In patients with mild cognitive impairment, apathy can be a predictor of Alzheimer’s disease

The presence of apathy in patients with mild cognitive impairment is strongly linked to a progression to Alzheimer’s disease, giving physicians a possible early diagnosis tool, according to UTHealth Houston research published recently in the Journal of Alzheimer’s Disease.

Apathy, the lack or reduced interest in doing something or accomplishing things, is one of the neuropsychiatric symptoms frequently observed in people with cognitive impairment.

“If you go outside big centers like Houston, the diagnosis and everything around the management of Alzheimer’s disease relies mainly on clinical markers,” said Antonio L. Teixeira, MD, PhD, professor in the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences and director of the Neuropsychiatry Program at McGovern Medical School at UTHealth Houston. “So, our results found that independent of other behavioral problems, apathy by itself was strongly associated with cognitive decline which can really help clinicians be aware of red flags sooner.”

Using the Texas Alzheimer’s Research and Care Consortium (TARCC) cohort, researchers with UTHealth Houston and The University of Texas Health Science Center at San Antonio (UT Health San Antonio) gave the Neuropsychiatry Inventory Questionnaire to family members and caregivers of the participants. They were asked to measure the presence and severity of 12 neuropsychiatry symptoms in patients with dementia, including apathy.

Eight years of data of 1,092 patients showed that 190 patients developed Alzheimer’s, or 17.3%. The presence of apathy in mild cognitive impairment patients was associated with a 2.40-fold greater hazard of progression to Alzheimer’s disease.

Given the demographics of the state of Texas, the TARCC cohort provided the study with a diverse population, including a significant number of Hispanics.  

“Previous studies relied on a relatively homogeneous population, in terms of ethnic backgrounds,” said Teixeira, who is the senior author of the study. “But the TARCC has a significant group of Hispanics, which allowed this study to have a more heterogenous population compared to previous studies.”    

As a result of the findings, Teixeira said clinicians should assess individuals with apathy for earlier intervention.

“The evaluation of apathy is cost-effective and does not rely on expensive equipment,” Teixeira said. “Therefore, assessments of apathy may provide an efficient and highly scalable method for improving risk stratification across clinical settings.”

Haitham Salem, MD, PhD, a former UTHealth Houston psychiatry resident who now is with Brown University, was first author. Co-authors of the study included Robert Suchting, PhD, professor in the Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth Houston; and Sudha Seshadri, MD, and Mitzi Gonzales, PhD, both professors in the Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases at UT Health San Antonio.

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