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Here’s a haiku that’s also a joke:
The sky is gray milk.
I could compose a haiku.
But apathy…
The joke is that haiku are supposed to have 5 syllables for the first line, 7 for the second, and 5 more for the third. But if you count the syllables here, you’ll find that I only got as far as 4 syllables in the last line.
I’ve written about apathy and Parkinson’s before, but recently found another research paper, titled “Evolution of Apathy in Early Parkinson’s Disease: A 4-Years Prospective Cohort Study,” published in 2021.
The researchers made extensive use of a series of questions called “Lille Apathy Rating Scale” (LARS). (See sample test item below.) They followed a group of people newly diagnosed with Parkinson’s (average age: 51.8 years) for four years, interviewing them with the LARS questionnaire at the start of the study and every year after that, and comparing the results each year to a battery of other tests (e.g., “Hamilton Depression Rating Scale”).
They define apathy as “a non-motor symptom that refers to a state of reduced motivation that manifests as diminished goal-directed behaviors, reduced interests, or emotional features that cannot be attributed to altered levels of consciousness, cognitive impairment, or emotional distress.” In addition, they note that “apathy is often associated with poor prognosis…and poor response to treatment” for people with PD.
Here’s a sample item from the LARS questionnaire, to give you an idea of how it works. The questionnaire consists of a variety of items that the interviewer asks, who then writes the Parky’s responses down and gives a score to each response. The final LARS score could be anything from –36 (indicating no apathy) to +36 (severe apathy). In the current study, PD patients were categorized as having apathy, based on a cut-off value of -21.
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- Everyday productivity: What do you do during the day? Tell me about your day-to-day life.
Time taken to reply:
+2 points – No reply
+1 point – Reply after prompting
0 points – Spontaneous reply but only after some time
–1 point – Immediate reply, one activity mentioned w/o hesitation
–2 points – Immediate reply, several activities mentioned w/o hesitation:
Number and variety of activities mentioned:
+2 points – None
+1 point – One activity but prompting needed to obtain another
0 points – Several activities mentioned
–1 point – Detailed organization of a typical day, but every day follows the same pattern
–2 points – Detailed organization of a typical day, but the reply shows that the activities change according to the day of the week or the time of the year (for example, housework, going to the cinema, watching TV, gardening, visiting friends, etc.)
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At the start of the experiment, 18.6% of the group of Parkies were rated as having apathy. Each year after that, the prevalence of apathy increased until the final year, when 28.8% of the group were rated as apathetic.
The researchers wrote about additional findings. To wit:
We also observed that the severity of apathy was associated with the male sex, the severity of motor symptoms, attention deficits, executive dysfuntion, and depression in patients with early PD. Interestingly, the severity of depression was the only predictor for the onset of apathy in patients with PD. Our results highlight that apathy is an early, common, and non-persistent non-motor symptom in patients with early PD and may, therefore, have implications for clinical management.
Also, when reviewing other research, the authors note the following:
Notably, men with PD were more likely to show apathy….Our study indicates that apathy in PD could be considered a predictor of poor prognosis in men. However, the association between apathy and male sex should be considered with caution because apathy is more comonly oberved in women than in men in the general population.
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Final notes:
- This article leads to a question about what’s omitted: namely, what do you do with a person whom you’ve identified as having severe apathy?
- If you want to read more haikus that I wrote pertaining to PD, click here. There are 100 of them!
