Diagnostic criteria for apathy in neurocognitive disorders

David S Miller; Philippe Robert; Larry Ereshefsky; Lawrence Adler; Daniel Bateman; Jeff Cummings; Steven T DeKosky; Corinne E Fischer; Masud Husain; Zahinoor Ismail; Judith Jaeger; Alan J Lerner; Abby Li; Constantine G Lyketsos; Valeria Manera; Jacobo Mintzer; Hans J Moebius; Moyra Mortby; Didier Meulien; Stephane Pollentier; Anton Porsteinsson; Jill Rasmussen; Paul B Rosenberg; Myuri T Ruthirakuhan; Mary Sano; Carla Zucchero Sarracini; Krista L Lanctôt

doi:10.1002/alz.12358

Diagnostic criteria for apathy in neurocognitive disorders

Alzheimers Dement. 2021 Dec;17(12):1892-1904. doi: 10.1002/alz.12358. Epub 2021 May 5.

Authors

David S Miller¹, Philippe Robert^{2

3

4}, Larry Ereshefsky⁵, Lawrence Adler⁶, Daniel Bateman⁷, Jeff Cummings^{8

9}, Steven T DeKosky¹⁰, Corinne E Fischer^{11

12}, Masud Husain^{13

14

15}, Zahinoor Ismail¹⁶, Judith Jaeger¹⁷, Alan J Lerner¹⁸, Abby Li¹⁹, Constantine G Lyketsos²⁰, Valeria Manera^{2

3}, Jacobo Mintzer²¹, Hans J Moebius²², Moyra Mortby²³, Didier Meulien²⁴, Stephane Pollentier²⁵, Anton Porsteinsson²⁶, Jill Rasmussen²⁷, Paul B Rosenberg²⁰, Myuri T Ruthirakuhan¹⁹, Mary Sano²⁸, Carla Zucchero Sarracini¹⁹, Krista L Lanctôt^{19

29}

Affiliations

¹ Signant Health, Blue Bell, Pennsylvania, USA.
² Cognition Behaviour Technology Lab, Université Côte d'Azur, Nice, France.
³ Association Innovation Alzheimer, Nice, France.
⁴ Centre Memoire, Centre Hospitalier Universitaire de Nice, Nice, France.
⁵ Follow the Molecule, Marina del Rey, California, USA.
⁶ Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁷ Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.
⁸ Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, USA.
⁹ Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA.
¹⁰ Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA.
¹¹ Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
¹² Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
¹³ Department of Experimental Psychology, University of Oxford, Oxford, UK.
¹⁴ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
¹⁵ Oxford NIHR Biomedical Research Centre, Oxford, UK.
¹⁶ Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
¹⁷ CognitionMetrics, Wilmington, Delaware, USA.
¹⁸ University Hospitals - Case Western Reserve University, Cleveland, Ohio, USA.
¹⁹ Sunnybrook Research Institute, Toronto, Ontario, Canada.
²⁰ Johns Hopkins University, Baltimore, Maryland, USA.
²¹ Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA.
²² Moebius-Consult, Baar, Switzerland.
²³ UNSW Ageing Futures Institute, The University of New South Wales, Sydney, Australia.
²⁴ Clinical Research and Development, H. Lundbeck A/S, Valby, Denmark.
²⁵ Boehringer Ingelheim Pharma GmbH & Co KG, CNS Diseases Research, Biberach an der Riss, Germany.
²⁶ University of Rochester, Rochester, New York, USA.
²⁷ Psi-Napse, Dorking, UK.
²⁸ Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²⁹ Departments of Psychiatry and Pharmacology/Toxicology, University of Toronto, Toronto, Ontario, Canada.

Abstract

Introduction: Apathy is common in neurocognitive disorders (NCD) but NCD-specific diagnostic criteria are needed.

Methods: The International Society for CNS Clinical Trials Methodology Apathy Work Group convened an expert group and sought input from academia, health-care, industry, and regulatory bodies. A modified Delphi methodology was followed, and included an extensive literature review, two surveys, and two meetings at international conferences, culminating in a consensus meeting in 2019.

Results: The final criteria reached consensus with more than 80% agreement on all parts and included: limited to people with NCD; symptoms persistent or frequently recurrent over at least 4 weeks, a change from the patient's usual behavior, and including one of the following: diminished initiative, diminished interest, or diminished emotional expression/responsiveness; causing significant functional impairment and not exclusively explained by other etiologies.

Discussion: These criteria provide a framework for defining apathy as a unique clinical construct in NCD for diagnosis and further research.

Keywords: apathy; behavior; cognition; diagnostic criteria; emotion; motivation; neurocognitive disorder (NCD); neuropsychiatric symptoms (NPS).

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Apathy / physiology*
Consensus*
Delphi Technique*
Emotions
Expert Testimony*
Humans
Motivation
Neurocognitive Disorders / classification*
Neurocognitive Disorders / diagnosis*
Neurocognitive Disorders / psychology

Abstract

Publication types

MeSH terms

Grants and funding