Skip to main content Accessibility help

Apathy in late-life depression among Taiwanese patients

  • Shwu-Hua Lee (a1), Ming-Ching Wen (a2), Chia-Chen Chao (a3), Ying Jen Chen (a4) and Cheng-Fang Yen (a5) (a6)...


Background: Apathy is defined as lack of motivation and occurs in a variety of neuropsychological disorders. The Apathy Evaluation Scale (AES) has been shown to be valid and reliable for assessing apathy in depression but the validity and reliability of the Chinese version has never been examined. The aims of the study were to (1) evaluate the validity and reliability of the Chinese version of the AES in late-life depression and (2) evaluate the severity of apathy in late-life depression.

Methods: We translated the AES into Chinese and used a cross-sectional design to evaluate apathy in elderly subjects. Diagnostic and Statistical Manual of Mental Disorders (DSM) -IV criteria and Hamilton Depression Rating Scale (HDRS) were applied for diagnosis and assessment. Three groups of subjects were recruited including one group (n = 31) of patients with major depressive disorder with current depression, the second group (n = 30) with major depressed disorder with remission, and the third group (n = 31) of healthy controls. Convergent validity was tested using four apathy-related items from the HDRS (loss of interest, psychomotor retardation, loss of energy, and loss of insight). Multiple forms of reliability (including internal consistency, test-retest, and interrater) and discriminant validity were examined.

Results: We demonstrated that the internal consistency (coefficient α = 0.90) and test-retest reliability (p < 0.001) were satisfied. Discriminant validity of apathy severity among these three groups was significant. The convergent validity and correlation coefficients based on the four apathy-related items from the HDRS and AES were acceptable.

Conclusion: Apathy is a distinct syndrome which may be treatable when depression is effective managed. Further application of the Chinese version of the AES to study the association of apathy with other neuropsychological symptoms is necessary.


Corresponding author

Correspondence should be addressed to: Cheng-Fang Yen, Department of Psychiatry, Kaohsiung Medical University Chung-Ho Memorial Hospital, No. 100, Tzyou 1st Rd, Kaohsiung 80756, Taiwan. Phone: 886 7 3121101 ext. 6822; Fax: 886 7 3134761. Email:


