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1 This is a Sample version of the Apathy Inventory (AI) The full version of watermark.. the AI comes without sample The full complete 13 page version includes AI Overview information AI Scoring/ Administration instructions AI Complete Assessment 3 versions: Caregiver Patient version, Clinician version AI Clinical Validity version, Buy full version here - for $ 5.00 Clicking the above buy now button will take you to the PayPal payment service website in which you can pay via credit card or your optional PayPal account. Once you have paid for your item you will receive a direct link to download your full complete e-book instantly. You will also receive an with a link to download your e-book. Each purchased product you order is available to download for 24 hours from time of purchase. Should you have any problems or enquiries please contact - info@agedcaretests.com To see more assessments tests and scales go to -

2 Apathy and Parkinson's Disease Sergio E. Starkstein, MD, PhD. Simone Brockman, MA (Hans) Address university of Western Australia, Fremantle Hospital T 7, Fremantle 69S9 WA, Australia ses@meddent.uwa.edu.au Published online: 1 March 2011 dia, L lc 2011 Opinion statement Apathy, a frequent findi ng in Parki nson's disease (PO), is significantly associated with depression and dementia. Few studies have examined the efficacy of psychotropic or psychological treatments of apathy in PO, and adequate rand omized controlled trials are still lacking. There is anecdotal evidence that dopaminergic agonists may be a useful treatment modality. Levodopa may improve the loss of motivation in the "off" motor state, and dopaminergic agonists could be useful to treat apathy after the withdrawal of dopa minergic treatment in patients undergoing deep brain stimulation of the subthalamic nucleus. On the other hand, the selective norepinephri ne reuptake inhibitor atomoxetine did not demonstrate efficacy in improving apathy in a randomized controlled trial with apathy as a secondary efficacy measure. Given the significant association between apathy and both depression and cognitive decline, future studies should examine whether improvi ng mood and cognition rna~ also have a positive impact upon apathy in PD. For those PO patients with "pure" apa1hy, specific psychotherapeutic techniques should be developed. Introduction Apathy is defined as the absence or lack of fee ling, emotion, interest, concern, or motivation II I. Stark stein and coworkers carried out one of the first studies on the frequency and clinical correlates of apathy in Parkinson's disease (PO) 121. They used the Apathy Scale to rate its severity, and the diagnosis was made based on a cutoff score on this instrume nt. Apathy was d iagnosed in 42% of a consecutive series of 50 patients atte nding a movement di.sorders unit. Two thirds of the patients with apathy were also depressed, suggesting that apathy in PD is a frequent comorbid condition of o ther nonmotor syndromes. On cognitive testing, PD patients with apa thy showed more severe defi cits on executive functions and verbal memory tasks than PD patients without apathy, suggesting that for a subgroup of patients with PD, apathy may be an epiphe nomenon of cognitive decl ine. Since this initial study, greater attention has been devoted to the frequency, correlates, and mecl1anism of apathy in PD. In this paper, we review and critically discuss the phenomenology of apathy and the psychometric instru mems that are used to assess this condition. We summarize the findings of studies on the frequency and the demographic a nd clinical correlates of apathy in PD, and address the potential problem of apathy as a side effect of surgical tecl111iques (e.g., deep brain stimulation) used to treat complications of PD. We a lso provide a cri tical discussion of the mecha

3 22. Ready RE, Friedman J, Crace ), Fernandez II. Testosterone deficiency and apathy in Parkinson's disease: a pilot study. J Neural Neurosurg Psychiatry. 27. LeJeune F, Ora pier D, Bourguignon r\, et al. Subthalamic nucleus stimulation in Parkinson disease induces apathy: a PET study. Neurology 2009;73: ;75: Kenangil C, Orken ON, Ur E, Forta H, Celik M. The n1is is the first study demonstrating brain regions related to the mechanism of apathy during STN stimulation relation of testostero ne levels with fatigue and apathy 28. Thobois S, Ardou in C, U1o mmee E. et at. Non-motor in Parkinso n's disease. Clin Neurol Neurosurg. dopamine withdrawal syndrome after surgery for 2009; I I I : Parkinson's disease: predictors and underlying mesolimbic 24. Bowers 0, M iller K. Mikos r\, ct al. Stanling facts denetvation. Brain. 2010;133: about emotion in Parkinson's disease: blunted reactivity to aversive stimuli. Brain. 2006; 129: Dubois B. Motivation, reward, and Parkinson's di s 29. Czernecki v, Pillon 13, Houeto JL. Pochon )13, Lery R. 25. Le\'Y R, Czernecki V. Apathy and the basal ganglia. J Neurol. 2006;253: ease: inoucnce of dopatherapy. NeuropsydlDiogia. 2002;40: Zgaljardic DJ, Bored JC, Foldi NS, et al. Relationship 30. Weintraub D. Mavandadi S, Mamikonyan E, et al. between sel f-reponed apathy and executive dysfunc- Atomoxetine for depressio n and other neuropsychiat tion in nondernented patients with Parkii\SOn disease. ric symptoms in Parkinson disease. Neurology. Cogn Behav NeuraL 2007;20: I 0;75: lnt J Geriatr Psychiatrv Dec; 17(12): The apathy inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment. Robert PH 1, Claire! S, Benoit M, Koutaich J, Bertogliati C, lible 0, Caci H, Borg M, Brocker P, Bedoucha P. ffi Author information Abstract OBJECTIVE: This study was designed to establish the validity and reliability of the apathy inventory {la), a rating scale for global assessment of apathy and separate assessment of emotional blunhng, lack of initiative, and lack of interest METHOD: Information for the la can be obtained from the patient or from a caregiver We evaluated 115 subjects using the la, consisting of 19 healthy elderly subjects, 24 patients with Mild Cognitive Impairment (MCI), 12 subjects with Parkinson's disease (PD) and 60 subjects with Alzheimer's disease (AD) RESULTS: Internal consistency, item reliability, and between-rater reliability were high A test-retest reliability study demonstrated that caregiver responses to la questions were stable over short intervals. A concurrent validity study showed that the la assesses apathy as effectively as the Neuro Psychiatric Inventory apathy domain. In the caregiver-based evaluation, AD subjects had significantly higher scores than controls, both for global apathy score and for the lack of interest dimension. When the AD patients were subdivided according to diagnostic criteria for apathy, apathetic patients had significantly higher scores than non apathetic patients With the patient-based evaluations, no differences were found among the AD, MCI and control groups The scores in the patient-based evaluations were only higher for the PD group versus the control subjects. The results a lso indicated that AD patients had poor awareness of their emotional blunting and lack of initiative. CONCLUSION S: The la is a reliable method for assessing in demented and non-demented elderly subjects several dimensions of the apathetic syndrome, and also the subject's awareness of these symptoms. This is the end of the SAMPLE AI clinical vadidity.

4 1 APATHY INVENTORY IA The principle of the Apathy Inventory (IA) is to obtain information on the presence of apathy in patients with brain disorders. The Apathy Inventory is composed of 3 versions: Caregiver version Patient version Clinician version Each version assess the 3 same clinical dimensions: - Emotional blunting - Lack of initiative - Lack of interest General principle At the time of the first assessment questions deal with behavior changes having appeared since the beginning of the disease. Behavior traits found throughout the life of the patient and not having changed since the evolution of the disease are not taken into account, even if they were abnormal. It is also possible to use the IA to measure changes occurred in a specific time lapse (eg. Found during the last four weeks or since the beginning of treatment given by a physician). Results analysis In clinical research there is different possible cut off score In clinical practice the most relevant scores are: In the caregiver version: - According to the interview rule, the presence compared to the absence of one of the IA dimension - According to the quantitative rule a score > 2 in one of the IA dimension Anosognosia: the caregiver patients discrepancy IA total score In the clinical version: - A score equal or upper to 4 is pathological. This is the end of the SAMPLE AI scoring & administration instructions.

5 3 APATHY INVENTORY - IA CAREGIVER Name: date : Type of evaluation: First Evaluation Follow up evaluation: time since the previous evaluation 1 - Emotional blunting F x S = / 12 Is he /she is as affectionate and express emotion as usual? Yes = 0 No = rate frequency and severity FREQUENCY Occasionally: less than once a week 1 Often: about once a week 2 Frequently: several times a week but less than everyday 3 Very frequently: essentially continuously present 4 SEVERITY Mild 1 Moderate 2 Marked 3 2 Lack of initiative: F x S = / 12 Is he /she initiates a conversation and or make decisions? In daily life, does he/she refer to you when he takes a decision or when he is asked a question? Yes = 0 No = rate frequency and severity This is the end of the SAMPLE AI-Caregiver questionnaire.

6 4 APATHY INVENTORY - IA PATIENT It is also possible to obtain the point of view from the subject himself on the same items. The interview is best conducted with the patient in the absence of the caregiver. The same questions result in scores directly obtained by using a visual analogical scale or a numeric evaluation between If the patient does not understand the visual scale functioning, try to obtain the score by a verbal rating (severity from 1 mild to 12 extremely severe according to the patient point of view. 1 - Emotional blunting Do you have the impression of being as affectionate as usual? Do you express your emotions? YES = 0 NO = Could you evaluate the amount of this emotional blunting from, mild at the extreme left to Severe at the extreme right Mild Severe This is the end of the SAMPLE AI-Patient questionnaire.

7 5 APATHY INVENTORY - IA CLINICIAN Name: Type of evaluation: First Evaluation Follow up evaluation: time since the previous evaluation: date: On this page (below) are the same questions from the caregiver and patient version as well as the scoring guide. On the following page (reverse side) are the instructions for scoring according to whether the patient is an outpatient or in an institution. IA dimension Score/4 Emotional blunting: Does the patient show affection? Does s/he show emotions? Evaluation / 4 0 No problem 1 2 Moderate problem 3 4. Major problem This is the end of the SAMPLE AI-Clinician questionnaire.