapter is to discuss the frequency and clinical correlates of depression and apathy in AD.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Cohen-Cole SA, Stoudemire A (1987) Major depression and physical illness. Psychiatr Clin North Am 10:1–17
Gallo JJ, Rabins PV, Anthony JC (1999) Sadness in older persons: 13-year follow-up of a community sample in Baltimore, Maryland. Psychol Med 29(2):341–350
Olin JT, Katz IR, Meyers BS et al (2002) Provisional diagnostic criteria for depression of Alzheimer disease: rationale and background. Am J Geriatr Psychiatry 10(2):129–141
Verkaik R, Nuyen J, Schellevis F et al (2007) The relationship between severity of Alzheimer’s disease and prevalence of comorbid depressive symptoms and depression: a systematic review. Int J Geriatr Psychiatry 22(11):1063–1086
Lyketsos CG, Sheppard JM, Steinberg M et al (2001) Neuropsychiatric disturbance in Alzheimer’s disease clusters into three groups: the Cache County study. Int J Geriatr Psychiatry 16(11):1043–1053 (see comment)
Olin JT, Schneider LS, Katz IR et al (2002) Provisional diagnostic criteria for depression of Alzheimer disease. Am J Geriatr Psychiatry 10(2):125–128
Chemerinski E, Petracca G, Sabe L et al (2001) The specificity of depressive symptoms in patients with Alzheimer’s disease. Am J Psychiatry 158(1):68–72
Starkstein SE, Jorge R, Mizrahi R et al (2005) The construct of minor and major depression in Alzheimer’s disease. Am J Psychiatry 162:2086–2093
Starkstein SE, Mizrahi R, Garau LM (2005) Specificity of symptoms of depression in Alzheimer disease: a longitudinal analysis. Am J Geriatr Psychiatry 13:803–807
Levy ML, Cummings JL, Fairbanks LA et al (1998) Apathy is not depression. J Neuropsychiatry Clin Neurosci 10(3):314–319
Lyketsos CG, Olin J (2002) Depression in Alzheimer’s disease: overview and treatment. Biol Psychiatry 52(3):243–252
Starkstein SE, Chemerinski E, Sabe L et al (1997) Prospective longitudinal study of depression and anosognosia in Alzheimer’s disease. Br J Psychiatry 171:47–52
Burns A, Jacoby R, Levy R (1990) Psychiatric phenomena in Alzheimer’s disease. III: Disorders of mood. Br J Psychiatry 157:81–86
Aalten P, de Vugt ME, Jaspers N et al (2005) The course of neuropsychiatric symptoms in dementia. Part I: Findings from the two-year longitudinal Maasbed study. Int J Geriatr Psychiatry 20(6):523–530
Shin IS, Carter M, Masterman D et al (2005) Neuropsychiatric symptoms and quality of life in Alzheimer disease. Am J Geriatr Psychiatry 13(6):469–474
Kunik ME, Snow AL, Molinari VA et al (2003) Health care utilization in dementia patients with psychiatric comorbidity. Gerontologist 43(1):86–91
Suh GH, Kil Yeon B, Shah A et al (2005) Mortality in Alzheimer’s disease: a comparative prospective Korean study in the community and nursing homes. Int J Geriatr Psychiatry 20(1):26–34
Lee HB, Lyketsos CG (2003) Depression in Alzheimer’s disease: heterogeneity and related issues. Biol Psychiatry 54(3):353–362
Cohen CI, Hyland K, Kimhy D (2003) The utility of mandatory depression screening of dementia patients in nursing homes. Am J Psychiatry 160:2012–2017
Marin RS (1991) Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 3(3):243–254
van Reekum R, Stuss DT, Ostrander L (2005) Apathy: why care? J Neuropsychiatry Clin Neurosci 17(1):7–19
Levy R, Dubois B (2006) Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex 16:916–928
Starkstein SE, Ingram L, Garau ML et al (2005) On the overlap between apathy and depression in dementia. J Neurol Neurosurg Psychiatry 76(8):1070–1074
Starkstein S, Leentjens AF (2008) The nosological position of apathy in clinical practice. J Neurol Neurosurg Psychiatry 79:1088–1092
Robert P, Onyike CU, Leentjens AF et al (2009) Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. Eur Psychiatry 24(2):98–104
Marin RS, Wilkosz PA (2005) Disorders of diminished motivation. J Head Trauma Rehabil 20(4):377–388
Marin RS, Biedrzycki RC, Firinciogullari S (1991) Reliability and validity of the apathy evaluation scale. Psychiatry Res 38(2):143–162
Starkstein SE, Mayberg HS, Preziosi TJ et al (1992) Reliability, validity, and clinical correlates of apathy in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 4(2):134–139
Cummings JL (1997) The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology 48(suppl 6):S10–S16
Strauss ME, Sperry SD (2002) An informant-based assessment of apathy in Alzheimer disease. Neuropsychiatry Neuropsychol Behav Neurol 15(3):176–183
Robert PH, Clairet S, Benoit M et al (2002) The apathy inventory: assessment of apathy and awareness in Alzheimer’s disease, Parkinson’s disease and mild cognitive impairment. IntJ Geriatr Psychiatry 17(12):1099–1105
Berrios GE, Gili M (1995) Abulia and impulsiveness revisited: a conceptual history. Acta Psychiatr Scand 92(3):161–167
Sims A (2003) Symptoms in the mind. Saunders, Philadelphia
Laplane D, Dubois B (2001) Auto-activation deficit: a basal ganglia related syndrome. Mov Disord 16(5):810–814
Starkstein SE, Petracca G, Chemerinski E et al (2001) Syndromic validity of apathy in Alzheimer’s disease. Am J Psychiatry 158(6):872–877
Tatsch MF, Bottino CM, Azevedo D et al (2006) Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity. Am J Geriatr Psychiatry 14(5):438–445
Landes AM, Sperry SD, Strauss ME (2005) Prevalence of apathy, dysphoria, and depression in relation to dementia severity in Alzheimer’s disease. J Neuropsychiatry Clin Neurosci 17(3):342–349
Starkstein SE, Jorge R, Mizrahi R et al (2006) A prospective longitudinal study of apathy in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 77:8–11
Starkstein SE, Fedoroff JP, Price TR et al (1993) Apathy following cerebrovascular lesions. Stroke 24(11):1625–1630
Starkstein S, Merello M, Jorge R et al (2009) The syndromal validity and nosological position of apathy in Parkinson’s disease. Mov Disord 15:1211–1216
Starkstein SE, Merello M, Brockman S et al (2009) Apathy predicts more severe parkinsonism in Alzheimer’s disease. Am J Geriatr Psychiatry 17(4):291–298
Acknowledgments
This study was partially supported with grants from the University of Western Australia, and the National Health and Medical Research Council.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer
About this chapter
Cite this chapter
Starkstein, S.E., Brockman, S. (2010). Diagnosis and Clinical Relevance of Depression and Apathy in Alzheimer’s Disease. In: Miyoshi, K., Morimura, Y., Maeda, K. (eds) Neuropsychiatric Disorders. Springer, Tokyo. https://doi.org/10.1007/978-4-431-53871-4_14
Download citation
DOI: https://doi.org/10.1007/978-4-431-53871-4_14
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-53870-7
Online ISBN: 978-4-431-53871-4
eBook Packages: MedicineMedicine (R0)