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REGULAR ARTICLES   |    
The Longitudinal Course of Post-Stroke Apathy Over Five Years
Henry Brodaty, M.D., D.Sc.; Zhixin Liu, Ph.D.; Adrienne Withall, Ph.D.; Perminder S. Sachdev, M.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:283-291. doi:10.1176/appi.neuropsych.12040080
View Author and Article Information

All authors contributed to the conception and design, or analysis and interpretation of the data, drafting of the article or revising it critically for important intellectual content, and gave their final approval of the version to be published. Megan Heffernan assisted with manuscript preparation.

Disclosures: Over the past 2 years, Dr Brodaty has been a consultant, Advisory Board member, sponsored speaker, and investigator for Pfizer Australia; he has been a speaker, an Advisory Board member for, and received research funding from Janssen Cilag Australia; has been an Advisory Board member, sponsored speaker, and investigator for Lundbeck; an Advisory Board member, sponsored speaker, and investigator for Novartis; has received research funding from Eisai, has been a consultant for Merck and Baxter, was an investigator for Lilly and Sanofi, and was an investigator on grants from National Health and Medical Research Council, Australia.

Over the past 2 years, Dr. Sachdev has received an honorarium from Eli Lilly for one lecture; was a sponsored speaker for Pfizer and Astra Zeneca, an expert witness for medico-legal cases, and was an investigator on grants from the National Health and Medical Research Council Australia.

This study was performed with grants from the National Health and Medical Research Council of Australia (970922, 222842).

From the Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney NSW 2052, Australia (HB, PSS); Dementia Collaborative Research Centre, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney NSW 2052, Australia (HB, ZL); School of Community Health, University of New South Wales, Sydney, NSW, 2052 Australia (AW); Neuropsychiatric Institute, Prince of Wales Hospital, Barker Street, Randwick NSW 2031, Australia (PSS).

Send correspondence to Henry Brodaty M.D., D.Sc., Dementia Collaborative Research Centre, The University of New South Wales, Sydney, Australia; e-mail: h.brodaty@unsw.edu.au

Copyright © 2013 by the American Psychiatric Association

Received April 03, 2012; Revised August 16, 2012; Accepted October 01, 2012.

Abstract

The prevalence of apathy is high after stroke, but its subsequent course remains unclear. We sought to determine the longitudinal course and predictors of apathy after stroke. Eligible patients admitted after a stroke and healthy control participants who were rated at least once on the Apathy Evaluation Scale were assessed over 5 years. Rates and levels of apathy in patients rose over 5 years. Significant risk factors for apathy were dementia, interval cerebrovascular events, poor physical functioning, and high depression scores. Apathy is common after stroke and becomes more prevalent with time, especially in those who show evidence of cognitive and functional decline.

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FIGURE 1. Timeline of Sample Attrition of Patients and Control Participants

AES: Apathy Evaluation Scale; TIA: transient ischemic attack.

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TABLE 1.Clinical Characteristics Over Five Years in Patients and Control Groups and Comparison in Patients With and Without Data Imputation for the AES
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Values are mean (standard error).

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AES: Apathy Evaluation Scale; range: 18–72 (higher score indicates more severe apathy); ADL: Activities of Daily Living, and IADL: Instrumental Activities of Daily Living (IADL), range: 0–14 (higher score indicates better daily activity); GDS: Geriatric Depression Scale, range: 0–15 (higher score indicates more severe depression); NA: not applicable.

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a 45 patients who completed the AES at all time-points.

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b 107 patients who had at least one AES rating missing and have imputed data for the missing AES rating.

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TABLE 2.Main Effect of Time and Univariate Predictors of Apathy Over 5 Years After Stroke
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a Lower Activities of Daily Living (ADL) + Instrumental Activities of Daily Living (IADL).

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b European Stroke Scale (ESS).

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c Higher Geriatric Depression Scale (GDS).

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d Higher Geriatric Depression Scale (GDS) minus items 2, 9, 13.

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e Interval cerebrovascular event (CVE) between Baseline and Index. (N.B.: All variables in Table 3 are measured at Index.)

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TABLE 3.Main Effect of Multiple Predictors of Apathy Over 5 Years After Stroke
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Interval CVE: Interval of cerebrovascular event between Baseline and Index.

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a Lower Activities of Daily Living (ADL) + Instrumental Activities of Daily Living (IADL), time-varying.

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b Higher Geriatric Depression Scale (GDS), time-varying.

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c Results when the 15-item Geriatric Depression Scale (GDS) is replaced with the GDS minus items 2, 9, and 13 (time-varying) in the multivariate model.

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