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Apathy in acute stroke patients


L. Caeiro, CEEM, Serviço de Neurologia, Hospital de Santa Maria, Av. Professor Egas Moniz, 1649-035 Lisboa, Portugal (tel./fax: +351 217957474; e-mail:


Background and purpose:  Apathy is a frequent disturbance in stroke patients. The aim of this case–control study was to elucidate whether apathy: (i) was secondary to stroke or related to hospitalization, (ii) was related to thalamic and striatocapsular stroke lesions, (iii) was independent from cognitive impairment and depression in the acute phase of stroke, (iv) was associated with clinical and demographical variables and (v) was associated with a worse functional outcome at discharge.

Methods:  We assessed a sample of 94 consecutive patients with an acute (≤4 days) stroke (22 intracerebral haemorrhages, 72 cerebral infarcts), and a control group of 50 patients with acute coronary syndrome, with the 10-item Apathy Evaluation Scale-Clinical. We related apathy with cognition (MMSE), depression (Montgomery Åsberg Depression Rating Scale) and with outcome (modified Rankin Scale).

Results:  Apathy was present in 36 (38.3%) acute stroke patients but was also frequent in patients with acute coronary syndrome (24%). Stroke patients were more inaccurate in understanding their problems than patients with acute coronary syndrome (P = 0.005). Logistic regression identified cerebral haemorrhage (OR = 3.5), low educational level (OR = 4.7) and a trend of right hemispherical lesion (OR = 3.0) as independent predictors for apathy (R2 = 32.3%). Cognitive impairment and depression were not associated to apathy. Apathy was associated with a worse outcome (P = 0.03).

Conclusion:  Apathy was frequent in acute stroke patients, and it was predicted by acute intracerebral haemorrhage and right hemispherical acute stroke lesion.