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Vol. 35, No. 6, 2013
Issue release date: July 2013
Section title: Original Paper
Cerebrovasc Dis 2013;35:507-513
(DOI:10.1159/000350202)

Post-Stroke Apathy: An Exploratory Longitudinal Study

Caeiro L. · Ferro J.M. · Pinho e Melo T. · Canhão P. · Figueira M.L.
aInstitute of Molecular Medicine, bStroke Unit, Neurology Service, and cPsychiatry Service, Department of Neurosciences, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 10/18/2012 2:36:44 PM
Accepted: 2/20/2013
Published online: 6/5/2013

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Introduction: Post-stroke apathy is a disturbance of motivation evidenced by low initiative, difficulties in starting, sustaining or finishing any goal-directed activity, low self-activation or self-initiated behavior and emotional indifference. Apathy is a common behavioral disturbance in stroke survivors. We aimed to analyze the relationship between post-stroke apathy at 1 year after stroke and (1) apathy in acute phase; (2) demographic, pre-stroke predisposing conditions (previous mild cognitive impairment, alcohol abuse, mood/anxiety disorder) and clinical features (stroke type and location, neurological symptoms); (3) post-stroke depression and post-stroke cognitive impairment, and (4) post-stroke functional outcome, quality of life and the perception of health. Methods: Consecutive stroke (infarct/intracerebral hemorrhage) patients without aphasia or consciousness disturbances were included in the acute phase of stroke and assessed at 1 year after stroke. We assessed apathy with the clinically rated version of the Apathy Evaluation Scale. We also assessed post-stroke depression (Montgomery Asberg Depression Rating Scale) and post-stroke cognitive impairment (attention, mental flexibility, verbal, motor and graphomotor initiative, and non-verbal and verbal abstract reasoning, and Mini-Mental State Examination), functional outcome (Barthel Index), quality of life and perception of health (EuroQol). Data were analyzed using bivariate associations (χ2 and t test) and stepwise multivariate analysis. Results: We included 76 stroke patients [32.9% women, mean age 62.9 years (SD = 10.9) and a mean of 6.9 (SD = 4.3) years of education]. Apathy was present in 17 patients in the acute phase and in 18 (23.7%) patients at 1 year after stroke. At 1 year after stroke, 41% of the acute apathetic patients remained apathetic. Sixty-one percent of new cases of post-stroke apathy were detected. Post-stroke apathy was associated only with previous cognitive impairment, apathy in acute stroke, post-stroke cognitive impairment, verbal abstract reasoning and with worse Barthel Index scale scores. In the multivariate logistic regression model, verbal abstract reasoning (odds ratio, OR = 7.03) and apathy in acute stroke (OR = 3.8) were identified as independent factors for post-stroke apathy at 1 year. Apathetic patients did not report worse quality of life or health. Conclusion: Apathy in acute stroke phase was a reliable indicator of post-stroke apathy. Apathy should be assessed in both phases. Verbal abstract reasoning impairment was also an independent factor for post-stroke apathy impairing patients' ability to reason about goal-directed activity. Even though apathetic patients had worse post-stroke functional outcome, they did not report losing quality of life or having worse health.


  

Author Contacts

Lara Caeiro
Serviço de Neurologia, Hospital de Santa Maria
Av. Professor Egas Moniz
PT-1649-035 Lisbon (Portugal)
E-Mail laracaeiro@fm.ul.pt

  

Article Information

Received: October 18, 2012
Accepted: February 20, 2013
Published online: June 5, 2013
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 1, Number of References : 52
Additional supplementary material is available online - Number of Parts : 1

  

Publication Details

Cerebrovascular Diseases

Vol. 35, No. 6, Year 2013 (Cover Date: July 2013)

Journal Editor: Hennerici M.G. (Mannheim)
ISSN: 1015-9770 (Print), eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 10/18/2012 2:36:44 PM
Accepted: 2/20/2013
Published online: 6/5/2013

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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