David Cash was a college student who found himself in the women's restroom of the Primadonna in Nevada. He witnessed his friend, Jeremy Strohmeyer raping and killing a 7-year-old girl. Cash did not take any action in trying to prevent this heinous crime. There are many elements to consider when bystanders neglect to take action. Research examining bystander apathy in critical situations is lacking, yet the number of violent crimes witnessed by others where intervention is not offered continues to escalate. Bullying often occurs in the presence of others. Bystander apathy is believed to play a passive role in most cases of bullying. This study investigated the psychological symptom patterns of intervening and non-intervening bystanders in bullying events. It was hypothesized that there would be a significant difference in the SLC-90-R profiles between intervening and non-intervening bystanders. It was further hypothesized that gender would significantly interact with the bystander response to witnessing bullying. Data were collected from undergraduate participants at the University of Central Florida through The Psychology Department's Psychological Research Participant System (aka, SONA). Psychological Symptoms were evaluated using the Symptom-Checklist-90-Revised (SCL-90-R). Data was obtained from 135 undergraduate participants. The sample consisted of 42 males and 93 females between 18 to 58 years of age. The participants were categorized by intervening and non-intervening bystanders. A two-way between subjects MANOVA was used to assess the influence of gender and intervening and non-intervening bystanders on the nine SLC-90-R symptom domains. No significant main effects or interaction was observed. However, a review of the univariate analyses revealed a significant gender x intervening interaction on the paranoid ideation subscale, F(1, 131) = 4.823, p = .03. Implications and directions for future research are discussed.

Political disillusionment is widespread in contemporary Japanese society, despite people’s struggles in the recession. Our social relationships become entangled, and we can no longer clearly identify our interest in politics. The search for the outside of stagnant reality sometimes leads marginalised young people to a disastrous imaginary for social change, such as war and death. The imaginary of disaster was actualised in March 2011. The huge earthquake and tsunami caused the meltdown of the Fukushima Daiichi nuclear plant, which triggered the largest wave of activism since the 1960s. Based on the author’s fieldwork on the post-Fukushima anti-nuclear movements in Tokyo, this thesis investigates how the disaster impacted people’s sense of agency and ethics, and ultimately explores the new political imaginary in postmodernity. The disaster revealed the interconnected nature of contemporary society. The thesis argues that their regret about their past indifference to politics motivated the protesters into social commitment without any totalising ideology or predetermined collective identity. They also found an ambiguity of the self, which is insufficient to know what should be done. Hence, they mobilise their bodies on to the streets, encountering others, and forcing themselves to feel and think. This is an ethical attitude, yet it simultaneously stems from the desire of each individual to make a difference to the self and society. The thesis concludes that the post-Fukushima anti-nuclear movements signify a new way of doing politics as endless experiments by collectively responding to an unexpected force from an outside in a creative way.

Early detection of Alzheimer's disease (AD) and related dementias in the elderly is critical for improving treatment methods and is a necessary component for improving public health interventions. One of the earliest and most common behavioral syndromes of AD is apathy and is associated with executive dysfunction. Apathy in AD is often misdiagnosed as depression due to an overlap in symptoms. Studies that have found depression to be associated with executive dysfunction have not always controlled for the presence of apathy. The Geriatric Depression Scale (GDS) is a widely used instrument designed to assess depression in the elderly. This study utilized the GDS and a set of standard neuropsychological instruments to investigate the relationship between apathy, depression, and executive functions in individuals with AD and related dementias. The first objective of this study was to determine if apathy has a greater impact on executive functions compared to depression in AD and related dementias. The second objective was to determine the effectiveness of the GDS as a screen for apathy. The results of the analyses did not support the hypotheses. However, exploratory analyses suggested a possible non-linear relationship with apathy and various levels of dementia severity. Exploratory analysis also suggested mean levels of endorsement for apathy varied by diagnosis. Further research is warranted to investigate this relationship and the GDS endorsement patterns for caregivers regarding their impression of the demented individual.

