Apathy is implicated as a prodrome of dementia

  • Neurology
  • 14 Oct 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Community-dwelling older adults with severe apathy at baseline had nearly double the risk for probable dementia over the course of 9 years.

Why this matters

  • Effective options for preventing and treating dementia are lacking.

Key results

  • Apathy at baseline (Apathy Evaluation Scale):
    • Low in 38%.
    • Moderate in 37%.
    • Severe in 25%.
  • Incidence of probable dementia overall: 18.9%.
  • Probable dementia in those with severe vs low apathy:
    • Incidence: 25% vs 14%.
    • Unadjusted HR: 1.9 (95% CI, 1.5-2.5).
    • aHR: 1.8 (95% CI, 1.3-2.3).
  • No significant adjusted association for those with moderate apathy.
  • Severe vs low apathy groups:
    • Worse baseline cognition on Digit Symbol Substitution Test (difference, 1.6 points; P=.029).
    • Worse baseline cognition on Modified Mini Mental State Examination (difference, 0.9 points; P=.019).
    • Similar rate of change in these measures over time.

Study design

  • US prospective, observational cohort study of 2018 White and Black community-dwelling older adults (mean age, 74 years; Health, Aging, and Body Composition study).
  • Main outcome: probable dementia (dementia medication use, hospital records, or clinically relevant cognitive decline on global cognition) at 9 years of follow-up.
  • Funding: National Institute on Aging.

Limitations

  • Use of an algorithm to identify patients with dementia.
  • Apathy was self-reported.
  • Limited information available on depression.