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Apathy is recognized to be a common, disabling syndrome that occurs across a range of psychiatric and neurological conditions, including Parkinson's disease. It can have a significant impact on quality of life, both for people affected and those around them. Currently, there are no established, evidence‐based treatments for this debilitating syndrome. Assessment and treatment have been complicated by overlaps with depression and anhedonia, as well as a lack of understanding of the underlying mechanisms. Emerging lines of evidence conceptualize apathy as a reduction of motivation associated with disordered effort‐based decision‐making and dysfunction of distinct neural circuitry between the basal ganglia and medial prefrontal cortex. Here, we introduce a novel cognitive‐behavioral framework that can inform a clinician's conceptualization and treatment of apathy, using cognitive‐behavioral therapy (CBT) techniques. We focus on people with Parkinson's disease in our model, but our approach is transdiagnostic and can be applied to other conditions. It considers both individual targets for therapy as well as maintenance and intervention at a systemic level. The generalizability and parsimony of the framework provides a structured assessment and formulation of apathy, while also allowing clinicians to remain sensitive to other neuropsychiatric symptoms that can occur alongside apathy, such as depression and anxiety. [ABSTRACT FROM AUTHOR]

We investigated the relationships between cognitive change following stroke, awareness of cognitive impairments, and mood to further understanding of change processes influencing psychological outcomes post-stroke in line with the "Y-shaped" process model. Patients (n = 143; Mage = 73 years, SD = 13.73; 74 males) were assessed at 3-weeks (T1) and 6-months (T2) post-stroke and had completed the Oxford Cognitive Screen (T1 and T2), the Cognitive Failures Questionnaire (CFQ; T2), and the Hospital Anxiety and Depression Scale (HADS; T2). An ANCOVA controlling for disability relating to activities of daily living (ADL) revealed that awareness of cognitive impairment was significantly lower in participants with moderate-severe cognitive impairment. Regression analysis indicated that greater awareness of cognitive impairment and reduced independence in ADL were associated with greater emotional distress at T2. Cognitive improvement was associated with lower emotional distressat T2. Contrary to the awareness hypothesis, moderation analyses suggest that this effect was largest for those most cognitively impaired at T1. Findings emphasize the importance of monitoring stroke patients' capacity to be self-aware when assessing and formulating long-term post-stroke distress and have potential implications for improving long-term emotional status in those most cognitively impaired post-stroke, e.g., through psychoeducation, cognitive rehabilitation, and emotional support. [ABSTRACT FROM AUTHOR]

Apathy is a common, disabling neuropsychiatric syndrome that occurs across many brain disorders and may be associated with diminished motivation in behavioural, cognitive, emotional and social domains. Assessment is complicated by the variability of symptoms across apathy domains and self‐report from patients, which can be misleading due to their lack of insight. Independent evaluation by clinicians also has limitations though if it has to be performed with limited time. Caregiver reports are a viable alternative, but current assessments for them either do not distinguish between different apathy domains or are interview‐based and take long to administer. In this study, we developed a brief caregiver questionnaire version of the recently developed Apathy Motivation Index (AMI), which is a self‐report tool. We confirmed three apathy factors in this new caregiver measure (AMI‐CG) that were also present in the AMI: Behavioural Activation, Emotional Sensitivity and Social Motivation. Furthermore, we validated the scores against more extensive caregiver interviews using the established Lillle apathy rating scale as well as patient self‐reports of apathy, measures of depression, anhedonia, cognition, activities of daily living and caregiver burden across four different neurological conditions: Parkinson's disease, Alzheimer's disease, subjective cognitive impairment and limbic encephalitis. The AMI‐CG showed good internal reliability, external validity and diagnostic accuracy. It also uncovered cases of social apathy overlooked by traditional instruments. Crucially, patients who under‐rated their apathy compared to informants were more likely to have difficulties performing everyday activities and to be a greater burden to caregivers. The findings provide evidence for a multidimensional conceptualization of apathy and an instrument for efficient detection of apathy based on caregiver reports for use in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Apathy is a common, disabling syndrome observed across neurodegenerative diseases. Self‐report of apathy from patients can be misleading so caregiver report is valuable. However, a compact instrument that does not require clinician interview, is brief but adequately detailed is lacking. Method: We developed a caregiver version of the Apathy Motivation Index (AMI CG) which requires a short 5 minute questionnaire to be completed by an informant. Scores were validated against a more extensive caregiver interview rating (Lille Apathy Rating, LARS CG), and compared to measures of depression, anhedonia, cognitive abilities, activities of daily living and caregiver burden. 124 patients (21 Alzheimer's; 45 Parkinson's; 30 limbic encephalitis; and 28 with subjective cognitive impairment) were tested. Result: The AMI CG showed good internal reliability with a significant three‐factor structure, mapping to domains of Behavioural Activation, Emotional Sensitivity and Social Motivation. It had good external validity, correlating well with other measures of apathy, but not with depression or anhedonia. A cut‐off criterion based on the LARS CG correctly classified patients as apathetic or non‐apathetic in 82% and 72% percent of cases respectively (AUC = 0.85). 20 cases identified as apathetic by the AMI CG but not the LARS CG had loss of social motivation, a dimension of apathy overlooked by traditional instruments. Patients who under‐rated their apathy compared to informants were more likely to be a greater burden to caregivers. Conclusion: The AMI CG successfully detects clinical apathy, including cases of social apathy. [ABSTRACT FROM AUTHOR]

