Emotional Symptoms and Apathy in Basal Ganglia Disorders: A Comparative Study

Abstract 

Study aim: This study assessed apathy and negative emotional symptoms in patients with basal ganglia disorders and examined their associations with demographic and clinical characteristics.

Methods: Ninety patients aged over 50 years were included and equally distributed across three diagnostic groups: Parkinson’s disease (PD; n = 30), Huntington’s disease (HD; n = 30), and drug-induced extrapyramidal syndrome (DIES; n = 30). Mean age was 65.10 ± 6.80 years in the PD group, 62.80 ± 7.90 years in the HD group, and 64.70 ± 7.60 years in the DIES group. Men accounted for 56.67% (17/30), 50.00% (15/30), and 53.33% (16/30) of the PD, HD, and DIES groups, respectively. Apathy was assessed using the Apathy Evaluation Scale–18 (AES-18), while depression, anxiety, and stress were measured using the Depression Anxiety Stress Scales–21 (DASS-21). Group differences were examined using Kruskal–Wallis tests with Dunn–Bonferroni post hoc comparisons, and associations were assessed using Spearman’s rank correlations.

Results: Significant differences were observed across diagnostic groups for apathy (AES-18: H(2) = 18.45, p < .001, ε² = .21), depression (H(2) = 14.12, p < .001, ε² = .16), anxiety (H(2) = 11.34, p = .003, ε² = .13), and stress (H(2) = 8.65, p = .013, ε² = .10). Patients with Huntington’s disease showed higher apathy scores than those with Parkinson’s disease and drug-induced extrapyramidal syndrome. Depression and stress were higher in the Parkinson’s disease group than in the drug-induced extrapyramidal syndrome group, whereas anxiety was higher in the latter group than in the Huntington’s disease group. AES-18 scores were positively correlated with depression (rs = .58), anxiety (rs = .46), and stress (rs = .50; all p < .001). Age was positively associated with depression (rs = .42, p < .001), whereas disease duration was not associated with the psychological measures.

Conclusion: Apathy and negative emotional symptoms, measured with the AES-18 and DASS-21, differ across basal ganglia disorders and are closely interrelated. Routine assessment of both motivational impairment and emotional distress may support more comprehensive and targeted clinical care.