Apathy among institutionalized stroke patients: prevalence and clinical correlates.
OBJECTIVE
Apathy is a frequent neuropsychiatric consequence of stroke. In the under-researched population of institutionalized stroke patients, we aimed to explore the prevalence of apathy, its clinical correlates, and the relation to the amount of stimulating activities in the nursing home (NH).


METHODS
A cross-sectional, observational study.


METHODS
Dutch NHs.


METHODS
274 chronic stroke patients.


METHODS
Data were collected through observation lists that were filled out in structured interviews with qualified nurse assistants who knew the residents well. The lists comprised the NH-version of the Apathy Evaluation Scale (AES10), the Barthel Index, the Neuropsychiatric Inventory Questionnaire, and sections of the Resident Assessment Instrument for Long-Term Care Facilities. Attending physicians and therapists provided additional information.


RESULTS
Apathy (AES10 score ≥30) was present in 28% of residents. Multilevel regression analyses revealed that this apathy was independently related to (moderate, severe) cognitive impairment (odds ratio [OR] 11.30 [95% confidence interval (CI): 4.96-25.74], OR 5.54 [95% CI: 2.48-12.40]), very severe ADL-dependency (OR 12.10 [95% CI: 1.35-108.66]), and being >12 hours per day in bed (OR 2.10 [95% CI: 1.07-4.13]). It was not related to depressive mood symptoms (OR 1.75 [95% CI: 0.91-3.37]). Only in residents aged less than 80 years were a higher amount of activities independently related to a lower AES10 score (-0.70 [95% CI: -1.18 to -0.20] points per four extra activities in a 4-week period).


CONCLUSIONS
Apathy is prevalent in largely one-quarter of institutionalized stroke patients, and that is most strongly related to cognitive impairment in this explorative study. We discuss the need for research on the relation with distinct dimensions of depression and fatigue as partly overlapping constructs, and on (individualized) stimulating activities as a possible intervention method.
VU University Medical Center, Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Electronic address: s.vanalmenkerk@vumc.nl.
Suzanne
S
van Almenkerk
VU University Medical Center, Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Martin
M
Smalbrugge
VU University Medical Center, Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Marja F I A
MF
Depla
VU University Medical Center, Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Jan A
JA
Eefsting
VU University Medical Center, Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Cees M P M
CM
Hertogh
D000203:Activities of Daily Living / Q000523:psychology; D000369:Aged, 80 and over; D057565:Apathy; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003858:Dependency, Psychological; D005260:Female; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D009043:Motor Activity; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data; D015995:Prevalence; D012044:Regression Analysis; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000523:psychology*
Apathy; long-term care; neuropsychiatry; stroke