Persistent apathy in Alzheimer's disease as an independent factor of rapid functional decline: the REAL longitudinal cohort study.
OBJECTIVE
To determine the role of persistent apathy in rapid loss of autonomy in Instrumental Activities of Daily Living (IADL) in women with Alzheimer s disease (AD), taking into account the grade of cognitive decline.


METHODS
The study was conducted on 272 women from the French REAL cohort. At inclusion patients had a Mini-Mental State Examination (MMSE) score between 10-26. A rapid functional decline was defined as a yearly drop of 4 points or more on the 14-point IADL Lawton scale. Persistent apathy was defined as a frequency score equal to 3 or 4 on the Neuro-Psychiatric Inventory at the three consecutive 6-monthly assessments.


RESULTS
27.6% of women had rapid functional decline in 1 year and 22.1% of them had persistent apathy. A logistic regression analysis showed that, in addition to cognitive decline, persistent apathy plays a role in rapid functional decline in 1 year. For example, for a 3-point decline in MMSE in 1 year, the probability of a rapid loss in IADL is 0.45 for women with persistent apathy compared with 0.28 for those without persistent apathy.


CONCLUSIONS
In this study, a rapid loss in IADL score was partly explained by persistent apathy.
Lechowski
L
L
Service de Médecine Gériatrique, Assistance Publique-Hôpitaux de Paris Groupe Hospitalier Sainte-Périne, Paris, France. laurent.lechowski@spr.ap-hop-paris.fr
Benoit
M
M
Chassagne
P
P
Vedel
I
I
Tortrat
D
D
Teillet
L
L
Vellas
B
B
D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology / Q000523:psychology*; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016017:Odds Ratio; D026684:Personal Autonomy; D011379:Prognosis; D012307:Risk Factors; D012727:Sex Characteristics