A small p-value (< 0.05) indicates that the solution with K classes fit better. The Apathy subscale comprises reduced activity and initiative, poor perseverance and quality of work, impaired judgment, personal neglect, and blunting of affect. Results: Fifteen apathy scales or subscales were examined. The MFIS is a 21-item scale that measures how fatigue affects daily life, with each item being rated on a 5-point Likert scale (0–4: 0 = ‘Never’, 4 = ‘Almost Always’). Introduction. Thus, these individuals were classified as ‘generally apathetic’. The three-factor structure of the 18-item AMI (Table 1) was confirmed, and had good model fit indices (RMSEA = 0.076 with 90% CI of 0.068–0.083, SRMR = 0.071, CFI = 0.83). Yes I feel awful if I say something insensitive). Chakraborty S, Lennon JC, Malkaram SA, Zeng Y, Fisher DW, Dong H. Neurosci Lett. 9 DOMAINS 4 Composite Subscales Everyday productivity Interests Taking initiative Novelty seeking Voluntary actions Emotional responses Concern Social life Self-awareness Intellectual Curiosity Emotion Action Initiation (AI) Self-Awareness (SA) TOTAL SCORE -36 (normal) to +36 (abnormal) Lille Apathy Rating Scale (LARS) Sockeel et al., 2006 The DAS is a 24-item scale that assesses apathy on three different subscales, namely executive, emotional and behavioural/cognitive initiation. In addition, they were also asked to complete a set of established related measures to assess construct validity, noted below. To examine whether we could identify distinct profiles of apathy and how these are differentially predictive of comorbid states (depression, anhedonia and fatigue), we conducted a latent profile analysis (LPA) [32] using the data acquired in study 2. To assess internal reliability, Cronbach’s coefficient alpha values were calculated for both the total score and subscales. Epub 2019 Apr 1. Two hand-scorable, carbonless test booklets (self and family) are available. 2006 Mar;21(3):259-65. doi: 10.1002/gps.1457. PLoS ONE 12(1): Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial. Latent profile analyses showed four different profiles of apathy that were associated with varying levels of depression, anhedonia and fatigue. No, Is the Subject Area "Motivation" applicable to this article? As a result, the mechanisms underlying variability in apathy are still poorly understood. Here we developed the Apathy Motivation Index (AMI; Table 1), a new instrument suitable for assessing levels of apathy and motivation in the healthy population. Each item was scored on a 4-point Likert scale, with a higher total score indicating greater apathy (1–4: 1 = ‘very true’, 4 = ‘not true at all’ for positively scored items). https://doi.org/10.1371/journal.pone.0169938.g002. Theoretical accounts have proposed that apathy is a multidimensional construct which actually covers motivation within dissociable domains: cognitive, emotional/affective and behavioural [2, 12]. A value of RMSEA and SRMR less than 0.08 is generally considered to be reasonable [24]. No, Is the Subject Area "Parkinson disease" applicable to this article? This site needs JavaScript to work properly. BA and SM correlated positively with BDI and MFIS, indicating that individuals that were more apathetic on these subscales also had higher levels of depression and fatigue. Yes CAS consisted of five subscales to measure multiple viewpoints of apathy. This gave rise to a preliminary 51-item scale [21]. Objective: (A) 3D scatterplot illustrating the distribution of each healthy individual’s mean rating along the three AMI subscales. Our data suggest that there may be particular subtypes of apathy that are more likely to co-occur with these symptoms. It was also positively associated with the BDI (ρ = 0.26, p < 0.01) and MFIS total (r = 0.19, p < 0.01). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We identified three domains of apathy, namely behavioural activation (BA), emotional sensitivity (ES) and social motivation (SM). People identified as ‘behaviourally/socially apathetic’ were significantly more depressed and fatigued than people who were ‘emotionally apathetic’ or ‘generally motivated’. Our finding suggests that apathy and anhedonia have a close relationship in the general population, with those individuals characterised by higher levels of apathy also more likely to report experiencing anhedonia. 