Apathy-depression overlap: unmasking hidden disability profiles in multiple sclerosis

Multiple sclerosis (MS), the leading cause of non-traumatic neurological disability in young adults, features heterogeneous motor and non-motor symptoms including fatigue, apathy and depression. Although fatigue and depression are well-studied in MS disability progression, to date, the independent and combined contributions of apathy, fatigue and depression to neurological disability remain unexplored.

This cross-sectional study assessed apathy, depression, and fatigue prevalence in 85 Italian MS patients, their associations with Expanded Disability Status Scale (EDSS) scores, and the relationship between psychological symptom profiles (apathy and/or depression) and disability. Non-parametric analyses and exploratory linear regression models were used.

In our sample of MS patients, the prevalence of apathy, depression and fatigue were 37.6%, 29.3%, and 51.8% respectively. Apathy (r = 0.30, p < 0.05) and depression (r = 0.48, p < 0.01), but not fatigue (p = 0.082), were associated with higher EDSS scores. Patients with co-occurring apathy and depression had significantly higher EDSS than asymptomatic (p < 0.01) or apathy-only (p < 0.05) groups; isolated apathy or depression were not independently associated with greater disability.

Co-occurring apathy and depression may identify an MS subgroup with greater neurological disability at the time of assessment emphasizing the potential value of systematic screening of motivational and affective disturbances in MS by all clinicians, particularly when they co-occur. Our results foster longitudinal studies that might determine whether these psychological profiles may predict future disability progression and whether their identification may inform integrated interventions aimed at improving clinical outcomes.