Table 1.

Critical Attribute Categories for Categorizing Definitions of Apathy and Passivity

Critical Attribute Category	Critical Attribute Definition & Coding Guidance	Examples
Conceptual Definition	Description of concept containing defining characteristics or attributes to aid in determining which phenomena match the concept and which do not. Conceptual definitions contain more abstract descriptions of phenomena as opposed to objective descriptions or operationalization of these constructs. Conceptual definitions are further denoted when using the words “defined as,” “characterized as” or “described as.”	▪ “Apathy has been defined as a lack of motivation leading to a reduction of self-generated voluntary and purposeful behaviors”  ▪ “Passivity is defined as a personality pattern that is exemplified by a diminished ability to be open, conscious, and engaged”
Observable Clinical Features	Descriptions of presence or absence of characteristics that aid in making differential diagnoses, or help name the occurrence of a specific phenomenon as differentiated from another similar or related one, as it occurs in a clinical setting. Observable clinical features are objective/observable indications or features of the conceptual definition. They are denoted when using the words “manifested by,” “characterized by,” “clinically manifested by,” “presents as,” “demonstrated by,” “items” and “behaviors.”	▪ “Patients with apathy display lack of interest, anergia, psycho-motor slowing, and fatigue”  ▪ “Passive behavior … characterizes the ‘silent majority’ of persons who manifest a reduction of energy, drive, and initiative”
Neurobiological Attribute	Characteristics that aid in making differential diagnoses, or help name the occurrence of a specific phenomenon as differentiated from another similar or related one, as it pertains to the nervous system of a patient. Only code neurobiological attributes that are descriptions of primary study findings.	▪ “Apathy associated with pathology and reduction in function of the anterior cingulate cortex”
Antecedent	Events or incidents that must occur/be present or not occur/be present prior to the occurrence of a concept, such that description denotes a specific time frame.	▪ “Apathy has been found to arise when there is pre-existing dysfunction in any GDB component in the brain”
Concurrent Condition	Descriptions of other clinical syndromes or diagnoses that are commonly present when the phenomena/concept of interest is present. These conditions may have significant influence on or determine the manifestation of the phenomena.	▪ “Apathy is common in patients with Alzheimer’s Disease”  ▪ “[Passive behaviors] as disturbing behaviors often observed in individuals with dementia”
Correlate	Descriptions of other factors (e.g. demographics, patient characteristics including neurobiological correlates – e.g. hypoperfusion in certain brain regions, clinical outcomes) that have been shown to have a relationship, association or correlation with the concept that but is not described as a causal relationship. General descriptions of neurobiological features that are associated with apathy may also be included.	▪ “Apathy is associated with early institutionalization, increased morbidity, and mortality”  ▪ “increased evidence of passivity in prodromal AD is related to the increasing cognitive decline that occurs during this period”
Consequence	Events or incidents that occur because of the occurrence of the concept of interest. Description denotes a temporal or causal relationship.	▪ “Apathy has been shown to contribute uniquely to the loss of independence observed in AD”  ▪ “Apathy has been shown to lead to functional decline”