Journal of Neurology

, Volume 257, Issue 2, pp 217–223

Apathy in drug-naïve patients with incident Parkinson’s disease: the Norwegian ParkWest study

  • Kenn Freddy Pedersen
  • Guido Alves
  • Kolbjørn Brønnick
  • Dag Aarsland
  • Ole-Bjørn Tysnes
  • Jan Petter Larsen
Original Communication

Abstract

Apathy is a common behavioural problem in Parkinson’s disease (PD), with important clinical consequences for patients and their families. However, little is known about apathy in early PD. We examined the frequency and clinical characteristics of apathy in 175 nondemented, drug-naïve patients with newly diagnosed PD and 165 control subjects matched for age, sex and education level in Western and Southern Norway. All participants underwent a comprehensive neurological, psychiatric and neuropsychological evaluation. Apathy was diagnosed based on Neuropsychiatric Inventory assessment and recently proposed consensus criteria. Apathy was found in 22.9% of the PD patients, of whom 37.5% had significant depressive symptoms, whereas none of the control subjects were apathetic. Apathy was significantly associated with male gender, higher depression scores and more severe motor symptoms, but was not associated with greater cognitive impairment. When excluding patients with significant depressive symptoms, apathy remained significantly associated with motor severity. Approximately 50% of the caregivers of patients with apathy reported the apathetic behaviour to be at least moderately distressing. The association between apathy and motor severity in our PD cohort suggests a common underlying pathophysiological mechanism. Future studies should explore the longitudinal effect of dopamine replacement therapy on apathetic behaviour in early PD. The relationship between apathy and male gender needs further study to be fully evaluated.