505 people (211 males, 271 females, 23 gender undisclosed, mean age = 28.7 years, SD = 14.9, range = 16–85, N = 27 age undisclosed), recruited from the local communities via online adverts and posters, completed a preliminary 51-item scale. Click through the PLOS taxonomy to find articles in your field. However, these measures were not perfectly correlated suggesting that there are also unique aspects of anhedonia not related to apathy. 83 ALS patients, 75 carers and 83 sex-age-education matched controls participated. This study was designed to establish the validity and reliability of the apathy inventory (IA), a rating scale for global assessment of apathy and separate assessment of emotional blunting, lack of initiative, and lack of interest. Yes Citation: Ang Y-S, Lockwood P, Apps MAJ, Muhammed K, Husain M (2017) Distinct Subtypes of Apathy Revealed by the Apathy Motivation Index. Items from the clinical LARS that were deemed to be applicable to healthy people were also adapted. The SM subscale contained items that examine a person’s engagement in social interactions. Clipboard, Search History, and several other advanced features are temporarily unavailable. This model is schematically illustrated in Fig 1. We briefly summarize key correlational results here in text (details in Table 5 and Fig 2). https://doi.org/10.1371/journal.pone.0169938, Editor: Maria Gulinello, Yeshiva University Albert Einstein College of Medicine, UNITED STATES, Received: September 25, 2016; Accepted: December 22, 2016; Published: January 11, 2017. Internal consistency, item reliability, and between-rater reliability were high. Maintenance of occupational therapy (OT) for dementia: protocol of a multi-center, randomized controlled and pragmatic trial. To interpret each class, we compared the conditional response means with the overall sample means on each AMI subscale (Table 7, Fig 3). While a CFI of at least 0.90 is normally taken to indicate an acceptable model [24], it should be noted that this index calculates the fit difference between a null independence model (i.e. Project 1 developed the Person-Environment Apathy Rating (PEAR) scale to measure environmental stimulation and apathy, and tested its psychometrics. In clinical disorders such as Parkinson’s disease (PD), it is now established that apathy is frequently linked to depression, with many overlapping symptoms including loss of interest and lack of initiative [17]. The Irritability subscale includes poor temper control, verbal and physical aggression, behavioral inflexibility, and … It has long been established that positive reinforcement is essential to maintain goal-directed behaviour [38]. Apathy Evaluation Scale, clinician version We used the AES‐C to measure indicators of apathy in the previous 4 weeks. Sheelakumari R, Bineesh C, Varghese T, Kesavadas C, Verghese J, Mathuranath PS. 63 of these participants also completed the AMI a second time between 6–8 days after initial completion to assess test-retest reliability. This is supported by positive associations found between the AMI BA subscale with DAS (Dimensional Apathy Scale [14]) executive and behavioural/cognitive initiation but not the emotional subscale. A series of rating scales have been proposed to iden-tify and quantify apathy and to di erentiate it from other disorders, especially depression [ ]. The BDI is 21-item scale that measures the severity of depression. Apathy Evaluation Scale, and the Geriatric Depression Scale- Short form. USA.gov. PLOS ONE promises fair, rigorous peer review, The variability of the prevalence rate might depend on the type of assessment used to detect apathy (e.g., Neuropsychiatric Inventory, Figved et al., 2005, or Apathy Evaluation Scale, AES, Raimo et al., 2014), and might be influenced by severity of disease-related disability. However, despite the evidence of links between apathy and depression, anhedonia and fatigue in neurological conditions, it remains to be established whether there are similar specific links in the healthy population. Key Descriptions. Apathy is a disorder of motivation characterised by reduced action initiation and goal-directed behaviour [1, 2]. Model fit was assessed using RMSEA, SRMR, and Comparative Fit Index (CFI). Participants were asked to self-rate each item on a five-point Likert scale by deciding how true that statement was based on the past two weeks of their life. We also showed for the first time that different subtypes of apathy are predictive of different associations with depression, anhedonia and fatigue in healthy people (Fig 4). Briefly, the scale is composed of 33 items grouped in 9 domains, or subscales, which evaluate “reduction in everyday productivity (EP), lack of interest (INT), lack of initiative (INI), extinction