Abstract
Objectives
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.
Design
Cross-sectional.
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]).
Measures
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.
Results
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.
Conclusions/Implications
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.
Keywords
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Article info
Publication history
Published online: July 20, 2018
Footnotes
The Netherlands Organization for Health Research and Development (ZonMW, contract/grant number: 170992801) supported the main study financially but had no role in the study design, data collection and interpretation, nor in reporting. The trial number is NTR1477 with The Netherlands National Trial Register (NTR).
The authors declare no conflicts of interest.
Identification
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
