Les objectifs étaient de rappeler les différentes conceptualisations de l’apathie, d’analyser les outils permettant son évaluation chez la personne âgée d’un point de vue critique et de présenter les corrélats de l’apathie.

L’équation suivante a été utilisée dans les bases de données EBSCOHOST, web of science et pubmed en anglais et en français : «  apathy OR lack of motivation OR motivation reduction  » et «  questionnaire OR survey OR scale OR instrument OR measure OR assessment  ».

Le concept d’apathie a connu une évolution importante, depuis la perte de motivation jusqu’à la réduction des comportements, pensées et émotions motivés par un but. L’apathie a fortement été investiguée sous ses formes syndromiques et symptomatiques dans le cadre des maladies neuro-évolutives et psychiatriques. Trois critères permettent actuellement son diagnostic : diminution de l’initiative, diminution de l’intérêt, diminution des expressions ou réponses émotionnelles. Au total, 7 outils d’évaluation ont été identifiés dans la littérature. Ceux-ci visent l’évaluation de l’apathie chez les personnes ne présentant pas de troubles, celles présentant un trouble psychiatrique, chez les individus avec une maladie neuro-évolutive non spécifique et ceux avec une maladie neuro-évolutive spécifique. Les principaux corrélats de l’apathie identifiés chez la personne âgée sont le fonctionnement cognitif, la dépression et l’anosognosie.

La majorité des échelles identifiées dans la littérature ont une bonne validité psychométrique. Du point de vue clinique, les caractéristiques des échelles sont discutées au regard des critères appui théorique, faisabilité et complexité. Les caractéristiques individuelles de la personne âgée doivent être prises en compte telles que le niveau de fonctionnement cognitif.

Apathy is a multidimensional concept characterized by a reduction in goal-directed behaviours, thoughts, and emotions. Apathy increases with age; it is therefore common during aging, especially since it is often associated with neuro-evolutive diseases and/or psychiatric diseases. Apathy has significant repercussions on the patient's life, their entourage, and their care pathway. To understand apathy, it is necessary to establish a consensus on its definition and causes. However, the scientific literature reports different definitions and its causes do not seem to be consensual. This multiplicity can be complex to understand and lead to diagnostic difficulties. The tools for evaluating apathy are, like its definitions and causes, numerous. The risk is then to use a tool that is poorly adapted to the population or to the problems of the older persons. The objectives were to review the different conceptualisations of apathy, to analyse the tools for critically assessing apathy in the older persons and to present the correlates of apathy.

The following equation was used in EBSCOHOST, web of science and pubmed databases: “ apathy OR lack of motivation OR motivation reduction ” et “ questionnaire OR survey OR scale OR instrument OR measure OR assessment ”.

Historically, the concept of apathy has been centered around three components (cognitive, behavioral, and emotional). Initially underpinned by the concept of motivation, it will be reoriented towards a reduction in goal-directed behaviors through loss of interest (cognitive), decreased self-initiation (behavior), and affective-emotional blunting. Apathy is considered as a symptom of a mental illness or as a neurological syndrome in its own right. Apathy has been extensively investigated in its syndromic and symptomatic forms in the context of neuroevolutive and psychiatric diseases. It is currently diagnosed on the basis of three criteria: reduced initiative, reduced interest and reduced emotional expression or response. Apathy assessment tools reflect its conceptual evolution and causes: we identify 7 in the literature. The scales can be grouped into three categories: those assessing apathy in older adults without pathologies or with a psychiatric illness; those assessing apathy in people with neurodevelopmental disorders; and those developed for older adults with a specific neurodevelopmental disorder. The psychometric characteristics of these scales are described in terms of sensitivity, reliability and validity. The main correlates of apathy identified among older persons were cognitive functioning, depression and anosognosia. This clearly suggests the influence of cognition on apathy and the interest in considering the cognitive status of the individual whose apathy one wishes to evaluate, understanding the anosognosia of apathy and its connection to the severity of cognitive disorders.

The scales have been subject to various psychometric validations and are therefore quite reliable. From a clinical and research perspective, three main criteria will be examined: theoretical support, feasibility and complexity. The first refers to the correspondence between the structure of the scale and the conceptualization of apathy in the literature. The second criterion refers to the adaptability of the scale to the specificities of older persons, in particular the fatigue associated with the number of items, the negative wording making the item more difficult to understand, etc. The third refers to the reliability of the responses in terms of the methods of assessment (self and other assessment) in contexts of cognitive impairment. It should be remembered that, in addition to the characteristics related to the subject's pathology and the psychometric qualities of the tool, the clinician's or researcher's choice should primarily be based on the existence of the subject's cognitive impairment and take into account its severity. In this context, a tool with a hetero-administered version appears all the more reliable as cognitive impairment is significant. Similarly, feasibility for the person concerned (simplicity of the items and their number) will be a particularly relevant criterion. Two limitations emerged during the writing of this article. For a number of scales, the validation articles in French were not accessible. This led us to present mainly the psychometric and clinical characteristics of the original scales in English. Moreover, some of the original scales were in English. The validation in French of a scale currently requires translation through the “backtranslation” method. As the majority of the scale validation articles presented previously do not report the methodology related to translation, we have excluded this criterion from our analysis. This article identifies the scales to use according to the contexts and the population targeted by the evaluation. It also highlights the limitations of certain scales in light of the different criteria we used during the analysis. Although not official, the criteria of feasibility, theoretical support, and complexity allow us to address the specificities of aging with or without cognitive difficulties. These criteria could be helpful in developing and validating assessment tools for older persons.