Lille Apathy Rating Scale Parameters in Parkinson's Disease

Apathy, say researchers in the The Journal of Neurology, Neurosurgery, and Psychiatry (JNNP), is defined as reduced interest and participation in daily life activities, lack of initiative, early withdrawal from activities, indifference and lack of emotional reactions.

Apathy may be a symptom of disorders which affect the basal ganglia, clusters of nerve cells in the brain responsible for movement, says Discovery Health. Basal ganglia disorders include cerebral palsy, Huntington's disease, and Parkinson's disease (PD).

Lille Apathy Rating Scale (LARS)

• The Lille Apathy Rating Scale, or LARS, was developed around 2006 by the authors of the JNNP paper cited in this article. These researchers from universities in Lille, France, wanted to develop an improved scale to measure apathy in patients with disorders like PD. Previous apathy rating scales, while demonstrating reliability and validity, lacked standardization and often depended too much on the opinion of the caregiver, who may be unavailable or unreliable.

  Based on concepts from these earlier rating scales, the LARS targets nine parameters with a total of 33 questions.

Reduced Productivity and Lack of Interest

• Regarding everyday productivity, the patient is asked what he does during the day; while regarding interests, the patient is asked what he does to keep himself occupied.

  Both questions are rated on how long the patient takes to answer and the number of activities and interests cited.

Lack of Initiatve

• The rest of the parameters are rated dichotomously, yes or no.

  Regarding taking initiative, the patient is asked if he does things himself; if he gets himself ready for appointments; if he makes appointments himself; and if he spontaneously participates in daily activities.

Lack of Novelty-Seeking and Motivation

• Regarding novelty-seeking, or seeking out new interests, the patient is asked if he likes discovering or trying new things; if he likes visiting new places; and when traveling by car or train, if he enjoys watching the scenery.

  Regarding motivation, or voluntary action, the patient is asked if completing a task is easy or difficult; if he can find solutions if the first try fails; if he completes activities or gives up; and if he makes the effort to look for misplaced objects.

Lack of Emotional Responses and Concern

• Lack of emotional response, or the flattening effect, is common in patients with Parkinson's disease. In LARS, the patient is asked if he becomes easily moved by movies; if he laughs easily at jokes; if he feels happy at hearing good news; and if he feels sad at hearing bad news.

  Regarding concern, the patient is asked if he feels worried when he has a problem; if he thinks about finding a solution for a problem; if he feels concerned about loved ones' problems; and if he regularly asks about the well-being of loved ones.

Poor Social Life and Self-Awareness

• Regarding social life, the patient is asked if he has friends; if he enjoys spending time with friends; if he initiates conversation; and if he gives his own opinion.

  Regarding self-awareness, the patient is asked if he evaluates situations; if he ever thinks he's made a wrong decision; if he feels guilty after being unpleasant with someone; and if he's able to admit he's wrong, at least to himself.