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Eur Psychiatry. 2018 Oct;54:71-76. doi: 10.1016/j.eurpsy.2018.07.008. Epub 2018 Aug 17.

Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group.

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CoBTeK IA, Memory Centre, University Cote d'Azur, France. Electronic address:
Sunnybrook Research Institute and Departments of Pharmacology/Toxicology and Psychiatry, University of Toronto, Toronto, Canada.
Department of Psychiatry, Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre & Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, Netherlands.
CoBTeK IA, Memory Centre, University Cote d'Azur, France; STARS team - INRIA Sophia Antipolis, Valbonne 06902, France.
Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Austria.
Regional Resource Centre of Old Age Psychiatry, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Corentin-Celton Hospital, Issy-les-Moulineaux, France.
Memory Center CMRR, CHU - CoBTeK lab, University Cote d'Azur, France.
Centre des Maladies Cognitives et Comportementales (IM2A), Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, AP-HP, Salpêtrière Hospital, Sorbonne University, Paris, France.
Neurology and Movement Disorders, Lille University Medical Center, Inserm U1171, Lille, France.
Nuffield Department of Clinical Neurosciences (John Radcliffe Hospital, Oxford OX3 9DU) & Department of Experimental Psychology, University of Oxford, UK.
STARS team - INRIA Sophia Antipolis, Valbonne 06902, France.
AP-HP, Neurology deparment, Salpetriere hospital Inserm, U 1127, CNRS, UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, FRONTlab School of medicine, Sorbonne Universités, Paris, France.
Agenzia Italiana del Farmaco, via del Tritone 181, 00187, Rome, Italy.
Clinical Research Neurology Lundbeck SAS, Denmark.
Bracket, Wayne, PA, USA.
moebius-consult GmbH, Baar, ZG, Switzerland.
psi-napse, Surrey, UK.
EA4712 "Comportement et noyaux gris centraux", Université de Rennes 1, France.
Laboratorio de Neurociencias LIM27, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, UNESP - Univ Estadual Paulista, Biosciences Institute, Campus of Rio Claro, SP, Brazil.
Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford University, Stanford, CA, USA.
CoBTeK IA, Memory Centre, University Cote d'Azur, France.



Apathy is a very common behavioural and psychological symptom across brain disorders. In the last decade, there have been considerable advances in research on apathy and motivation. It is thus important to revise the apathy diagnostic criteria published in 2009. The main objectives were to: a) revise the definition of apathy; b) update the list of apathy dimensions; c) operationalise the diagnostic criteria; and d) suggest appropriate assessment tools including new technologies.


The expert panel (N = 23) included researchers and health care professionals working on brain disorders and apathy, a representative of a regulatory body, and a representative of the pharmaceutical industry. The revised diagnostic criteria for apathy were developed in a two-step process. First, following the standard Delphi methodology, the experts were asked to answer questions via web-survey in two rounds. Second, all the collected information was discussed on the occasion of the 26th European Congress of Psychiatry held in Nice (France).


Apathy was defined as a quantitative reduction of goal-directed activity in comparison to the patient's previous level of functioning (criterion A). Symptoms must persist for at least four weeks, and affect at least two of the three apathy dimensions (behaviour/cognition; emotion; social interaction; criterion B). Apathy should cause identifiable functional impairments (criterion C), and should not be fully explained by other factors, such as effects of a substance or major changes in the patient's environment (Criterion D).


The new diagnostic criteria for apathy provide a clinical and scientific framework to increase the validity of apathy as a clinical construct. This should also help to pave the path for apathy in brain disorders to be an interventional target.


Apathy; Behaviour; Brain disorders; Emotion; Motivation; Neuropsychiatry; Social interaction; Treatment

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