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Measuring clinically relevant change in apathy symptoms in ADMET and ADMET 2
Shankar Tumati1, Nathan Herrmann1, Jaime Perin2
1Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
Objectives:
Among participants with Alzheimer's disease (AD) we estimated the minimal clinically important difference (MCID) in apathy symptom severity on three scales.
Design:
Retrospective anchor- and distribution-based analyses of change in apathy symptom scores.
Setting:
Apathy in Dementia Methylphenidate Trial (ADMET) and ADMET 2 randomized controlled trials conducted at three and ten clinics specialized in dementia care in United States and Canada, respectively.
Participants:
Two hundred and sixty participants (60 ADMET, 200 ADMET 2) with clinically significant apathy in Alzheimer's disease.
Measurements:
The Clinical Global Impression of Change in Apathy scale was used as the anchor measure and the MCID on the Neuropsychiatric Inventory - Apathy (NPI-A), Dementia Apathy Interview and Rating (DAIR), and Apathy Evaluation Scale-Informant (AES-I) were estimated with linear mixed models across all study visits. The estimated thresholds were evaluated with performance metrics.
Results:
Among the MCID was a decrease of four points (95% CI: -4.0 to -4.8) on the NPI-A, 0.56 points (95% CI: -0.47 to -0.65) on the DAIR, and three points on the AES-I (95% CI: -0.9 to -5.4). Distribution-based analyses were largely consistent with the anchor-based analyses. The MCID across the three measures showed ∼60% accuracy. Sensitivity analyses found that MMSE scores and apathy severity at baseline influenced the estimated MCID.
Conclusions:
MCIDs for apathy on three scales will help evaluate treatment efficacy at the individual level. However, the modest correspondence between MCID and clinical impression of change suggests the need to consider other scales.
Insights
Researchers determined the minimal clinically important difference (MCID) for apathy in Alzheimer's disease (AD) patients. These findings aid in assessing treatment effectiveness for apathy symptoms in individuals with AD.
Area of Science:
- Neurology
- Geriatrics
- Psychiatry
Background:
- Apathy is a common and disabling symptom in Alzheimer's disease (AD).
- Accurate measurement of apathy symptom severity is crucial for evaluating treatment efficacy.
- Minimal Clinically Important Difference (MCID) provides a threshold for meaningful change in patient-reported outcomes.
Purpose of the Study:
- To estimate the MCID for apathy symptom severity in individuals with Alzheimer's disease.
- To compare MCID estimates across three validated apathy assessment scales.
Main Methods:
- Retrospective analysis of data from the Apathy in Dementia Methylphenidate Trial (ADMET) and ADMET 2.
- Used anchor-based and distribution-based methods with the Clinical Global Impression of Change in Apathy scale as the anchor.
- Estimated MCID for the Neuropsychiatric Inventory - Apathy (NPI-A), Dementia Apathy Interview and Rating (DAIR), and Apathy Evaluation Scale-Informant (AES-I) using linear mixed models.
Main Results:
- Estimated MCIDs were: a decrease of 4 points on NPI-A, 0.56 points on DAIR, and 3 points on AES-I.
- Anchor-based and distribution-based analyses yielded consistent results.
- MCID estimates showed approximately 60% accuracy, with baseline apathy severity and MMSE scores influencing the results.
Conclusions:
- Established MCIDs for apathy on three scales can aid in evaluating treatment efficacy at the individual level for Alzheimer's disease patients.
- The moderate agreement between MCID and clinical impression highlights the need for careful interpretation and consideration of multiple assessment tools.
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