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Multidimensional Apathy: The Utility of the Dimensional Apathy Scale in Huntington's Disease
Kelly J Atkins1, Sophie C Andrews1,2,3, Trevor T-J Chong1,4,5
1School of Psychological Sciences, Turner Institute for Brain and Mental Health Monash University Melbourne Victoria Australia.
Insights
Huntington's disease (HD) patients show higher apathy across all subtypes, including Executive, Initiation, and Emotional dimensions. The Dimensional Apathy Scale (DAS) effectively measures these distinct apathy aspects in HD.
Area of Science:
- Neuroscience
- Clinical Psychology
- Genetics
Background:
- Apathy, a common motivational disorder in Huntington's disease (HD), is increasingly understood as having distinct subtypes.
- Previous research has not clarified which specific apathy dimensions are most affected in HD or how they change with disease progression.
Purpose of the Study:
- To investigate the prevalence of apathy subtypes in HD using the Dimensional Apathy Scale (DAS).
- To compare the DAS with a general apathy measure (Apathy Evaluation Scale, AES).
- To evaluate the reliability of self- and observer-ratings on the DAS.
- To examine the relationship between DAS dimensions, disease burden, functional capacity, and AES scores.
Main Methods:
- The study involved 50 pre-manifest HD, 51 manifest HD participants, 87 controls, and 50 HD observers.
- Participants completed the DAS, AES, and Total Functional Capacity (TFC) assessments.
- Statistical analyses included hierarchical regressions to explore relationships between variables.
Main Results:
- Manifest HD participants exhibited higher apathy levels across all DAS dimensions (Executive, Initiation, Emotional) compared to pre-manifest and control groups.
- Self- and observer-ratings on the DAS demonstrated comparable reliability.
- Initiation subscale scores correlated with AES scores; Executive subscale scores related to disease burden; Emotional subscale scores linked to lower TFC.
Conclusions:
- This study is the first to utilize the DAS in HD, confirming that manifest HD is associated with increased apathy across all measured subtypes.
- The DAS appears to be a valuable instrument for assessing the multifaceted nature of apathy in individuals with HD.
Background:
Apathy is a disorder of motivation common to Huntington's disease (HD). Recent conceptual frameworks suggest that apathy is not unitary but consists of discrete subtypes ("dimensions"). Which of the proposed dimensions are preferentially affected in HD, and how these dimensions evolve with disease progression is unknown.
Objectives:
The Dimensional Apathy Scale (DAS) separates apathy into Executive, Initiation and Emotional subscales. Using the DAS, we aimed to: 1) Determine the apathy subtypes prevalent in HD; 2) Compare the DAS against a unitary measure of apathy (Apathy Evaluation Scale, AES); 3) Assess the reliability of self- and observer-ratings; and 4) Determine the relationship between the DAS, and disease burden, total functional capacity (TFC) and the AES.
Method:
Fifty pre-manifest, 51 manifest-HD, 87 controls, and 50 HD-observers completed the DAS, AES, and TFC.
Results:
Manifest-HD participants had the highest levels of apathy across all dimensions (30.4% on Executive subscale, 34.8% on Initiation subscale, and 15.2% on Emotional subscale), relative to pre-manifest and control participants. Self- and observer-ratings on the DAS did not differ. Hierarchical regressions across the entire gene-expanded sample showed that scores on the Initiation subscale correlated with AES scores; higher Executive subscale scores were related to higher disease burden; and Emotional subscale scores with lower total functional capacity.
Conclusions:
In this first study of the DAS in HD, manifest-HD participants were more apathetic than pre-manifest and control participants across all apathy subtypes. The DAS may be a useful tool for measuring different aspects of apathy in people with HD.