Thesis (MScMedSc (Biomedical Sciences. Medical Physiology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: HIV/AIDS is a global epidemic that accounts for a large percentage of the mortality in South Africa every year. Since the implementation of anti-retroviral treatment, HIV positive individuals have been living longer, and the cognitive impairment associated with the disease is becoming increasingly apparent. During the initial systemic infection of HIV, the virus migrates through the blood-brain barrier and inflicts axonal injury by causing upregulation of cytokines and neurotoxic proteins. HIV-associated dementia is a neuropsychological classification of cognitive impairment in HIV and a variety of symptoms have been classified as a part of the dementia complex. One of these is apathy, which is thought to be a precursor for dementia in HIV patients. Three groups of individuals have been recruited and scanned using magnetic resonance imaging (MRI) to examine changes in the brain. These are an HIV non-apathetic cohort, an HIV apathetic cohort and a healthy control cohort. Diffusion tensor imaging (DTI) is an MRI technique used to quantitatively assess white matter (WM) integrity using metrics such as fractional anisotropy (FA). Voxel-based analysis, tract-based spatial statistics (TBSS) and tractography are three established DTI analysis methods that have been applied in numerous studies. However, there are certain methodological strengths and limitations associated with each technique and therefore all three of these techniques were used to compare WM differences across groups. The frontal-subcortical pathways are known to be abnormal in apathy, and this has been demonstrated in a number of imaging studies. Most of these studies have examined apathy in the context of neurodegenerative disorders such as Alzheimer’s disease and Parkinson’s. However, to our knowledge this is the first DTI study in HIV apathetic patients. With the tractography method, the anterior thalamic radiation and the corpus callosum were reconstructed for each individual to determine whether there were any global changes in these tracts. No significant changes were found. However, a variety of regions in the WM were significantly abnormal in the HIV cohorts when comparing the data at a voxel-based level and using TBSS. This included areas such as the genu and splenium of the corpus callosum, the internal capsule and corona radiata. Changes in frontal WM for the HIV apathy group are an indication of dysfunction in the frontal-striatal circuits, and previous literature has implicated these circuits in the neuropathology of apathy in a variety of central nervous system (CNS) disorders. / AFRIKAANSE OPSOMMING: MIV/VIGS is `n wêreldwye epidemie wat verantwoordelik is vir `n hoë sterftesyfer in Suid- Afrika elke jaar. Sedert die inleiding van anti-retrovirale behandeling, het die MIV-positiewe populasie se lewensduur verleng. Tesame met langer lewensduur, het die kognitiewe verswakking wat geassosieer word met die siekte ook meer prominent na vore gekom. Gedurende die beginstadium van sistemiese infeksie in MIV is daar `n migrasie van die virus deur die bloed-breinskans. MIV kan indirek verantwoordelik wees vir aksonale beskadiging deur verhoging van neurotoksiese proteine en sitokinien te induseer. MIV-geassosieerde demensie is `n neurosielkundige klassifikasie van kognitiewe verswakking in MIV en verskeie simptome is al geïdentifiseer as deel van die demensie kompleks. Een van die simptome is apatie en daar word gespekuleer dat dit `n voorloper is vir demensie in MIV pasiënte. Drie groepe individue was gewerf vir die studie en geskandeer deur magnetiese resonansie beeldvorming (MRB) om sodoende veranderinge in die brein te ondersoek. Die groepe was onderskeidelik `n HIV nie-apatiese kohort, `n HIV apatiese kohort en `n gesonde kontrole kohort. Diffusie tensor beelding (DTB) is `n MRB tegniek wat toegepas word om witstof integriteit te meet deur gebruik te maak van maatstawwe soos fraksionele anisotropie (FA). “Voxel-based analysis”, “tract-based spatial statistics (TBSS)” en “tractography” is drie gevestigde DTB analitiese metodes wat al in talle studies toegepas was. Daar is egter sekere metodologiese voordele en beperkings verbonde aan elke tegniek en daarom is al drie tegnieke gebruik om witstof verskille tussen groepe te vergelyk. Die frontale-subkortikale roetes in die brein is bekend vir abnormaliteite in apatie en dit was ook al gedemonstreer in verskeie studies. Die meeste van die studies het apatie ondersoek in die konteks van neurodegeneratiewe siektes soos Alzheimer se siekte en Parkinson se siekte. Maar sover ons weet is hierdie die eerste DTB studie in MIV pasiënte met apatie. Met die “tractography” metode was die anterior thalamic radiation en corpus callosum herbou vir elke individu. Dit was om te bepaal of daar enige globale veranderinge is in hierdie gebiede, maar geen beduidende veranderinge is gevind nie.`n Verskeidenheid van gebiede in die witstof was beduidend abnormaal in die MIV kohorte wanneer die data vergelyk was met “TBSS” en “voxel-based analysis.” Dit het gebiede ingesluit soos die genu en splenium van die corpus callosum, die internal capsule en die corona radiata. Veranderinge in die frontale witstof vir die MIVapatie groep is `n aanduiding van disfunksie in die frontale-striatale bane. Vorige literatuur impliseer dat hierdie bane betrokke is in die neuro-patologie van apatie in verskeie sentrale senuweestelsel (SS) steurings.

