Apathy in dementia with Lewy bodies: Frequency, correlates, and impact on patient and caregiver experiences.

BACKGROUND Apathy is a common behavioral symptom in parkinsonian syndromes. Limited prior research investigates the correlates and impact of apathy in dementia with Lewy bodies (DLB).

METHODS A retrospective analysis of two databases was conducted: (1) a University of Florida clinical-research database and (2) the Predicting Accurately End-of-Life in DLB and Promoting Quality End-of-Life Experiences (PACE-DLB) study in moderate-advanced DLB. Apathy was assessed via the Starkstein Apathy Scale in the former and the Neuropsychiatric Inventory Questionnaire (NPI-Q) in the latter. Apathy was correlated with other available measures including depression, anxiety, parkinsonism, cognition, quality of life and caregiver measures.

RESULTS For individuals with DLB in the clinical database (76% men, mean age 73, mean disease duration 2.18 y), 80% had apathy. Apathy correlated with depression (BDI-II: r = 0.562, p < 0.001; GDS: r = 0.773, p = 0.042), anxiety (BAI: r = 0.478, p = 0.002), and motor symptoms (r = 0.248; p = 0.013) but not cognitive screening (performed in a subset). In PACE-DLB (78% men, mean age 75, mean disease duration 3.24 y), 78% had apathy. Apathy correlated with cognitive severity (QDRS; r = 0.162, p = 0.026), depression (NPI-Q: r = 0.263, p < 0.001), anxiety (NPI-Q: r = 0.155, p = 0.034) and participant quality of life (QoL-AD: r = -0.319, p = 0.006) but not hallucinations or delusions. Apathy correlated with caregiver quality of life (QoL-AD: r = -0.149, p = 0.005) but not depression or burden.

CONCLUSION Apathy is highly prevalent in DLB and correlates with cognitive severity, anxiety, depression and patient and caregiver quality of life. This study underscores the importance of screening for apathy. Research is needed to identify pharmacologic and non-pharmacologic treatments.