Advertisement

Journal of Neuro-Oncology

, Volume 140, Issue 1, pp 27–35 | Cite as

Self- and informant-rated apathy in patients with childhood-onset craniopharyngioma

  • Aylin Mehren
  • Jale Özyurt
  • Paula zu Klampen
  • Svenja Boekhoff
  • Christiane M. Thiel
  • Hermann L. Müller
Laboratory Investigation

Abstract

Introduction

The current study aimed to assess whether childhood-onset craniopharyngioma patients suffer from symptoms of apathy, as assessed by patients themselves and their close others. We further analyzed whether apathy scores are related to symptoms of depression.

Methods

Childhood-onset craniopharyngioma patients (n = 35, 16 female, median age = 22) and matched healthy controls (n = 35, 19 female, median age = 21) were asked to complete self-ratings of the Apathy Evaluation Scale, whereas informant-ratings were obtained from their close others. Depression was assessed by self-ratings using the German version of the Center for Epidemiological Studies Depression Scale. As primary outcome measures, self- and informant-rated apathy scores were compared between patients and healthy controls. As secondary outcome measures, differences between self- and informant-rated apathy within the single groups and associations between apathy and depression were analyzed.

Results

Compared to healthy controls, patients displayed significantly higher apathy levels in informant-ratings (medianpatients = 18, mediancontrols = 12, p = .021), but not in self-ratings (medianpatients = 11, mediancontrols =12, p = .68). In patients, there was a significant discrepancy between self- and informant-rated apathy and self-rated apathy was related to symptoms of depression.

Conclusions

This is the first study to show that childhood-onset craniopharyngioma patients may be at high risk for apathy. Noteworthy, apathy levels in the patient group were judged to be high by their close others but not by the patients themselves, indicating that many patients were not fully aware of their impairments. As apathy is associated with numerous adverse outcomes affecting everyday life and vocational opportunities, future investigations are needed to identify specific risk factors for apathy.

Clinical Trial Registration No: NCT00258453.

Keywords

Apathy Brain tumors Craniopharyngioma Depression Hypothalamus Pituitary 

Abbreviation

CP

Craniopharyngioma

Notes

Acknowledgements

The authors would like to acknowledge Saskia Sauer for helping in the collection and analysis of data.

Disclosure

The authors have no financial relationships relevant to this article to disclose.

