title: Apathy is associated with poor prognosis in amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  Apathy is the most commonly reported behavioural change in amyotrophic lateral sclerosis (ALS). However, the degree to which it affects prognosis and overlaps with depression in this population is unknown. The present study examined the relationship between level of apathy, mortality and survival time and whether apathy was linked to specific symptom clusters of depression.
  
  
  METHODS
  A cohort of 76 consecutive ALS patients attending specialized multidisciplinary clinics were classified according to level of apathy. The effects of clinical factors and apathy on survival time were analysed using univariate and multivariate methods.
  
  
  RESULTS
  The majority of patients with moderate to severe apathy died during the study (P = 0.003) and had a median survival time of 21.7 months, considerably shorter than patients with mild apathy (46.9 months) and no apathy (51.9 months) (P = 0.0001). Apathy remained a significant predictor of survival even after controlling for clinical factors and symptom duration at the time of study entry (hazard ratio 3.8, 95% confidence interval 1.9-7.5, P = 0.0001). Depression with demoralization was not associated with level of apathy (P = 0.172) whereas depression with anhedonia was more common in patients with apathy than in those without apathy (P = 0.006).
  
  
  CONCLUSIONS
  The presence of severe apathy is an independent, negative prognostic factor in ALS.
authors.affiliation: Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.|Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Caga
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Turner
authors.affiliation: Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Hsieh
authors.affiliation: Neuroscience Research Australia, Randwick, NSW, Australia.
authors.forename: R M
authors.initials: RM
authors.lastname: Ahmed
authors.affiliation: Neuroscience Research Australia, Randwick, NSW, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Devenney
authors.affiliation: Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Ramsey
authors.affiliation: Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.
authors.forename: M C
authors.initials: MC
authors.lastname: Zoing
authors.affiliation: Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: E
authors.initials: E
authors.lastname: Mioshi
authors.affiliation: Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.|Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.
authors.forename: M C
authors.initials: MC
authors.lastname: Kiernan
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D057565:Apathy / Q000502:physiology*; D003863:Depression / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
keywords: amyotrophic lateral sclerosis; apathy; depression; mortality; prognosis; survival