Evaluation of apathy among institutionalized older persons: Its mediating role between cognitive functioning and lack of awareness.

OBJECTIVES: The main objective of this study was to determine the directions of the relationships between apathy, cognitive deficits and lack of awareness. METHODS: One hundred and twenty-one older persons living in nursing homes, aged between 65 and 99 years old, participated in the study. Cognitive functioning, autonomy, depressive and anxious symptoms, general self-efficacy, self-esteem and apathy were evaluated through tests and questionnaires. Lack of awareness was calculated using the patient-caregiver discrepancy method. The sample was divided into two groups (n1 = 60, n2 = 61) depending on cognitive functioning level (Dementia Rating Scale < median score: 120). We first explored the characteristics of each group. Then, we compared the mode of evaluation of apathy. Finally, we investigated the direction of relationships by applying mediation analyses. RESULTS: Older persons in the low cognitive functioning group were less autonomous, had a lower cognitive functioning level, higher caregiver-rated apathy and higher lack of awareness than the high cognitive functioning group (ps < 0.05). Evaluation differences were found only in the low cognition group. Caregiver-rated apathy totally mediated the relationship between cognitive functioning (predictor) and lack of awareness (dependent variable) for the whole sample (90%) and for the low cognitive functioning group (100%). CONCLUSIONS: Cognitive deficits should be taken into account when evaluating apathy. Interventions should combine cognition training and emotion intervention to reduce lack of awareness. Future research should develop a therapy dedicated to apathy among older persons without pathologies.

[Updates on anosognosia in Alzheimer's disease]. / Actualités sur l'anosognosie dans la maladie d'Alzheimer.

Impaired awareness increases dependency of patients suffering from Alzheimer's Disease (AD) and caregivers' burden but remains insufficiently evaluated in clinical practice. The numerous conceptualisations of this symptomatology (anosognosia, denial, insight…) have only a slight impact on the three main assessment methodologies which are: the patient-caregiver discrepancy; the clinician rating of patients' awareness of illness; and the prediction of performance discrepancy methods. Nevertheless, most of evaluating tools are not validated yet, in particular regarding the clinician rating, leading to contrasted results. Most of recent studies reported positive correlations with apathy and AD severity, and negative relationships with depressive symptoms. Therefore, impaired awareness seems to be mainly influenced by patient's depression and apathy. We discuss these correlates and shared aspects of apathy and impaired awareness from neuroanatomical, clinical and conceptual viewpoints. We also highlight the relevance and limits of quantitative and qualitative assessment methods, in particular phenomenological.

Adaptation of a short-form nostalgia scale: convergent and divergent validity in a sample of French elders.

Nostalgia is an efficient coping strategy that helps elders overcome major life transitions. To better explore the protective functions of nostalgia, we set out to adapt a short-form nostalgia scale to French elders and examine its convergent and divergent validity in terms of self-esteem, depression, and wellbeing. Participants were 175 institutionalized French elders. After providing their written informed consent, they were asked to complete a demographic information form and respond to four questionnaires probing self-esteem, nostalgia, depression, and wellbeing. Principal component analyses and fit indices were used to explore convergent validity. An 8-item version showed acceptable psychometric properties and measured two dimensions of nostalgia. Spearman correlations were conducted to explore divergent validity. In our sample, the first dimension was negatively associated with global cognitive functioning, while the second dimension was positively associated with self-esteem and wellbeing, and negatively associated with depression. The negative relationship between depression and nostalgia supports the idea that nostalgia is a positive concept. Future research should explore factors liable to impact nostalgia, such as cultural differences and reminiscence therapy.