Although Parkinson’s disease (PD) is commonly characterized by motor symptoms and physical limitations, there is growing recognition of nonmotor and mood symptoms associated with the disease as well. There has been limited research exploring how individual coping might affect the relationships between PD symptoms and mental health outcomes. The resilience construct was originally developed within the child literature, and it is often used in conceptualizing how people have adaptive or positive outcomes when facing adversity. Current resilience measures may not adequately assess the construct within an older population, however, given the unique emotion regulation and coping skills seen in late life. This survey study of 139 community-dwelling adults with PD (M age = 64.25 years, SD = 10.12, range 34-89 years) investigated whether resilience moderated the relationship between PD-related factors (nonmotor symptoms, functional impairment, and disease symptom-related QOL) and mental health outcomes (depression, apathy, satisfaction with and adjustment-quality of life). Further analyses explored whether hypothesized age-related resilience components (optimism, goal-flexibility, and meaning-making ability), accounted for unique variance above and beyond a standard resilience measure (Resilience Scale for Adults). Results indicated that disease symptom-related QOL predicted depression and adjustment-related QOL, while functional impairment predicted apathy, life satisfaction, and adjustment related QOL. Participants overall reported moderate to high resilience; resilience was a significant predictor of all mental health/QOL outcome measures, and those with comparatively lower self-reported resilience had worse disease symptoms. Resilience did not moderate the relationship between disease symptoms and mental health/QOL. Meaning-making ability and goal-flexibility accounted for unique variance above and beyond the standard resilience measure for several outcome variables. Age was a significant moderator, such that the protective value of meaning-making ability and optimism on depression were greater for younger compared to older participants. This study highlighted the presence of moderate to high resilience in PD patients, however those with comparatively lower resilience had poorer outcomes. Other coping variables appear to be important contributors to mental health/QOL beyond a standard resilience measure. Patient age also affected several outcomes, emphasizing the importance of further integration of developmental literature into our understanding of resilience in chronic disease management.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-11-05T12:59:47Z No. of bitstreams: 1 Adriana Meyer Barbuda Gradin.pdf: 1097151 bytes, checksum: d17bb90919633bfdb4d680b5f50b0ee0 (MD5) / Made available in DSpace on 2018-11-05T12:59:47Z (GMT). No. of bitstreams: 1 Adriana Meyer Barbuda Gradin.pdf: 1097151 bytes, checksum: d17bb90919633bfdb4d680b5f50b0ee0 (MD5) Previous issue date: 2018-09-14 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / This research starts from the objective of deepening theoretical and clinical thinking about boredom and apathy, symptoms that have been reported in analysis in an increasingly significant number, both by young people, and by adults and children who experience an anesthetized existence, unmotivated and without pleasure; also starts from the enigmas and obstacles experienced in psychoanalytic clinic and aims to group knowledge about boredom and apathy, in order to propose an instrument of clinical management for cases of psychic suffering of individuals marked by such symptoms. It has, therefore, the nature of a psychoanalytic research, of theoretical-clinical order. From the listening of such cases, it is proposed in this work a classification of the manifestations of boredom and apathy, a choice that is made not by ode to the theory, but rather, with the intention of finding subsidies to differentiate each manifestation of the others in order to reflect on the possible clinical management. The appreciation of the symptoms of apathy and boredom is made from some vignettes and clinical cases. In the dissertation, it is also appreciated the performance of the analyst against such impasses. It seeks to understand how analytical