Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.
Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
Clin Neuropsychol. 2020 Feb;34(2):423-435. doi: 10.1080/13854046.2019.1621382. Epub 2019 Jun 3.
Apathy is a prominent syndrome across neurodegenerative diseases. The Dimensional Apathy Scale (DAS) assesses three apathy subtypes-executive, emotional, and initiation-and is sensitive and valid in amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), and Parkinson's disease. This study describes the development of the brief DAS (b-DAS), which will enable apathy to be swiftly detected in the clinic. 102 ALS and 102 AD patients' previously collected data were used. Mokken analyses were performed on item-level data of each informant/carer-rated DAS subscale (executive, emotional, and initiation) for the initial scale reduction. Item-total correlational analyses against standard apathy (convergent validity criteria) and depression (divergent validity criteria) measures and qualitative examination of items aided final item selection. Receiver operating curve analysis determined optimal cutoffs for the reduced subscales. Mokken analyses suggested unidimensionality of each DAS subscale. Three items were removed that failed to satisfy monotone homogeneity model requirements, three items were removed due to validity criteria not being met, and six items were removed due to a combination of lower item scalability and item-total correlations. Item-theme examination further reduced the b-DAS to nine items, three per subscale, with a supplemental awareness deficit assessment being added. Sensitivity- and specificity-based optimal cutoffs were calculated for each b-DAS subscale. This study presents the b-DAS, an informant/carer-based robust yet short multidimensional apathy instrument with good convergent and divergent validity, with recommended clinical cutoffs. The b-DAS is appropriate for use in the clinic and for research to quickly and comprehensively screen for apathy subtype impairments.
淡漠是神经退行性疾病中突出的综合征。维度淡漠量表（DAS）评估了三种淡漠亚型——执行性、情感性和启动性，在肌萎缩侧索硬化症（ALS）、阿尔茨海默病（AD）和帕金森病中具有敏感性和有效性。本研究描述了简短 DAS（b-DAS）的开发，这将使临床能够快速检测淡漠。使用了 102 名 ALS 和 102 名 AD 患者的先前收集的数据。对每个知情者/护理者评定的 DAS 子量表（执行性、情感性和启动性）的项目水平数据进行莫肯分析，以进行初始量表缩减。与标准淡漠（收敛有效性标准）和抑郁（发散有效性标准）测量的项目与总分相关分析以及项目的定性检查有助于最终项目选择。接收者操作曲线分析确定了缩减子量表的最佳截止值。莫肯分析表明每个 DAS 子量表的单维性。有三个项目因未能满足单调同质性模型要求而被删除，有三个项目因不符合有效性标准而被删除，还有六个项目因项目可扩展性和项目与总分的相关性较低而被删除。项目主题检查进一步将 b-DAS 减少到九个项目，每个子量表三个项目，增加了一个补充的意识缺陷评估。基于灵敏度和特异性的每个 b-DAS 子量表的最佳截止值进行了计算。本研究提出了 b-DAS，这是一种基于知情者/护理者的、可靠但简短的多维淡漠工具，具有良好的收敛和发散有效性，推荐了临床截止值。b-DAS 适合在临床和研究中使用，以快速全面地筛查淡漠亚型障碍。