Funding

This work was funded by a Grant (DKS2014.13) of the German Childhood Cancer Foundation, Bonn, Germany and a Grant (Forschungspool) of the European Medical School, Oldenburg, Germany.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Muller HL, Merchant TE, Puget S, Martinez-Barbera JP (2017) New outlook on the diagnosis, treatment and follow-up of childhood-onset craniopharyngioma. Nat Rev Endocrinol  https://doi.org/10.1038/nrendo.2016.217 PubMedCrossRefGoogle Scholar
  2. 2.
    Muller HL (2016) Craniopharyngioma and hypothalamic injury: latest insights into consequent eating disorders and obesity. Curr Opin Endocrinol Diabetes Obes 23:81–89.  https://doi.org/10.1097/MED.0000000000000214 CrossRefPubMedGoogle Scholar
  3. 3.
    Ozyurt J, Muller HL, Thiel CM (2015) A systematic review of cognitive performance in patients with childhood craniopharyngioma. J Neurooncol 125:9–21.  https://doi.org/10.1007/s11060-015-1885-z CrossRefPubMedGoogle Scholar
  4. 4.
    Zada G, Kintz N, Pulido M, Amezcua L (2013) Prevalence of neurobehavioral, social, and emotional dysfunction in patients treated for childhood craniopharyngioma: a systematic literature review. PLoS ONE 8:e76562.  https://doi.org/10.1371/journal.pone.0076562 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Dekkers OM, Biermasz NR, Smit JW, Groot LE, Roelfsema F, Romijn JA, Pereira AM (2006) Quality of life in treated adult craniopharyngioma patients. Eur J Endocrinol 154:483–489.  https://doi.org/10.1530/eje.1.02114 CrossRefPubMedGoogle Scholar
  6. 6.
    Sterkenburg AS, Hoffmann A, Gebhardt U, Warmuth-Metz M, Daubenbuchel AM, Muller HL (2015) Survival, hypothalamic obesity, and neuropsychological/psychosocial status after childhood-onset craniopharyngioma: newly reported long-term outcomes. Neuro Oncol 17:1029–1038.  https://doi.org/10.1093/neuonc/nov044 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Muller HL (2010) Increased daytime sleepiness in patients with childhood craniopharyngioma and hypothalamic tumor involvement: review of the literature and perspectives. Int J Endocrinol 2010:519607  https://doi.org/10.1155/2010/519607 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Laffond C, Dellatolas G, Alapetite C, Puget S, Grill J, Habrand JL, Doz F, Chevignard M (2012) Quality-of-life, mood and executive functioning after childhood craniopharyngioma treated with surgery and proton beam therapy. Brain Inj 26:270–281.  https://doi.org/10.3109/02699052.2011.648709 CrossRefPubMedGoogle Scholar
  9. 9.
    Marin RS (1990) Differential diagnosis and classification of apathy. Am J Psychiatry 147:22–30.  https://doi.org/10.1176/ajp.147.1.22 CrossRefPubMedGoogle Scholar
  10. 10.
    Weitzner MA (1998) Neuropsychiatry and pituitary disease: an overview. Psychother Psychosom 67:125–132CrossRefPubMedGoogle Scholar
  11. 11.
    Weitzner MA, Kanfer S, Booth-Jones M (2005) Apathy and pituitary disease: it has nothing to do with depression. J Neuropsychiatry Clin Neurosci 17:159–166.  https://doi.org/10.1176/jnp.17.2.159 CrossRefPubMedGoogle Scholar
  12. 12.
    Fox ME, King TZ (2016) Pituitary disorders as a predictor of apathy and executive dysfunction in adult survivors of childhood brain tumors. Pediatric Blood Cancer 63:2019–2025.  https://doi.org/10.1002/pbc.26144 CrossRefPubMedGoogle Scholar
  13. 13.
    Marin RS (1991) Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 3:243–254.  https://doi.org/10.1176/jnp.3.3.243 CrossRefPubMedGoogle Scholar
  14. 14.
    Starkstein SE, Petracca G, Chemerinski E, Kremer J (2001) Syndromic validity of apathy in Alzheimer’s disease. Am J Psychiatry 158:872–877.  https://doi.org/10.1176/appi.ajp.158.6.872 CrossRefPubMedGoogle Scholar
  15. 15.
