Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-30T23:50:58.588Z Has data issue: false hasContentIssue false

A longitudinal study examining the independence of apathy and depression after stroke: the Sydney Stroke Study

Published online by Cambridge University Press:  18 August 2010

Adrienne Withall*
Affiliation:
School of Psychiatry, University of New South Wales, Randwick, Australia Academic Department for Old Age Psychiatry, The Prince of Wales Hospital, Randwick, Australia Primary Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
Henry Brodaty
Affiliation:
School of Psychiatry, University of New South Wales, Randwick, Australia Academic Department for Old Age Psychiatry, The Prince of Wales Hospital, Randwick, Australia Primary Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
Annette Altendorf
Affiliation:
School of Psychiatry, University of New South Wales, Randwick, Australia Academic Department for Old Age Psychiatry, The Prince of Wales Hospital, Randwick, Australia
Perminder S. Sachdev
Affiliation:
School of Psychiatry, University of New South Wales, Randwick, Australia Primary Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia Neuropsychiatric Institute, The Prince of Wales Hospital, Randwick, Australia
*
Correspondence should be addressed to: Adrienne Withall, Primary Dementia Collaborative Research Centre, 45 Beach St, Coogee, NSW Australia 2034. Phone: +61 2 9385 9060; Fax: +61 2 9385 9075. Email: [email protected].

Abstract

Background: There is growing recognition that apathy is not only a symptom of depression but may be an independent syndrome. This is the first study to investigate the relationship of apathy and depression longitudinally following stroke and to examine the association with dementia.

Method: 106 consecutive eligible participants following stroke received extensive medical, psychiatric and neuropsychological assessments at three to six months (index assessment) and 15 months (follow-up assessment) after their stroke. A subset of participants received magnetic resonance imaging (MRI) scans at index assessment. Ratings were made for DSM-IV major or minor depression and for apathy using the Apathy Evaluation Scale (AES).

Results: While there was no significant overlap between apathy and depression at index assessment (OR = 1.79, 95% CI 0.48, 6.66), the overlap was significant a year later (OR = 7.75, 95% CI 2.60, 23.13). Dementia at index assessment was a common risk factor for both apathy and depression at follow-up (OR = 12.45, 95% CI 2.98, 52.02 and OR = 10.35, 95% CI 2.84, 37.72, respectively).

