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Italian version of the Starkstein Apathy Scale (SAS-I) and a shortened version (SAS-6) to assess “pure apathy” symptoms: normative study on 392 individuals

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Abstract

Objectives

The present normative study aimed to (1) develop the Italian version of the Starkstein Apathy Scale (SAS-I) and (2) construct a shortened version including only the most sensitive items to “pure apathy” experiences.

Methods

The normative sample included 392 healthy subjects. A regression-based procedure was used to explore the effects of sex, age, and education on the raw SAS-I score. A correction grid was designed for adjusting raw scores by adding or subtracting the contribution of any significant variable and net of sociodemographic interindividual differences. Cutoff scores were also calculated and fixed at the external tolerance limit on the ninety-fifth centile. To obtain the shortened version, each SAS-I item was correlated with the Beck’s Depression Inventory (BDI) score. The only items showing no correlation with BDI were implemented to bypass the well-known overlap between apathetic and depressive symptoms.

Results

The mean raw SAS-I score was 11.27 (SD = 4.42). A significant education effect was observed, with highly educated subjects obtaining lower scores than lowly educated ones. The proposed general cutoff score was 20.68. The SAS-I had fair internal consistency and discriminant validity. Internal consistency increased by removing item 3. The new SAS-6 included items 1, 2, 4, 10, 11, and 13 of the original scale.

Conclusion

The SAS-I is a reliable assessment tool to support the diagnosis of apathy. The SAS-6, instead, is a brief questionnaire useful for quickly screening apathetic symptoms in outpatient practice, addressing or not the clinician to further investigations.

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Authors and Affiliations

  1. Neurological Unit, CTO Hospital, AORN “Ospedali dei Colli”, Naples, Italy

    Elisabetta Garofalo, Alessandro Iavarone, Michele Carpinelli Mazzi, Maria Sannino, Bruno Ronga & Ciro Rosario Ilardi

  2. Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Sergio Chieffi

  3. Italian Association of Alzheimer’s Patients (AIMA Campania), Naples, Italy

    Michele Carpinelli Mazzi

  4. Laboratory of Experimental Psychology, Suor Orsola Benincasa University, Naples, Italy

    Nadia Gamboz

  5. Department of Motor Science and Wellness, University of Naples “Parthenope”, Naples, Italy

    Ferdinando Ivano Ambra

  6. Frailty Unit, ASL Napoli 1 Centro, Naples, Italy

    Filomena Galeone

  7. Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Sabrina Esposito

  8. Department of Psychology, University of Campania “Luigi Vanvitelli”, Caserta, Italy

    Ciro Rosario Ilardi

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  1. Elisabetta Garofalo
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  2. Alessandro Iavarone
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Correspondence to Alessandro Iavarone.

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The study was carried out in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of Campania “Luigi Vanvitelli.”

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Garofalo, E., Iavarone, A., Chieffi, S. et al. Italian version of the Starkstein Apathy Scale (SAS-I) and a shortened version (SAS-6) to assess “pure apathy” symptoms: normative study on 392 individuals. Neurol Sci 42, 1065–1072 (2021). https://doi.org/10.1007/s10072-020-04631-y

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