Measuring Apathy in Alzheimer's Disease in the Apathy in Dementia Methylphenidate Trial 2 (ADMET 2): A Comparison of Instruments

• Type of Material: Article
• Authors: Krista L Lanctôt, Sunnybrook Research Institute; Roberta W Scherer, Johns Hopkins University; Abby Li, Sunnybrook Research Institute; Danielle Vieira, Sunnybrook Research Institute; Hamadou Coulibaly, Johns Hopkins University; Paul B Rosenberg, Johns Hopkins University; Nathan Herrmann, Sunnybrook Research Institute; Alan J Lerner, University Hospital – Case Western Reserve University; Prasad R Padala, University of Arkansas for Medical Science; Olga Brawman-Mintzer, Veterans Administration Medical Cente; Chris H van Dyck, Yale University; Anton P Porsteinsson, University of Rochester; Suzanne Craft, Wake Forest University School of Medicine; Allan Levey, Emory University; William J Burke, Banner Alzheimer’s Institute; Jacobo E Mintzer, Veterans Administration Medical Center, Atlanta
• Language: English
• Date: 2021-01-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jagp.2020.05.020
• Title of Journal or Parent Work: AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY
• Volume: 29
• Issue: 1
• Start Page: 81
• End Page: 89
• Grant/Funding Information: ADMET 2 is funded by NIA, NIH, R01AG046543. The Sponsor had no role in the design of the trial, and is not involved in data collection, analysis, or interpretation of data.
• Keywords: DESIGN; apathy; DISORDERS; MORTALITY; Geriatrics & Gerontology; Gerontology; DIAGNOSTIC-CRITERIA; INVENTORY; Life Sciences & Biomedicine; SYMPTOMS; RISK; IMPAIRMENT; neuropsychiatric inventory; methylphenidate; Alzheimer's disease; Psychiatry; diagnostic criteria; dementia; Science & Technology

Abstract

Background: Diagnostic criteria for apathy have been published but have yet to be evaluated in the context of clinical trials. The Apathy in Dementia Methylphenidate Trial 2 (ADMET 2) operationalized the diagnostic criteria for apathy (DCA) into a clinician-rated questionnaire informed by interviews with the patient and caregiver. Objective: The goal of the present study was to compare the classification of apathy using the DCA with that using the Neuropsychiatric Inventory-apathy (NPI-apathy) subscale in ADMET 2. Comparisons between NPI-Apathy and Dementia Apathy Interview Rating (DAIR) scale, and DCA and DAIR were also explored. Methods: ADMET 2 is a randomized, double-blind, placebo-controlled phase III trial examining the effects of 20 mg/day methylphenidate on symptoms of apathy over 6 months in patients with mild to moderate Alzheimer's disease (AD). Participants scoring at least 4 on the NPI-Apathy were recruited. This analysis focuses on cross-sectional correlations between baseline apathy scale scores using cross-tabulation. Results: Of 180 participants, the median age was 76.5 years and they were predominantly white (92.8%) and male (66.1%). The mean (±standard deviation) scores were 7.7 ± 2.4 on the NPI-apathy, and 1.9 ± 0.5 on the DAIR. Of those with NPI-defined apathy, 169 (93.9%, 95% confidence interval [CI] 89.3%–96.9%) met DCA diagnostic criteria. The DCA and DAIR overlapped on apathy diagnosis for 169 participants (93.9%, 95% CI 89.3%–96.9%). Conclusion: The measurements used for the assessment of apathy in patients with AD had a high degree of overlap with the DCA. The NPI-apathy cut-off used to determine apathy in ADMET 2 selects those likely to meet DCA criteria.