of novelty seeking (NS) and motivation (M), blunting of emotional responses (ER), lack of concern (C), poor social life (SL), and extinction of self-awareness (SA)” [ 11 The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. https://doi.org/10.1371/journal.pone.0169938.g003. For more information about PLOS Subject Areas, click doi: 10.2196/17167. Objective: This dissertation includes three projects that study care environments and apathy in dementia as well as measures of activity. The behaviourally/socially apathetic experienced the greatest depression and fatigue while the generally motivated were most hedonic. Apathy is the most common behavioral change reported in amyotrophic lateral sclerosis (ALS; Strong et al., 2017) and has been shown to have negative practical impact, such as caregiver burden (Burke et al., 2015).Apathy is a syndrome composed of different subtypes of demotivation (Radakovic & Abrahams, 2018).The dimensional apathy scale (DAS; Radakovic & Abrahams, 2014) is a … Aim: To adapt, translate, and utilize the Dimensional Apathy Scale (DAS) in Amyotrophic Lateral Sclerosis (ALS) to the Spanish population.Method: We recruited 104 ALS patients (67 of their caregivers) and 49 controls. The emotionally apathetic people were also more hedonic than the generally apathetic class (Fig 4B). They showed adequate values, indicating acceptable internal consistency (αoverall = 0.77, αBA = 0.79, αSM = 0.75, αES = 0.75). [ ] proposed the apathy evaluation scale (AES) based on his Most people (60.8%) were identified as ‘generally motivated’ with their group average on each AMI subscale being lower than the overall mean. Regular Article Validation of apathy evaluation scale and assessment of severity of apathy in Alzheimer’s disease pcn_2315 227..234 Chia-Jung Hsieh, P hD, RN,1 Hsin Chu, MD, P D,2 Joseph Jror-Serk Cheng, MD, MHS,3 Winston W. Shen, MD4 and Chia-Chin Lin, PhD, RN5* 1School of Nursing, College of Nursing, National Taipei University of Nursing and Health Science, 2Institute of Aerospace The most psychometrically robust measures for assessing apathy across any disease population appear to be the Apathy Evaluation Scale and the apathy subscale of the Neuropsychiatric Inventory based on the criteria set in this review. Test-retest reliability coefficients for the scale and subscales were also satisfactory, indicating stable responses across time (roverall: 0.83, rBA: 0.88, rSM: 0.84, rES: 0.72). Whilst apathy is a common syndrome associated with altered motivation [2, 12], it is also frequently comorbid with other states which may have symptoms of reduced motivation, particularly depression, anhedonia and fatigue [3, 4, 15, 16]. Discover a faster, simpler path to publishing in a high-quality journal. Method: Information for the IA can be obtained from the patient or from a caregiver. [28] and scored responses using a 4-point Likert-style instead (1–4: 1 = ‘Strongly Disagree’, 4 = ‘Strongly Agree’) with higher scores reflecting greater hedonic tone. 2012 Aug-Sep;168(8-9):598-604. doi: 10.1016/j.neurol.2012.05.002. The PEAR-Apathy subscale was validated using the Neuropsychiatric Inventory (NPI)-Apathy, Passivity in Dementia Scale (PDS), and NPI-Depression. The scores in the patient-based evaluations were only higher for the PD group versus the control subjects. Rationale and protocol of the ENGAGE study: a double-blind randomized controlled preference trial using a comprehensive cohort design to measure the effect of a cognitive and leisure-based intervention in older adults with a memory complaint. 2020 Mar 11;22(3):e17167. It also correlated positively with all three subscales of the DAS. Results of factor analyses—both exploratory (EFA) and confirmatory (CFA)–in large samples indicated that the AMI has a clear three-factor structure with good psychometric properties. background section, the scale allows a rapid and reliable assessment of negative symptoms.  |  The AMI is a novel and reliable measure of individual differences in apathy and might provide a useful means of probing different mechanisms underlying sub-clinical lack of motivation in otherwise healthy individuals. 