    Robert P, Onyike CU, Leentjens AFG, Dujardin K, Aalten P, Starkstein S, Verhey FRJ, 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 24:98–104.  https://doi.org/10.1016/j.eurpsy.2008.09.001 CrossRefPubMedGoogle Scholar
  16. 16.
    Resnick B, Zimmerman SI, Magaziner J, Adelman A (1998) Use of the apathy evaluation scale as a measure of motivation in elderly people. Rehabilit Nurs 23:141–147.  https://doi.org/10.1002/j.2048-7940.1998.tb01766.x CrossRefGoogle Scholar
  17. 17.
    van Reekum R, Stuss DT, Ostrander L (2005) Apathy: why care? J Neuropsychiatry Clin Neurosci 17:7–19.  https://doi.org/10.1176/jnp.17.1.7 CrossRefPubMedGoogle Scholar
  18. 18.
    Marin RS, Firinciogullari S, Biedrzycki RC (1993) The sources of convergence between measures of apathy and depression. J Affect Disord 28:117–124CrossRefPubMedGoogle Scholar
  19. 19.
    Levy ML, Cummings JL, Fairbanks LA, Masterman D, Miller BL, Craig AH, Paulsen JS, Litvan I (1998) Apathy is not depression. J Neuropsychiatry Clin Neurosci 10:314–319.  https://doi.org/10.1176/jnp.10.3.314 CrossRefPubMedGoogle Scholar
  20. 20.
    Marin RS, Firinciogullari S, Biedrzycki RC (1994) Group differences in the relationship between apathy and depression. J Nerv Ment Dis 182:235–239CrossRefPubMedGoogle Scholar
  21. 21.
    Moretti R, Signori R (2016) Neural correlates for apathy: frontal-prefrontal and parietal cortical- subcortical circuits. Front Aging Neurosci 8:289.  https://doi.org/10.3389/fnagi.2016.00289 PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Le Heron C, Apps MAJ, Husain M (2017) The anatomy of apathy: a neurocognitive framework for amotivated behaviour. Neuropsychologia  https://doi.org/10.1016/j.neuropsychologia.2017.07.003 PubMedCrossRefGoogle Scholar
  23. 23.
    Hua C, Shulkin BL, Indelicato DJ, Li Y, Li X, Boop FA, Merchant TE (2015) Postoperative cerebral glucose metabolism in pediatric patients receiving proton therapy for craniopharyngioma. J Neurosurg 16:567–573  https://doi.org/10.3171/2015.4.PEDS159 CrossRefGoogle Scholar
  24. 24.
    Ozyurt J, Muller HL, Warmuth-Metz M, Thiel CM (2017) Hypothalamic tumors impact gray and white matter volumes in fronto-limbic brain areas. Cortex 89:98–110.  https://doi.org/10.1016/j.cortex.2017.01.017 CrossRefPubMedGoogle Scholar
  25. 25.
    Marin RS, Biedrzycki RC, Firinciogullari S (1991) Reliability and validity of the Apathy evaluation scale. Psychiatry Res 38:143–162CrossRefPubMedGoogle Scholar
  26. 26.
    Lueken U, Seidl U, Schwarz M, Volker L, Naumann D, Mattes K, Schroder J, Schweiger E (2006) Psychometric properties of a German version of the apathy evaluation scale. Fortschr Neurol Psychiatr 74:714–722.  https://doi.org/10.1055/s-2006-932164 CrossRefPubMedGoogle Scholar
  27. 27.
    Hautzinger M, Bailer M, Hofmeister D, Keller F (2012) Allgemeine depressionsskala. Hogrefe, GöttingenGoogle Scholar
  28. 28.
    Radloff LS (1977) The CES-D scale—a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401 doi.  https://doi.org/10.1177/014662167700100306 CrossRefGoogle Scholar
  29. 29.
    Smets EM, Garssen B, Bonke B, De Haes JC (1995) The Multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39:315–325CrossRefPubMedGoogle Scholar
  30. 30.
    Schwarz R, Krauss O, Hinz A (2003) Fatigue in the general population. Onkologie 26:140–144 doi:69834PubMedGoogle Scholar
  31. 31.
    Kuhnt S, Ernst J, Singer S, Ruffer JU, Kortmann RD, Stolzenburg JU, Schwarz R (2009) Fatigue in cancer survivors-prevalence and correlates. Onkologie 32:312–317.  https://doi.org/10.1159/000215943 CrossRefPubMedGoogle Scholar
  32. 32.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRefPubMedGoogle Scholar
  33. 33.
    Sander C, Hegerl U, Wirkner K, Walter N, Kocalevent RD, Petrowski K, Glaesmer H, Hinz A (2016) Normative values of the Epworth sleepiness scale (ESS), derived from a large German sample. Sleep Breath 20:1337–1345.  https://doi.org/10.1007/s11325-016-1363-7 CrossRefPubMedGoogle Scholar
