Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-20T04:27:09.321Z Has data issue: false hasContentIssue false

Apathy and Depression: Separate Factors in Parkinson's Disease

Published online by Cambridge University Press:  30 September 2011

Lindsey Kirsch-Darrow
Affiliation:
Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
Michael Marsiske
Affiliation:
Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
Michael S. Okun
Affiliation:
Department of Neurology, Movement Disorders Center, University of Florida, Gainesville, Florida
Russell Bauer
Affiliation:
Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
Dawn Bowers*
Affiliation:
Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida Department of Neurology, Movement Disorders Center, University of Florida, Gainesville, Florida
*
Correspondence and reprint requests to: Dawn Bowers, Department of Clinical & Health Psychology, University of Florida, Gainesville, FL 32611. E-mail: [email protected]

Abstract

The objective of this study was to test the hypothesis that apathy and depression are dissociable in Parkinson disease (PD) by conducting a confirmatory factor analysis (CFA) of items from two commonly used mood scales. A total of 161 non-demented PD patients (age = 64.1; ± 8.4 years) were administered the Apathy Scale and the Beck Depression Inventory-II. Items were hypothesized to load onto four factors: (1) an apathy factor representing loss of motivation, (2) dysphoric mood factor representing sadness and negativity, (3) loss of interest/pleasure factor representing the features common to both apathy and depression, and (4) a somatic factor representing bodily complaints. Results indicated a good fit for the overall CFA model, χ2 (128, N = 146) = 194.9; p<.01. RMSEA was .060 (p = .16). The four-factor model was significantly better than all alternative nested models at p < .001, including an overarching single factor model, representing “depression.” Results support the concept that apathy and depression are discrete constructs. We suggest a “factor based” scoring of the Apathy Scale and Beck Depression Inventory-II that disentangles symptoms related to apathy, depression, overlapping symptoms, and somatic complaints. Such scoring may be important in providing useful information regarding differential treatment options. (JINS, 2011, 17, 1058–1066)

Type
Regular Articles
Copyright
Copyright © The International Neuropsychological Society 2011

