Apathy and depression are the most common neuropsychiatric symptoms in mild cognitive impairment (MCI) and Alzheimer disease (AD). This study was the first to explore midlife motivational abilities as a predictor of the progression of apathy and depression in MCI and AD. It used a subsample of the Aging, Demographics, and Memory Study (N = 137). Participants, aged over 70, were categorized according to baseline clinical diagnosis (normal cognition, MCI, or AD). Assessments were conducted at an 18-month interval. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. Midlife motivational abilities were estimated on the basis of the main occupation using the Occupational Information Network (O*NET) database, which provides detailed information on worker abilities. Repeated measures analysis of covariance was used. Apathy and depression were found to be particularly high in participants with AD and high motivational abilities. Apathy, but not depression, increased over time in those with AD and high motivational abilities. It would appear that holding on to unattainable goals with strong motivational efforts when faced with severe cognitive loss might lead to unproductive persistence, depressive reaction, and more apathetic behavior.
LyketsosCGLopezOJonesBFitzpatrickALBreitnerJDeKoskyS. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288(12):1475–1483.
2.
BenoitMAndrieuSLechowskiLGillette-GuyonnetSRobertPHVellasB. Apathy and depression in Alzheimer’s disease are associated with functional deficit and psychotropic prescription. Int J Geriatr Psychiatry. 2008;23(4):409–414.
3.
PalmerKDi IulioFVarsiAE. Neuropsychiatric predictors of progression from amnestic-mild cognitive impairment to Alzheimer’s disease: the role of depression and apathy. J Alzheimer Dis. 2010;20(1):175–183.
4.
ZuidemaSUde JongheJFVerheyFRKoopmansRT. Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity. Int J Geriatr Psychiatry. 2009;24(10):1079–1086.
5.
TreiberKALyketsosCGCorcoranC. Vascular factors and risk for neuropsychiatric symptoms in Alzheimer’s disease: the Cache County Study. Int Psychogeriatr. 2008;20(3):538–553.
6.
ZuidemaSUde JongheJFVerheyFRKoopmansRT. Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. Int J Geriatr Psychiatry. 2010;25(1):14–22.
7.
ClarkeDEvan ReekumRSimardM. Apathy in dementia: clinical and sociodemographic correlates. J Neuropsychiatry Clin Neurosci. 2008;20(3):337–347.
8.
GilleyDWWilsonRSBieniasJLBennettDAEvansDA. Predictors of depressive symptoms in persons with Alzheimer’s disease. J Gerontol B Psychol Sci Soc Sci. 2004;59(2):P75–P83.
9.
ArcherNBrownRGReevesSJ. Premorbid personality and behavioral and psychological symptoms in probable Alzheimer disease. Am J Geriatr Psychiatry. 2007;15(3):202–213.
10.
RobertPOnyikeCULeentjensAF. Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. Eur Psychiatry. 2009;24(2):98–104.
11.
JohnsonCLBarerBM. Coping and a sense of control amongst the oldest old: an exploratory analysis. J Aging Studies. 1993;7:67–80.
12.
StaudingerUMFreundAMLindenMMaasISelf, personality, and life management: psychological resilience and vulnerability. In: BaltesPBMayerKU (Eds.), The Berlin Aging Study: Aging from 70 to 100. New York, NY: Cambridge; 1999:302–328.
13.
KruglanskiAWThompsonEPHigginsET. To “do the right thing” or to “just do it”: locomotion and assessment as distinct self-regulatory imperatives. J Pers Soc Psychol. 2000;79(5):793–815.
14.
BanduraA. Self-Efficacy: The Exercise of Control. New York, NY: Freeman; 1997.
15.
RholesWSMichasLShroffJ. Action control as a vulnerability factor in dysphoria. Cogn Ther Res. 1989;13(3):263–274.
16.
TangneyJPBaumeisterRFBooneAL. High self-control predicts good adjustment, less pathology, better grades, and interpersonal success. J Pers. 2004;72(2):271–324.
17.
GabryelewiczTStyczynskaMLuczywekE. The rate of conversion of mild cognitive impairment to dementia: predictive role of depression. Int J Geriatr Psychiatry. 2007;22(6):563–567.
18.
ModregoPJFerrandezJ. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol. 2004; 61(8):1290–1293.
19.
BartoliniMCocciaMLuzziSProvincialiLCeravoloMG. Motivational symptoms of depression mask preclinical Alzheimer’s disease in elderly subjects. Dement Geriatr Cogn Disord. 2005;19(1):31–36.
20.
