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Apathy Scale (AS)
Please visit this website for more information about the instrument: Apathy Scale
Please email the author for information about obtaining the instrument: Dr. Sergio Starkstein,
NeuroRehab Supplemental - Highly Recommended
Recommendations for use: Indicated for studies requiring a measure of psychiatric and psychological functions.
Supplemental - Highly Recommended: Mitochondrial Disease (Mito)* and Parkinson's Disease (PD)*
*Recommendations for use: Indicated for studies requiring a measure of severity of apathy in a semi-structured interview format.
Supplemental: Huntington's Disease (HD)
Short Description of Instrument
Summary/ Overview of Instrument:
The Apathy Scale (AS) is an abridged version of the Apathy Evaluation Scale (Marin, 1990). The AS consists of 14 items regarding different dimensions of apathetic behavior. The score for each item ranges from 0 to 3. Rating of each item is based on a semi-structured interview: each question should be read by the examiner, and the patient is provided with the four possible answers.
Construct measured: Apathy.
Generic vs. disease-specific: Generic.
Intended use of instrument/ purpose of tool: Assessment of severity.
Means of administration: Paper and Pencil.
Location of administration: Clinic or at home.
Intended respondent: Patient/self and informant.
# of items: 14.
# of subscales and names of sub-scales: None.
Special Requirements for administration: None.
Administration Time: Likely 15-30 minutes.
Translations available: Available in English, Dutch, German, French, Spanish and multiple other languages.
Comments/Special Instructions
Parkinson's Disease-Specific: One score- presence(dx)/ severity of apathy, used in numerous studies; factor analysis indicates two factors: cognitive-behavioral aspects of apathy (Motivation-Interest-Energy) and emotional apathy symptoms (Indifference)
Scoring and Psychometric Properties
Scoring: Ratings should be based on both verbal and non-verbal information of the past 4 weeks (sometimes 2 weeks). For each item ratings should be judged: 4 possible responses for each question: 'not at all', 'slightly', 'somewhat', 'a lot'. With a cutoff score of 14 points, a sensitivity of 66% and specificity of 100% has been reported in patients with Alzheimer's disease.
Standardization of scores to a reference population (z scores, T scores, etc): Not available.
If scores have been standardized to a reference population, indicate frame of reference for scoring (general population, HD subjects, other disease groups, etc). Not available.
Psychometric Properties:
Test-retest or intra-interview (within rater) reliability: The AS showed test-retest reliability (r = 0.90, df = 10, p < 0.01) (Starkstein, 1992).
Inter-interview (between-rater) reliability: The AS showed good inter-rater reliability (r = 0.81, df = 10, p < 0.01) (Starkstein, 1992). Inter-interview (between-rater) reliability (as applicable): Inter-rater agreement for the presence of apathy above a median score in a HD population ranged from poor for the most cognitively impaired participants to good for the less cognitively impaired participants (Chatterjee, 2005).
Internal consistency: Fair internal consistency (Cronbach's alpha = 0.69) as assessed in a larger study of 194 PD participants (Pedersen et al., 2012).
Statistical methods used to assess reliability: Not available in reviewed references.
Content validity: Not available in reviewed references.
Construct validity: Not available in reviewed references.
Sensitivity to Change/ Ability to Detect Change (over time or in response to an intervention): Not available in reviewed references.
Known Relationships to Other Variables: Participants with depression score higher on the AS.
Diagnostic Sensitivity and Specificity, if applicable (in general population, HD population- premanifest / manifest, and other disease groups): Not available.
Strengths: This instrument assesses multiple aspects of apathy and has been used in a variety of neuropsychiatric disorders and allows for comparison between patient/self and informant reports.
Weaknesses: The AS may not discriminate apathy from depression.
Key Reference:
Starkstein SE, Mayberg HS, Preziosi TJ, Andrezejewski P, Leiguarda R, Robinson RG. Reliability, validity, and clinical correlates of apathy in Parkinson's disease. J Neuropsychiatry Clin Neurosci. 1992 Spring;4(2):134-9.
Additional References:
Chatterjee A, Anderson KE, Moskowitz CB, Hauser WA, Marder KS. A comparison of self-report and caregiver assessment of depression, apathy, and irritability in Huntington's disease. J Neuropsychiatry Clin Neurosci. 2005 Summer;17(3):378-83.
Leentjens AF, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE, Weintraub D, Sampaio C, Poewe W, Rascol O, Stebbins GT, Goetz CG. Apathy and anhedonia rating scales in Parkinson's disease: critique and recommendations. Mov Disord. 2008 Oct 30;23(14):2004-14.
Marin RS. Differential diagnosis and classification of apathy. Am J Psychiatry. 1990 Jan;147(1):22-30.
Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the Apathy Evaluation Scale. Psychiatry Res. 1991 Aug;38(2):143-62.
Parkinson's Disease-Specific References:
Lopez FV, Eglit GML, Schiehser DM, Pirogovsky-Turk E, Litvan I, Lessig S, Filoteo JV. Factor Analysis of the Apathy Scale in Parkinson's Disease. Mov Disord Clin Pract. 2019 Apr 30;6(5):379-386.
Pedersen KF, Alves G, Larsen JP, Tysnes OB, MØller SG, BrØnnick K. Psychometric properties of the Starkstein Apathy Scale in patients with early untreated Parkinson disease. Am J Geriatr Psychiatry. 2012 Feb;20(2):142-8.
Document last updated March 2024