Regular Research Articles
Apathy Predicts More Severe Parkinsonism in Alzheimer's Disease

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Objectives

Parkinsonian signs are frequent in Alzheimer disease (AD) and are associated with a faster cognitive decline, worse quality of life, and early nursing home admission. Cross-sectional studies in AD reported a significant association between parkinsonism and apathy. The aim of this study was to assess the chronological association between apathy and parkinsonism in AD.

Design

Longitudinal study of a consecutive series of patients with AD.

Setting

Dementia clinic from a tertiary clinical center.

Participants

One hundred sixty-nine patients meeting diagnostic criteria for AD.

Intervention

A consecutive series of 169 patients with probable AD were assessed for the presence of parkinsonism, cognitive deficits, apathy, and depression with the Unified Parkinson's Disease Rating Scale and a comprehensive neuropsychiatry assessment. One hundred thirty-six (80%) of the patients had a follow-up assessment between 1 and 4 years after the baseline evaluation.

Measurements

Scores on apathy, parkinsonism, and depression scales at follow-up were the main outcome measures.

Results

Patients with apathy at baseline or those who developed apathy during follow-up had a significant increase in parkinsonism at follow-up when compared with patients with no apathy at both assessments. The association between apathy and increasing parkinsonism was unrelated to age, gender, the severity of cognitive deficits, the presence of depression, or use of psychotropic medications. On the other hand, neither the presence of parkinsonism nor depression at baseline was significantly associated with more severe apathy at follow-up.

Conclusion

Apathy may be an early manifestation of a more aggressive AD phenotype characterized by loss of motivation, increasing parkinsonism, a faster cognitive and functional decline, and more severe depression.

Section snippets

PATIENTS METHODS

The AD group included a consecutive series of 354 outpatients attending the dementia clinic at a tertiary neurology center in Buenos Aires, Argentina, between January 1996 and October 2001 for evaluation and treatment of progressive cognitive decline. Because structured assessments for parkinsonism were started after the study was commenced, 169 of the 354 participants were assessed for the present study. All patients met the following inclusion criteria: 1) National Institute of Neurological

RESULTS

Eighty-two patients had no apathy at either baseline or follow-up, 29 patients had apathy at both time points, 21 patients with no apathy at baseline developed apathy at follow-up, and four patients had apathy at baseline but no apathy at follow-up (due to its small size, this group was excluded from further comparisons).

DISCUSSION

We examined the association between apathy and parkinsonism in a 1–4 year follow-up study that included a series of 132 patients with probable AD. We found that patients with apathy at baseline or patients who developed apathy during the follow-up period had a significant increase in parkinsonism than patients who never developed apathy. On the other hand, neither the severity of parkinsonism nor the presence of depression at baseline was related to the severity of apathy at follow-up. Taken

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    The authors thank Drs. Eran Chemerinski, Romina Mizrahi, Janus Kremer, Ricardo Migliorelli, and Laura Garau for data collection. This work was supported, in part, by a grant from the National Health and Medical Research Council.

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