title: Apathy in older patients with type 2 diabetes.
abstract: OBJECTIVE
  To determine the prevalence, incidence, persistence, likely causes, and consequences of apathy in patients with Type 2 diabetes and to compare the prevalence with a healthy control sample.
  
  
  METHODS
  Cross-sectional comparison of diabetic and nondiabetic samples; longitudinal follow-up of diabetic sample.
  
  
  METHODS
  Academic research department.
  
  
  METHODS
  Non-demented, older patients with long-standing Type 2 diabetes (N = 122) recruited from a community-based cohort study and 69 healthy volunteers.
  
  
  METHODS
  Clinical assessments of apathy and potential causative conditions, repeated in the diabetic sample after 16.7 ± 2.5 months. Informant rated symptoms from the 14-item Apathy Scale were used to generate apathy diagnoses based on standardized criteria. Cognition was assessed by Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR).
  
  
  RESULTS
  The diabetic and comparison samples had the same age and MMSE scores, but the diabetic sample had a higher frequency of depression, cerebrovascular history, and cognitive deficits. Apathy was more prevalent in diabetes (diabetic 13.9% versus control sample 1.4%, p = 0.005) and was independently associated with CDR 0.5 status (OR [95% CI]: 3.66 [1.25-19.70]) and depression (8.48 [2.74-26.21]). In 108 diabetic patients who were followed up, incident apathy occurred in 7.4% of cases, and persisted in 50% of those with baseline apathy. Baseline apathy was independently associated with lnHbA1c levels (β: 0.20, t = 2.29, df = 119, p = 0.024; model R(2) = 0.10) and incident/persistent apathy was associated with greater risk of cognitive decline (6.72 [1.19-37.87]).
  
  
  CONCLUSIONS
  Apathy is a frequent neuropsychiatric syndrome in older patients with Type 2 diabetes, and is associated with poor glycaemic control and cognitive decline.
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Crawley, Western Australia, Australia. Electronic address: David.Bruce@uwa.edu.au.
authors.forename: David G
authors.initials: DG
authors.lastname: Bruce
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Melinda E
authors.initials: ME
authors.lastname: Nelson
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Mace
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Davis
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
authors.affiliation: School of Psychiatry & Neuroscience, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Sergio E
authors.initials: SE
authors.lastname: Starkstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy / Q000502:physiology*; D003072:Cognition Disorders / Q000097:blood / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence
keywords: Apathy; cognitive impairment; diabetes