Apathy is highly prevalent in Parkinson's disease. New findings suggest the syndrome is multifaceted. Here, we investigate whether all aspects of apathy are equally affected in Parkinson's disease and whether different dimensions of apathy were associated with depression and anhedonia. On the Apathy Motivation Index, while behavioral apathy and social apathy were elevated, emotional motivation was relatively preserved in Parkinson's disease, although a few patients did show impaired emotional sensitivity. Behavioral and social, but not emotional, apathy was associated with depression and anhedonia. These findings suggest aspects of motivation can be selectively impaired in Parkinson's disease and may have implications for guiding treatment. [ABSTRACT FROM AUTHOR]

Background: Deficits in visual short‐term memory (STM), rather than episodic long‐term memory, have recently been found to be associated with Alzheimer's Disease (AD). However, the brain microstructural underpinning of selective abilities within visual STM remains poorly described. Method: 52 AD and 60 age‐matched healthy controls were recruited from the Oxford Centre for Cognitive Disorders. We used a novel digital visual STM task – the "What was where?" task (Figure 1) and extracted four metrics: Identification Accuracy (percentage of correctly identified items), Target detection (probability of correctly identifying the target), Misbinding (erroneously localizing an item to the remembered location of another item in memory) and Guessing (random guessing), (Figure 1). We then applied TBSS (Tract‐Based Spatial Statistics) to investigate in which areas of the brain microstructural disruption of physiological diffusivity correlated with behavioural performance. Result: In AD patients, a core area including Forceps Major, left Optic Radiation (OR) and left Middle Longitudinal Fasciculus (MLF) was commonly associated with performance across all four metrics (Figure 2). Misbinding also involved the left MLF (part III), left inferior Fronto‐Occipital Fasciculus (IFOF) and left Vertical Occipital Fasciculus (VOF). Target detection additionally was associated with Superior Longitudinal Fasciculus (SLF), and Identification Accuracy with left Superior Thalamic Radiation (STR) in AD and also right OR in controls. Conclusion: There is a common shared area of altered diffusivity in AD patients that underlies a global impairment in visual STM, while distinct types of memory errors were associated with disruption of additional contribution of selective white matter fibers. [ABSTRACT FROM AUTHOR]

Background: We developed a novel delayed reproduction task, the "What was where?" task, which obtains a continuous measure of localization error and is more sensitive compared to conventional span measures of Short‐term Memory (STM). Method: We recruited 44 MCI (Mild Cognitive Impairment), 41 AD (Alzheimer's Disease) patients and 109 healthy elderly controls (EHCs) from memory clinics in Oxford, UK and Jena, Germany, where they performed the "What was where?" task (Figure 1). We extracted the following metrics: Identification Accuracy (percentage correctly identified items), Absolute Localization Error (how far the object was misplaced), Misbinding rate (erroneously localizing an item to the remembered location of another item in memory) and Guessing response rate. Result: Absolute Localization Error and Misbinding rates were greater in MCI and AD patients (p < 0.001) compared to EHCs, while AD and MCI performed similarly on these metrics. However, Identification Accuracy as well as Guessing (p = 0.003) were greater in MCI (p < 0.001) compared to AD patients. Moreover, EHCs identified the correct object more often (p < 0.001) and guessed less (p < 0.001) than MCI patients. Conclusion: This novel task is able to detect STM impairment in MCI cases on a continuous scale, and is a sensitive memory measure which might be a useful index of memory for future clinical trials in AD in its earliest stages. [ABSTRACT FROM AUTHOR]