Apathy: Why Care? The Relationship Between Apathy and Cognition in Young Adults and Individuals with Cerebrovascular Disease

Abstract

Apathy is characterized by diminished goal-directed behaviour (e.g., lack of effort, initiative, and/or productivity), decreased goal-directed cognition (e.g., lack of interest in learning/pursuing new experiences), and blunted emotion (e.g., unchanging affect; Marin, 1991). Greater apathy is correlated with poorer social, physical, and functional outcomes (Kaufer et al., 1998; Starkstein, Federoff, Price, Leiguarda, & Robinson, 1993). Apathy may be present in both clinical and non-clinical populations, including individuals with stroke, dementia, depression, and healthy adults. Apathy is related to depression and is a common characteristic of dysexecutive syndromes. It may occur in conjunction with a variety of other clinical difficulties and comorbidities, complicating assessment and treatment (Marin, 1990). The purpose of the current dissertation was to advance our understanding of apathy, its relationship to depression, and its influence on cognition, in individuals with cerebrovascular disease and in young adults. This dissertation had three primary goals, which were addressed in five chapters. First, it explored how symptoms of apathy (i.e., decreases in goal-oriented behaviour, goal-oriented cognition, and/or emotional blunting) were related to cognition (i.e., memory and executive functioning) beyond the influence of depressive symptoms in individuals with cerebrovascular disease (Articles 1 and 2). Second, it examined the relative contribution of apathy and depression on cognition (particularly neutral and emotional memory) in young educated adults (N = 96), positing that apathy may impair overall cognitive performance to a greater degree than depression, but that depression may impact the type of emotional content that is remembered (Article 3). Last, it extended upon findings from Articles 1 and 2 by designing and implementing a randomized controlled trial (N = 72 stroke patients) to evaluate whether goal-setting could improve cognitive performance in the chronic phase after stroke (Article 4). These studies demonstrate the importance of a) screening for apathy (even in the absence of depressive symptoms), b) differentiating between apathy and depression, c) appreciating the relationship between apathy and cognition (e.g., executive function and memory) in young educated adults and in individuals with cerebrovascular disease, and d) demonstrating the utility of intervention tools (e.g., goal-setting) to enhance cognitive performance.