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Decreased Daytime Motor Activity Associated With Apathy in Alzheimer Disease: An Actigraphic Study

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Objective

Across all stages of Alzheimer disease (AD), apathy is the most common neuropsychiatric symptom. Studies using the Neuropsychiatric Inventory (NPI) have found that apathy is present in up to 70% of individuals with Alzheimer disease. One of the main difficulties in assessing apathy and other neuropsychiatric symptoms is the absence of reliable, objective measures. Motor activity assessment using ambulatory actigraphy could provide an indirect, objective evaluation of apathy. The aim of our study was to assess the relationship between apathy and daytime motor activity in AD, using ambulatory actigraphy.

Methods

One hundred seven AD outpatients wore a wrist actigraph (Motionlogger) during seven consecutive 24-hour periods to evaluate motor activity. Participants were divided into two subgroups according to their apathy subscores on the NPI: individuals with apathy (NPI-apathy subscores >4) and those without. Daytime mean motor activity scores were compared between the two subgroups.

Results

Individuals with AD who had symptoms of apathy (n = 43; age = 79 ± 4.7 years; Mini-Mental State Examination = 20.9 ± 4.8) had significantly lower daytime mean motor activity than AD patients without apathy (n = 64; age = 76.3 ± 7.7; Mini-Mental State Examination = 21.5 ± 4.7), while nighttime mean motor activity did not significantly differ between the two subgroups.

Conclusions

Ambulatory actigraphy could be added to currently used questionnaires as a simple, objective technique for assessing apathy in the routine assessment of AD patients.

Section snippets

Sample

One hundred seven individuals with an AD diagnosis were recruited in two centers: 80 participants at the Centre Hospitalier Universitaire de Nice Memory Center and 27 participants at the Stanford/Veterans Affairs National Institute on Aging Alzheimer's Disease Core Center. An AD diagnosis was determined using the NINCDS-ADRDA criteria.21 Patients were not included if they had a history of head trauma with loss of consciousness, psychotic or major depressive disorder, or aberrant motor activity

RESULTS

A total of 11 subjects were excluded because they had NPI subscores greater than four (except for the NPI apathy subscore), five other subjects were excluded because of technical problems with their actigraph, and five more subjects were excluded because the number of recorded actigraphic 24-hour periods was less than three. Characteristics of the 107 AD participants (including participants both with and without apathy) and their actigraphic data are presented in Table 1. Participants in the

DISCUSSION

In the present study, individuals with AD and apathy had significantly lower mean motor activity during the daytime than those without apathy. This result is in agreement with previous studies17,20 and suggests that apathy measurement using actigraphic measurement of daytime mean motor activity is a simple and objective method of discriminating apathy. In our study, apathy was also correlated with the number and duration of naps, as suggested in Muller's study, such that those with apathy had

References (36)

  • L Lechowski et al.

    Persistent apathy in Alzheimer disease as an independent factor of rapid functional decline: the REAL longitudinal cohort study

    Int J Geriatr Psychiatry

    (2009)
  • SE Starkstein et al.

    A prospective longitudinal study of apathy in Alzheimer's disease

    J Neurol Neurosurg Psychiatry

    (2006)
  • E Teng et al.

    Neuropsychiatric symptoms are associated with progression from mild cognitive impairment to Alzheimer's disease

    Dement Geriatr Cogn Disord

    (2007)
  • K De Medeiros et al.

    The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia

    Int Psychogeriatr

    (2010)
  • K de Medeiros et al.

    The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia

    Int Psychogeriatr

    (2010)
  • S Ancoli-Israel et al.

    Use of wrist activity for monitoring sleep/wake in demented nursing-home patients

    Sleep

    (1997)
  • JA Yesavage et al.

    A follow-up study of actigraphic measures in home-residing Alzheimer's disease patients

    J Geriatr Psychiatry Neurol

    (1998)
  • D Kemlink et al.

    A comparison of polysomnographic and actigraphic evaluation of periodic limb movements in sleep

    Neurol Res

    (2008)
  • Cited by (0)

    This study was supported by a grant from the Conseil Général des Alpes Maritimes (Alzheimer's disease 06 Plan 2008–2012) and the Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), and the Medical Research Service of the Department of Veterans Affairs.

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