Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Diagnosis and Clinical Relevance of Depression and Apathy in Alzheimer’s Disease

  • Chapter
Neuropsychiatric Disorders

  • 1464 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cohen-Cole SA, Stoudemire A (1987) Major depression and physical illness. Psychiatr Clin North Am 10:1–17

    PubMed  CAS  Google Scholar 

  2. 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

    Article  PubMed  CAS  Google Scholar 

  3. 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

    PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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)

    Article  PubMed  CAS  Google Scholar 

  6. 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

    PubMed  Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Google Scholar 

  10. Levy ML, Cummings JL, Fairbanks LA et al (1998) Apathy is not depression. J Neuro­psychiatry Clin Neurosci 10(3):314–319

    PubMed  CAS  Google Scholar 

  11. Lyketsos CG, Olin J (2002) Depression in Alzheimer’s disease: overview and treatment. Biol Psychiatry 52(3):243–252

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  CAS  Google Scholar 

  13. Burns A, Jacoby R, Levy R (1990) Psychiatric phenomena in Alzheimer’s disease. III: Disorders of mood. Br J Psychiatry 157:81–86

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    PubMed  Google Scholar 

  16. Kunik ME, Snow AL, Molinari VA et al (2003) Health care utilization in dementia patients with psychiatric comorbidity. Gerontologist 43(1):86–91

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Lee HB, Lyketsos CG (2003) Depression in Alzheimer’s disease: heterogeneity and related issues. Biol Psychiatry 54(3):353–362

    Article  PubMed  CAS  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. Marin RS (1991) Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 3(3):243–254

    PubMed  CAS  Google Scholar 

  21. van Reekum R, Stuss DT, Ostrander L (2005) Apathy: why care? J Neuropsychiatry Clin Neurosci 17(1):7–19

    Article  PubMed  Google Scholar 

  22. Levy R, Dubois B (2006) Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex 16:916–928

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  CAS  Google Scholar 

  24. Starkstein S, Leentjens AF (2008) The nosological position of apathy in clinical practice. J Neurol Neurosurg Psychiatry 79:1088–1092

    Article  PubMed  CAS  Google Scholar 

  25. 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

    Article  PubMed  CAS  Google Scholar 

  26. Marin RS, Wilkosz PA (2005) Disorders of diminished motivation. J Head Trauma Rehabil 20(4):377–388

    Article  PubMed  Google Scholar 

  27. Marin RS, Biedrzycki RC, Firinciogullari S (1991) Reliability and validity of the apathy evaluation scale. Psychiatry Res 38(2):143–162

    Article  PubMed  CAS  Google Scholar 

  28. 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

    PubMed  CAS  Google Scholar 

  29. Cummings JL (1997) The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology 48(suppl 6):S10–S16

    Article  PubMed  CAS  Google Scholar 

  30. Strauss ME, Sperry SD (2002) An informant-based assessment of apathy in Alzheimer disease. Neuropsychiatry Neuropsychol Behav Neurol 15(3):176–183

    PubMed  Google Scholar 

  31. 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

    Article  PubMed  CAS  Google Scholar 

  32. Berrios GE, Gili M (1995) Abulia and impulsiveness revisited: a conceptual history. Acta Psychiatr Scand 92(3):161–167

    Article  PubMed  CAS  Google Scholar 

  33. Sims A (2003) Symptoms in the mind. Saunders, Philadelphia

    Google Scholar 

  34. Laplane D, Dubois B (2001) Auto-activation deficit: a basal ganglia related syndrome. Mov Disord 16(5):810–814

    Article  PubMed  CAS  Google Scholar 

  35. Starkstein SE, Petracca G, Chemerinski E et al (2001) Syndromic validity of apathy in Alzheimer’s disease. Am J Psychiatry 158(6):872–877

    Article  PubMed  CAS  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  Google Scholar 

  38. 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

    Article  PubMed  CAS  Google Scholar 

  39. Starkstein SE, Fedoroff JP, Price TR et al (1993) Apathy following cerebrovascular lesions. Stroke 24(11):1625–1630

    Article  PubMed  CAS  Google Scholar 

  40. 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

    Google Scholar 

  41. 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

    Article  PubMed  Google Scholar 

Download references

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

  1. School of Psychiatry and Clinical Neurosciences, University of Western Australia, WA, Australia

    Sergio E. Starkstein & Simone Brockman

  2. and Fremantle Hospital, Education Building T-7, Fremantle, 6959, WA, Australia

    Sergio E. Starkstein & Simone Brockman

Authors
  1. Sergio E. Starkstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Brockman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sergio E. Starkstein .

Editor information

Editors and Affiliations

  1. Jinmeikai Research Institute for Mental Health, 53-20 Kabutoyama-cho, Nishinomiya, Hyogo, 662-0001, Japan

    Koho Miyoshi M.D., Ph.D. (Director, The former Professor) & Yasushi Morimura M.D., Ph.D. (Chief Executive Officer) (Director, The former Professor) &  (Chief Executive Officer)

  2. Ohmura Hospital, 200 Kitayama-Ohmura, Miki, Hyogo, 673-0404, Japan

    Koho Miyoshi M.D., Ph.D. (Director, The former Professor) (Director, The former Professor)

  3. Department of Occupational Therapy, Kobe Gakuin University School of Rehabilitation, 518 Ikawadani-cho, Nishi-ku, Kobe, 651-2180, Japan

    Kiyoshi Maeda M.D., Ph.D. (Professor) (Professor)

Rights and permissions

Reprints 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)

Publish with us

Policies and ethics

Search

Navigation