2019 Jun 21;704:36-44. doi: 10.1016/j.neulet.2019.03.050. Method: Information for the IA can be obtained from the patient or from a caregiver. The Akaike Information Criterion (AIC) [34] and sample-size adjusted Bayesian Information Criterion (sBIC) [35] are descriptive fit indices with lower values indicating more optimal model fit. Given this relationship between motivation and reward, we predicted that anhedonia and apathy would be linked. Funding: This research was supported by a Wellcome Trust Principal Research Fellowship to MH, an A*STAR National Science Scholarship to YA, a BBSRC Anniversary Future Leader Fellowship (BB/M013596/1) to MAJA, and a Wellcome Trust Clinical Research Training Fellowship to KM. zero correlation between all observed variables) and the hypothesized model. Finally, the AMI total score was negatively correlated with the SHAPS (r = - 0.46, p < 0.01), indicating that apathetic people experience greater anhedonia. In this study we used the CAS3, the scale for assessment of spontaneity about patients’ ADL. The SHAPS is a 14-item scale that assesses hedonic tone, or ability to experience pleasure. Each item was rated on a 4-point Likert scale, with a higher score indicating greater apathy (0–3: 0 = ‘Almost Always’, 3 … Please enable it to take advantage of the complete set of features! Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Parkinsonism Relat Disord. Intriguingly, these different apathy subtypes were predictive of different associations with depression, anhedonia and fatigue. This was adapted from the original AES (Marin et al., 1991) to assess individuals’ apathy level based on their thoughts, emotions, and behaviors over the past 4 weeks. In contrast the ES scale was negatively correlated with depression and fatigue. Would you like email updates of new search results? The four classes were labelled generally motivated (orange), behaviourally/socially apathetic (green), emotionally apathetic (blue), and generally apathetic (red). After the EFA, twenty-one items were excluded, as their loadings were less than 0.40. This raises the question of the extent to which apathy can be meaningfully distinguished from these other conditions and whether they might perhaps be associated with discrete dimensions of apathy in healthy individuals. The purpose of this study was to investigate the characteristics of evaluation between families and nurses in assessing patients’ apathy. broad scope, and wide readership – a perfect fit for your research every time. Using the most rigorous psychometric procedures, we then dissected out the different factors that comprise the AMI and determined whether depression, anhedonia and fatigue are related to distinct profiles of apathy. To examine construct validity, correlational analyses between the overall and subscale scores of the AMI and other related measures were conducted. To create a comparable measure suitable for the general population, a team of clinical neurologists and university researchers developed, based on their experience with clinically apathetic patients, novel items to specifically reflect each domain of the LARS. Epub 2012 Aug 24. Information for the IA can be obtained from the patient or from a caregiver. In this study we used the CAS3, the scale for assessment of spontaneity about patients’ ADL. Nonetheless, it is recognised that apathy may be characterised by emotional blunting whereas depression is an affective disorder featured by extreme emotional fluctuations [37]. The 4-class model was the most appropriate (Table 6). Yes here.  |  Rather than discuss every individual association between the scale/subscales, we highlight key findings here. Division of Psychology and Language Sciences, University College London, London, United Kingdom, Affiliation The factor analysis identified three distinct subscales, namely behavioural activation (BA), social motivation (SM) and emotional sensitivity (ES). The Lo-Mendell-Rubin Adjusted Likelihood Ratio Test [33] (LMRT) and Bootstrapped Likelihood Ratio Test (BLRT) [32] compares the fit of the current model with K classes to one with K-1 classes. The factor loadings for each subscale were good (BA: 0.56–0.75; SM: 0.54–0.66; ES: 0.46–0.78). National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Furthermore, are these different symptoms associated with distinct profiles of apathy in healthy people? Test structure. Significant differences were found between classes for all three measures (BDI: F(3,475) = 14.7, p < 0.001; SHAPS: F(3,475) = 29.9, p < 0.001; MFIS: F(3,475) = 8.63, p < 0.001). He defined apathy as “lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress.” (Marin, 1991). (**: p < 0.01). While SM correlated with BA and ES, BA did not associate with ES. (* p < 0.05, ** p < 0.01, *** p < 0.001). 