Conclusions: Apathy and depression after stroke have a common predictor and overlap longitudinally. The overlap might be due to cumulative vascular pathology and because of the relationship of each of these syndromes to dementia, which was an important, possibly causal, predictor for both.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andersen, G., Vestergaard, K., Riis, J. and Lauritzen, L. (1994). Incidence of post-stroke depression during the first year in a large unselected stroke population determined using a valid standardized rating scale. Acta Psychiatrica Scandinavica, 90, 190195.CrossRefGoogle Scholar
Astrom, M., Adolfsson, R. and Asplund, K. (1993). Major depression in stroke patients: a 3-year longitudinal study. Stroke, 24, 976982.CrossRefGoogle ScholarPubMed
Brodaty, H., Sachdev, P., Withall, A., Altendorf, A., Valenzuela, M. J. and Lorentz, L. (2005). Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke: the Sydney Stroke Study. Psychological Medicine, 35, 17071716.CrossRefGoogle ScholarPubMed
Brodaty, H., Withall, A., Altendorf, A. and Sachdev, P. S. (2007). Rates of depression at 3 and 15 months post-stroke and their relationship with cognitive decline: the Sydney Stroke Study. American Journal of Geriatric Psychiatry, 15, 477486.CrossRefGoogle Scholar
Fazekas, F., Chawluk, J. B., Alavi, A., Hurtig, H. I. and Zimmerman, R. A. (1987). MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. American Journal of Roentgenology, 149, 351356.CrossRefGoogle ScholarPubMed
First, M., Spitzer, R., Gibbon, M. and Williams, J. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version. Arlington, VA: American Psychiatric Publishing Inc.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Gainotti, G., Azzoni, A. and Marra, C. (1999). Frequency, phenomenology and anatomical-clinical correlates of major post-stroke depression.[see comment]. British Journal of Psychiatry, 175, 163167.CrossRefGoogle ScholarPubMed
Hantson, L. et al. (1994). The European Stroke Scale. Stroke, 25, 22152219.CrossRefGoogle ScholarPubMed
Holthoff, V. et al. (2005). Regional cerebral metabolism in early Alzheimer's disease with clinically significant apathy or depression. Biological Psychiatry, 57, 412421.CrossRefGoogle ScholarPubMed
Jorm, A. F. (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychological Medicine, 24, 145–53.CrossRefGoogle Scholar
Katz, S. and Akpom, C. A. (1976). A measure of primary sociobiological functions. International Journal of Health Services, 6, 493508.CrossRefGoogle ScholarPubMed
Kauhanen, M. L. et al. (1999). Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke, 30, 18751880.CrossRefGoogle ScholarPubMed
Kirsch-Darrow, L., Fernandez, H. F., Marsiske, M., Okun, M. S. and Bowers, D. (2006). Dissociating apathy and depression in Parkinson disease. Neurology, 67, 3338.CrossRefGoogle ScholarPubMed
Kunitz, S. C. et al. (1984). The pilot Stroke Data Bank: definition, design, and data. Stroke, 15, 740746.CrossRefGoogle Scholar
Landes, A. M., Sperry, S. D., Strauss, M. E. and Geldmacher, D. S. (2001). Apathy in Alzheimer's disease. Journal of the American Geriatrics Society, 49, 17001707.CrossRefGoogle ScholarPubMed
Landes, A. M., Sperry, S. D. and Strauss, M. E. (2005). Prevalence of apathy, dysphoria, and depression in relation to dementia severity in Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 342349.Google ScholarPubMed
Lavretsky, H., Ballmaier, M., Pham, D., Toga, A. and Kumar, A. (2007). Neuroanatomical characteristics of geriatric apathy and depression: a magnetic resonance imaging study. American Journal of Geriatric Psychiatry, 15, 386394.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.CrossRefGoogle ScholarPubMed
Levy, M. L. et al. (1998). Apathy is not depression. Journal of Neuropsychiatry, 10, 314319.CrossRefGoogle Scholar
Litvan, I., Mega, M. S., Cummings, J. L. and Fairbanks, L. (1996). Neuropsychiatric aspects of progressive supranuclear palsy. Neurology, 47, 11841189.CrossRefGoogle ScholarPubMed
Marin, R. S., Biedrzycki, R. C. and Firinciogullari, S. (1991). Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 38, 143162.CrossRefGoogle ScholarPubMed
Marin, R. S., Firinciogullari, S. and Biedrzycki, R. C. (1994). Group differences in the relationship between apathy and depression. Journal of Nervous and Mental Disease, 182, 235239.CrossRefGoogle ScholarPubMed
Migliorelli, R., Teson, A., Sabe, L., Petracchi, M., Leiguarda, R. and Starkstein, S. E. (1995). Prevalence and correlates of dysthymia and major depression among patients with Alzheimer's disease. American Journal of Psychiatry, 152, 3744.Google ScholarPubMed
Nelson, H. (1983). National Adult Reading Test (NART): Test Manual. Windsor: NFER-Nelson.Google Scholar
Niedermaier, N., Bohrer, E., Schulte, K., Schlattmann, P. and Heuser, I. (2004). Prevention and treatment of poststroke depression with Mirtazapine in patients with acute stroke. Journal of Clinical Psychiatry, 65, 16191623.CrossRefGoogle ScholarPubMed
Padala, P. R., Petty, F. and Bhatia, S. C. (2005). Methylphenidate may treat apathy independent of depression. Annals of Pharmacotherapy, 39, 19471949.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Federoff, J. P., Price, T. R., Leiguarda, R. and Robinson, R. G. (1993). Apathy following cerebrovascular lesions. Stroke, 24, 16251630.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Jorge, R., Mizrahi, R. and Robinson, R. G. (2006). A prospective longitudinal study of apathy in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 811.CrossRefGoogle ScholarPubMed
Sugden, S. G. and Bourgeois, J. A. (2004). Modafinil monotherapy in poststroke depression. Psychosomatics, 45, 8081.CrossRefGoogle ScholarPubMed
van Reekum, R., Stuss, D. T. and Ostrander, L. (2005). Apathy: why care? Journal of Neuropsychiatry and Clinical Neurosciences, 17, 719.CrossRefGoogle ScholarPubMed