Properties of the Apathy Scale (AS) for use on Parkinson’s patients

Marcos Serrano-Dueñas, Pablo Martínez-Martín, Tamara Merchán, Rosaura Bravo, Maite Serrano

Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
Medicine Faculty, Pontifical Catholic University of Ecuador, Quito, Ecuador.
Movement Disorder and Biostatistics Units, Neurological Service, Carlos Andrade Marín Hospital, Quito, Ecuador; Medicine Faculty, Pontifical Catholic University of Ecuador, Quito, Ecuador.

DOI: 10.4236/apd.2013.22010                

Abstract

Parkinson’s disease is a neurodegenerative disorder characterized by motor, autonomic, and neuropsychiatric symptoms, among the latter, apathy has been found to be present in up to 70% of patients. The main objective of the present study was to assess the psychometric properties of the Apathy Scale for evaluation of Ecuadorian patients with Parkinson’s. This was a cross sectional study, with re-test. There were 73 women (34.5%) in the final sample of 211 patients. Mean age was 67.5 ± 10.2 years, mean length of illness was 7.1 ± 5.5 years, and the mean ldopa dose was 656.1 ± 292.7 mg/day. The mean Apathy Scale score was 12.7 ± 7.1. Reliability: The Guttman’s λ obtained was 0.89. The SEM was 2.34 for the AS. The ICC using an absolute agreement definition was: ICC = 0.78 [(95% IC 0.73 - 0.82) f = 4.96; p ≤ 0.000]. Discriminative validity, analyzed with the Kruskal-Wallis statistic and using H&Y stages as segmentation variable registered an X(2) value of p < 0.0001. In conclusion the Apathy Scale proved to have suitable metric attributes in this specific PD patient sample: internal consistency, reliability, stability, and convergent and known-groups validity.

Keywords

Parkinson’s Disease; Apathy Associated with Parkinson’s Disease; Apathy Scale; Metric Properties