BergerAKFratiglioniLForsellYWinbladBBackmanL. The occurrence of depressive symptoms in the preclinical phase of AD: a population-based study. Neurology. 1999;53(9):1998–2002.
21.
MulinELeoneEDujardinK. Diagnostic criteria for apathy in clinical practice. Int J Geriatr Psychiatry. 2011;26:158–165.
22.
RobertPHBerrCVolteauM. Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer’s disease: a one-year follow-up study. Clin Neurol Neurosurg. 2006;108(8):733–736.
23.
TengELuPHCummingsJL. Neuropsychiatric symptoms are associated with progression from mild cognitive impairment to Alzheimer’s disease. Dement Geriatr Cogn Disord. 2007; 24(4):253–259.
24.
RobertPHBerrCVolteauM. Importance of lack of interest in patients with mild cognitive impairment. Am J Geriatr Psychiatry. 2008;16(9):770–776.
25.
BrownRGPluckG. Negative symptoms: the ‘pathology’ of motivation and goal-directed behaviour. Trends Neurosci. 2000;23(9):412–417.
26.
ForstmeierSMaerckerA. Motivational reserve: Lifetime motivational abilities influence cognitive and emotional health in old age. Psychol Aging. 2008;23(4):886–899.
27.
AndelRCroweMPedersenNL. Complexity of work and risk of Alzheimer’s disease: a population-based study of Swedish twins. J Gerontol B Psychol Sci Soc Sci. 2005; 60(5):P251–P258.
28.
JusterFTSuzmanR. An overview of the health and retirement study. J Hum Resources. 1995;30(suppl):135–145.
29.
LangaKMPlassmanBLWallaceRB. The aging, demographics, and memory study: study design and methods. Neuroepidemiology. 2005;25(4):181–191.
30.
PlassmanBLLangaKMFisherGG. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148(6):427–434.
31.
AssociationAP. Diagnostic and Statistical Manual of Mental Disorders. 4th ed.
Washington, DC: APA; 2000.
BiglerEDLowryCMAndersonCVJohnsonSCTerryJSteedM. Dementia, quantitative neuroimaging, and apolipoprotein E genotype. Am J Neuroradiol. 2000;21(10): 1857–1868.
34.
CummingsJLMegaMGrayKRosenberg-ThompsonSCarusiDAGornbeinJ. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–2314.
35.
ConnorDJSabbaghMNCummingsJL. Comment on administration and scoring of the neuropsychiatric inventory in clinical trials. Alzheimers Dement. 2008;4(6):390–394.
36.
PetersonNGMumfordMDBormanWCJeanneretPRFleishmanEA. An Occupational Information System for the 21st Century: The Development of O*NET. Washington, DC: American Psychological Association; 1999.
37.
NolteMAServaisMA. Occupation and Industry Coding in HRS/AHEAD (Health and Retirement Study Doccumentation Report DR-021). August2008.
38.
FolsteinMFFolsteinSEMcHughPR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198.
39.
KuhlJFuhrmannADecomposing self-regulation and self-control: the violitional components inventory. In: HeckhausenJDweckCS (Eds.), Motivation and Self-Regulation Across the Life Span. Cambrige: Cambridge University Press; 1998:15–49.
40.
LuszczynskaAGutiérrezDBSchwarzerR. General self-efficacy in various domains of human functioning: evidence from five countries. Int J Psychol. 2005;40(5):80–89.
41.
ThompsonSCCheekPRGrahamMAThe other side of perceived control: disadvantaged and negative effects. In: SpacapanSOskampS (Eds.), The Social Psychology of Health. Newbury Park: Sage; 1988:69–93.
42.
WolkS. Situational constraint as a moderator of the locus of control-adjustment relationship. J Consult Clin Psychol. 1976; 44(3):420–427.
43.
KuhlJHelleP. Motivational and volitional determinants of depression: the degenerated-intention hypothesis. J Abnorm Psychol. 1986;95(3):247–251.
44.
BrandtstädterJRothermundK. The life-course dynamics of goal pursuit and goal adjustment: a two-process framework. Develop Rev. 2002;22(2):117–150.
45.
LandesAMSperrySDStraussMEGeldmacherDS. Apathy in Alzheimer's disease. J Am Geriatr Soc. 2001;49(12):1700–1707.
46.
MarinRS. Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci. 1991;3(3):243–254.
47.
OkuraTPlassmanBLSteffensDCLlewellynDJPotterGGLangaKM. Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: the aging, demographics, and memory study. J Am Geriatr Soc. 2010;58(2):330–337.
