Apathy in untreated, de novo patients with Parkinson’s disease: validation study of Apathy Evaluation Scale

Gabriella Santangelo, Paolo Barone, Sofia Cuoco, Simona Raimo, Domenica Pezzella, Marina Picillo, Roberto Erro, Marcello Moccia, Maria Teresa Pellecchia, Marianna Amboni, Santangelo Franco, Dario Grossi, Luigi Trojano, Carmine Vitale

Research output: Contribution to journalArticlepeer-review


Apathy is a behavioural disturbance occurring alone or in concomitance with depression in Parkinson’s disease (PD). Here we present a validation study for the self-report version of the Apathy Evaluation Scale (AES-S), carried out in a sample of 60 non-demented, non-depressed untreated, drug-naïve, de novo PD patients; 20 patients of the sample (33.3 %) were classified as apathetic according to current clinical criteria. All enrolled patients completed the AES-S and a neurological and cognitive assessment. Mean AES-S score was 34.43. AES-S did not show floor or ceiling effect. Cronbach’s alpha was 0.872. Principal component analysis revealed three factors: the first (34.4 % of the variance) represented constitutive aspects of the construct of apathy; the second (8.5 % of the variance) represented a social dimension; the third factor (7.9 % of the variance) represented a dimension related to insight. With respect to clinical criteria for apathy considered as the gold standard, receiver operating characteristics curve analysis showed that a cut-off of 36/37 has the maximum discrimination power. High sensitivity and negative predictive values were obtained with cut-off scores of 33/34 or lower; high specificity and positive predictive values were obtained with cut-off scores of 38/39 or higher. AES-S score correlated with scores on frontal tasks, but not on Beck Depression Inventory, Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr scale. The AES-S is a reliable and valid questionnaire for detecting apathy in PD. For screening purposes a 33/34 cut-off score is indicated, but a 38/39 cut-off score is necessary when a high specificity is desired.

Original languageEnglish
Pages (from-to)2319-2328
Number of pages10
JournalJournal of Neurology
Issue number12
Publication statusPublished - 2014


  • Apathy
  • Apathy Evaluation Scale
  • Frontal executive dysfunctions
  • Nonmotor symptoms
  • Parkinson’s disease
  • Validation study

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Medicine(all)


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