management can enable a route of symbolization and access the ability to be alive to the bored or apathetic pacient. It is argued that, in such cases, the analyst should offer a space not only for deciphering verbal contents to meet the purposse of making que repressed material conscious, but, more broadly, to offer a space of continence of nonverbal aspects and forms of unconscious communication. It is maintained that clinical listening of boredom and apathy requires the analyst to adopt an ethics of care: the analysis must be a potential space that can enable an amplification of the analysand's capacity to represent his traumas and psychic pains that had to be silenced; a space that produces a fruitful encounter as well as the work of mourning of the analysand and his works of play and dreaming, so that he can invest in objects and recognize otherness in a non-threatening way / A presente pesquisa parte do objetivo de aprofundamento do pensamento teórico e clínico a respeito do tédio e da apatia, sintomas que vêm sendo relatados em análise em número cada vez mais significativo, tanto por jovens, quanto por adultos e crianças que experimentam uma existência anestesiada, desmotivada e sem prazer; parte dos enigmas e dos obstáculos vivenciados na clínica psicanalítica e tem como propósito agrupar conhecimentos sobre o tédio e a apatia, a fim de propor um instrumental de manejo clínico para casos de sofrimento psíquico de indivíduos marcados por esses sintomas. Ela tem, assim, a natureza de uma pesquisa em psicanálise, de ordem teórico-clínica. A partir da escuta analítica de tais casos, propõe-se neste trabalho uma classificação das modalidades de manifestação do tédio e da apatia, escolha que se faz não por ode à teoria, mas sim, com o intuito de encontrar subsídios para diferenciar cada manifestação das demais a fim de refletir sobre os manejos clínicos possíveis. A apreciação dos sintomas da apatia e do tédio é feita a partir de algumas vinhetas e casos clínicos. Busca-se entender de que forma o manejo analítico pode viabilizar uma rota de simbolização e a capacidade de estar vivo do analisando apático ou entediado. Defende-se que, nesses casos, o analista deve oferecer um espaço não só de decifração de conteúdos verbais para atender ao fim de tornar consciente o material reprimido, mas sim, de forma mais ampla, ofertar um espaço de continência de aspectos não-verbais e de formas de comunicação inconsciente. Sustenta-se que a escuta clínica do tédio e da apatia requer do analista a adoção de uma ética do cuidado: a análise há de ser um espaço potencial que possa viabilizar uma ampliação da capacidade de representação do analisando quanto aos seus traumas e dores psíquicas que tiveram que silenciar; um espaço que produza um encontro frutífero também quanto aos trabalhos de luto do analisando e os seus trabalhos do brincar e do sonhar, para que possa investir em objetos e reconhecer a alteridade de forma não ameaçadora

Made available in DSpace on 2016-04-27T18:47:07Z (GMT). No. of bitstreams: 1 Rafael Fortes.pdf: 1216994 bytes, checksum: dadc60b6b7445bed5da90ffbfcd6ffb8 (MD5) Previous issue date: 2011-06-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / From a humane approach, involving the touch in orthopedic physical therapy and respiratory diseases, the creation of a bond with the caregiver and given guidance as to the physical care and social on the patients with Alzheimer's at an advanced stage, it is possible to work with physical therapy under a look geriatric, encouraging the patient to control their thinking and behavioral changes, particularly apathy. This is a qualitative study using participant observation, interviews with caregivers, the Zarit Burden Interview, and a diary, where for three months, three patients with Alzheimer's disease at an advanced stage will undergo a physical therapy program. Every session will be accompanied by family caregivers, that will be instructed as to the environmental awareness, accessibility, physical care with the patient in addition to socialization and family integration. Creating, in this way, a new physical therapy approach aimed at improvement of behavioral changes in Alzheimer's disease at an advanced stage / A partir de uma abordagem mais humanizada, envolvendo o toque fisioterapêutico