Apathy is associated with poor prognosis in amyotrophic lateral sclerosis
Corresponding Author
J. Caga
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
Correspondence: J. Caga, Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia (tel.: +61 (2) 9114 4250; fax: +61 (2) 9114 4254; e-mail: [email protected]).Search for more papers by this authorM. R. Turner
Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
Search for more papers by this authorS. Hsieh
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Search for more papers by this authorR. M. Ahmed
Neuroscience Research Australia, Randwick, NSW, Australia
Search for more papers by this authorE. Devenney
Neuroscience Research Australia, Randwick, NSW, Australia
Search for more papers by this authorE. Ramsey
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Search for more papers by this authorM. C. Zoing
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Search for more papers by this authorE. Mioshi
Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
Search for more papers by this authorM. C. Kiernan
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
Search for more papers by this authorCorresponding Author
J. Caga
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
Correspondence: J. Caga, Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia (tel.: +61 (2) 9114 4250; fax: +61 (2) 9114 4254; e-mail: [email protected]).Search for more papers by this authorM. R. Turner
Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
Search for more papers by this authorS. Hsieh
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Search for more papers by this authorR. M. Ahmed
Neuroscience Research Australia, Randwick, NSW, Australia
Search for more papers by this authorE. Devenney
Neuroscience Research Australia, Randwick, NSW, Australia
Search for more papers by this authorE. Ramsey
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Search for more papers by this authorM. C. Zoing
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Search for more papers by this authorE. Mioshi
Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
Search for more papers by this authorM. C. Kiernan
Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
Search for more papers by this authorAbstract
Background and purpose
Apathy is the most commonly reported behavioural change in amyotrophic lateral sclerosis (ALS). However, the degree to which it affects prognosis and overlaps with depression in this population is unknown. The present study examined the relationship between level of apathy, mortality and survival time and whether apathy was linked to specific symptom clusters of depression.
Methods
A cohort of 76 consecutive ALS patients attending specialized multidisciplinary clinics were classified according to level of apathy. The effects of clinical factors and apathy on survival time were analysed using univariate and multivariate methods.
Results
The majority of patients with moderate to severe apathy died during the study (P = 0.003) and had a median survival time of 21.7 months, considerably shorter than patients with mild apathy (46.9 months) and no apathy (51.9 months) (P = 0.0001). Apathy remained a significant predictor of survival even after controlling for clinical factors and symptom duration at the time of study entry (hazard ratio 3.8, 95% confidence interval 1.9–7.5, P = 0.0001). Depression with demoralization was not associated with level of apathy (P = 0.172) whereas depression with anhedonia was more common in patients with apathy than in those without apathy (P = 0.006).
Conclusions
The presence of severe apathy is an independent, negative prognostic factor in ALS.
Supporting Information
| Filename | Description |
|---|---|
| ene12959-sup-0001-TableS1.docxWord document, 11.9 KB | Table S1. Demographic and clinical characteristics of patients who did and did not complete the depression measure. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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