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Weintraub, D., Comella, C.L. and Horn, S. (2008) Parkinson’s disease—Part 3: Neuropsychiatric symptoms. American Journal of Managed Care, 14, S59-S69.
[2]	Marin, R.S. (1990) Differential diagnosis and classification of apathy. The American Journal of Psychiatry, 147, 22-30.
[3]	Marin, R.S. (1991) Apathy: A neuropsychiatric syndrome. The Journal of Neuropsychiatry & Clinical Neurosciences, 3, 243-254.
[4]	Habib, M. (2004) Athymhormia and disorders of motivation in basal ganglia disease. The Journal of Neuropsychiatry & Clinical Neurosciences, 16, 509-524.
[5]	Schmidt, L., d’Arc, B.F., Lafargue, G., Galanaud, D., Czernecki, V., Grabli, D., et al. (2008) Disconnecting force from money: Effects of basal ganglia damage on incentive motivation. Brain, 131, 1303-1310. doi:10.1093/brain/awn045
[6]	Starkstein, S.E. and Leentjens, A.F.G. (2008) The nosological position of apathy in clinical practice. Journal of Neurology, Neurosurgery & Psychiatry, 79, 1088-1092.
[7]	Leentjens, A.F.G., Dujardin, K., Marsh, L., Martinez-Martin, P., Richard, I.H., Starkstein, S.E., et al. (2008) Apathy and anhedonia rating scales in Parkinson’s disease: Critique and recommendations. Movement Disorders, 23, 2004-2014. doi:10.1002/mds.22229
[8]	Starkstein, S.E., Mayberg, H.S., Preziosi, T.J., Andrezejewski, P., Leiguarda, R., Robinson, R.G., et al. (1992) Reliability, validity, and clinical correlates of apathy in Parkinson’s disease. The Journal of Neuropsychiatry & Clinical Neurosciences, 4, 134-139.
[9]	Gibb, W.R.G. and Lees, A.J. (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry, 51, 745-752. doi:10.1136/jnnp.51.6.745
[10]	Pfeiffer, E. (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23, 433-441.
[11]	Marin, R.S., Biedrzycki, R.C. and Firingiogullari, S. (1991) Reliability and validity of the apathy evaluation scale. Psychiatry Research, 38, 143-162. doi:10.1016/0165-1781(91)90040-V
[12]	Marinus, J., Visser, M., Stiggelbout, A.M., Martin Rabey, J., Martínez-Martín, P., Bonuccelli, U., Kraus, P.H. and van Hilten, J.J. (2004) A short scale for the assessment of motor impairments and disabilities in Parkinson’s disease: The SPES/SCOPA. Journal of Neurology, Neurosurgery & Psychiatry, 75, 388-395.
[13]	Zigmond, A.S. and Snaith, R.P. (1983) The hospital anxiety and depresión scale. Acta Psychiatrica Scandinavica, 67, 361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
[14]	Calne, S., Schulzer, M., Mak, E., Guyette, C., Rohs, G., Hatchard, S., et al. (1996) Validating a quality of life rating scale for idiopathic Parkinsonism: Parkinson’s impact scale (PIMS). Parkinsonism & Related Disorders, 2, 55-61. doi:10.1016/1353-8020(95)00026-7
[15]	Martínez-Martín, P., Forjaz, J., Cubo, E., Frades, B. and The ELEP Project Members (2006) Global versus factor related impression of severity in Parkinson’s disease: A new clinimetric index (CISI-PD). Movement Disorders, 21, 208-214.
[16]	Lamping, D., Schroter, S., Marquis, P., Marrel, A., Duprat, I. and Sagnier, P. (2002) The community-acquired pneumonia symptom questionnaire: A new, patient-based outcome measure to evaluate symptoms in patients with community-acquired pneumonia. Chest, 122, 920-929. doi:10.1378/chest.122.3.920
[17]	McHorney, C.A. and Tarlov, A.R. (1995) Individual-patient monitoring in clinical practice: Are available health status surveys adequate? Quality of Life Research, 4, 293-307. doi:10.1007/BF01593882
[18]	Van der Linden, K., Kragt, J., Klein, M., Van der Ploeg, H., Polman, C., et al. (2005) Psychometric evaluation of the multiple sclerosis impact scale (MSIS-29) for proxy use. Journal of Neurology, Neurosurgery & Psychiatry, 76, 1677-1681. doi:10.1136/jnnp.2005.065227
[19]	Smith, S.C., Lamping, D.L., Banarjee, S., Harwood, R., Foley, B., Smith, P., et al. (2005) Measurement of health-related quality of life for people with dementia: Development of a new instrument (DEMQOL) and an evaluation of current methodology. Health Technology Assessment, 9, 16-19.
[20]	Eisen, M., Ware Jr., J.E., Donald, C.A. and Brook, R.H. (1979) Measuring components of children’s health status. Medical Care, 17, 902-921. doi:10.1097/00005650-197909000-00003
[21]	Helms, J.E., Henze, K.T., Sass, T.L. and Mifsud, V.A. (2006) Treating Cronbach’s alpha reliability coefficients as data in counseling research. The Counseling Psychologist, 34, 630-660. doi:10.1177/0011000006288308
[22]	Feldt, L.S., Steffen, M. and Gupta, N.C. (1985) A comparison of five methods for stimating the standard error of measuremente at specific score levels. Applied Psychological Measurement, 9, 351-361. doi:10.1177/014662168500900402
[23]	Juniper, E.F., Guyatt, G.H. and Jaeschke, R. (1996) How to develop and validate a new health-related quality of life instrument. In: Spilker, B., Ed., Quality of Life and Pharmacoeconomics in Clinical Trials, 2nd Edition, Lippincott-Raven Publishers, Philadelphia, 49-56.
[24]	Marinus, J., Leentjens, A.F.G., Visser, M., Stiggelbout, A.M. and van Hilten, J.J. (2002) Evaluation of the hospital anxiety and depression scale in patients with Parkinson’s disease. Clinical Neuropharmacology, 25, 318-324. doi:10.1097/00002826-200211000-00008
[25]	Armitage, P., Berry, G. and Matthews, J.N.S. (2002) Statistical methods in medical research. 4th Edition, Blackwell Publishing, Malden. doi:10.1002/9780470773666
[26]	Clarke, D.E., Van Reekum, R., Patel, J., Simard, M., Gomez, E. and Streiner, D.L. (2007) An appraisal of the psychometric properties of the clinician version of the apathy evaluation scale (AES-C). International Journal of Methods in Psychiatric Research, 16, 97-110. doi:10.1002/mpr.207
[27]	Reijnders, J.S.A.M., Ehrt, U., Lousberg, R., Aarsland, D. and Leentjens, A.F.G. (2009) The association between motor subtypes and psychopathology in Parkinson’s disease. Parkinsonism and Related Disorders, 15, 379-382. doi:10.1016/j.parkreldis.2008.09.003
[28]	Isella, V., Melzi, P., Grimaldi, M., Iurlaro, S., Piolti, R., Ferrarese, C., Frattola, L. and Appollonio, I. (2002) Clinical, neuropsychological, and morphometric correlates of apathy in Parkinson’s disease. Movement Disorders, 17, 366-371. doi:10.1002/mds.10041
[29]	Dujardin, K., Sockeel, P., Devos, D., Delliaux, M., Krystkowiak, P., Destée, A. and Defebvre, L. (2007) Characteristics of Apathy in Parkinson’s disease. Movement Disorders, 22, 778-784. doi:10.1002/mds.21316
[30]	Sockeel, P., Dujardin, K., Devos, D., Denéve, C., Destée, A. and Defebvre, L. (2006) The Lille apathy rating scale (LARS), a new instrument for detecting and quantifying apathy: Validation in Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry, 77, 579-586. doi:10.1136/jnnp.2005.075929