Objective: We tried to address the question of whether agitation and apathy as occurring in nursing home residents represent two poles of a behavioral continuum or separate psychobehavioral manifestations that can occur separately, or co-exist.
Design: Data had been previously collected part of a quality improvement project in a nursing home focusing on the prevalence of Apathy and its concomitants in that institution. A stratified random sample amounting to 20% (N: 70) of the total population in that institution was considered and assessed in a cross sectional manner with respect to presence of apathy and of agitation.
Materials and Methods: Assessments were based on chart review and ratings performed by interviewing clinical staff most familiar with the resident considered. Demographics, psychiatric and medical co-morbidity, social support, qualitative data on presence of agitation, qualitative and quantitative data on presence of apathy were collected. The Apathy Evaluation Scale was used to quantify this symptom. Non-parametric statistics were used for the main outcome measure: qualitative association between agitation and apathy.
Results: 55.7% of the sample had agitation and 57% had apathy, consistent with the high prevalence of both these conditions in nursing home populations. 64% of residents with agitation were also found to have apathy while 62.5% of residents with apathy were also agitated. Only 20% of the total sample suffered with agitation without apathy and only 21% of the total sample suffered with apathy without agitation. Co-occurrence of dementia and depression were also analyzed.
Conclusion: These preliminary data seem to suggest that agitation and apathy in nursing home residents are not mutually exclusive but in fact are more often coexistent than occurring in isolation. If these results were to be confirmed by research with greater extrapolation value (multi-site sampling, larger sample, diagnostic specific sample, longitudinal design, prospective design) there would be important implications for the empirical treatment and the design of clinical trials for both agitation and apathy: medications proposed for agitation have been intuitively sedative, while medication tried to treat apathy is stimulant. Furthermore, our understanding of the phenomenology and pathophysiology of psychobehavioral complications encountered in long term care settings, could be advanced by a concept of “mixed behavioral state” accommodating apparently opposite ends of the spectrum of psychomotor expression in this population in general, and in dementia in particular.
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