em condutas ortopédicas e respiratórios, da criação de um vínculo com o cuidador e dadas orientações quanto ao cuidado físico e social no sujeito com Alzheimer em fase avançada, é possível trabalhar com a fisioterapia sob um olhar gerontológico, estimulando o doente e pensando em controlar as alterações comportamentais, principalmente a apatia. Esse é um estudo qualitativo, que utiliza a observação participante, uma entrevista, o inventário de sobrecarga do cuidador, avaliação fisioterapêutica e um diário de campo, onde durante três meses, três sujeitos com Doença de Alzheimer em fase avançada serão submetidos a um programa de tratamento fisioterapêutico. Toda sessão será acompanhada pelo cuidador familiar, sendo este orientado quanto à alterações no ambiente, acessibilidade, cuidados físicos com o doente além de socialização e integração familiar. Criando assim uma nova abordagem fisioterapêutica visando melhora das alterações comportamentais na doença de Alzheimer em fase avançada

L'AVC est la seconde cause de décès et la première cause de handicaps acquis chez l’adulte dans le monde. Au cours des vingt dernières années le traitement en phase aigüe de l'AVC s’est considérablement amélioré. La mortalité post-AVC a alors commencé à diminuer et la proportion de patients survivants avec un handicap léger ou modéré a augmenté. Le suivi à long terme de ces patients a permis de mettre en évidence, chez une proportion importante d’entre-eux, la survenue d’une forte détresse psychologique. Ces troubles de l’humeur réduisent considérablement la qualité de vie post- AVC. La prise en charge principalement axée sur les déficits moteurs, sensoriels ou de langage, commence alors à s’orienter vers la prise en charge psychiatrique des patients. Ces complications restent cependant insuffisamment comprises et leur prise en charge demeure insatisfaisante. Dans ce contexte, l’objectif de ce travail de thèse a été de mieux décrire les troubles de l’humeur post-AVC et de mettre en évidence, grâce à des outils de mesure objectifs, l’existence de facteurs de risques de leur survenue. 91 patients ont été suivis durant un an et ont répondu à des évaluations cognitives, de l’humeur, du sommeil et/ou du langage. Les résultats obtenus ont permis d’identifier certaines variables impliquées dans la survenue ou l’évolution de certains troubles post-AVC, par exemple la fragmentation du sommeil avec l’apathie ou la prosodie affective avec la dépression. Les lésions cérébelleuses semblent également liées à la survenus des troubles de l’humeur post-AVC. Ces résultats s’inscrivent dans une dynamique de recherche de plus en plus importante concernant les troubles de l’humeur post-AVC. / Stroke is the second leading cause of death and the leading cause of acquired disability in adults worldwide. Over the last twenty years, treatment in the acute phase of stroke has improved considerably. As a result, post-stroke mortality began to decline and the proportion of surviving patients with mild or moderate disabilities has increased. The long-term monitoring of this category of patients allowed to highlight, in a significant proportion of them, the occurrence of high psychological distress. These mood disorders significantly reduce post-stroke quality of life and, therefore, the assumption that put primary emphasis on the motor deficits, sensory or language now begins to move towards the psychological care of patients. These complications are however still insufficiently understood and their management remains unsatisfactory.In this context, the objective of this PhD was to better describe these post-stroke mood disorders and highlight, through objective measurement tools, the existence of risk factors for their occurrence. 91 patients were followed during one year after stroke and were evaluated on cognitive assessments, mood state evaluation, sleep recording and language recording. The results allowed us to better understand the involvement of some variables in the occurrence or progression of some mood disorders, for example sleep fragmentation and post-stroke apathy or affective prosody and post-stroke depression. Cerebellar lesions also appear to be related to the occurrence of post-stroke mood disorders. These results are part of the increasing research on post-stroke mood disorders.

