Browsing by Author "Havins, Whitney"
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Item Apathy, Depression, and Emotional Lability in Patients with Amyotrophic Lateral Sclerosis(2014-08) Havins, Whitney; Massman, Paul J.; Dulay, Mario F., Jr.; Hiscock, Merrill; Bradshaw, Major R.The presence of cognitive and behavioral impairment in some patients with amyotrophic lateral sclerosis (ALS) is now well-known. However, the prevalence of behavioral impairment and the relationship between behavioral and cognitive impairment in ALS is not fully understood. This study is the first to examine systematically cognitive profiles associated with apathy, depression, and emotional lability (EL) in patients with ALS. Participants were 161 consecutive referrals to the Neurology service of the Houston Methodist Hospital MDA-ALS clinic. All patients met El Escorial World Federation of Neurology diagnostic criteria for probable or definite ALS. All participants underwent comprehensive neuropsychological evaluation, including measures of cognition, mood, and behavior. Multiple hierarchical regression analyses were used to predict performance on neuropsychological measures from apathy, depression, and emotional lability. Of the 161 patients, 24.8% were diagnosed with EL and 18.6% met criteria for DSM-IV-TR diagnosis of a mood disorder (including 9.9% with a Major Depressive Disorder (MDD) or Dysthymia and 8.7% with an adjustment disorder). Of the 117 with complete apathy data, 32.5% met criteria for clinically significant apathy. Approximately 22% of patients were experiencing two or more of these neuropsychiatric disorders. After controlling for disease severity, apathy accounted for significant variance in predicting performance on a measure of mental flexibility, over and above depression and emotional lability. Neither MDD nor EL significantly predicted performance on any neuropsychological measure. Results suggested that apathy, depression, and emotional lability co-occur, but are dissociable in ALS. After controlling for disease severity, only apathy was associated with executive functioning.Item Factor Structure of the Geriatric Depression Scale and its Relationship to Cognition in Alzheimer's Disease(2011-12) Havins, Whitney; Massman, Paul J.; Hiscock, Merrill; Dulay, Mario F., Jr.Evidence suggests that patients with Alzheimer’s disease (AD) experience more frequent and severe apathy and depression than their healthy age counterparts. Moreover, some studies have shown that apathy and depression are associated with greater cognitive and functional decline in these patients. Previous research has shown the Geriatric Depression Scale to be capable of identifying symptoms of both apathy and dysphoria in older adults. However, no study to date has systematically explored whether the Geriatric Depression Scale measures symptoms of apathy and dysphoria in patients with AD and related these constructs to performance on neuropsychological measures. This study employed exploratory factor analysis to identify factors of the Geriatric Depression Scale in a sample of 569 patients with pure probable AD. A four-factor solution was obtained, yielding factors associated with apathy, dysphoria, social withdrawal, and cognitive impairment. It was hypothesized that symptoms of apathy would be associated with cognitive and functional impairment, even after controlling for dysphoria. Two-way ANOVAs showed that endorsement of Apathy factor items was associated with greater impairment in verbal memory and motor speed, as well as functional impairment. Dysphoria was not associated with any cognitive or functional variables. Findings suggest that the GDS may be used as a screening measure for symptoms of apathy in AD, hopefully aiding early identification and intervention to reduce patient and caregiver burden.