{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:48:29Z","timestamp":1784040509408,"version":"3.55.0"},"reference-count":67,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T00:00:00Z","timestamp":1725321600000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016966","name":"Bethune Charitable Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100016966","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["8227052605"],"award-info":[{"award-number":["8227052605"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,8,24]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the relationship among patients\u2019 apathy, cognitive impairment, depression, anxiety, and caregiver burden in amyotrophic lateral sclerosis (ALS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study design was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted at a tertiary hospital in Wuhan, Hubei, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 109 patients with ALS and their caregivers were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Patients with ALS were screened using the Edinburgh Cognitive and Behavioural Screen, Beck Depression Inventory-II, Generalised Anxiety Disorder-7 and Apathy Scale to assess their cognition, depression, anxiety and apathy, respectively. The primary caregivers completed the Zarit Burden Interview. The association between apathy, cognitive impairment, depression, anxiety and caregiver burden was analysed using logistic regression. Mediation models were employed to investigate the mediating effect of patients\u2019 apathy on the relationship between depression\/anxiety and caregiver burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients in the high caregiver burden group exhibited significantly higher levels of depression, anxiety and apathy compared with those in the low caregiver burden group (p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05). There was a positive association observed between caregiver burden and disease course (rs=0.198, p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05), depression (rs=0.189, p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05), anxiety (rs=0.257, p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05) and apathy (rs=0.388, p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05). There was a negative association between caregiver burden and the Revised ALS Functional Rating Scale (rs=\u22120.275, p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05). Apathy was an independent risk factor for higher caregiver burden (OR 1.121, 95%\u2009CI 1.041 to 1.206, p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05). Apathy fully mediated the relationship between depression and caregiver burden (\u03b2=0.35, 95%\u2009CI 0.16 to 0.54, p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05) while partially mediating the relationship between anxiety and caregiver burden (\u03b2=0.34, 95%\u2009CI 0.16 to 0.52, p\n                      <jats:italic>&lt;<\/jats:italic>\n                      0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Apathy, depression and anxiety exerted a detrimental impact on caregiver burden in individuals with ALS. Apathy played a mediating role in the relationship between depression and caregiver burden and between anxiety and caregiver burden. These findings underscore the importance of identifying apathy and developing interventions for its management within the context of ALS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-080803","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T01:10:28Z","timestamp":1725412228000},"page":"e080803","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Association between apathy and caregiver burden in patients with amyotrophic lateral sclerosis: a cross-sectional study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6105-0587","authenticated-orcid":false,"given":"Zhenxiang","family":"Gong","sequence":"first","affiliation":[{"name":"Department of Neurology, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhua","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Neurology, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahui","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China"},{"name":"Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, China"},{"name":"Department of Neurology, Shanxi Bethune Hospital, Taiyuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"key":"2025121407494865000_14.9.e080803.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61156-7"},{"key":"2025121407494865000_14.9.e080803.2","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S1474-4422(18)30091-7","article-title":"Riluzole, disease stage and survival in ALS","volume":"17","author":"Dharmadasa","year":"2018","journal-title":"Lancet Neurol"},{"key":"2025121407494865000_14.9.e080803.3","doi-asserted-by":"crossref","unstructured":"Rothstein JD . 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