Keywords

Parkinson’s disease Drug-naïve Apathy Motor severity Caregiver burden 

References

  1. 1.
    Alves G, Muller B, Herlofson K, Hogenesch I, Telstad W, Aarsland D, Tysnes OB, Larsen JP (2009) Incidence of Parkinson’s disease in Norway: the Norwegian ParkWest study. J Neurol Neurosurg Psychiatry 80:851–857Google Scholar
  2. 2.
    Benton AL, Hamsher KD (1989) Multilingual aphasia examination. AJA Associates, Iowa CityGoogle Scholar
  3. 3.
    Brown RG, Pluck G (2000) Negative symptoms: the ‘pathology’ of motivation and goal-directed behaviour. Trends Neurosci 23:412–417CrossRefPubMedGoogle Scholar
  4. 4.
    Braak H, Del Tredici K, Rub U, de Vos RA, Jansen Steur EN, Braak E (2003) Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 24:197–211CrossRefPubMedGoogle Scholar
  5. 5.
    Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J (1994) The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44:2308–2314PubMedGoogle Scholar
  6. 6.
    Czernecki V, Pillon B, Houeto JL, Pochon JB, Levy R, Dubois B (2002) Motivation, reward, and Parkinson’s disease: influence of dopatherapy. Neuropsychologia 40:2257–2267CrossRefPubMedGoogle Scholar
  7. 7.
    Delis DC, Kramer JH, Kaplan E, Ober BA (2000) CVLT-II. California verbal learning test. Adult Version, 2nd edn, The Psychological Corporation, Harcourt Assessment Inc., San AntonioGoogle Scholar
  8. 8.
    Dujardin K, Sockeel P, Devos D, Delliaux M, Krystkowiak P, Destee A, Defebvre L (2007) Characteristics of apathy in Parkinson’s disease. Mov Disord 22:778–784CrossRefPubMedGoogle Scholar
  9. 9.
    Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, Broe GA, Cummings J, Dickson DW, Gauthier S, Goldman J, Goetz C, Korczyn A, Lees A, Levy R, Litvan I, McKeith I, Olanow W, Poewe W, Quinn N, Sampaio C, Tolosa E, Dubois B (2007) Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov Disord 22:1689–1707CrossRefPubMedGoogle Scholar
  10. 10.
    Fahn S, Elton RL, Members of the UPDRS Development Committee (1987) Unified Parkinson’s disease rating scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M (eds) Recent developments in Parkinson’s disease. Macmillan Healthcare Information, Florham Park, NJ, pp 153–163Google Scholar
  11. 11.
    Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
  12. 12.
    Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56:33–39CrossRefPubMedGoogle Scholar
  13. 13.
    Golden CJ, Freshwater SM (1998) The Stroop color and word test. The Stoelting Company, Wood DaleGoogle Scholar
  14. 14.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442PubMedGoogle Scholar
  15. 15.
    Isella V, Melzi P, Grimaldi M, Iurlaro S, Piolti R, Ferrarese C, Frattola L, Appollonio I (2002) Clinical, neuropsychological, and morphometric correlates of apathy in Parkinson’s disease. Mov Disord 17:366–371CrossRefPubMedGoogle Scholar
  16. 16.
    Jorm AF (2004) The informant questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr 16:275–293CrossRefPubMedGoogle Scholar
  17. 17.
    Kaufer DI, Cummings JL, Christine D, Bray T, Castellon S, Masterman D, MacMillan A, Ketchel P, De Kosky ST (1998) Assessing the impact of neuropsychiatric symptoms in Alzheimer’s disease: the neuropsychiatric inventory caregiver distress scale. J Am Geriatr Soc 46:210–215PubMedGoogle Scholar
  18. 18.
    Kenangil G, Orken DN, Ur E, Forta H, Celik M (2009) The relation of testosterone levels with fatigue and apathy in Parkinson’s disease. Clin Neurol Neurosurg 111:412–414CrossRefPubMedGoogle Scholar
  19. 19.
    Kirsch-Darrow L, Fernandez HF, Marsiske M, Okun MS, Bowers D (2006) Dissociating apathy and depression in Parkinson disease. Neurology 67:33–38CrossRefPubMedGoogle Scholar
  20. 20.
    Kuhn W, Heye N, Muller T, Kraus P, Klotz P, Friedrich B, Welter FL, Przuntek H (1996) The motor performance test series in Parkinson’s disease is influenced by depression. J Neural Transm 103:349–354CrossRefPubMedGoogle Scholar
  21. 21.
    Kulisevsky J, Pagonabarraga J, Pascual-Sedano B, Garcia-Sanchez C, Gironell A (2008) Prevalence and correlates of neuropsychiatric symptoms in Parkinson’s disease without dementia. Mov Disord 23:1889–1896CrossRefPubMedGoogle Scholar
  22. 22.
    Leentjens AF, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE, Weintraub D, Sampaio C, Poewe W, Rascol O, Stebbins GT, Goetz CG (2008) Apathy and anhedonia rating scales in Parkinson’s disease: critique and recommendations. Mov Disord 23:2004–2014CrossRefPubMedGoogle Scholar
  23. 23.
    Marin RS (1991) Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 3:243–254PubMedGoogle Scholar
  24. 24.
    Marin RS, Wilkosz PA (2005) Disorders of diminished motivation. J Head Trauma Rehabil 20:377–388CrossRefPubMedGoogle Scholar
