Apathy phenotypes in depression and dementia: A latent profile analysis

Apathy is a frequent psychopathological construct, recently described as a multidimensional concept involving executive, initiation, and emotional features, and is observed in both psychiatric and neurodegenerative disorders. We aimed to identify latent apathy profiles in major depressive disorder (MDD) and Major Neurocognitive Disorder (MND) groups using the Dimensional Apathy Scale - Italian version (I-DAS), and to examine their clinical and sociodemographic correlates.

A total of 328 participants (MDD = 149; MND = 179) were assessed using the I-DAS. Additional measures included MMSE, MADRS, BDI-II, CGI, and EQ-5D-3L scales. Latent profile analysis (LPA) was conducted to identify distinct apathy profiles based on the I-DAS dimensions (executive, initiation, and emotional).

The four-profile solution provided the best model, including: Global Apathy (32.9%), Mild Apathy (36.6%), Minimal Apathy (22.0%), and Executive Apathy (8.5%). The Global Apathy profile was characterized by high scores across all apathy domains, older age, poorer cognitive functioning, greater illness severity, lower quality of life, and a predominance of MND diagnoses. The Mild Apathy profile showed moderate apathy levels and a balanced distribution of MDD and MND. The Minimal Apathy profile mainly included individuals with MDD and showed the lowest depressive symptoms and best quality of life. The Executive Apathy profile showed selective executive motivational deficits and was predominantly associated with MDD.

Our findings support the multidimensional nature of apathy and highlight distinct motivational profiles across MDD and MND. Identifying such specific apathy clinical patterns may improve differential diagnosis and support more targeted clinical assessment and treatment strategies.