INTRODUÇÃO: A apatia constitui o transtorno neuropsiquiátrico mais prevalente na doença de Alzheimer (DA) e se relaciona com uma série de desfechos deletérios. Sua neurobiologia ainda é pouco compreendida, e alguns autores postulam sua associação com disfunção de circuitos fronto-estriatais. A maior parte da evidência disponível sobre essa relação provém de estudos em que foram avaliados pacientes com DA leve a moderada. OBJETIVO: Investigar a associação entre apatia e disfunção executiva em estágios bastante iniciais do processo de declínio cognitivo no contexto da DA. MÉTODOS: Foram avaliados 87 indivíduos, sendo 28 deles com DA leve, 26 com Comprometimento Cognitivo Leve de subtipo amnéstico (CCLa) e 33 controles. Os participantes foram submetidos a uma bateria de avaliações da qual constavam a Bateria Breve de Rastreio Cognitivo (BBRC-Edu), o Mini-Exame do Estado Mental (MEEM), a Entrevisa Executiva (EXIT-25), a Bateria de Avaliação Frontal (BAF), a Escala de Avaliação de Demência (DRS), o Teste de Aprendizagem Auditivo Verbal de Rey (RAVLT), a Escala de Avaliação de Incapacidade na Demência (DAD) e a Escala de Apatia (EA). Explorou-se correlações entre o desempenho nos testes empregados e os escores aferidos pela EA, nos grupos com comprometimento cognitivo (DA ou CCLa), e em grupos constituídos a partir da combinação deles, considerando os pacientes com CCLa conversores à DA no seguimento. RESULTADOS: O grupo de pacientes com DA apresentava média de idade de 81,9 ± 4,8 anos e escolaridade média de 2,5 ± 2,0 anos. O grupo com CCLa apresentava média de idade de 80,8 ± 3,7 anos e escolaridade média de 3,7 ± 2,8 anos. O grupo dos controles apresentava média de idade de 79,5 ± 3,5 anos e escolaridade média de 3,7 ± 3,3 anos. Os três grupos não se distinguiam significativamente quanto às suas características sociodemográficas. Não foram observadas correlações entre o desempenho em quaisquer dos testes de função executiva empregados e os escores obtidos por meio da EA. Observou-se correlação forte entre o desempenho funcional auferido através da DAD e os escores na EA (rho= -0,7; p<0,001) no grupo DA. Documentou-se correlação moderada entre a sintomatologia apática e o desempenho na subescala Atenção da DRS (rho= -0,59; p<0,01) e em tarefas de evocação tardia nos testes de memória episódica da BBRC (rho=-0,37; p<0,05) e do RAVLT (rho= -0,47; p< 0,001), quando analisados em conjunto os pacientes com DA e aqueles com CCLa que converteram para DA. CONCLUSÃO: Nesta amostra de indivíduos com baixa escolaridade, composta por pacientes com DA leve e CCLa, não se observou associação entre o desempenho em testes de função executiva e a sintomatologia apática medida pela EA / INTRODUCTION: Apathy is the most prevalent neuropsychiatric disorder in Alzheimer disease (AD), and has been related to several deleterious outcomes. Its neurobiology is still poorly understood, and some studies have suggested an association with frontostriatal circuits dysfunction. Most of this evidence comes from studies with mild to moderate AD patients. OBJECTIVE: To investigate the association between apathy and executive dysfunction in the very early stages of cognitive impairment in the context of AD. METHODS: 87 subjects were evaluated, being 28 with mild AD, 26 with amnestic Mild Cognitive Impairment (aMCI) and 33 controls. The participants were submitted to a comprehensively evaluation consisting on the Brief Cognitive Screening Battery (BCSC), the Mini-Mental State Examination (MMSE), the Executive Interview (EXIT-25), the Frontal Assessment Battery (FAB), the Mattis Dementia Rating Scale (DRS), the Rey Auditory Verbal Learning Test (RAVLT), the Disability Assessment in Dementia (DAD), and the Apathy Scale (AS). Correlations were investigated between AS scores and the performance in the cognitive measures within the two cognitively impaired groups (AD or aMCI) and also within combinations of them, considering aMCI convertion to AD. RESULTS: The AD group had mean age of 81.9 ± 4.8 years, and 2.5 ± 2.0 