title: Apathy in late-life depression: common, persistent, and disabling.
abstract: OBJECTIVE
  The aims of this study were to examine: (1) the relationship between apathy and disability in late-life depression, and (2) the functional significance of improvement in apathy following escitalopram treatment in terms of its relationship to disability.
  
  
  METHODS
  Subjects were 71 non-demented elderly with non-psychotic major depression. After a 2-week single-blind placebo period, subjects who had Hamilton Depression Rating Scale (HDRS) ≥ 18 received escitalopram 10 mg daily for 12 weeks. Apathy and disability were assessed with the Apathy Evaluation Scale (AES) and the World Health Organization Disability Assessment Scale II (WHODAS), respectively. These measures and the HDRS were administered at baseline and again following 12 weeks of treatment.
  
  
  RESULTS
  At baseline, 38% of depressed subjects had significant apathy (AES ≥ 36.5). Severity of apathy at baseline significantly correlated with severity of disability. In a multivariate regression model, baseline severity of apathy, but not the overall depressive syndrome (HDRS), significantly correlated with baseline disability. Following escitalopram treatment, improvement in apathy significantly correlated with improvement in disability measures, while change in the rest of the depressive syndrome did not. The overall change in apathy and disability in response to escitalopram treatment was significant but small.
  
  
  CONCLUSIONS
  Apathy is common in late-life depression and is associated with disability above and beyond the influence of other depressive symptoms. Given the strong relationship between apathy and disability, understanding the neurobiology of apathy and developing treatments for apathy may improve the functional outcomes of late-life depression.
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY. Electronic address: gsyuen@med.cornell.edu.
authors.forename: Genevieve S
authors.initials: GS
authors.lastname: Yuen
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Saumya
authors.initials: S
authors.lastname: Bhutani
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Bryony J
authors.initials: BJ
authors.lastname: Lucas
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Faith M
authors.initials: FM
authors.lastname: Gunning
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Bassem
authors.initials: B
authors.lastname: AbdelMalak
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Seirup
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: Sibel A
authors.initials: SA
authors.lastname: Klimstra
authors.affiliation: Weill Medical College of Cornell University, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
mesh_terms: D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage; D057565:Apathy; D015283:Citalopram / Q000008:administration & dosage*; D003866:Depressive Disorder / Q000175:diagnosis*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D000067562:Late Onset Disorders; D008297:Male; D011569:Psychiatric Status Rating Scales; D013223:Statistics as Topic; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram
keywords: Apathy; amotivation; atypical depression; disability; function; geriatric