15 1 Vascular risk factors for depression and apathy retardation23. Accordingly, several studies have suggested that it might not be the depressive disorder but rather comorbid apathy that is related to CSVD 24 and to executive dysfunction 25. Apathy Being part of many neurological and psychiatric diseases, apathy is a transdiagnostic symptom 26 but it can also be a stand-alone syndrome. Characterized by reduced activity, thought and emotions, it clearly overlaps with definitions of motivational constructs. The consequences of apathy are serious as it reduces quality of life 27 and causes more functional impairment 28, while increasing the caregiver burden 29 30. Apathy is, moreover, associated with a higher risk of incident cardiovascular disease, stroke and mortality 31 and dementia 32. Apathy diagnostic criteria (2018) CRITERION A: a quantitative reduction of goal-directed activity (behavioural, cognitive, emotional or social) in comparison to the patient’s previous level of functioning CRITERION B: at least 2 of the 3 following dimensions for at least 4 weeks B1 BEHAVIOUR AND COGNITION: reduced general level of activity; diminished persistence of activity; less interest or slow in making choices; less interest in external issues; less interest in own health and image B2 EMOTION: less spontaneous emotion; fewer emotional reactions to the environment; less concern about the impact of actions/feelings on others; less empathy; less use of verbal or physical expressions B3 SOCIAL INTERACTION: less spontaneous social initiative; less environmentally stimulated social interaction; decreased interest in interactions with family members; less verbal interaction; being more homebound CRITERION C: These symptoms cause clinically significant impairment in functioning CRITERION D: The symptoms are not solely attributable to physical or motor disabilities, a diminished level of consciousness, substance use or major changes in the patient’s environment Adapted from: Robert P, Lanctôt KL, Agüera-Ortiz L, Aalten P, Bremond F, Defrancesco M, et al. Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group. Eur Psychiatry 2018; 54:71–6. https://doi.org/10.1016/J.EURPSY.2018.07.008.
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