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Journal of Neuro-Oncology

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01-10-2018 | Laboratory Investigation

Self- and informant-rated apathy in patients with childhood-onset craniopharyngioma

Authors: Aylin Mehren, Jale Özyurt, Paula zu Klampen, Svenja Boekhoff, Christiane M. Thiel, Hermann L. Müller

Published in: Journal of Neuro-Oncology | Issue 1/2018

Abstract

Introduction

The current study aimed to assess whether childhood-onset craniopharyngioma patients suffer from symptoms of apathy, as assessed by patients themselves and their close others. We further analyzed whether apathy scores are related to symptoms of depression.

Methods

Childhood-onset craniopharyngioma patients (n = 35, 16 female, median age = 22) and matched healthy controls (n = 35, 19 female, median age = 21) were asked to complete self-ratings of the Apathy Evaluation Scale, whereas informant-ratings were obtained from their close others. Depression was assessed by self-ratings using the German version of the Center for Epidemiological Studies Depression Scale. As primary outcome measures, self- and informant-rated apathy scores were compared between patients and healthy controls. As secondary outcome measures, differences between self- and informant-rated apathy within the single groups and associations between apathy and depression were analyzed.

Results

Compared to healthy controls, patients displayed significantly higher apathy levels in informant-ratings (median_patients = 18, median_controls = 12, p = .021), but not in self-ratings (median_patients = 11, median_controls =12, p = .68). In patients, there was a significant discrepancy between self- and informant-rated apathy and self-rated apathy was related to symptoms of depression.

Conclusions

This is the first study to show that childhood-onset craniopharyngioma patients may be at high risk for apathy. Noteworthy, apathy levels in the patient group were judged to be high by their close others but not by the patients themselves, indicating that many patients were not fully aware of their impairments. As apathy is associated with numerous adverse outcomes affecting everyday life and vocational opportunities, future investigations are needed to identify specific risk factors for apathy.

Clinical Trial Registration No: NCT00258453.

Muller HL, Merchant TE, Puget S, Martinez-Barbera JP (2017) New outlook on the diagnosis, treatment and follow-up of childhood-onset craniopharyngioma. Nat Rev Endocrinol https://doi.org/10.1038/nrendo.2016.217 CrossRefPubMed

Muller HL (2016) Craniopharyngioma and hypothalamic injury: latest insights into consequent eating disorders and obesity. Curr Opin Endocrinol Diabetes Obes 23:81–89. https://doi.org/10.1097/MED.0000000000000214 CrossRefPubMed

Ozyurt J, Muller HL, Thiel CM (2015) A systematic review of cognitive performance in patients with childhood craniopharyngioma. J Neurooncol 125:9–21. https://doi.org/10.1007/s11060-015-1885-z CrossRefPubMed

Zada G, Kintz N, Pulido M, Amezcua L (2013) Prevalence of neurobehavioral, social, and emotional dysfunction in patients treated for childhood craniopharyngioma: a systematic literature review. PLoS ONE 8:e76562. https://doi.org/10.1371/journal.pone.0076562 CrossRefPubMedPubMedCentral

Dekkers OM, Biermasz NR, Smit JW, Groot LE, Roelfsema F, Romijn JA, Pereira AM (2006) Quality of life in treated adult craniopharyngioma patients. Eur J Endocrinol 154:483–489. https://doi.org/10.1530/eje.1.02114 CrossRefPubMed

Sterkenburg AS, Hoffmann A, Gebhardt U, Warmuth-Metz M, Daubenbuchel AM, Muller HL (2015) Survival, hypothalamic obesity, and neuropsychological/psychosocial status after childhood-onset craniopharyngioma: newly reported long-term outcomes. Neuro Oncol 17:1029–1038. https://doi.org/10.1093/neuonc/nov044 CrossRefPubMedPubMedCentral

Muller HL (2010) Increased daytime sleepiness in patients with childhood craniopharyngioma and hypothalamic tumor involvement: review of the literature and perspectives. Int J Endocrinol 2010:519607 https://doi.org/10.1155/2010/519607 CrossRefPubMedPubMedCentral

Laffond C, Dellatolas G, Alapetite C, Puget S, Grill J, Habrand JL, Doz F, Chevignard M (2012) Quality-of-life, mood and executive functioning after childhood craniopharyngioma treated with surgery and proton beam therapy. Brain Inj 26:270–281. https://doi.org/10.3109/02699052.2011.648709 CrossRefPubMed

Marin RS (1990) Differential diagnosis and classification of apathy. Am J Psychiatry 147:22–30. https://doi.org/10.1176/ajp.147.1.22 CrossRefPubMed

10.