mean years of formal education, while the aMCI group had mean age of 80.8 ± 3.7 years and a mean of 3.7 ± 2.8 years of schooling. Controls were aged 79.5 ± 3.5 years, with 3.7 ± 3.3 years of education. The three groups did not differ statistically from each other regarding the main sociodemographic features. There was no correlation between any executive measure and AS scores. We found strong correlations between AS scores and functional performance evaluated with the DAD (rho= -0.70; p <0.001) in the AD group. There were also modest to moderate correlations between AS scores and DRS Attention subscale (rho= -0.59; p<0.01), and with delayed recall tasks of episodic memory tests from the BCSB (rho=-0.37; p<0.05) and the RAVLT (rho= -0.47 ; p< 0.05), when AD and aMCI converters were analysed toghether as a group. CONCLUSION: In this sample consisting of mild AD and aMCI subjects, with very low educational level, we failed to find any association between executive function tests performance and apathy symptoms measured with the AS

Objective: This dissertation includes three projects that study care environments and apathy in dementia as well as measures of activity. Project 1 developed the Person-Environment Apathy Rating (PEAR) scale to measure environmental stimulation and apathy, and tested its psychometrics. Project 2 examined the association between care environments and apathy in persons with dementia. Project 3 tested the accuracy of ActiGraph and activPALTM activity monitors in measuring weight-bearing activities among persons with previous diabetic foot ulcers. Methods: The PEAR consists of environment (PEAR-Environment) and apathy (PEAR-Apathy) subscales. The validity and reliability of the PEAR was examined through video observation of 24 participants. Project 2 selected 40 participants with dementia in order to examine the association between apathy and environmental stimulation, ambiance, crowding, staff familiarity, and light and sound. Study procedures involved video observation and data extraction. Project 3 enrolled 31 participants to test the accuracy of ActiGraph and activPALTM in measuring number of steps taken and duration of walking, standing, sitting, and lying. Results: The PEAR-Environment subscale had significant but fair correlation with the Crowding Index (Ρ=.27, p<.01), suggesting fair validity. The PEAR-Apathy highly correlated with the Passivity in Dementia Scale (ρ=.81) and Neuropsychiatry Inventory (NPI)-Apathy subscale (ρ=.266), and moderately correlated with the NPI-Depression subscale (ρ=.46), indicating good convergent validity and moderate discriminate validity. The PEAR also demonstrated good internal consistency (Cronbach's Α= .84 -.85) and moderate to good inter-rater (Weighted Kappa=.47-.94) and intra-rater (Weighted Kappa=.47-.94) reliability. Project 2 revealed that stimulation clarity and strength were significantly associated with a low apathy level (p<.001). An increase of 1 point on stimulation clarity and strength corresponded to a decrease on apathy score of 1.3 and 1.9 points, respectively. Project 3 revealed that ActiGraph had widely varied accuracy in measuring duration of standing, walking, sitting, and lying (0-100%) and in measuring number of steps taken (43-81%). In contrast, activPALTM showed consistently high accuracy in measuring duration of standing, walking, sitting, and lying (97-100%) and in measuring number of steps of taken (91-99%). Discussion: The PEAR is a valid and reliable measure of care environment and apathy in long-term care residents with dementia. Care environments that contain clear and sufficiently strong environmental stimulation are significantly associated with lower apathy levels, providing a foundation for interventions targeting apathy. ActivPALTM is a valid tool to measure weight-bearing activity in persons with diabetes in order to examine the role of weight-bearing activity in foot ulceration. This monitor may also be useful as a supplemental measure for apathy in persons with dementia.