Hide All
Alexopoulos, G. S. et al. 2000. Executive dysfunction and long-term outcomes of geriatric depression. Archives of General Psychiatry, 57, 285290.
Årsland, D. et al. 1999. Range of neuropsychiatric disturbances in patients with Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry, 67, 492496.
Bartolini, M., Coccia, M., Luzzi, S., Provinciali, L. and Ceravolo, M. G. 2005. Motivational symptoms of depression mask preclinical Alzheimer's disease in elderly subjects. Dementia and Geriatric Cognitive Disorders, 19, 3136.
Bhalla, R. K. et al. 2006. Persistence of neuropsychologic deficit in the remitted state of late-life depression. American Institute of Geriatric Psychiatry, 14, 419427.
Benoit, M. et al. 1999. Behavioral and psychological symptoms in Alzheimer's disease. Relation between apathy and regional cerebral perfusion. Dementia and Geriatric Cognitive Disorders, 10, 511517.
Berger, A. K., Fratiglioni, L., Forsell, Y., Winblad, B. and Backman, L. 1999. The occurrence of depressive symptoms in the preclinical phase of AD: a population-based study. Neurology, 53, 19982002.
Bozzola, F. G., Gorelick, P. B. and Freels, S. 1992. Personality changes in Alzheimer's disease. Archives of Neurology, 49, 297300.
Brislin, R. W. 1970. Back-translation for cross-culture research. Journal of Cross-Cultural Psychology, 1, 185216.
Craig, A. H. et al. 1996. Cerebral blood flow correlates of apathy in Alzheimer disease. Archives of Neurology, 53, 11161120.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. 1994. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
Gabryelewicz, T. et al. 2004. Prevalence of major and minor depression in elderly persons with mild cognitive impairment-MADRS factor analysis. International Journal of Geriatric Psychiatry, 19, 11681172.
Greene, J. G., Smith, R., Gardiner, M. and Timbury, G. C. 1982. Measuring behavioural disturbance of elderly demented patients in the community and its effects on relatives: a factor analytic study. Age and Ageing, 11, 121126.
Hamilton, M. 1960. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.
Kaufer, D. I. et al. 1998. Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale. Journal of the American Geriatrics Society, 46, 210215.
Krishnan, K. R. et al. 2004. Clinical characteristics of magnetic resonance imaging-defined subcortical ischemic depression. Biological Psychiatry, 55, 390397.
Krishnan, K. R., Hays, J. C., Tupler, L. A., George, L. K. and Blazer, D. G. 1995. Clinical and phenomenological comparisons of late-onset and early-onset depression. American Journal of Psychiatry, 152, 785788.
Landes, A. M., Sperry, S. D., Strauss, M. E. and Geldmacher, D. S. 2001. Apathy in Alzheimer's disease. Journal of the American Geriatrics Society, 49, 17001707.
Lavretsky, H., Lesser, I. M., Wohl, M., Miller, B. L. and Mehringer, C. M. 1999. Clinical and neuroradiologic features associated with chronicity in late-life depression. American Journal of Geriatric Psychiatry, 7, 309316.
Marin, R. S., Biedrzycki, R. C. and Firinciogullari, S. 1991. Reliability and validity of the Apathy Evaluation Scale. Psychiatry Research, 38, 143162.
Marin, R. S., Firinciogullari, S. and Biedrzycki, R. C. 1993. The sources of convergence between measures of apathy and depression. Journal of Affective Disorders, 28, 117124.
Marin, R. S., Firinciogullari, S. and Biedrzycki, R. C. 1994. Group differences in the relationship between apathy and depression. Journal of Nervous and Mental Disease, 182, 235239.
Mega, M. S., Cummings, J. L., Fiorello, T. and Gornbein, J. 1996. The spectrum of behavioral changes in Alzheimer's disease. Neurology, 46, 130135.
Morris, J. C. 1993. The clinical dementia rating (CDR): current version and scoring rules. Neurology, 43, 24122414.
Okada, K., Kobayashi, S., Yamagata, S., Takahashi, K. and Yamaguchi, S. 1997. Poststroke apathy and regional cerebral blood flow. Stroke, 28, 24372441.
Padala, P. R., Petty, F. and Bhatia, S. C. 2005. Methylphenidate may treat apathy independent of depression. Annals of Pharmacotherapy, 39, 19471949.
Resnick, B., Zimmerman, S. I. and Adelman, A. 1998. Use of the apathy evaluation scale as a measure of motivation in elderly people. Rehabilitation Nursing, 23, 141147.
Robert, P. H. et al. 2006. Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease: a one-year follow-up study. Clinical Neurology and Neurosurgery, 108, 733736.
Starkstein, S. E., Fedoroff, J. P., Price, T. R., Leiguarda, R. and Robinson, R. G. 1993. Apathy following cerebrovascular lesions. Stroke, 24, 16251630.
Starkstein, S. E., Sabe, L., Chemerinski, E., Jason, L. and Leiguarda, R. 1996. Two domains of anosognosia in Alzheimer's disease. Journal of Neurology, Neurosurgery and Psychiatry, 61, 485490.
Steffens, D. C., Hays, J. C. and Krishnan, K. R. 1999. Disability in Geriatric Depression. American Journal of Geriatric Psychiatry, 7, 3440.
Tekin, S. and Cummings, J. L. 2002. Frontal-subcortical neuronal circuits and clinical neuropsychiatry: an update. Journal of Psychosomatic Research, 53, 647654.


Apathy in late-life depression among Taiwanese patients

  • Shwu-Hua Lee (a1), Ming-Ching Wen (a2), Chia-Chen Chao (a3), Ying Jen Chen (a4) and Cheng-Fang Yen (a5) (a6)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed