TABLE 1.

RECOMMENDATIONS FOR FUTURE RESEARCH TO ADVANCE KNOWLEDGE ABOUT APATHY

General Recommendation	Evidence/Rationale for Recommendation
Prospective clinical trials are needed with apathy as a primary outcome together with important secondary outcomes, such as function.	With few exceptions, apathy has been investigated as a secondary outcome in retrospective studies
Novel technology-approaches including activity-monitoring devices and eye-trackers are necessary for more objective measurement of apathy.	Apathy is often measured subjectively by the individual, caregiver or provider.
Use of a uniform operational definition of apathy10 and a standard measure specific to the definition would enhance precision and facilitate comparison across studies.	Apathy has been described and measured inconsistently in the literature.
Recruitment of well-characterized samples that meet criteria for specific types of neurodegenerative disease.	The pathophysiology of apathy may not be the same across the neurodegenerative disease spectrum.
Continued study of the neurobiological basis of the different apathy components using neuroimaging techniques.	Without greater neurobiological specificity, it will be difficult to understand the neuroanatomical associations with specific apathy symptoms. Greater specificity of apathy subtypes will also help investigators to more precisely identify treatment targets and to determine who is likely to respond to specific treatments.
Longitudinal studies of apathy are needed to allow for sufficient time to observe potential treatment effects.	Intervention trials need to be of sufficient duration to detect clinically relevant effects in the treatment arm and to observe the likelihood of worsening apathy in the control arm. In addition, given apathy’s association with conversion to MCI and AD, intervention studies should examine whether efficacious treatments delay this conversion.
Investigators should consider stabilization of apathy severity an important outcome of intervention in addition to delay in emergence or reduction of apathy.	Apathy worsens as dementia progresses and the type and severity of dementia likely influences response to pharmacotherapy.
Studies that combine biological and psychosocial approaches are needed to more successfully treat apathy.	There is a general lack of high quality research to support the use of non-pharmacological approaches.
Strong conceptual frameworks that go beyond condition-specific indicators of treatment success and include person-centered goals are needed to guide future studies of apathy.	Few, if any, intervention studies include outcomes that reflect goals and preferences meaningful to people with apathy and/or their caregivers. The lived experience of neurodegenerative disease can provide important ecological insight into meaningful and achievable outcomes, such as the ability to maintain social and physical activity.