Weitzner MA (1998) Neuropsychiatry and pituitary disease: an overview. Psychother Psychosom 67:125–132CrossRefPubMed

11.

Weitzner MA, Kanfer S, Booth-Jones M (2005) Apathy and pituitary disease: it has nothing to do with depression. J Neuropsychiatry Clin Neurosci 17:159–166. https://doi.org/10.1176/jnp.17.2.159 CrossRefPubMed

12.

Fox ME, King TZ (2016) Pituitary disorders as a predictor of apathy and executive dysfunction in adult survivors of childhood brain tumors. Pediatric Blood Cancer 63:2019–2025. https://doi.org/10.1002/pbc.26144 CrossRefPubMed

13.

Marin RS (1991) Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci 3:243–254. https://doi.org/10.1176/jnp.3.3.243 CrossRefPubMed

14.

Starkstein SE, Petracca G, Chemerinski E, Kremer J (2001) Syndromic validity of apathy in Alzheimer’s disease. Am J Psychiatry 158:872–877. https://doi.org/10.1176/appi.ajp.158.6.872 CrossRefPubMed

15.

Robert P, Onyike CU, Leentjens AFG, Dujardin K, Aalten P, Starkstein S, Verhey FRJ, Yessavage J, Clement JP, Drapier D, Bayle F, Benoit M, Boyer P, Lorca PM, Thibaut F, Gauthier S, Grossberg G, Vellas B, Byrne J (2009) Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. Eur Psychiatry 24:98–104. https://doi.org/10.1016/j.eurpsy.2008.09.001 CrossRefPubMed

16.

Resnick B, Zimmerman SI, Magaziner J, Adelman A (1998) Use of the apathy evaluation scale as a measure of motivation in elderly people. Rehabilit Nurs 23:141–147. https://doi.org/10.1002/j.2048-7940.1998.tb01766.x CrossRef

17.

van Reekum R, Stuss DT, Ostrander L (2005) Apathy: why care? J Neuropsychiatry Clin Neurosci 17:7–19. https://doi.org/10.1176/jnp.17.1.7 CrossRefPubMed

18.

Marin RS, Firinciogullari S, Biedrzycki RC (1993) The sources of convergence between measures of apathy and depression. J Affect Disord 28:117–124CrossRefPubMed

19.

Levy ML, Cummings JL, Fairbanks LA, Masterman D, Miller BL, Craig AH, Paulsen JS, Litvan I (1998) Apathy is not depression. J Neuropsychiatry Clin Neurosci 10:314–319. https://doi.org/10.1176/jnp.10.3.314 CrossRefPubMed

20.

Marin RS, Firinciogullari S, Biedrzycki RC (1994) Group differences in the relationship between apathy and depression. J Nerv Ment Dis 182:235–239CrossRefPubMed

21.

Moretti R, Signori R (2016) Neural correlates for apathy: frontal-prefrontal and parietal cortical- subcortical circuits. Front Aging Neurosci 8:289. https://doi.org/10.3389/fnagi.2016.00289 CrossRefPubMedPubMedCentral

22.

Le Heron C, Apps MAJ, Husain M (2017) The anatomy of apathy: a neurocognitive framework for amotivated behaviour. Neuropsychologia https://doi.org/10.1016/j.neuropsychologia.2017.07.003 CrossRefPubMed

23.

Hua C, Shulkin BL, Indelicato DJ, Li Y, Li X, Boop FA, Merchant TE (2015) Postoperative cerebral glucose metabolism in pediatric patients receiving proton therapy for craniopharyngioma. J Neurosurg 16:567–573 https://doi.org/10.3171/2015.4.PEDS159 CrossRef

24.

Ozyurt J, Muller HL, Warmuth-Metz M, Thiel CM (2017) Hypothalamic tumors impact gray and white matter volumes in fronto-limbic brain areas. Cortex 89:98–110. https://doi.org/10.1016/j.cortex.2017.01.017 CrossRefPubMed

25.

Marin RS, Biedrzycki RC, Firinciogullari S (1991) Reliability and validity of the Apathy evaluation scale. Psychiatry Res 38:143–162CrossRefPubMed

26.

Lueken U, Seidl U, Schwarz M, Volker L, Naumann D, Mattes K, Schroder J, Schweiger E (2006) Psychometric properties of a German version of the apathy evaluation scale. Fortschr Neurol Psychiatr 74:714–722. https://doi.org/10.1055/s-2006-932164 CrossRefPubMed

27.

