Decreased Daytime Motor Activity Associated With Apathy in Alzheimer Disease: An Actigraphic Study

Objective: Across all stages of Alzheimer disease (AD), apathy is the most common neuropsychiatric symptom. Studies using the Neuropsychiatric Inventory (NPI) have found that apathy is present in up to 70% of individuals with Alzheimer disease. One of the main difficulties in assessing apathy and other neuropsychiatric symptoms is the absence of reliable, objective measures. Motor activity assessment using ambulatory actigraphy could provide an indirect, objective evaluation of apathy. The aim of our study was to assess the relationship between apathy and daytime motor activity in AD, using ambulatory actigraphy. Methods: One hundred seven AD outpatients wore a wrist actigraph (Motionlogger) during seven consecutive 24-hour periods to evaluate motor activity. Participants were divided into two subgroups according to their apathy subscores on the NPI: individuals with apathy (NPI-apathy subscores > 4) and those without. Daytime mean motor activity scores were compared between the two subgroups. Results: Individuals with AD who had symptoms of apathy (n = 43; age = 79 +/- 4.7 years; Mini-Mental State Examination = 20.9 +/- 4.8) had significantly lower daytime mean motor activity than AD patients without apathy (n = 64; age = 76.3 +/- 7.7; Mini-Mental State Examination = 21.5 +/- 4.7), while night-time mean motor activity did not significantly differ between the two subgroups. Conclusions: Ambulatory actigraphy could be added to currently used questionnaires as a simple, objective technique for assessing apathy in the routine assessment of AD patients. (Am J Geriatr Psychiatry 2012; 20:806-814)