Working Memory Deficit as a Risk Factor for Severe Apathy in ă Schizophrenia: A 1-Year Longitudinal Study

Apathy, described as impaired motivation and goal-directed behavior, is ă a common yet often overlooked multidimensional psychopathological state ă in schizophrenia. Its underlying cognitive processes remain largely ă unexplored. Data was drawn from a longitudinal hospital study of ă patients with a DSM-IV diagnosis of schizophrenia; 137 (82.5%) ă participated at the 1-month follow-up and 81 (59.1%) at the 1-year ă follow-up. Apathy was assessed with the Lille Apathy Rating Scale, ă validated in French and in schizophrenia. Severe apathy, overall (total ă score > -13) and on 4 previously identified distinct dimensions, was ă considered. Episodic verbal learning was assessed with the California ă Verbal Learning Test, executive functioning with the Trail Making Test, ă the Six Element Test and the Stop Signal Paradigm and working memory ă with the Letter-Number Sequencing Test. After controlling for ă confounding variables, only episodic verbal learning was associated with ă severe overall apathy in the cross-sectional study. At 1 year, working ă memory was associated with an increased risk of severe overall apathy, ă adjusting for baseline apathy. Using a dimensional approach to apathy, ă specific types of cognition were found to be associated with specific ă dimensions of apathy. Our findings confirm the need for a ă multidimensional approach of negative symptoms in schizophrenia. ă Moreover, cognitive functioning could be a risk factor for developing ă severe apathy. Cognitive remediation may thus be a useful ă non-pharmacological intervention for treating apathy in schizophrenia ă patients.