  34. 34.
    Bloch KE, Schoch OD, Zhang JN, Russi EW (1999) German version of the Epworth sleepiness scale. Respiration 66:440–447.  https://doi.org/10.1159/000029408 CrossRefPubMedGoogle Scholar
  35. 35.
    Handwerker G (2007) Narkolepsie. Monatsschr Kinderheilkd 155:624–629CrossRefGoogle Scholar
  36. 36.
    Wolff JE, Daumling E, Dirksen A, Dabrock A, Hartmann M, Jurgens H (1996) Munster Heidelberg abilities scale—a measuring instrument for global comparison of illness sequelae. Klin Padiatr 208:294–298.  https://doi.org/10.1055/s-2008-1046486 CrossRefPubMedGoogle Scholar
  37. 37.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMedGoogle Scholar
  38. 38.
    Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37:1345–1351CrossRefPubMedGoogle Scholar
  39. 39.
    Hoffmann A, Warmth-Metz M, Gebhardt U, Pietsch T, Pohl F, Kortmann RD, Calaminus G, Muller HL (2014) Childhood craniopharyngioma—changes of treatment strategies in the trials KRANIOPHARYNGEOM 2000/2007. Klin Padiatr 226:161–168.  https://doi.org/10.1055/s-0034-1368785 CrossRefPubMedGoogle Scholar
  40. 40.
    Muller HL, Bueb K, Bartels U, Roth C, Harz K, Graf N, Korinthenberg R, Bettendorf M, Kuhl J, Gutjahr P, Sorensen N, Calaminus G (2001) Obesity after childhood craniopharyngioma-German multicenter study on pre-operative risk factors and quality of life. Klin Padiatr 213:244–249.  https://doi.org/10.1055/s-2001-16855 CrossRefPubMedGoogle Scholar
  41. 41.
    Rolland-Cachera MF, Cole TJ, Sempe M, Tichet J, Rossignol C, Charraud A (1991) Body Mass Index variations: centiles from birth to 87 years. Eur J Clin Nutr 45:13–21PubMedGoogle Scholar
  42. 42.
    Muller HL, Gebhardt U, Teske C, Faldum A, Zwiener I, Warmuth-Metz M, Pietsch T, Pohl F, Sorensen N, Calaminus G, Study Committee of K (2011) Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up. Eur J Endocrinol 165:17–24.  https://doi.org/10.1530/EJE-11-0158 CrossRefPubMedGoogle Scholar
  43. 43.
    Muller HL, Gebhardt U, Faldum A, Warmuth-Metz M, Pietsch T, Pohl F, Calaminus G, Sorensen N (2012) Xanthogranuloma, Rathke’s cyst, and childhood craniopharyngioma: results of prospective multinational studies of children and adolescents with rare sellar malformations. J Clin Endocrinol Metab 97:3935–3943.  https://doi.org/10.1210/jc.2012-2069 CrossRefPubMedGoogle Scholar
  44. 44.
    Radakovic R, Harley C, Abrahams S, Starr JM (2015) A systematic review of the validity and reliability of apathy scales in neurodegenerative conditions. Int Psychogeriatr 27:903–923.  https://doi.org/10.1017/S1041610214002221 CrossRefPubMedGoogle Scholar
  45. 45.
    Poretti A, Grotzer MA, Ribi K, Schonle E, Boltshauser E (2004) Outcome of craniopharyngioma in children: long-term complications and quality of life. Dev Med Child Neurol 46:220–229CrossRefPubMedGoogle Scholar
  46. 46.
    Levi RB, Drotar D (1999) Health-related quality of life in childhood cancer: discrepancy in parent-child reports. Int J Cancer Suppl 12:58–64CrossRefPubMedGoogle Scholar
  47. 47.
    Heinks K, Boekhoff S, Hoffmann A, Warmuth-Metz M, Eveslage M, Peng J, Calaminus G, Muller HL (2018) Quality of life and growth after childhood craniopharyngioma: results of the multinational trial KRANIOPHARYNGEOM 2007. Endocrine 59:364–372.  https://doi.org/10.1007/s12020-017-1489-9 CrossRefPubMedGoogle Scholar
  48. 48.
    Canning EH, Canning RD, Boyce WT (1992) Depressive symptoms and adaptive style in children with cancer. J Am Acad Child Adolesc Psychiatry 31:1120–1124.  https://doi.org/10.1097/00004583-199211000-00021 CrossRefPubMedGoogle Scholar
  49. 49.
    Grace J, Malloy P (2001) The frontal systems behavior scale manual. Psychological Assessment Resources, OdessaGoogle Scholar
  50. 50.