  25. 25.
    Marsh L, McDonald WM, Cummings J, Ravina B (2006) Provisional diagnostic criteria for depression in Parkinson’s disease: report of an NINDS/NIMH Work Group. Mov Disord 21:148–158CrossRefPubMedGoogle Scholar
  26. 26.
    Marsh L (2006) Behavioral disturbances. In: Menza M, Marsh L (eds) Psychiatric issues in Parkinson’s disease, a practical guide. Taylor & Francis, London, pp 193–218Google Scholar
  27. 27.
    Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389CrossRefPubMedGoogle Scholar
  28. 28.
    Pedersen KF, Alves G, Aarsland D, Larsen JP (2009) Occurrence and risk factors for apathy in Parkinson’s disease: a 4-year prospective longitudinal study. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp.2008.170043
  29. 29.
    Pedersen KF, Larsen JP, Alves G, Aarsland D (2009) Prevalence and clinical correlates of apathy in Parkinson’s disease: a community-based study. Parkinsonism Relat Disord 15:295–299CrossRefPubMedGoogle Scholar
  30. 30.
    Pluck GC, Brown RG (2002) Apathy in Parkinson’s disease. J Neurol Neurosurg Psychiatry 73:636–642CrossRefPubMedGoogle Scholar
  31. 31.
    Ready RE, Friedman J, Grace J, Fernandez H (2004) Testosterone deficiency and apathy in Parkinson’s disease: a pilot study. J Neurol Neurosurg Psychiatry 75:1323–1326CrossRefPubMedGoogle Scholar
  32. 32.
    Reijnders JS, Ehrt U, Weber WE, Aarsland D, Leentjens AF (2008) A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord 23:183–189CrossRefPubMedGoogle Scholar
  33. 33.
    Robert P, Onyike CU, Leentjens AF, Dujardin K, Aalten P, Starkstein S, Verhey FR, Yessavage J, Clement JP, Drapier D, Bayle F, Benoit M, Boyer P, Lorca PM, Thibaut F, Gauthier S, Grossberg G, Vellas B, Byrne J (2009) Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. Eur Psychiatry 24:98–104Google Scholar
  34. 34.
    Schrag A, Barone P, Brown RG, Leentjens AF, McDonald WM, Starkstein S, Weintraub D, Poewe W, Rascol O, Sampaio C, Stebbins GT, Goetz CG (2007) Depression rating scales in Parkinson’s disease: critique and recommendations. Mov Disord 22:1077–1092CrossRefPubMedGoogle Scholar
  35. 35.
    Schrag A, Jahanshahi M, Quinn NP (2001) What contributes to depression in Parkinson’s disease? Psychol Med 31:65–73CrossRefPubMedGoogle Scholar
  36. 36.
    Schwab RS, England AC (1969) Projection technique for evaluating surgery in Parkinson’s disease. In: Third Symposium on Parkinson’s disease, Royal College of Surgeons in Edinburgh. E&S Livingstone Ltd., pp 152–157 (Table 1, p 153)Google Scholar
  37. 37.
    Starkstein SE, Mayberg HS, Preziosi TJ, Andrezejewski P, Leiguarda R, Robinson RG (1992) Reliability, validity, and clinical correlates of apathy in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 4:134–139PubMedGoogle Scholar
  38. 38.
    Starkstein SE, Merello M, Jorge R, Brockman S, Bruce D, Petracca G, Robinson RG (2008) A validation study of depressive syndromes in Parkinson’s disease. Mov Disord 23:538–546CrossRefPubMedGoogle Scholar
  39. 39.
    Warrington EK, James M (1991) The visual object and space perception battery. Thames Valley Test Company, Bury St EdmundsGoogle Scholar
  40. 40.
    Aarsland D, Bronnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, Cummings JL (2007) Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry 78:36–42CrossRefPubMedGoogle Scholar
  41. 41.
    Aarsland D, Bronnick K, Larsen JP, Tysnes OB, Alves G (2009) Cognitive impairment in incident, untreated Parkinson disease: the Norwegian ParkWest study. Neurology 72:1121–1126CrossRefPubMedGoogle Scholar
  42. 42.
    Aarsland D, Bronnick K, Alves G, Tysnes OB, Pedersen KF, Ehrt U, Larsen JP (2009) The spectrum of neuropsychiatric symptoms in patients with early untreated Parkinson’s disease. J Neurol Neurosurg Psychiatry 80:928–930CrossRefPubMedGoogle Scholar
  43. 43.
    Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, Cummings JL (1999) Range of neuropsychiatric disturbances in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 67:492–496CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Kenn Freddy Pedersen
    • 1
    • 2
  • Guido Alves
    • 1
    • 2
  • Kolbjørn Brønnick
    • 1
  • Dag Aarsland
    • 1
    • 3
    • 5
  • Ole-Bjørn Tysnes
    • 4
    • 5
  • Jan Petter Larsen
    • 1
    • 2
    • 5
  1. 1.The Norwegian Centre for Movement DisordersStavanger University HospitalStavangerNorway
  2. 2.Department of NeurologyStavanger University HospitalStavangerNorway
  3. 3.Department of PsychiatryStavanger University HospitalStavangerNorway
  4. 4.Department of NeurologyHaukeland University HospitalBergenNorway
  5. 5.Institute of Clinical Medicine, School of MedicineUniversity of BergenBergenNorway

Personalised recommendations