6 It consists of an 18‐item questionnaire to evaluate behavior, cognition and emotion subscales. https://doi.org/10.1371/journal.pone.0169938.g001, https://doi.org/10.1371/journal.pone.0169938.t004. Moreover, although apathy is commonly comorbid with symptoms of depression, anhedonia and fatigue, how and why these symptoms are associated is unclear. Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom, Affiliations Robert PH, Schuck S, Dubois B, Lépine JP, Gallarda T, Olié JP, Goni S, Troy S. Encephale. The Apathy Evaluation Scale (AES) with its clinical version (AES-C) is one of the most used scales in an interdisciplinary context, but it has never previously been used in a population with first episode psychosis. 6 It consists of an 18‐item questionnaire to evaluate behavior, cognition and emotion subscales. I get things done when they need to be done, without requiring reminders from others), (2) social motivation (SM): level of engagement in social interactions (e.g. The IA is a reliable method for assessing in demented and non-demented elderly subjects several dimensions of the apathetic syndrome, and also the subject's awareness of these symptoms. We investigated models with one to five classes and determined the optimal number of classes for our sample with several statistical indicators. Post-hoc comparisons showed that the behaviourally/socially apathetic class were significantly more depressed and fatigued than the emotionally apathetic and generally motivated classes. It consists of 13 items and 6 subscales (anhedonia, distress, avolition, blunted affect and alogia, see Table 2) and can be split into the two different factors motivation and pleasure and emotional expressivity [14]. These three factors were labelled according to their common themes as (1) behavioural activation (BA): tendency to self-initiate goal-directed behaviour (e.g. Recently, the Lille Apathy Rating Scale (LARS), a semistructured interview yielding a global score, and composite subscores for different domains of apathy (i.e., cognitive, behavioral, affective, self awareness), was developed and given to a sample of patients with PD in … However, currently there are no validated assessments of apathy in healthy people. All three AMI subscales were negatively correlated with the SHAPS (lower scores indicate higher levels of anhedonia), suggesting that higher apathy was associated with lower hedonia. https://doi.org/10.1371/journal.pone.0169938.t006. The variability of the prevalence rate might depend on the type of assessment used to detect apathy (e.g., Neuropsychiatric Inventory, Figved et al., 2005, or Apathy Evaluation Scale, AES, Raimo et al., 2014), and might be influenced by severity of disease-related disability. [13] as a domain of apathy during the development of the LARS, although it is not specified within other cognitive-behaviour-emotion frameworks of apathy [1, 2]. It is also unknown whether different domains of apathy can be identified in healthy people, and whether they might be dissociable across individuals. Although it often occurs in several neurological and psychiatric disorders, it is also apparent to varying degrees in healthy people [3–9]. Trials. Epub 2007 Sep 21. A concurrent validity study showed that the IA assesses apathy as effectively as the Neuro Psychiatric Inventory apathy domain. Table 3 shows higher scores on the Initiation and Executive apathy subscales. Whilst many tools have been developed to assess levels of apathy in clinical disorders, surprisingly there are no measures of apathy suitable for healthy people. The Apathy Evaluation Scale (AES) was developed by Marin (1991) as a method for measuring apathy resulting from brain-related pathology. Using exploratory factor analysis (in a sample of 505 people), and then confirmatory analysis (in a different set of 479 individuals), we identified subtypes of apathy in behavioural, social and emotional domains. Furthermore, as data collection for RUN DMC is still ongoing, no data on progression to dementia were available beyond 2015, so only 2011 AES scores were analysed. The Apathy Evaluation Scale (AES) was developed as a method for measuring apathy resulting from brain-related pathology. All post-hoc comparison differences were significant at p < 0.05 (Emotionally apathetic: BDI mean = 8.0, SD = 8.8, SHAPS mean = 47.6, SD = 5.6, MFIS mean = 20.9, SD = 14.0; Behaviourally/socially apathetic: BDI mean = 16.2, SD = 11.8, SHAPS mean = 45.7, SD = 5.8, MFIS mean = 34.9, SD = 17.6; Generally motivated: BDI mean = 9.7, SD = 9.0, SHAPS mean = 50.4, SD = 4.9, MFIS mean = 29.3, SD = 17.3; Generally apathetic: BDI mean = 12.8, SD = 13.0, SHAPS mean = 42.3, SD = 6.6, MFIS mean = 29.3, SD = 26.7).