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

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.Google Scholar
Beck, A.T., Steer, R., Brown, G. (1996). Beck Depression Inventory-II. San Antonio, TX: The Psychological Corporation.Google Scholar
Brown, R.G., Pluck, G. (2000). Negative symptoms: The ‘pathology’ of motivation and goal-directed behaviour. Trends in Neurosciences, 23(9), 412417. doi:S0166-2236(00)01626-X [pii]CrossRefGoogle ScholarPubMed
Butterfield, L.C., Cimino, C.R., Oelke, L.E., Hauser, R.A., Sanchez-Ramos, J. (2010). The independent influence of apathy and depression on cognitive functioning in Parkinson's disease. Neuropsychology, 24(6), 721730. doi:2010-19103-001 [pii] 10.1037/a0019650CrossRefGoogle ScholarPubMed
Czernecki, V., Pillon, B., Houeto, J.L., Pochon, J.B., Levy, R., Dubois, B. (2002). Motivation, reward, and Parkinson's disease: Influence of dopatherapy. Neuropsychologia, 40(13), 22572267. doi:S0028393202001082 [pii]CrossRefGoogle ScholarPubMed
Damasio, A.R., Van Hoesen, G.W. (1983). Emotional disturbances associated with focal lesions of the limbic frontal lobe. In K.M. Heilman & P. Satz (Eds.), Neuropsychology of Human Emotion (pp. 85110). New York: Guilford.Google Scholar
Davidson, R.J., Irwin, W. (1999). The functional neuroanatomy of emotion and affective style. Trends in Cognitive Science, 3(1), 1121. doi:S1364-6613(98)01265-0 [pii]CrossRefGoogle ScholarPubMed
Dobkin, R.D., Allen, L.A., Menza, M. (2007). Cognitive-behavioral therapy for depression in Parkinson's disease: A pilot study. Movement Disorders, 22(7), 946952. doi:10.1002/mds.21455CrossRefGoogle ScholarPubMed
Dobkin, R.D., Menza, M., Bienfait, K.L. (2008). CBT for the treatment of depression in Parkinson's disease: A promising nonpharmacological approach. Expert Review of Neurotherapeutics, 8(1), 2735. doi:10.1586/14737175.8.1.27CrossRefGoogle ScholarPubMed
Dujardin, K., Sockeel, P., Delliaux, M., Deste, A., Defebvre, L. (2009). Apathy may herald cognitive decline and dementia in Parkinson's disease. Movement Disorders, doi:10.1002/mds.22843CrossRefGoogle ScholarPubMed
Dujardin, K., Sockeel, P., Devos, D., Delliaux, M., Krystkowiak, P., Deste, A., Defebvre, L. (2007). Characteristics of apathy in Parkinson's disease. Movement Disorders, 22(6), 778784. doi:10.1002/mds.21316CrossRefGoogle ScholarPubMed
Ferencz, B., Kirsch-Darrow, L., Bogordskaya, M., Okun, M.S., Bowers, D. (2010). Toys and Gadgets: Construct Validity of Apathy in Parkinson Disease. Abstract accepted for presentation at the American Academy of Neurology 62nd Annual Meeting.Google Scholar
Groenewegen, H.J., Wright, C.I., Beijer, A.V. (1996). The nucleus accumbens: Gateway for limbic structures to reach the motor system? Progress in Brain Research, 107, 485511.CrossRefGoogle ScholarPubMed
Hobson, D.E., Lang, A.E., Martin, W.R., Razmy, A., Rivest, J., Fleming, J. (2002). Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: A survey by the Canadian Movement Disorders Group. Journal of the American Medical Association, 287(4), 455463. doi:joc10367 [pii]CrossRefGoogle ScholarPubMed
Hughes, A.J., Ben-Shlomo, Y., Daniel, S.E., Lees, A.J. (1992). What features improve the accuracy of clinical diagnosis in Parkinson's disease: A clinicopathologic study. Neurology, 42(6), 11421146.CrossRefGoogle ScholarPubMed
Hughes, A.J., Daniel, S.E., Kilford, L., Lees, A.J. (1992). Accuracy of clinical diagnosis of idiopathic Parkinson's disease: A clinico-pathological study of 100 cases. Journal of Neurology, Neurosurgery, and Psychiatry, 55(3), 181184.CrossRefGoogle ScholarPubMed
Isella, V., Melzi, P., Grimaldi, M., Iurlaro, S., Piolti, R., Ferrarese, C., Appollonio, I. (2002). Clinical, neuropsychological, and morphometric correlates of apathy in Parkinson's disease. Movement Disorders, 17(2), 366371. doi:10.1002/mds.10041 [pii]CrossRefGoogle ScholarPubMed
