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Rehab Measures: Apathy Evaluation Scale (includes three forms – self, informant and clinician versions)

Link to instrument

Apathy Evaluation Scale available here (other languauges available below) 

Title of Assessment

Apathy Evaluation Scale (includes three forms – self, informant and clinician versions) 

Acronym

AES

Instrument Reviewer(s)

Initially reviewed by Karen McCulloch, PT, PhD, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 6/2012

Summary Date

12/7/2012 

Purpose

The measure addresses characteristics of goal directed behavior that reflects apathy including behavioral, cognitive and emotional indicators.

Description

  • 18 items
  • 18-72 (higher scores reflect more apathy)
  • Items are scored on 4-point Likert scale with descriptors for the “self” version (not at all true, slightly true, somewhat true, very true) and those for the clinician and informant version (not at all characteristic, slightly characteristic, somewhat characteristic, very characteristic)
  • Some items must be reverse scored because of the way they are written
  • Two open questions are also asked (number of items reported, details offered in response to questions) to characterize apathy
  • Administration instructions are provided in the Marin et al 1991 reference; pages 161-162.

Area of Assessment

 

Body Part

 

ICF Domain

Activity; Participation 

Domain

 

Assessment Type

 

Length of Test

06 to 30 Minutes 

Time to Administer

10-20 minutes

Number of Items

18 items 

Equipment Required

No equipment required

Training Required

Marin recommends bachelor’s level training with two years clinical experience in psychological settings with 4-6 hours of exposure to apathy to ensure reliable use.

Type of training required

 

Cost

Free 

Actual Cost

No charge for the measure

Age Range

 

Administration Mode

 

Diagnosis

Acquired Brain Injury; Geriatrics; Parkinson’s Disease; Stroke; Traumatic Brain Injury 

Populations Tested

  • Alzheimer's Disease
  • Depression
  • Older adults
  • Stroke
  • Hypoxic brain damage
  • Traumatic brain injury
  • Parkinson's Disease
  • Schizophrenia

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

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)

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.

Normative Data

Young adult controls: (Kant et al, 1998)

  • Mean AES-S = 24.4 (4.5)

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

Test-retest Reliability

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))

Interrater/Intrarater Reliability

Mixed sample: (Marin et al, 1991)

  • Excellent interrater reliability (ICC= .94)

Internal Consistency

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)

Criterion Validity (Predictive/Concurrent)

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)

Construct Validity (Convergent/Discriminant)

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)

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)

Content Validity

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

Face validity supported by expert review during development.

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

LS

LS

R

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

TBI EDGE

No

No

Yes

Not reported

Considerations

Some items on the AES-I and AES-C involve judging philosophical intention (e.g. “S/he approaches life with intensity”, which may be difficult to judge as an observer. The self-rated version of the AES may be problematic if there are issues with insight into deficits as can occur with TBI.

Translated AES:

Spanish (slide 62-63): 
http://www.extensionuned.es/archivos_publicos/qdocente_planes/3535/sindromes_organicos__personalidad.ppt

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Andersson, A. F. S. (2000). "Coping strategies in patients with acquired brain injury: relationships between coping, apathy, depression and lesion location." Brain Injury 14(10): 887-905.

Andersson, S. and Bergedalen, A. M. (2002). "Cognitive correlates of apathy in traumatic brain injury." Neuropsychiatry, Neuropsychology, and Behavioral Neurology 15(3): 184-191. Find it on PubMed

Andersson, S., Gundersen, P. M., et al. (1999). "Emotional activation during therapeutic interaction in traumatic brain injury: effect of apathy, self-awareness and implications for rehabilitation." Brain Injury 13(6): 393-404. Find it on PubMed

Andersson, S., Krogstad, J. M., et al. (1999). "Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophysiological reactivity." Psychological Medicine 29(2): 447-456. Find it on PubMed

Clarke, D. E., Van Reekum, R., et al. (2007). "An appraisal of the psychometric properties of the Clinician version of the Apathy Evaluation Scale (AES-C)." Int J Methods Psychiatr Res 16(2): 97-110. Find it on PubMed

Glenn, M. (2005). "The Apathy Evaluation Scale." The Center for Outcome Measurement In Brain Injury.

Glenn, M. B., Burke, D. T., et al. (2002). "Cutoff score on the apathy evaluation scale in subjects with traumatic brain injury." Brain Injury 16(6): 509-516. Find it on PubMed

Kant, R., Duffy, J. D., et al. (1998). "Prevalence of apathy following head injury." Brain Injury 12(1): 87-92. Find it on PubMed

Lane-Brown, A. T. and Tate, R. L. (2009). "Measuring apathy after traumatic brain injury: Psychometric properties of the Apathy Evaluation Scale and the Frontal Systems Behavior Scale." Brain Injury 23(13-14): 999-1007. Find it on PubMed

Marin, R. S., Biedrzycki, R. C., et al. (1991). "Reliability and validity of the Apathy Evaluation Scale." Psychiatry Research 38(2): 143-162. Find it on PubMed

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 12/7/2012 2:58 PM  by Jason Raad 
Last modified at 4/29/2016 9:04 AM  by Jason Raad