Workshop : Apathy and Disorders of Motivation Assessment and Therapeutic Perspectives

Uranie    Monday, March 5, 2018   08:00 – 09:30

K. Lanctot
Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Toronto, Canada
Apathy in Pre Dementia: Prevalence, Neurobiology and Treatment
Background: Apathy, characterized by diminished motivation, is found in cognitively normal elderly, as well as throughout the spectrum of prodromal dementia states including in those with mild behavioural impairment (MBI) and mild cognitive impairment (MCI). Importantly, the presence of apathy predicts increased risk of conversion to dementia.  This talk will review recent research on the prevalence and neurobiology of apathy and discuss possible treatments.

Findings: The prevalence of apathy in MCI has ranged from 3% to 55% depending on the population and detection methods.  Neuroimaging studies assessing structure, functional connectivity, blood flow and metabolism as well as amyloid burden and regional tau depositions reveal consistent differences in those with and without apathy.  Findings implicate regions commonly associated with apathy (e.g., frontal involvement), as well as regions typically affected in early AD (e.g., parietal and inferior temporal involvement).  Interventions being evaluated include neurostimulation and appear to target a variety of mechanisms.  Improved understanding of the underlying neurobiology may have treatment implications.

A. König
CoBTeK lab, Research Memory Center – University Cote d’Azur, Nice, France Association IA‏ @InnoAlzheimerHow Audio, Video and Actigraphic Sensors Can Be Used for the Apathy Assessment
Automatic speech analysis for the assessment of apathy

Introduction: Apathy is one of the most frequent neuropsychiatric symptoms found in dementia. It has an important impact on quality of life of both patients and their caregivers and represents a strong predictor of progression of the illness. Current clinical assessment methods risk biais resulting from the assessor’s subjectivity, pointing to a need for additional objective and systematic assessment tools. Therefore, the use of information and communication technologies (ICT) such as automatic speech analysis could be of interest in addition to current assessment methods.

Objectives: To investigate whether automatic analysis of linguistic and paralinguistic features extracted from audio recordings of patients’ answers to an open questions about personal interests could be useful for the assessment of apathy in elderly people.

Methods: 150 older persons at different apathy severity stages were recorded while answering the question ‘What interests and motivates you ?’. Every participant received the Apathy Diagnostic criteria and Apathy Inventory (AI). Speech signal processing techniques were applied to extract features which were compared to the baseline apathy assessment scores.

Results: Preliminary results show that the feature ‘speech rate’ correlates significantly with the AI.  More detailed results will be presented at the workshop. Our results demonstrate the additional value of vocal analytics for the assessment and monitoring of apathy in elderly people. This time saving automated tool can provide clinicians immediately with reliable data based on non-invasive, simple and low-cost methods.

V. Manera
CoBTeK lab, Research Memory Center – University Cote d’Azur, Nice, France Association IA‏ @InnoAlzheimer How Information and Communication Technologies Can Be Used As Therapeutic Options for Patients with Apathy
New Information and Communication Technologies (ICTs) are more and more employed in the domain of neurodegenerative disorders for patients’ treatment and stimulation. In particular, Serious Games (SG, i.e., video-games designed to train specific cognitive and/or physical functions) and Virtual Reality (VR) are now considered as promising solutions to build motivating cognitive and physical trainings, as they embed playful and entertaining aspects. In the present talk we will briefly review the literature concerning the use of VR and SG in people with neurodegenerative disorders, and we will then present some studies conducted by the CoBTeK team employing VR and SG in older adults (apathetic vs. non-apathetic) with mild to moderate cognitive impairment due to neurodegenerative disorders. The results of these studies converge in demonstrating that VR and SG can be successfully employed to create motivating trainings, and that these solutions seem mostly adapted to apathetic patients.

R. David
CoBTeK lab, Research Memory Center – University Cote d’Azur, Nice, France Association IA‏ @InnoAlzheimerRelationships Between Apathy and Motor Activity in Actigraphic Studies Apathy is a multi-dimensional syndrome (lack of interest, lack of initiative, emotional blunting) that has been described as a decrease in goal-oriented behaviours. It has therefore been hypothesized that apathy could be associated with a decrease in levels of daily locomotor activity associated to goal-oriented behaviours. The use of actimetry, a wearable device comprising an accelerometer that records variations in individual’s movements, has been proposed as a indirect but objective method to assess apathy in daily routine. In Alzheimer’s disease, individuals with apathy had reduced actimetric levels of motor activity compared to non apathetic individuals, in different conditions: over a short 1-hour period during a medical consultation, over seven consecutive 24-hour period in ecological conditions with community-dwelling individuals. Additionally, the daytime patterns of motor activity differed between non-apathetic individuals, individuals diagnosed with depression and individuals with apathy.Levels of motor activity were also found to be reduced among individuals with Mild Cognitive Impairment.The use of actimetry has to be considered as an objective method in addition to the clinical judgment for the diagnosis of apathy, but also to monitor the evolution of apathy and the response the treatments.

R. Levy, B. Dubois
Neurology department, Salpetriere Hospital, Paris, France Apathy: The Neurological Perspective
Apathy is the most frequent behavioral syndrome in neurodegenerative diseases. In our presentation, we will discuss several different dimensions of apathy from a neurological perspective: 1/ the advantage of defining apathy as an observable behavioral syndrome consisting in a quantitative reduction of voluntary (or goal-directed) actions; 2/ How to objectively assess apathy using novel and ecological experimental tools; 3/ What are the available treatments and future leads to improve care management and, 4/ what do we know about pathophysiology (mechanisms and neural bases) of apathy. In that matter, we propose that apathy is not a single entity but multiple, depending on which specific process or macrofunction is disrupted during the completion of goal-directed behavior. We propose dividing apathetic syndromes into three subtypes (‘emotional-motivational’, ‘cognitive-executive’ and ‘auto-activation-energetisation’). Each of the three groups of mechanisms can be ascribed to lesions of different prefrontal cortex (PFC)-basal ganglia territories as follows: ‘emotional–motivational’ to the orbital/medial PFC and presumably to its connected region within the striatum, namely the ventral striatum; ‘cognitive-executive’ to the lateral PFC and to its striatal input, namely the dorsal caudate nuclei; and ‘auto-activation-energetisation’ to basal ganglia lesions that usually affect both the cognitive and limbic territories (bilateral GPi or bilateral paramedian thalamic lesions) and also the dorsal–medial aspect of the PFC.

P. Robert 
CoBTeK lab, Research Memory Center – University Cote d’Azur, Nice, France Association IA‏ @InnoAlzheimer Diagnostic Criteria for Apathy Revisited
Apathy is an important and distressing behavioral syndrome in various neuropsychiatric disorders including Alzheimer’s disease and related disorders.  Apathy is defined as a persistent deficit of motivation reported by the subject himself or by his entourage, affecting behavioral (decreased goal-directed behavior), cognitive and emotional dimensions. During the 2008 EPA meeting a task force developed Diagnostic criteria for apathy, which are now used in various disease conditions and in clinical practice. Concerning the quantitative assessment until today, apathy is scored with the help of clinical rating scales such as the NPI (Neuropsychiatric Inventory), the AES (Apathy Evaluation scale), the LARS (Lille apathy rating scale) or the AI (Apathy Inventory). However, these tools allow only a punctual and not continuous assessment and risk biases resulting from the assessor’ subjectivity, pointing to a need for additional systematic assessment tools. The aim of this presentation is to present an update of the diagnostic criteria for apathy and results of the validation study of an application using serious game designed to assess quantitatively apathy in an implicit, more objective and dynamic way