C M2R - Nice Table 1: Comparison of patients with and without apathy diagnostic * Kruskall-Wallis non parametric test. In comparison with patient who did not fulfil the diagnostic criteria, patients with apathy had: - more frequently a social support - lower MMSE & ADL scores - higher co morbidity severity index Table 2: Comparison of patients with and without depression diagnostic In comparison with patient who did not fulfil the diagnostic criteria, patients with depression had: - more frequently a social support - lower MMSE & ADL scores - higher co morbidity severity index • The new MOUS Scale (Multidomain Occupational Useful Score) Figure 3: The MOUS scale results Manual activities Participation in Intellectual conversations activities Activities outside home Concerning the MOUS scale, all domains were significantly different between the 4 groups. Internal consistency of the MOUS scale was assessed by Cronbach's coefficient alpha is 0.697. Figure 4: The MOUS SCALE in function of the apathetic and depressive disorders Manual activities Participation in Intellectual conversations activities Activities outside home ■ Apathy and Depression ■ Apathy alone ■ Depression alone ■ Neither Apathy nor depression DISCUSSION This study confirms the high prevalence of apathy and depression in mild AD. Looking at the overall criteria indicated that depression (47.9%) was more frequent than apathy (41.6%). Looking at the clinical symptoms level: - Clinical symptoms of apathy (52.7%) are more frequent than depressed mood (24%). - Within the diagnosis of depression, the diminished interest symptoms is frequent (46%). - This symptom also belong to the apathy criteria. The typology of patients based on the presence or the combination of apathy and depression showed significant differences. AD, suffering from apathy, depression or both received significantly more social assistance (APA: Personalized Autonomy Allocation) and were more impaired on IADL scores. REFERENCES Robert PH, Berr C, Volteau M, Bertogliati-Filleau C, Benoit M, Guerin O, et al. Importance of lack of interest in patients with mild cognitive impairment. Am J Geriatr Psychiatry 2008;16(9):770-776 Robert PH, Onyike CU, Leentjens AFG, Dujardin K, Aalten P, Starkstein SE, et al. Proposeddiagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders. European Psychiaty 2009;24:98-104. Mulin E, Leone E, Dujardin K, Delliaux M, Leentjens A, Nobili F, Dessi B, Tible O, Agüera-Ortiz L, Osorio RS, Yessavage J, Dachevsky D, Verhey FR, Jentoft AJ, Blanc O, Llorca PM, Robert PH. Diagnostic criteria for apathy in clinical practice. Int J Geriatr Psychiatry. 2011, 26: 158 - 165 Olin JT, Schneider LS, Katz IR, Meyers BS, Alexopoulos GS, Breitner JC, BruceML, Caine ED, Cummings JL, Devanand DP, Krishnan KR, Lyketsos CG, Lyness JM,Rabins PV, Reynolds CF 3rd, Rovner BW, Steffens DC, Tariot PN, Lebowitz BD. Provisional diagnostic criteria for depression of Alzheimer disease. Am J Geria- trPsychiatry. 2002 125-8. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968 May;16(5):622-6. Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982, 17: 37-49 The Estime Study : Apathy and Depression in mild and newly diagnosed Alzheimer Disease The Estime Study : Apathy and Depression in mild and newly diagnosed Alzheimer Disease Patients Patients with without Apathy Apathy diagnosis diagnosis P value (N=296) (N=416) APA Recipient 66 (22.4%) 44 (10.6%) <0.0001 (Personalized Non-profit 223 (75.6%) 354 (85.1%) Autonomy No information 6 (2%) 18 (4.3%) Allocation) MMSE Score Average (±SD) 22.7 (± 1.9) 23.4 (± 2.3) <0.0001* Median 22 23 IADL Average (±SD) 2.5 (± 1.1) 3 (± 1) <0.0001* Detection Score Median 3 3 IADL Average (±SD) 1.9 (± 1.2) 2.6 (± 1.3) <0.0001* Consequences Median 2 3 Score Severity Average (±SD) 1.5 (± 1.5) 1.1 (± 1.2) <0.01* Index of comorbidities (Without psy/ Median 1 1 comportemental) Patients with Patients without apathy depressive diagnosis or depression diagnosis P value (N=332) (N=298) APA Recipient 67 (20.2%) 33 (11.1%) <0.01 (Personalized Non-profit 257 (77.6%) 251 (84.2%) Autonomy Allocation) No information 7 (2.1% 14 (4.7%) Data points missing 1 - 0 - Age of diagnosis Nb of subjects analyzed 327 296 of Alzheimer's disease Average (±SD) 3.4 (± 6) 2.2 (± 6.3) 0.01 at the inclusion day Median 1 0 (in months) Range 0 - 57 0 - 60 MMSE Score Nb of subjects analyzed 332 298 Average (±SD) 23 (± 2.1) 23.3 (± 2.3) 0.05 Median 23 23 Range 20 - 29 20 - 29 IADL Detection Nb of subjects analyzed 225 297 Score Average (±SD) 332 297 Median 2.6 (± 1.1) 3 (± 1) <0.0001 Range 3 3 IADL Consequences Nb of subjects analyzed 330 295 Score Average (±SD) 2.1 (± 1.2) 2.7 (± 1.3) <0.0001 Median 2 3 Range 0 - 4 0 - 4 Severity Index Nb of subjects analyzed 301 281 of comorbidities Average (±SD) 3.1 (± 2.4) 2.3 (± 1.6) <0.0001 (Without psy/ Median 3 2 comportemental) Range 0 - 15 0 - 11 2 4 6 8 10 0 2 4 6 8 10 0 2 4 6 8 10 0 BACKGROUND Apathy is defined as a disorder of motivation. Apathy is one of the most common behavioural complications of neurodegenerative disorders such as Alzheimer (AD) and in Mild Cognitive Impairment (MCI). The risk of conversion to AD was significantly higher for MCI patients with lack of interest, which is one of the core apathetic symptoms (Robert 2008). Recently a task force has developed diagnostic criteria for apathy (Robert 2009). In them, apathy is defined as a disorder of motivation that per- sists over time and should meet all the following requirements. Firstly, the core feature of apathy, i.e. diminished motivation; secondly (Clinical dimensions), presence of at least one symptom in at least two of the three following domains for a period of at least four weeks and present most of the time.(i.e. reduced goal-directed behavior, goal-directed cognitive activity and emotions) must also be present; thirdly, there should be identifiable functional impairments attributable to apathy. Finally, exclusion criteria are specified to exclude symptoms and conditions. In order to validate these criteria a cross-sectional, multicentric, observational study was performed on 306 patients (Mulin, 2011). The frequency of apathy was of 55% in AD. Depressive symptoms also are among the most frequently problems associated with dementia and diagnostic criteria are still available (Olin & al). Both apathy and depressive symptoms are important in early stage of the disease and are persistent during the disease process. OBJECTIVES - Using diagnostic criteria to estimate the frequency of apathy and depression in patients suffering from mild AD, newly diagnosed. - To describe the metrological parameters of the MOUS scale (Multiple domains Occupational Useful Score), a new tool funded on visual analogue scale evaluation about occupational activities) METHODS A cross-sectional, national epidemiological study was set up and conducted among a nationally representative sample of investigators. The investigators were either private practice neurologist or other specialist (geriatrician, psychiatrist) working in Memory clinic Each clinician had to check the presence of apathy and depression according to the diagnostic criteria in consecutive patients. In addition the following informations have been completed: sociodemographic variables, MMSE, the 15-item Geriatric Depression Scale (Yesavage), the Occupational Single domains Useful Score (MOUS) and the comorbidity scale (CIRS (Linn). Statistical analysis included: - Groups comparison: Kruskal-Wallis test - MOU scale: internal consistency (Cronbach alpha coefficient and Pearson's correlation coefficient inter-items), reliability (Kappa coefficient of concordance) and unidimensionality of the scale. RESULTS • Diagnosis of apathy and depression 734 patients were enrolled by 115 physicians (469 patients by 83 private practices neurologists and 265 patients by 32 specialists working in Memory Center). Patients were predominantly female (62%), with an average age of 80 years (+/- 6.6). For 56% of patients diagnosis of AD was made between the day of consultation and one month before. 41.6% (n=296) of the patients presented the overall diagnostic criteria for apathy and 52.7% (n=381) fulfilled the clinical dimension criteria. Patients with apathy had a lower average MMSE than patients without apathy (22.7 versus 23.4) and IADL scores lowest detection (2.5 vs. 3) and consequences (1.9 versus 2.6) and a severity index of comorbidities more elevated. They received significantly more social assistance (APA: Personalized Autonomy Allocation), respectively 22.4% versus 10.6%. 