    Drijgers RL, Verhey FR, Leentjens AF, Kohler S, Aalten P (2011) Neuropsychological correlates of apathy in mild cognitive impairment and Alzheimer’s disease: the role of executive functioning. Int Psychogeriatr 23:1327–1333.  https://doi.org/10.1017/S1041610211001037 CrossRefPubMedGoogle Scholar
  51. 51.
    Balazs J, Miklosi M, Kereszteny A, Hoven CW, Carli V, Wasserman C, Apter A, Bobes J, Brunner R, Cosman D, Cotter P, Haring C, Iosue M, Kaess M, Kahn JP, Keeley H, Marusic D, Postuvan V, Resch F, Saiz PA, Sisask M, Snir A, Tubiana A, Varnik A, Sarchiapone M, Wasserman D (2013) Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry 54:670–677.  https://doi.org/10.1111/jcpp.12016 CrossRefPubMedGoogle Scholar
  52. 52.
    Zenker S, Haverkamp F, Klingmuller D (2002) Growth hormone deficiency in pituitary disease: relationship to depression, apathy and somatic complaints. Eur J Endocrinol 147:165–171CrossRefPubMedGoogle Scholar
  53. 53.
    Mortby ME, Maercker A, Forstmeier S (2012) Apathy: a separate syndrome from depression in dementia? A critical review. Aging Clin Exp Res 24:305–316.  https://doi.org/10.3275/8105 PubMedCrossRefGoogle Scholar
  54. 54.
    Duffy J (2000) Apathy in neurologic disorders. Current Psychiatry Rep 2:434–439.  https://doi.org/10.1007/s11920-000-0029-z CrossRefGoogle Scholar
  55. 55.
    Thobois S, Prange S, Sgambato-Faure V, Tremblay L, Broussolle E (2017) Imaging the etiology of apathy, anxiety, and depression in Parkinson’s disease: implication for treatment. Curr Neurol Neurosci Rep 17:76.  https://doi.org/10.1007/s11910-017-0788-0 CrossRefPubMedGoogle Scholar
  56. 56.
    Skorvanek M, Gdovinova Z, Rosenberger J, Saeedian RG, Nagyova I, Groothoff JW, van Dijk JP (2015) The associations between fatigue, apathy, and depression in Parkinson’s disease. Acta Neurol Scand 131:80–87.  https://doi.org/10.1111/ane.12282 CrossRefPubMedGoogle Scholar
  57. 57.
    Carroll C, Watson P, Spoudeas HA, Hawkins MM, Walker DA, Clare IC, Holland AJ, Ring HA (2013) Prevalence, associations, and predictors of apathy in adult survivors of infantile (< 5 years of age) posterior fossa brain tumors. Neuro Oncol 15:497–505.  https://doi.org/10.1093/neuonc/nos320 CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Ailion AS, Hortman K, King TZ (2017) Childhood brain tumors: a systematic review of the structural neuroimaging literature. Neuropsychol Rev 27:220–244.  https://doi.org/10.1007/s11065-017-9352-6 CrossRefPubMedGoogle Scholar
  59. 59.
    Zhang Y, Zou P, Mulhern RK, Butler RW, Laningham FH, Ogg RJ (2008) Brain structural abnormalities in survivors of pediatric posterior fossa brain tumors: a voxel-based morphometry study using free-form deformation. Neuroimage 42:218–229.  https://doi.org/10.1016/j.neuroimage.2008.04.181 CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Muller HL, Gebhardt U, Teske C, Faldum A, Zwiener I, Warmuth-Metz M, Pietsch T, Pohl F, Sorensen N, Calaminus G (2011) Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up. Eur J Endocrinol 165:17–24.  https://doi.org/10.1530/EJE-11-0158 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Biological Psychology Lab, Department of Psychology, School of Medicine and Health Sciences, European Medical SchoolCarl von Ossietzky UniversitätOldenburgGermany
  2. 2.Psychiatry and Psychotherapy, School of Medicine and Health Sciences, University Hospital Karl-Jaspers-KlinikCarl von Ossietzky UniversitätOldenburgGermany
  3. 3.Department of Pediatrics and Pediatric Hematology/Oncology, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg AöRMedical Campus University OldenburgOldenburgGermany
  4. 4.Research Center Neurosensory ScienceCarl von Ossietzky UniversitätOldenburgGermany
  5. 5.Cluster of Excellence “Hearing4all”Carl von Ossietzky Universität OldenburgOldenburgGermany

Personalised recommendations