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More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes


Leontjevas, Ruslan, Teerenstra, Steven, Smalbrugge, Martin, Vernooij-Dassen, Myrra J. F. J., Bohlmeijer, Ernst T., Gerritsen, Debby L, Koopmans, Raymond T. C. M.


International Psychogeriatrics / IPA, Volume: 25, No.: 12, Pages.: 1941-1952

Year of Publication



Background: Apathy is common in nursing home (NH) residents and it overlaps with depression. This study examines the effects of a multidisciplinary depression program on apathy and depressive motivational and mood symptoms.; Methods: Secondary analyses of a stepped-wedge cluster-randomized controlled trial were conducted with six measurements. Sixteen dementia NH units and 17 somatic units were enrolled. In the intervention condition, a program containing depression assessment procedures and multidisciplinary treatment (activating strategies, psychotherapy, and medication) was introduced. Usual care was provided in the control condition. Outcomes were assessed using the 10-item Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia.; Results: Intention-to-treat analyses showed that the whole depression management program reduced apathy in dementia units (p < 0.001; Cohen's d, -0.35), and depressive motivational symptoms in somatic units (p = 0.008; Cohen's d, -0.40). Depressive mood symptoms were not affected in both unit types. The effect on apathy in dementia units was mainly attributed to activating strategies (p < 0.001; Cohen's d, -0.73). The effect on motivational symptoms in somatic units was mainly attributed to psychotherapy (p = 0.002; Cohen's d, -0.80). Apathy worsening was associated with pharmacological depression treatment in both unit types (p = 0.009; Cohen's d, 0.35).; Conclusions: Depression management may affect apathy and depressive symptoms differently, which underpins the position of apathy as a distinct syndrome. NH professionals can effectively use activating strategies in dementia units, and psychotherapy in somatic units. More research is needed on treating depressive mood symptoms, and on effects of antidepressants in NHs.;

Bibtex Citation

@article{Leontjevas_2013, doi = {10.1017/s1041610213001440}, url = {}, year = 2013, month = {sep}, publisher = {Cambridge University Press ({CUP})}, volume = {25}, number = {12}, pages = {1941--1952}, author = {Ruslan Leontjevas and Steven Teerenstra and Martin Smalbrugge and Myrra J.F.J. Vernooij-Dassen and Ernst T. Bohlmeijer and Debby L. Gerritsen and Raymond T.C.M. Koopmans}, title = {More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes}, journal = {Int. Psychogeriatr.} }


aged, aged, 80 and over, antidepressive agents, apathy, combined modality therapy, depression, female, homes for the aged, humans, male, multidisciplinary, nursing homes, patient care team, patient compliance, programme, psychiatric status rating scales, psychological tests, psychology, psychotherapy, therapeutic use, therapy, treatment outcome

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Behaviour, Depression and Anxiety, Prevention and/or management of co-morbidities


Nursing Homes

Type of Interventions

Non-pharmacological Treatment, Treatment/prevention of co-morbidities or additional risks

Non-Pharmaceutical Interventions

Behavioural Therapies, Other


Depression / Prevention Management