COSMIN database

Are the available apathy measures reliable and valid? A review of the psychometric evidence

Clarke, D. E., Ko, J. Y., Kuhl, E. A., van Reekum, R., Salvador, R., and Marin, R. S.
OBJECTIVE: Apathy is highly prevalent among neuropsychiatric populations and is associated with greater morbidity and worse functional outcomes. Despite this, it remains understudied and poorly understood, primarily due to lack of consensus definition and clear diagnostic criteria for apathy. Without a gold standard for defining and measuring apathy, the availability of empirically sound measures is imperative. This paper provides a psychometric review of the most commonly used apathy measures and provides recommendations for use and further research.

METHODS: Pertinent literature databases were searched to identify all available assessment tools for apathy in adults aged 18 and older. Evidence of the reliability and validity of the scales were examined. Alternate variations of scales (e.g., non-English versions) were also evaluated if the validating articles were written in English.

RESULTS: Fifteen apathy scales or subscales were examined. The most psychometrically robust measures for assessing apathy across any disease population appear to be the Apathy Evaluation Scale and the apathy subscale of the Neuropsychiatric Inventory based on the criteria set in this review. For assessment in specific populations, the Dementia Apathy Interview and Rating for patients with Alzheimer's dementia, the Positive and Negative Symptom Scale for schizophrenia populations, and the Frontal System Behavior Scale for patients with frontotemporal deficits are reliable and valid measures.

CONCLUSION: Clinicians and researchers have numerous apathy scales for use in broad and disease-specific neuropsychiatric populations. Our understanding of apathy would be advanced by research that helps build a consensus as to the definition and diagnosis of apathy and further refine the psychometric properties of all apathy assessment tools.
J Psychosom Res
1879-1360 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the nervous system
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
2 - Interviews
6 - Clinical rating scales
AES-C - Apathy Evaluation Scale Clinician
AES-I - Apathy Evaluation Scale Informant
AES-S - Apathy Evaluation Scale Self report version
AI - Apathy inventory
BPRS - Brief Psychiatric Rating Scale
DAIR - Dementia Apathy Interview and Rating scale
FrSBe - Frontal System Behavior scale [alias: FLOPS - Frontal Lobe Personality Scale]
IAS - Irritability-Apathy Scale
KBCI - Key Behavior Change Inventory
LARS (Also: LARS-I and LARS-C) - Lille Apathy Rating Scale (Also: Informant and Clinician version)
NPI - Neuropsychiatric inventory
NPI-NH - Neuropsychiatric inventory-Nursing Home version
NPI-Q - Neuropsychiatric Inventory – Questionnaire (Brief version)
PANSS - Positive and Negative Syndrome Scale for Schizophrenia(modified)
SANS - Scale for the Assessment of Negative Symptoms
UPDRS - Unified Parkinson’s Disease Rating Scale