The associations between caregivers’ psychological characteristics and patients’ apathy symptoms in multiple sclerosis

Background/objectives: Apathy is a common neuropsychiatric symptom in people with Multiple Sclerosis (PwMS), and is significantly associated with increased dependency on caregivers, intensifying their emotional and physical burden. The present study aims to evaluate apathy from the perspectives of both PwMS and caregivers, considering the MS clinical phenotype; and to explore the impact of caregiver-reported patient apathy on their distress, particularly in relation to their coping strategies and resilience. Methods: Eighty dyads of PwMS and caregivers completed the self-evaluation or caregiver version of the Apathy-Motivation Index, which assesses apathy in terms of behavioral activation, social motivation, and emotional sensitivity. Caregivers also completed the Zarit Burden Interview and the Caregiver Burden Inventory to assess burden, the Coping Orientation to Problems Experienced to evaluate coping strategies, and the Connor-Davidson Resilience Scale to measure resilience. Results: Caregivers consistently reported higher levels of perceived patient apathy than PwMS, particularly in terms of behavioral apathy. Notably, higher levels of emotional apathy in PwMS, as perceived by caregivers, were strongly associated with increased psychological distress and burden. Furthermore, caregivers relying on maladaptive coping strategies experienced significantly greater levels of emotional exhaustion and role strain related to caregiver-reported patient apathy. Conclusions: These findings highlight the need to comprehensively assess all dimensions of apathy and integrate the caregiver’s perspective in its assessment. Tailored interventions should focus on reinforcing adaptive coping mechanisms to mitigate caregiver distress, associated with caregiver-reported patient apathy, ultimately improving the well-being of both PwMS and their caregivers.