Apathy in Cerebral Small Vessel Disease Stroke Is a Predictor of Quality of Life, Mood and Distress in Both Patients and Carers.

OBJECTIVE: Apathy occurs in one-third of patients after stroke and is particularly common in small vessel disease (SVD) stroke. Apathy is known to be associated with reduced ability to engage in everyday life activities, including neurorehabilitation. Apathy has been associated with increased caregiver burden and distress in other neurological diseases, but there is little data on stroke. We aimed to evaluate whether distress is higher and quality of life (QoL) lower in apathetic stroke patients and their caregivers. METHODS: We conducted a cohort study on patients with symptomatic SVD and their caregivers. We recruited 40 patient-caregiver pairs (20 with apathy and 20 without) and assessed apathy, patient disability, QoL, cognition and depression. We assessed apathy-related caregivers' distress, caregiver burden, mood and quality of life. Statistical tests were performed to compare the apathetic and control groups. Univariate correlations and multiple linear regressions were used to assess relationships between apathy and measures of quality of life, burden, distress and mood. RESULTS: Apathy was a strong predictor of caregiver distress (β = 0.11, p < 0.001), burden (β = 0.7, p < 0.001) and depression (β = 0.12, p < 0.001). In contrast, physical disability was not an independent predictor of caregiver burden. Apathy was also a strong predictor of patient QoL (β = -0.67, p < 0.001) and depression (β = 0.49, p < 0.001). CONCLUSION: Apathy is a major independent predictor of caregiver burden. Caregivers of apathic patients experience increased distress, burden and lower mood. Patients with apathy also experience lower mood and worse QoL. The major effect of apathy on caregivers suggests targeting them should be an important component of the treatment of apathy in patients with stroke.