title: Apathy in Alzheimer's disease: any effective treatment?
abstract: OBJECTIVE
  This review has evaluated the effectiveness of pharmacological treatment of apathy in patients with Alzheimer's disease (AD).
  
  
  METHODS
  A systematic literature search was conducted on published clinical trials assessing the effects of pharmacological treatment on apathy in AD over the last 10 years.
  
  
  RESULTS
  Fourteen studies considered of good quality were included in the analysis (4 randomized controlled trials, 9 open-label studies, and 1 retrospective analysis). Cholinesterase inhibitors were investigated in 9 studies, monoaminergic compounds such as methylphenidate and modafinil in two trials and one trial, respectively, and Ginkgo biloba (EGb 761 extract) and citalopram in one study each. Cholinesterase inhibitors did not show statistical significant effect in 1 RCT study but were associated to improvement in 3 open-label studies. Methylphenidate elicited a small but significant activity accompanied by relevant side effects such as high blood pressure, cough, and osteoarticular pain. EGb 761 was well tolerated and countered apathy. Other treatments induced modest improvements or were ineffective.
  
  
  CONCLUSIONS
  Apathy treatment remains a challenge and there is no evident advantage of any specific pharmacotherapy tested so far. The development of controlled studies according to updated guidelines for the diagnosis of apathy in patients with AD is desirable.
authors.affiliation: Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, 62032 Camerino, Italy ; Unità Complessa Neurologia, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, 80131 Naples, Italy.
authors.forename: Raffaele
authors.identifier: 0000-0001-9061-197X
authors.initials: R
authors.lastname: Rea
authors.affiliation: Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, 62032 Camerino, Italy ; Unità Complessa Neurologia, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, 80131 Naples, Italy.
authors.forename: Anna
authors.identifier: 0000-0002-1312-5246
authors.initials: A
authors.lastname: Carotenuto
authors.affiliation: Unità Complessa Neurologia, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, 80131 Naples, Italy.
authors.forename: Angiola M
authors.initials: AM
authors.lastname: Fasanaro
authors.affiliation: Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, 62032 Camerino, Italy.
authors.forename: Enea
authors.identifier: 0000-0001-5275-4099
authors.initials: E
authors.lastname: Traini
authors.affiliation: Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, 62032 Camerino, Italy.
authors.forename: Francesco
authors.identifier: 0000-0002-7794-4662
authors.initials: F
authors.lastname: Amenta
mesh_terms: D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
chemical_list: D002800:Cholinesterase Inhibitors