9 Is apathy a problem in huntington’s disease? a systematic review of the evidence

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ObjectiveHuntington’s disease (HD) is characterised by the presence of a motor disorder and neuropsychiatric phenomena, including apathy.Whilst apathy is widely regarded as a significant feature of HD, it is unknown whether it presents a major problem. The purpose of this systematic review is to assess whether apathy is an problem for the patient, the caregiver and the clinician.MethodI followed the PRISMA guidelines for conducting a systematic review, searching for literature using Medline, Embase and PsycInfo. I began by searching for “huntington*” and Medical Subject Headings (MeSH) for Huntington’s Disease, combining these searches with OR. I then searched for the term “apathy” OR MeSH for apathy. I combined the first with the second search using the word AND, giving 61 search results. I read the abstracts, narrowing down the search results to 7. Since the focus of this review is whether apathy is a problem in HD, I conducted another search for all literature containing information relating to quality of life in HD. To do this I made a search for MeSH for quality of life, “quality” and “qualy”,combining these search terms with OR. I combined the result with the first search using AND, giving 329 results. Reading these abstracts left 3 additional papers to be added to the first 7.ResultsMason and Barker (2015) found that patients with early stage disease rated their apathy higher than the rating of companions, whilst those with late stage disease rated it lower.Increased apathy was found to decrease total functional capacity in 4 studies. Apathy subscore was a predictor of disability not caregiver burden/reduced QoL.Ready et al. (2008) looked at both patient and caregiver QoL in HD, finding that difficult to manage behaviours (e.g. aggression) affected QoL more than apathy. Eddy and Rickards (2013) found that QoL scores were lower for patients who exhibited increased apathy scores (p≤0.05).ConclusionOur findings suggest that apathy is a perceived problem to the clinician, reducing total functional capacity. It may be a problem to the caregiver or may appear easier to manage than aggression/irritability. Patients with early-stage disease often feel their apathy is a problem but patients with late stage disease (and, therefore, most likely worse apathy) do not perceive their apathy to be a problem as it is not detrimental to their QoL.

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