Post-Stroke Apathy: Screening and Functional Impact

Myhre, Pernille (2020) Post-Stroke Apathy: Screening and Functional Impact. Doctoral thesis, University of East Anglia.

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Background: Apathy, a disorder of motivation observed in up to 40% of stroke survivors, is likely to have a negative impact on stroke rehabilitation. It is often theorised to be a multidimensional construct yet frequently assessed using unidimensional measures. The Dimensional Apathy Scale (DAS, Radakovic & Abrahams, 2014)is a multidimensional assessment, with Executive, Emotional and Initiation Apathy subscales. The aims of this thesis were to examine the relationship between apathy and functional activity after stroke and assess the suitability of the DAS as a screen for post-stroke apathy (PSAp).

Method: A systematic review identified 8 papers investigating the associations between PSAp and functional activity. An online survey of 53 stroke, and 71 non-stroke participants investigated the psychometric properties and validity of the DAS in relation to a frequently used, unidimensional apathy measure and measures of depression and anxiety.

Results: The systematic review found that PSAp is associated with negative outcomes, including negatively affecting family life and later social reintegration and autonomy. The review highlights a negative relationship between PSAp and functional activity, although there were concerns regarding the quality of studies and the lack of multidimensional apathy assessment being utilised. The survey found that the DAS has good internal consistency, good convergent and divergent validity in stroke. Stroke survivors scored significantly higher on total apathy and all subscales than did non-stroke participants. Initiation and Executive Apathy were particularly prevalent, similar to previous DAS validation studies in neurogenerative diseases. Stroke survivors also had significantly higher levels of depression, but not anxiety, compared with non-stroke participants.

Conclusion: PSAp is common but under-researched. This thesis contributes to PSAp research, finding that PSAp is associated with functional disability and validating the DAS for use in stroke rehabilitation and research. Limitations and suggestions for future research are discussed.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Chris White
Date Deposited: 11 Nov 2020 11:34
Last Modified: 11 Nov 2020 11:34


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