Original Study| Volume 19, ISSUE 12, P1110-1117, December 2018

Bayesian Analyses Showed More Evidence for Apathy than for Depression Being Associated With Cognitive Functioning in Nursing Home Residents

  • Ruslan Leontjevas
    Address correspondence to Ruslan Leontjevas, PhD, Faculty of Psychology and Educational Sciences, Open University of The Netherlands, PO Box 2960, 6401 DL Heerlen, The Netherlands.
    Department of Primary and Community Care, Radboud University, Medical Center, Nijmegen, The Netherlands

    Faculty of Psychology and Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands

    Radboud Alzheimer Center, Nijmegen, The Netherlands
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  • Lily Fredrix
    Faculty of Psychology and Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands

    Faculty of Management, Science, and Technology, Open University of The Netherlands, Heerlen, The Netherlands
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  • Martin Smalbrugge
    Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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  • Raymond T.C.M. Koopmans
    Department of Primary and Community Care, Radboud University, Medical Center, Nijmegen, The Netherlands

    Radboud Alzheimer Center, Nijmegen, The Netherlands

    Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
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  • Debby L. Gerritsen
    Department of Primary and Community Care, Radboud University, Medical Center, Nijmegen, The Netherlands

    Radboud Alzheimer Center, Nijmegen, The Netherlands
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      Depression, apathy, and cognitive impairments are widespread in nursing home (NH) residents. Scarce research that explicitly compares apathy to depression suggests that the association between apathy and cognitive functioning is stronger than the association between depression and cognitive functioning. This study in Dutch NH residents aimed to use Bayesian methods for comparing the evidence for the relationship of cognitive performance with apathy to that with depression.



      Setting and Participants

      Sixteen NH somatic care units (N = 190 residents; mean age 77.2 years, standard deviation 12.9), and 17 dementia special care units (N = 243 residents; mean age 82.8 years standard deviation, 6.8]).


      The Frontal Assessment Battery (FAB) and Mini-Mental State Examination (MMSE) were administered in residents for cognitive performance. Professional carers were interviewed for the Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia.


      Regression models built with the BayesFactor package in R showed Bayesian factors (BFs) that implied extremely strong evidence in terms of the Jeffrey classification for the relationship of apathy with MMSE [standardized effect size, −0.57 (−0.66 to −0.48), BF = 3.4E+28], and with FAB [−0.50 (−0.59 to −0.42), BF = 3.0E+24]. Regarding depression, evidence was a minor fraction of that for apathy [MMSE, −0.17 (−0.27 to −0.06), BF = 15.45; FAB, −0.12 (−0.22 to −0.02), BF = 2.11]. The most evidence existed for the associations of apathy with MMSE orientation problems, especially orientation in time.


      The study implies that cognitive assessments are important to differentiate apathy from depression in NH residents both with dementia and without dementia. More research is needed to clarify whether disorientation in time is a specific cognitive marker of apathy that may be used to reduce false positive depression diagnoses.


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