Apathy Evaluation Scale (Self, Informant, and Clinician Versions)

Acquired brain injury: (Andersson et al, 1999a; n=72; mean age = 30.1 (ages 16-60 years old); mean time post injury = 12.6 months ; TBI, CVA and hypoxic brain damage)

• Score greater than 34 indicates apathy on AES-C

Traumatic brain injury: Andersson et al, 1999b (n=30; mean age = 30.1( ages 16-64); mean time post injury = 10.5 months; inpatient TBI)

• Score greater than 34 indicates apathy on AES-C

Glenn et al, 2002 (n=46; mean age 43.1(14.9) years; mean time since injury 43.0 months; initial injury severity 52% mild, 18% moderate, 30% severe)

• Investigators were not able to identify a reasonable cut-off score of AES-I (area under ROC curve was 0.62) or AES-S (area under ROC curve was 0.74). AES-C score of >32 had the best combination of sensitivity and specificity (area under ROC curve 0.82), with sensitivity of 95% but specificity of 0% to predict an ordinal rating of presence of behaviors that reflect apathy (a 7 point scale developed for the study).

(Lane-Brown & Tate, 2009; n=34, mean age=34.4(9.4); mean time post injury= 80.6 months; mean duration of PTA 53.2 (33.5) days)

• Adequate diagnostic accuracy, with score greater than 36.5 resulted in ROC of .8, with sensitivity of 83% and specificity of 67%. A higher cutpoint could be used to increase specificity if desired (see Lane-Brown for values). It is likely that there is some overlap of symptoms related to fatigue and/or depression in this population that should be considered for clinical management.

Traumatic brain injury: (Glenn et al, 2002)

• Mean AES-S scores  = 37 (8.6), no difference between levels of injury severity

(Kant et al, 1998; n=83; mean age 38 (12.3) years; TBI referrals to neuropsychiatric outpatient clinic)

• Mean AES-scores = 40.5 (6.3), 71% met criteria for apathy

Acquired brain injury: (Andersson, 1999a)

• Excellent internal consistency (Chronbach’s alpha of AES-C=.84)

TBI: (Andersson 1999b)

• Excellent internal consistency(Chronbach’s alpha of AES-C=.89)

(Andersson & Bergedalen, 2002; n= 53; mean age = 28.3 years (2.38); mean time post injury= 12.2 months (10.6))

• Excellent internal consistency (Chronbach’s alpha of AES-C=.87)

(Lane-Brown, 2009)

• Excellent internal consistency (Chronbach’s alpha of AES-I= .89)

Acquired BI: (Andersson et al, 1999a)

• AES-C correlates as expected with items on depression scale (excellent levels with positive items, insignificant correlation with items reflecting depression).
• Differentiates between hypoxia and other forms of acquired brain injury.

TBI: (Andersson et al, 1999b)

• Significant relationships between AES-C and heart rate/blood pressure reactivity and mean arterial pressure (beta values reported, p<.01). Significant inverse relationships between AES-C and emotional discomfort.

(Andersson and Bergedalen, 2002)

• Adequate negative correlation between AES-C and acquistion/memory (r=-.50).

(Lane-Brown, 2009)

• Excellent correlation with the Frontal Systems Behavior Scale-Apathy items (r=.71)

Possible items for inclusion, described as hundreds, were gleaned from literature review and reduced via expert review based on items that were most clear and demonstrated item to total score correlations of >.4 in pilot testing. (Marin et al, 1991)

Face validity supported by expert review during development.

Young adult controls: (Kant et al, 1998; n=108, age range 20-65 years, 94.5% in 20-49 age range, 49% male) Mean AES-S was 24.4 (4.5), therefore cutoff score of >34 indicating apathy (2 SD above mean)

Young adult controls: (Kant et al, 1998)

• Mean AES-S = 24.4 (4.5)

Mixed sample: (Marin 1991; n=123; aged 53-85, mixed sample of stroke, AD, depression, community dwelling well older adults)

•  Excellent test-retest reliability (Pearson= .88 (AES-C); Pearson = .94 (AES-I); Pearson= .76 (AES-S))

Mixed sample: (Marin et al, 1991)

• Excellent interrater reliability (ICC= .94)

Predictive validity:

Mixed sample: (Marin et al, 1991)

• AES-C predicts average scores and time spontaneously engaged on videogame at levels of significance p<.002)

Mixed sample: (Marin et al, 1991)

• Excellent convergent validity of AES-C with other forms (r= .62-.72); Adequate discriminant validity differentiating apathy from depression and anxiety (r=.35-.39); Excellent differentiation between patients with Alzheimer’s disease, right and left hemisphere stroke and major depression (F=18.86, p<.001)

Possible items for inclusion, described as hundreds, were gleaned from literature review and reduced via expert review based on items that were most clear and demonstrated item to total score correlations of >.4 in pilot testing. (Marin et al, 1991)

Face validity supported by expert review during development.