title: A novel rating scale for the measurement of apathy in institutionalized persons with dementia: the APADEM-NH.
abstract: OBJECTIVE
  Apathy is one of the most frequent symptoms of dementia, still needing better measurement methods. The objective of this study was to validate a new scale for apathy in institutionalized persons with dementia (APADEM-NH).
  
  
  METHODS
  The scale includes 26 items distributed in three dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. The sample included 100 institutionalized patients (90% female) with probable Alzheimer disease (AD) (57%), possible AD (13%), AD + cerebral vascular disease (17%), Lewy body dementia (11%), and Parkinson associated to dementia (2%), covering all stages of dementia severity according to the Global Deterioration Scale and Clinical Dementia Rating. Additional assessments were the Apathy Inventory, Neuropsychiatric Inventory, Cornell Scale for Depression, and the tested scale. Re-test and inter-rater reliability were carried out in 50 patients.
  
  
  RESULTS
  All subscales lacked relevant floor and ceiling effects (<15%). Internal consistency for each dimension was (Cronbach's α): DT = 0.88, EB = 0.83, CI = 0.88; item-total correlations were >0.40; and item homogeneity 0.36-0.51. Test-retest reliability for the items was kW = 0.48-0.92; for the subscales, intraclass correlation coefficient (ICC) = 0.80-0.88; and for the total score, ICC = 0.90. Inter-rater reliability reached kW values of 0.84-1.00; subscales ICC, 0.97-0.99, and total score ICC, 0.99. Standard error of measurement for total score was 6.41 and internal validity ranged from rS = 0.69-0.80.
  
  
  CONCLUSIONS
  APADEM-NH proved to be feasible, reliable, and valid for apathy assessment in institutionalized patients suffering mild to severe dementia, discerning well between apathy and depression.
authors.affiliation: Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. Electronic address: laguera@fundacioncien.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Agüera-Ortiz
authors.affiliation: Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Gil-Ruiz
authors.affiliation: Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cruz-Orduña
authors.affiliation: Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ramos-García
authors.affiliation: Center for Brain Health, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
authors.forename: Ricardo S
authors.initials: RS
authors.lastname: Osorio
authors.affiliation: Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Valentí-Soler
authors.affiliation: Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Olazarán-Rodriguez
authors.affiliation: Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Dobato-Ayuso
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Krista
authors.initials: K
authors.lastname: Lanctôt
authors.affiliation: Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofia Foundation, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martínez-Martín
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006801:Humans; D007326:Institutionalization; D008297:Male; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics
keywords: Apathy; dementia; institutionalized persons; psychometrics; rating scale; validation study