47,9% (340) of patients had a diagnosis of depression [Olin’s Criteria]. 24% of patients had a depressed mood and 46% had a markedly diminished interest or pleasure in activities or in response to social demands. Figure 1: Diagnosis of apathy and depression (N=695) ⇒ 32.4% (n=225) of patients had both apathy and depression ⇒ 9.4% (n=65) of patients had apathy alone ⇒ 15.4% (n=107) had depression alone ⇒ 42.9% (n=298) had neither apathy nor depression ■ Apathy and Depression ■ Apathy alone ■ Depression alone ■ Neither Apathy nor depression • Clinical characteristics Figure 2 : Distribution of MMSE scores in mild AD patient population The average MMSE was 23 (SD 2.2;median 23). 0 20 21 22 23 24 25 26 27 28 29 (N=64) (N=153) (N=110) (N=109) (N=104) (N=80) MMSE Score (N=50) (N=32) (N=26) (N=6) 5% 10% 15% 20% Partnership: Support from pharmaceuticals laboratories: Acknowledgment: The ESTIME STUDY GROUP Poster P2-159 (n° 14999), Epidemiological session, exposed on Monday, July 18 at the 2011 AAICAD in Paris. 32 % 9 % 16 % 43 % Table 3: Comparison according to the presence/absence and association of apathy & depression * Kruskal-Wallis test - ° 2 groups with the same symbol show a statistically significative difference (p ≤ 5%). The 4 groups were significantly different regarding age, social level, APA allocation, time to diagnosis, MMSE, and IADL. Post-hoc tests showed a statistically significant difference in time to diagnosis of Alzheimer's disease (older diagnosis for apathetic and depressed patients compared to apathetic alone or to those without apathy or depression), MMSE and IADL scores. Apathy and Depression Apathy alone Depression alone Neither Apathy nor Depression p value (N=225) (N=65) (N=107) (N=298) Age (in years) Average (±SD) 79.9 (± 6.5) 80.5 (± 7) 78.1 (± 7.4) 80.5 (± 6.2) 0.01 Median 80.5 81.2 79.4 81.1 post-hoc° Tests ** ** Social level impoverished 2 (0.9%) 0 (0%) 0 (0%) 3 (1%) 0.04 low 26 (12%) 10 (15.4%) 5 (4.9%) 25 (8.4%) middle 147 (67.7%) 35 (53.8%) 70 (68%) 217 (73.1%) Well off 42 (19.4%) 20 (30.8%) 28 (27.2%) 52 (17.5%) APA Recipient 58 (25.9%) 7 (10.8%) 9 (8.4%) 33 (11.1%) <0.0001 Non-profit 161 (71.9%) 58 (89.2%) 96 (89.7%) 251 (84.2%) No information 5 (2.2%) 0 (0%) 2 (1.9%) 14 (4.7%) Age of diagnosis of Alzheimer's Average (±SD) 3.7 (± 6.3) 0.9 (± 2.7) 2.9 (± 5.5) 2.2 (± 6.3) <0.0001* disease at the inclusion day Median 2 0 0 0 (in months) post-hoc° Tests ** ** ++ ++ MMSE Score Average (±SD) 22.7 (± 1.9) 22.7 (± 2) 23.6 (± 2.4) 23.3 (± 2.3) <0.0001 Median 22 22 23 23 post-hoc° Tests ** ** ++ ++ °° °° IADL Average (±SD) 2.4 (± 1.1) 2.9 (± 1) 3 (± 1) 3 (± 1) <0.0001 Detection Median 2 3 3 3 Score post-hoc° Tests ** ** ++ ++ °° °° IADL Average (±SD) 1.8 (± 1.1) 2.1 (± 1.2) 2.6 (± 1.2) 2.7 (± 1.3) <0.0001 Consequences Median 2 2 3 3 Score post-hoc° Tests ** ** ++ ++ °° °° ## ## Reference : INF-ALZ-031-05/11 Philippe ROBERT 1 , Gilles BERRUT 2 , Sylvie BONIN-GUILLAUME 3 , Claude MEKIES 4 , Serge BAKCHINE 5 , Michel BENOIT 6 , Johanna DOUSSAINT 7 , Stéphane SCHUCK 7 , Thierry MARQUET 8 and the ESTIME STUDY GROUP. 1 Centre Mémoire de Ressources et de Recherche, CHU ; EA CoBTeK Nice, Sophia Antipolis University , France. - 2 Pôle de Gérontologie clinique, Hôpital Bellier, 44300 Nantes, France. - 3 Service Médecine Interne, Gériatrie et Thérapeutique, Hôpital Sainte Marguerite, 13274 Marseille Cedex, France. - 4 Service de neurologie, Clinique des Cèdres, 31700 Cornebarrieu, France. 5 Head of Department of Neurology, C.H.U. Reims, Hôpital Maison Blanche 51092 Reims Cedex, France. - 6 Hôpital Pasteur, 06002 Nice Cedex 1, France. - 7 Kappa Santé, 21 rue de Turbigo, 75002 Paris, France. - 8 Eisai, 5/6 Place de l’Iris, 92095 La Défense 2 Cedex, France. The ESTIME STUDY GROUP is composed by the following french experts : Pr Philippe Robert (Nice), Pr Serge Bakchine (Reims), Dr Michel Benoit (Nice), Pr Gilles Berrut (Nantes), Pr Sylvie Bonin-Guillaume (Marseille), Dr Patrick Frémont (Lagny sur Marne), Dr Thierry Gallarda (Paris), Pr Pierre Krolak-Salmon (Villeurbanne), Dr Thierry Marquet (Paris), Dr Claude Mékiès (Cornebarrieu), Dr François Sellal (Colmar). 1107-00-ESTIME poster 850x1200:- 11/07/11 8:19 Page 1