Hautzinger M, Bailer M, Hofmeister D, Keller F (2012) Allgemeine depressionsskala. Hogrefe, Göttingen

28.

Radloff LS (1977) The CES-D scale—a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401 doi. https://doi.org/10.1177/014662167700100306 CrossRef

29.

Smets EM, Garssen B, Bonke B, De Haes JC (1995) The Multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39:315–325CrossRefPubMed

30.

Schwarz R, Krauss O, Hinz A (2003) Fatigue in the general population. Onkologie 26:140–144 doi:69834PubMed

31.

Kuhnt S, Ernst J, Singer S, Ruffer JU, Kortmann RD, Stolzenburg JU, Schwarz R (2009) Fatigue in cancer survivors-prevalence and correlates. Onkologie 32:312–317. https://doi.org/10.1159/000215943 CrossRefPubMed

32.

Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRefPubMed

33.

Sander C, Hegerl U, Wirkner K, Walter N, Kocalevent RD, Petrowski K, Glaesmer H, Hinz A (2016) Normative values of the Epworth sleepiness scale (ESS), derived from a large German sample. Sleep Breath 20:1337–1345. https://doi.org/10.1007/s11325-016-1363-7 CrossRefPubMed

34.

Bloch KE, Schoch OD, Zhang JN, Russi EW (1999) German version of the Epworth sleepiness scale. Respiration 66:440–447. https://doi.org/10.1159/000029408 CrossRefPubMed

35.

Handwerker G (2007) Narkolepsie. Monatsschr Kinderheilkd 155:624–629CrossRef

36.

Wolff JE, Daumling E, Dirksen A, Dabrock A, Hartmann M, Jurgens H (1996) Munster Heidelberg abilities scale—a measuring instrument for global comparison of illness sequelae. Klin Padiatr 208:294–298. https://doi.org/10.1055/s-2008-1046486 CrossRefPubMed

37.

Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMed

38.

Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37:1345–1351CrossRefPubMed

39.

Hoffmann A, Warmth-Metz M, Gebhardt U, Pietsch T, Pohl F, Kortmann RD, Calaminus G, Muller HL (2014) Childhood craniopharyngioma—changes of treatment strategies in the trials KRANIOPHARYNGEOM 2000/2007. Klin Padiatr 226:161–168. https://doi.org/10.1055/s-0034-1368785 CrossRefPubMed

40.

Muller HL, Bueb K, Bartels U, Roth C, Harz K, Graf N, Korinthenberg R, Bettendorf M, Kuhl J, Gutjahr P, Sorensen N, Calaminus G (2001) Obesity after childhood craniopharyngioma-German multicenter study on pre-operative risk factors and quality of life. Klin Padiatr 213:244–249. https://doi.org/10.1055/s-2001-16855 CrossRefPubMed

41.

Rolland-Cachera MF, Cole TJ, Sempe M, Tichet J, Rossignol C, Charraud A (1991) Body Mass Index variations: centiles from birth to 87 years. Eur J Clin Nutr 45:13–21PubMed

42.

Muller HL, Gebhardt U, Teske C, Faldum A, Zwiener I, Warmuth-Metz M, Pietsch T, Pohl F, Sorensen N, Calaminus G, Study Committee of K (2011) Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up. Eur J Endocrinol 165:17–24. https://doi.org/10.1530/EJE-11-0158 CrossRefPubMed

43.

Muller HL, Gebhardt U, Faldum A, Warmuth-Metz M, Pietsch T, Pohl F, Calaminus G, Sorensen N (2012) Xanthogranuloma, Rathke’s cyst, and childhood craniopharyngioma: results of prospective multinational studies of children and adolescents with rare sellar malformations. J Clin Endocrinol Metab 97:3935–3943. https://doi.org/10.1210/jc.2012-2069 CrossRefPubMed

44.

Radakovic R, Harley C, Abrahams S, Starr JM (2015) A systematic review of the validity and reliability of apathy scales in neurodegenerative conditions. Int Psychogeriatr 27:903–923. https://doi.org/10.1017/S1041610214002221 CrossRefPubMed

45.

Poretti A, Grotzer MA, Ribi K, Schonle E, Boltshauser E (2004) Outcome of craniopharyngioma in children: long-term complications and quality of life. Dev Med Child Neurol 46:220–229CrossRefPubMed

46.

Levi RB, Drotar D (1999) Health-related quality of life in childhood cancer: discrepancy in parent-child reports. Int J Cancer Suppl 12:58–64CrossRefPubMed

47.