Judd, L.L., Paulus, M.P., Wells, K.B., Rapaport, M.H. (1996). Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. Am J Psychiatry, 153(11), 14111417.Google Scholar
Jurica, P.J., Leitten, C.J., Mattis, S. (2001). Dementia Rating Scale-2: Professional manual, Psychological Assessment Resources, Lutz, FL, USA.Google Scholar
Kirsch-Darrow, L., Fernandez, H.H., Marsiske, M., Okun, M.S., Bowers, D. (2006). Dissociating apathy and depression in Parkinson disease. Neurology, 67(1), 3338. doi:67/1/33 [pii] 10.1212/01.wnl.0000230572.07791.22CrossRefGoogle ScholarPubMed
Kirsch-Darrow, L., Zahodne, L.B., Has, C., Mikos, A., Okun, M.S., Fernandez, H.H., Bowers, D. (2009). How cautious should we be when assessing apathy with the Unified Parkinson's Disease Rating Scale? Movement Disorders, 24(5), 684688. doi:10.1002/mds.22437CrossRefGoogle ScholarPubMed
Leentjens, A.F., Dujardin, K., Marsh, L., Martinez-Martin, P., Richard, I.H., Starkstein, S.E., Goetz, C.G. (2008). Apathy and anhedonia rating scales in Parkinson's disease: Critique and recommendations. Movement Disorders, 23(14), 20042014. doi:10.1002/mds.22229CrossRefGoogle ScholarPubMed
Leentjens, A.F., Verhey, F.R., Luijckx, G.J., Troost, J. (2000). The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease. Movement Disorders, 15(6), 12211224.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
Levin, B.E., Llabre, M.M., Weiner, W.J. (1988). Parkinson's disease and depression: Psychometric properties of the Beck Depression Inventory. Journal of Neurology, Neurosurgery, and Psychiatry, 51(11), 14011404.CrossRefGoogle ScholarPubMed
Levy, M.L., Cummings, J.L., Fairbanks, L.A., Masterman, D., Miller, B.L., Craig, A.H., et al. (1998). Apathy is not depression. J Neuropsychiatry Clin Neurosci, 10(3), 314319.CrossRefGoogle Scholar
Little, T.D., Cunningham, W.A., Shahar, G., Widaman, K.F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. [Empirical Study]. Structural Equation Modeling, 9(2), 151173. doi:10.1207/s15328007sem0902_1CrossRefGoogle Scholar
Lyness, J.M., Bruce, M.L., Koenig, H.G., Parmelee, P.A., Schulz, R., Lawton, M.P., et al. (1996). Depression and medical illness in late life: report of a symposium. J Am Geriatr Soc, 44(2), 198203.CrossRefGoogle Scholar
Marcoulides, G., Hershberger, S. (1997). Multivariate statistical methods: A first course. Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Marin, R.S. (1990). Differential diagnosis and classification of apathy. American Journal of Psychiatry, 147(1), 2230.Google ScholarPubMed
Marin, R.S. (1991). Apathy: A neuropsychiatric syndrome. The Journal of Neuropsychiatry and Clinical Neurosciences, 3(3), 243254.Google Scholar
Marin, R.S., Biedrzycki, R.C., Firinciogullari, S. (1991). Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 38(2), 143162. doi:0165-1781(91)90040-V [pii]CrossRefGoogle ScholarPubMed
Marsh, L., McDonald, W.M., Cummings, J., Ravina, B. (2006). Provisional diagnostic criteria for depression in Parkinson's disease: Report of an NINDS/NIMH Work Group. Movement Disorders, 21(2), 148158. doi:10.1002/mds.20723CrossRefGoogle ScholarPubMed
Mayberg, H.S. (1994). Frontal lobe dysfunction in secondary depression. The Journal of Neuropsychiatry and Clinical Neurosciences, 6(4), 428442.Google ScholarPubMed
Mayberg, H.S., Starkstein, S.E., Sadzot, B., Preziosi, T., Andrezejewski, P.L., Dannals, R.F., Robinson, R.G. (1990). Selective hypometabolism in the inferior frontal lobe in depressed patients with Parkinson's disease. Annals of Neurology, 28(1), 5764. doi:10.1002/ana.410280111CrossRefGoogle ScholarPubMed
