Movement disorders clinical practice · 2025
Discrepant Views of Apathy in Patients and Caregivers: the Role of Cognitive Deficits in Parkinson's Disease.
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Funghi Giulia, Fabris Francesca, Meli Claudia, Speranza Chiara, Rabini Giuseppe, Fumagalli Giorgio Giulio, Zappini Francesca, Schintu Selene, Di Giacopo Raffaella, Tambalo Stefano, Turella Luca, Jovicich Jorge, Papagno Costanza, Dodich Alessandra
Аннотация
BACKGROUND: Apathy is a common early symptom of Parkinson's disease (PD), often co-occurring with cognitive decline and associated with fronto-striatal and mesocortico-limbic dysfunctions. Discrepancies between self- and caregiver-reported apathy have been preliminarily associated with cognitive impairments affecting patients' awareness and self-report accuracy.
OBJECTIVES: This study investigates discrepancies between PD patient- and informant-reported apathy in relation to the cognitive status (unimpaired-CU vs. impaired-CI), and explores neural correlates of apathy using magnetic resonance imaging (MRI).
METHODS: Apathy was assessed in 23 PD participants using self-report (AES-S) and informant (AES-I) versions of the Italian Apathy Evaluation Scale. Discrepancy scores (ΔAES) were compared between groups and correlated with cognitive performance. Resting-state fMRI examined associations between AES indices and connectivity from the bilateral nucleus accumbens, while whole-brain structural analyses assessed associations with gray matter (GM) volume.
RESULTS: PD-CI participants showed higher ΔAES, underestimating their apathy compared to PD-CU. ΔAES values correlated with attentional and visuospatial functioning. Higher AES-I scores were associated with hyperconnectivity between right nucleus accumbens, paracingulate, and medial frontal cortices. Structural analyses revealed associations between both AES-I and ΔAES values and GM volume in the cingulate gyrus.
DISCUSSION: These findings highlight the impact of cognitive dysfunction on apathy evaluation in PD, emphasizing the importance of caregiver perspective. Neuroimaging results further validated caregiver ratings, showing an association between fronto-striatal network changes and apathy. Further research is needed to clarify the role of such discrepancy in apathy assessment in predicting disease progression.
OBJECTIVES: This study investigates discrepancies between PD patient- and informant-reported apathy in relation to the cognitive status (unimpaired-CU vs. impaired-CI), and explores neural correlates of apathy using magnetic resonance imaging (MRI).
METHODS: Apathy was assessed in 23 PD participants using self-report (AES-S) and informant (AES-I) versions of the Italian Apathy Evaluation Scale. Discrepancy scores (ΔAES) were compared between groups and correlated with cognitive performance. Resting-state fMRI examined associations between AES indices and connectivity from the bilateral nucleus accumbens, while whole-brain structural analyses assessed associations with gray matter (GM) volume.
RESULTS: PD-CI participants showed higher ΔAES, underestimating their apathy compared to PD-CU. ΔAES values correlated with attentional and visuospatial functioning. Higher AES-I scores were associated with hyperconnectivity between right nucleus accumbens, paracingulate, and medial frontal cortices. Structural analyses revealed associations between both AES-I and ΔAES values and GM volume in the cingulate gyrus.
DISCUSSION: These findings highlight the impact of cognitive dysfunction on apathy evaluation in PD, emphasizing the importance of caregiver perspective. Neuroimaging results further validated caregiver ratings, showing an association between fronto-striatal network changes and apathy. Further research is needed to clarify the role of such discrepancy in apathy assessment in predicting disease progression.