Question
What is post-stroke apathy and the clinical features of post-stroke apathy?
Answer
Recently, research has moved towards redefining apathy as a loss of goal-directed behavior, since behavior is something external, which we can both observe and measure. I just wanted to take a moment to recognize how we, as physical therapists frequently describe our patients. So this loss of goal-directed behavior, what does that mean, and how do we typically document it? Think about how many times you have seen or documented yourself that someone has, "poor task initiation", or "poor task persistence" or my favorite, that "they exhibit self-limiting behavior". These phrases describe aspects of apathy, but we're sort of talking around the issue with these phrases. We're not saying that this person has post-stroke apathy or apathetic affect. I would like to propose to you today is that perhaps we should be documenting things specifically as this patient has an apathetic affect or they have apathy so that we can make sure that not only do they have access to the correct resources or the correct interdisciplinary care team after their stroke but also that we're using that to document why further skilled intervention is necessary or making sure that they make it to the appropriate level of care after their discharge.
What tends to happen to these individuals with apathy? Well, it does not tend to change very much throughout the more acute phases of the stroke, or even over the first year of stroke recovery, it tends to be fairly persistent. And these patients are more likely to be discharged from the acute care hospital to either skilled nursing rather than inpatient or more likely to be discharged to a skilled nursing facility rather than home. And they do tend to require more support From caregivers, whether institutional caregivers or family caregivers because they do have those lower levels of initiation. These individuals also tend to see lower levels of functional recovery irrespective of neurologic recovery.
For more information on post-stroke apathy, check out the course: Post-Stroke Apathy and Depression: Addressing Psychosocial Barriers to Patient Success
