Assessment of apathy in neurological patients using the Apathy Motivation Index caregiver version

V.S. Klar, Y.-S. Ang, P. Lockwood, B. Attaallah, S. Dickson, D. Drew, A. Kienast, M.R. Maio, O. Plant, E. Slavkova, S. Toniolo, R. Zambellas, S.R. Irani, M. Husain

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Apathy is a common, disabling neuropsychiatric syndrome that occurs across many brain disorders and may be associated with diminished motivation in behavioural, cognitive, emotional and social domains. Assessment is complicated by the variability of symptoms across apathy domains and self-report from patients, which can be misleading due to their lack of insight. Independent evaluation by clinicians also has limitations though if it has to be performed with limited time. Caregiver reports are a viable alternative, but current assessments for them either do not distinguish between different apathy domains or are interview-based and take long to administer. In this study, we developed a brief caregiver questionnaire version of the recently developed Apathy Motivation Index (AMI), which is a self-report tool. We confirmed three apathy factors in this new caregiver measure (AMI-CG) that were also present in the AMI: Behavioural Activation, Emotional Sensitivity and Social Motivation. Furthermore, we validated the scores against more extensive caregiver interviews using the established Lillle apathy rating scale as well as patient self-reports of apathy, measures of depression, anhedonia, cognition, activities of daily living and caregiver burden across four different neurological conditions: Parkinson's disease, Alzheimer's disease, subjective cognitive impairment and limbic encephalitis. The AMI-CG showed good internal reliability, external validity and diagnostic accuracy. It also uncovered cases of social apathy overlooked by traditional instruments. Crucially, patients who under-rated their apathy compared to informants were more likely to have difficulties performing everyday activities and to be a greater burden to caregivers. The findings provide evidence for a multidimensional conceptualization of apathy and an instrument for efficient detection of apathy based on caregiver reports for use in clinical practice.

Original languageEnglish
JournalJournal of Neuropsychology
Publication statusPublished - 16 Sept 2021

Bibliographical note

Funding Information:
This work was funded by a Wellcome Trust Principal Research Fellowship to MH (206330/Z/17/Z). SRI is supported by the Wellcome Trust (104079/Z/14/Z), The UCB‐Oxford University Alliance, BMA Research Grants – 2013 Vera Down grant, Epilepsy Research UK (P1201) and by the Fulbright UK‐US commission (MS‐Research Society Award). The work is supported by funding from the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) to both MH and SRI. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Publisher Copyright:
© 2021 The Authors. Journal of Neuropsychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.


  • Alzheimer’s disease
  • Limbic encephalitis
  • Parkinson’s disease
  • Subjective cognitive impairment
  • apathy
  • motivation
  • neuropsychiatry

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Cognitive Neuroscience
  • Behavioral Neuroscience


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