A Longitudinal View of Apathy and Its Impact After Stroke

• Published in: Stroke (1970) Vol. 40; no. 10; pp. 3299 - 3307
• Main Authors: MAYO, Nancy E, FELLOWS, Lesley K, SCOTT, Susan C, CAMERON, Jill, WOOD-DAUPHINEE, Sharon
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.10.2009
• Subjects: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Caregivers; Cognition Disorders - etiology; Cognition Disorders - psychology; Cohort Studies; Comorbidity; Depressive Disorder - diagnosis; Depressive Disorder - epidemiology; Disability Evaluation; Disease Progression; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Longitudinal Studies; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Outcome Assessment (Health Care); Prevalence; Quality of Life - psychology; Recovery of Function - physiology; Severity of Illness Index; Stroke - epidemiology; Stroke - psychology; Stroke Rehabilitation; Surveys and Questionnaires; Time Factors; Vascular diseases and vascular malformations of the nervous system; Vascular disease; Mood disorder; Apathy; Stroke; Nervous system diseases; Central nervous system disease; function; motivation; Cardiovascular disease; Depression; Cerebrovascular disease; Cerebral disorder
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/strokeaha.109.554410

Stroke survivors are often described as apathetic. Because apathy may be a barrier to participation in promising therapies, more needs to be learned about apathy symptoms after stroke. The specific objective was to estimate the extent to which apathy changes with time over the first year after stroke and the impact of apathy on recovery. The Apathy Assessed cohort was formed from stroke survivors participating in a longitudinal study of health-related quality of life after stroke. A family caregiver completed an apathy questionnaire by telephone at 1, 3, 6, and 12 months after stroke (n=408). Group-based trajectory modeling and ordinal regression were used to identify distinctive groups of individuals with similar trajectories of apathy over the first year after stroke and predictors of apathy trajectory. Both 3- and 5-group trajectory models fit the data. We used the 5-group model because of the potential to further explore the apathy construct. The largest group (50%) had low apathy and 33% had minor apathy that remained stable throughout the first year after stroke. A small proportion (3%) of the study sample had high apathy that remained high. Two other groups of almost equal size (7%) showed worsening and improving apathy. Poor cognitive status, low functional status, and high comorbidity predicted higher apathy. High apathy had a significant negative effect on physical function, participation, health perception, and physical health over the first 12 months after stroke. Some degree of apathy was prevalent and persistent after stroke and was predicted by older age, poor cognitive status, and low functional status after stroke. Even a minor level of apathy had an important and statistically significant impact on stroke outcomes.