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(Stroke. 2009;40:3299.)
© 2009 American Heart Association, Inc.

Original Contributions

A Longitudinal View of Apathy and Its Impact After Stroke

Nancy E. Mayo, PhD; Lesley K. Fellows, MD, DPhil; Susan C. Scott, MSc; Jill Cameron, PhD Sharon Wood-Dauphinee, PhD

From Division of Clinical Epidemiology (N.E.M., S.C.S., S.W.-D.), Department of Medicine and School of Physical and Occupational Therapy (N.E.M., S.W.-D.), Joint Department of Epidemiology and Biostatistics and Occupational Health (N.E.M., S.W.-D.), Department of Neurology & Neurosurgery (L.K.F.), McGill University Health Center, Montreal, Quebec, Canada; Department of Occupational Science and Occupational Therapy (J.C.), University of Toronto, Toronto, Canada; Toronto Rehabilitation Institute (J.C.), Toronto, Canada.

Correspondence to Nancy Mayo, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, R4.17, Montreal, Quebec, Canada, H3A 1A1. E-mail nancy.mayo{at}mcgill.ca

Background and Purpose— Stroke survivors are often described as apathetic. Because apathy may be a barrier to participation in promising therapies, more needs to be learned about apathy symptoms after stroke. The specific objective was to estimate the extent to which apathy changes with time over the first year after stroke and the impact of apathy on recovery.

Methods— The Apathy Assessed cohort was formed from stroke survivors participating in a longitudinal study of health-related quality of life after stroke. A family caregiver completed an apathy questionnaire by telephone at 1, 3, 6, and 12 months after stroke (n=408). Group-based trajectory modeling and ordinal regression were used to identify distinctive groups of individuals with similar trajectories of apathy over the first year after stroke and predictors of apathy trajectory.

Results— Both 3- and 5-group trajectory models fit the data. We used the 5-group model because of the potential to further explore the apathy construct. The largest group (50%) had low apathy and 33% had minor apathy that remained stable throughout the first year after stroke. A small proportion (3%) of the study sample had high apathy that remained high. Two other groups of almost equal size (7%) showed worsening and improving apathy. Poor cognitive status, low functional status, and high comorbidity predicted higher apathy. High apathy had a significant negative effect on physical function, participation, health perception, and physical health over the first 12 months after stroke.

Conclusion— Some degree of apathy was prevalent and persistent after stroke and was predicted by older age, poor cognitive status, and low functional status after stroke. Even a minor level of apathy had an important and statistically significant impact on stroke outcomes.

Key Words: depression • function • motivation • stroke