Mogenson, G.J., Jones, D.L., Yim, C.Y. (1980). From motivation to action: Functional interface between the limbic system and the motor system. Progress in Neurobiology, 14(2-3), 6997. doi:0301-0082(80)90018-0 [pii]CrossRefGoogle ScholarPubMed
Oguru, M., Tachibana, H., Toda, K., Okuda, B., Oka, N. (2010). Apathy and depression in Parkinson disease. Journal of Geriatric Psychiatry and Neurology, 23(1), 3541. doi:0891988709351834 [pii] 10.1177/0891988709351834CrossRefGoogle ScholarPubMed
Pedersen, K.F., Alves, G., Bronnick, K., Aarsland, D., Tysnes, O.B., Larsen, J.P. (2009). Apathy in drug-naive patients with incident Parkinson's disease: The Norwegian ParkWest study. Journal of Neurology, 257, 217223. doi:10.1007/s00415-009-5297-xCrossRefGoogle ScholarPubMed
Pluck, G.C., Brown, R.G. (2002). Apathy in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 73(6), 636642.CrossRefGoogle ScholarPubMed
Remy, P., Doder, M., Lees, A., Turjanski, N., Brooks, D. (2005). Depression in Parkinson's disease: Loss of dopamine and noradrenaline innervation in the limbic system. Brain, 128(Pt 6), 13141322. doi:awh445 [pii] 10.1093/brain/awh445CrossRefGoogle ScholarPubMed
Santangelo, G., Vitale, C., Trojano, L., Longo, K., Cozzolino, A., Grossi, D., Barone, P. (2009). Relationship between depression and cognitive dysfunctions in Parkinson's disease without dementia. Journal of Neurology, 256(4), 632638. doi:10.1007/s00415-009-0146-5CrossRefGoogle ScholarPubMed
Schrag, A., Barone, P., Brown, R.G., Leentjens, A.F., McDonald, W.M., Starkstein, S., Goetz, C.G. (2007). Depression rating scales in Parkinson's disease: Critique and recommendations. Movement Disorders, 22(8), 10771092. doi:10.1002/mds.21333CrossRefGoogle ScholarPubMed
Sockeel, P., Dujardin, K., Devos, D., Deneve, C., Deste, A., Defebvre, L. (2006). The Lille apathy rating scale (LARS), a new instrument for detecting and quantifying apathy: Validation in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77(5), 579584. doi:77/5/579 [pii] 10.1136/jnnp.2005.075929CrossRefGoogle Scholar
Starkstein, S.E., Mayberg, H.S., Preziosi, T.J., Andrezejewski, P., Leiguarda, R., Robinson, R.G. (1992). Reliability, validity, and clinical correlates of apathy in Parkinson's disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 4(2), 134139.Google ScholarPubMed
Thobois, S., Ardouin, C., Lhomme, E., Klinger, H., Lagrange, C., Xie, J., Krack, P. (2010). Non-motor dopamine withdrawal syndrome after surgery for Parkinson's disease: Predictors and underlying mesolimbic denervation. Brain, 133(Pt 4), 11111127. doi:awq032 [pii] 10.1093/brain/awq032CrossRefGoogle ScholarPubMed
van Reekum, R., Stus, D.T., Ostrander, L. (2005). Apathy: Why care? The Journal of Neuropsychiatry and Clinical Neurosciences, 17(1), 719. doi:17/1/7 [pii] 10.1176/appi.neuropsych.17.1.7CrossRefGoogle ScholarPubMed
Visser, M., Leentjens, A.F., Marinus, J., Stiggelbout, A.M., van Hilten, J.J. (2006). Reliability and validity of the Beck depression inventory in patients with Parkinson's disease. Movement Disorders, 21(5), 668672. doi:10.1002/mds.20792CrossRefGoogle ScholarPubMed
Zahodne, L.B., Young, S., Kirsch-Darrow, L., Nisenzon, A., Fernandez, H.H., Okun, M.S., Bowers, D. (2009). Examination of the Lille Apathy Rating Scale in Parkinson disease. Movement Disorders, 24(5), 677683. doi:10.1002/mds.22441CrossRefGoogle ScholarPubMed
Zgaljardic, D.J., Borod, J.C., Foldi, N.S., Rocco, M., Mattis, P.J., Gordon, M.F., Eidelberg, D. (2007). Relationship between self-reported apathy and executive dysfunction in nondemented patients with Parkinson disease. Cognitive and Behavioral Neurology, 20(3), 184192. doi:10.1097/WNN.0b013e318145a6f6 00146965-200709000-00008 [pii]CrossRefGoogle ScholarPubMed