Development and validation of the geriatric apathy scale: Examining multi-dimensional apathy profiles in a neurodegenerative population with cultural considerations

Hsin-Jou Yi; Chun-Hsiang Tan; Wei-Pin Hong; Rwei-Ling Yu

doi:10.1016/j.ajp.2024.103924

Development and validation of the geriatric apathy scale: Examining multi-dimensional apathy profiles in a neurodegenerative population with cultural considerations

Asian J Psychiatr. 2024 Mar:93:103924. doi: 10.1016/j.ajp.2024.103924. Epub 2024 Jan 9.

Authors

Hsin-Jou Yi¹, Chun-Hsiang Tan², Wei-Pin Hong³, Rwei-Ling Yu⁴

Affiliations

¹ Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Office of Strategic Planning, National Cheng Kung University, Tainan, Taiwan. Electronic address: lingyu@mail.ncku.edu.tw.

PMID: 38232445
DOI: 10.1016/j.ajp.2024.103924

Abstract

Background: Apathy is a common motivational deficit in neurodegenerative diseases, but lacks a culturally sensitive tool accounting for ethnic Chinese culture's impact on motivation initiation. This study developed and validated the Geriatric Apathy Scale (GAS), comprehensively incorporating cultural nuances, setting diagnostic cutoffs, and examining apathy's multi-dimensional aspects in a neurodegenerative cohort.

Methods: The 16-item GAS was developed by considering ethnic Chinese cultural characteristics and conducting a literature review. The study involved 296 participants, comprising 113 with Parkinson's disease (PD), 66 with Alzheimer's disease (AD), and 117 healthy controls (HC). All participants completed the GAS, Apathy Evaluation Scale (AES), Geriatric Depression Scale (GDS-15), Mini-Mental State Examination, and Activities of Daily Living (ADLs).

Results: The GAS showed good internal consistency (r = 0.862) and test-retest reliability (r = 0.767). It correlated moderately with the AES (r = 0.639, p < .001), weakly with GDS-15 (r = 0.166, p < .01), and negatively with ADLs (r = -1.19, p < .05). Clinical diagnosis cutoff scores were identified at 15.5 for PD (sensitivity: 0.789; specificity: 0.693) and 12.5 for AD (sensitivity: 0.821; specificity: 0.632). Noteworthy disparities were observed in the Cognition and Social Motivation dimension, with elevated severity in both PD and AD compared to HC (p < .01). Interestingly, within-group comparisons revealed greater apathy severity in the Cognition and Social Motivation dimension for PD (p < .001) and AD (p = .001) versus Emotional Response and Expression and Spontaneous Behavioral Activation.

Conclusions: The GAS, a psychometrically validated scale, assesses apathy in neurodegenerative populations, accounting for ethnic Chinese culture's influence. It establishes clinical cutoff points and explores the multi-dimensional nature of apathy.

Keywords: Apathy; Culturally sensitive; Inventory; Neurodegenerative diseases; Psychometrically validated.

Publication types

Review

MeSH terms

Activities of Daily Living / psychology
Aged
Alzheimer Disease* / diagnosis
Apathy* / physiology
Humans
Parkinson Disease* / psychology
Psychiatric Status Rating Scales
Psychometrics / methods
Reproducibility of Results