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


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.

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Serrano-Dueñas, M. , Martínez-Martín, P. , Merchán, T. , Bravo, R. and Serrano, M. (2013) Properties of the Apathy Scale (AS) for use on Parkinson’s patients. Advances in Parkinson's Disease, 2, 53-57. doi: 10.4236/apd.2013.22010.

Conflicts of Interest

The authors declare no conflicts of interest.


[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

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