Heinks K, Boekhoff S, Hoffmann A, Warmuth-Metz M, Eveslage M, Peng J, Calaminus G, Muller HL (2018) Quality of life and growth after childhood craniopharyngioma: results of the multinational trial KRANIOPHARYNGEOM 2007. Endocrine 59:364–372. https://doi.org/10.1007/s12020-017-1489-9 CrossRefPubMed

48.

Canning EH, Canning RD, Boyce WT (1992) Depressive symptoms and adaptive style in children with cancer. J Am Acad Child Adolesc Psychiatry 31:1120–1124. https://doi.org/10.1097/00004583-199211000-00021 CrossRefPubMed

49.

Grace J, Malloy P (2001) The frontal systems behavior scale manual. Psychological Assessment Resources, Odessa

50.

Drijgers RL, Verhey FR, Leentjens AF, Kohler S, Aalten P (2011) Neuropsychological correlates of apathy in mild cognitive impairment and Alzheimer’s disease: the role of executive functioning. Int Psychogeriatr 23:1327–1333. https://doi.org/10.1017/S1041610211001037 CrossRefPubMed

51.

Balazs J, Miklosi M, Kereszteny A, Hoven CW, Carli V, Wasserman C, Apter A, Bobes J, Brunner R, Cosman D, Cotter P, Haring C, Iosue M, Kaess M, Kahn JP, Keeley H, Marusic D, Postuvan V, Resch F, Saiz PA, Sisask M, Snir A, Tubiana A, Varnik A, Sarchiapone M, Wasserman D (2013) Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry 54:670–677. https://doi.org/10.1111/jcpp.12016 CrossRefPubMed

52.

Zenker S, Haverkamp F, Klingmuller D (2002) Growth hormone deficiency in pituitary disease: relationship to depression, apathy and somatic complaints. Eur J Endocrinol 147:165–171CrossRefPubMed

53.

Mortby ME, Maercker A, Forstmeier S (2012) Apathy: a separate syndrome from depression in dementia? A critical review. Aging Clin Exp Res 24:305–316. https://doi.org/10.3275/8105 CrossRefPubMed

54.

Duffy J (2000) Apathy in neurologic disorders. Current Psychiatry Rep 2:434–439. https://doi.org/10.1007/s11920-000-0029-z CrossRef

55.

Thobois S, Prange S, Sgambato-Faure V, Tremblay L, Broussolle E (2017) Imaging the etiology of apathy, anxiety, and depression in Parkinson’s disease: implication for treatment. Curr Neurol Neurosci Rep 17:76. https://doi.org/10.1007/s11910-017-0788-0 CrossRefPubMed

56.

Skorvanek M, Gdovinova Z, Rosenberger J, Saeedian RG, Nagyova I, Groothoff JW, van Dijk JP (2015) The associations between fatigue, apathy, and depression in Parkinson’s disease. Acta Neurol Scand 131:80–87. https://doi.org/10.1111/ane.12282 CrossRefPubMed

57.

Carroll C, Watson P, Spoudeas HA, Hawkins MM, Walker DA, Clare IC, Holland AJ, Ring HA (2013) Prevalence, associations, and predictors of apathy in adult survivors of infantile (< 5 years of age) posterior fossa brain tumors. Neuro Oncol 15:497–505. https://doi.org/10.1093/neuonc/nos320 CrossRefPubMedPubMedCentral

58.

Ailion AS, Hortman K, King TZ (2017) Childhood brain tumors: a systematic review of the structural neuroimaging literature. Neuropsychol Rev 27:220–244. https://doi.org/10.1007/s11065-017-9352-6 CrossRefPubMed

59.

Zhang Y, Zou P, Mulhern RK, Butler RW, Laningham FH, Ogg RJ (2008) Brain structural abnormalities in survivors of pediatric posterior fossa brain tumors: a voxel-based morphometry study using free-form deformation. Neuroimage 42:218–229. https://doi.org/10.1016/j.neuroimage.2008.04.181 CrossRefPubMed

60.

Muller HL, Gebhardt U, Teske C, Faldum A, Zwiener I, Warmuth-Metz M, Pietsch T, Pohl F, Sorensen N, Calaminus G (2011) Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up. Eur J Endocrinol 165:17–24. https://doi.org/10.1530/EJE-11-0158 CrossRefPubMed

Title: Self- and informant-rated apathy in patients with childhood-onset craniopharyngioma
Authors: Aylin Mehren
Jale Özyurt
Paula zu Klampen
Svenja Boekhoff
Christiane M. Thiel
Hermann L. Müller
Publication date: 01-10-2018
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 1/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-018-2936-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Self- and informant-rated apathy in patients with childhood-onset craniopharyngioma

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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