Apathy in Early Relapsing-Remitting Multiple Sclerosis: Prevalence and Predictors

Abstract.

Apathy, a neuropsychiatric symptom characterized by a lack of motivation and affecting cognitive, emotional, and behavioral domains, is being increasingly recognized in multiple sclerosis (MS), with an estimated prevalence of 19% to 43%. However, apathy remains underinvestigated in early MS. In this study, we aim to evaluate apathy in people with relapsing-remitting MS (RRMS) whose disease duration has been less than 5 years.

The study included 38 people with RRMS with a disease duration of less than 5 years and 38 matched controls. Clinical and comprehensive neuropsychological evaluations were performed. Apathy was evaluated using the Apathy Evaluation Scale, Clinician Version (AES-C).Depressive symptoms, anxiety, fatigue, and quality of life were also assessed.

Apathy prevalence was 42.1%. Apathy scores correlated with depressive symptoms, anxiety, fatigue, lower quality of life, younger age, and worse performance in frontal lobe tests (Trail Making Test-A [TMT-A] and Symbol Digit Modalities Test). Independent apathy predictors were depressive symptoms (OR, 4.05; 95% CI, 1.22-13.5; P = .023), global quality of life (OR, 1.7; 95% CI, 1.08-2.64; P = .021), and TMT-A score (OR, 1.14; 95% CI, 1.02-1.27; P = .020).

Apathy is a disabling symptom that is present in a significant percentage of people in the first years after they have been diagnosed with RRMS. Thus, people with MS should should be routinely screened for apathy, and symptoms should be managed when it occurs. We identified depressive symptoms, low quality of life, and executive dysfunction as predictors of apathy in this population.