Apathy subtypes in acute stroke: validation of the Russian self-rated Dimensional Apathy Scale

Background: Apathy is a syndrome that can occur in a third of stroke patients. It can be measured by the Dimensional Apathy Scale (DAS), not yet utilized in acute stroke or translated to Russian. 

Aim: To explore apathy subtypes in acute stroke while validating the self-rated Russian DAS. Methods: Acute stroke patients (10 days post-stroke) and controls completed the Russian self-rated DAS, a depression measure, cognitive screen, and functional and stroke severity measures. Russian DAS psychometrics and apathy subtype relationships were explored. 

Results: Eighty-seven acute stroke patients and 50 controls were recruited. The Russian DAS internal consistency reliability was good (Alpha = 0.70). Depression was not significantly correlated with emotional apathy, but was significantly positively correlated with initiation and executive apathy, with no functional and stroke severity relationships observed. 34.6% of acute stroke patients displayed apathy, with Executive apathy as the most common, followed by Initiation apathy. Initiation apathy was significantly negatively correlated with cognitive functioning, with cognitively impaired patients having significantly higher Initiation apathy (p < 0.01). Executive apathy was higher in those with higher depression severity (p < 0.001). 

Conclusions: The Russian DAS is a psychometrically robust multidimensional measure for assessment in acute stroke with emergent preliminary apathy profiles observed, associated with cognitive functioning and depression.