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The assessment and measurement of apathy are crucial in clinical practice, as well as in research settings. Apathy is commonly assessed using a variety of instruments, including diagnostic criteria-based clinical interviews and validated assessment scales, based on patient (self-rated) and/or informant reports. While many apathy scales are available, these scales are biased by the subjective evaluation of the patient or his or her relatives, and important differences in quotations can be noted between patients and caregivers, especially in neurological diseases with anosognosia, such as bvFTD.
In line with these considerations, we built an ecological framework under controlled conditions and a structured scenario designed to identify and measure behavior and/or behavioral disorders to obtain objective and quantitative measurements for assessing neuropsychiatric symptoms, such as apathy and disinhibition, given the limitations in measuring these behaviors using questionnaires and scales administered to patients or caregivers.
The ECOCAPTURE paradigm mimics a naturalistic situation (i.e., waiting comfortably in a waiting room), and the assessment of participant's behavior was driven by a 45-minute controlled scenario. The experiments took place on an experimental platform dedicated to the functional exploration of human behavior (PRISME, ICM core facility, Salpêtrière Hospital, Paris, France), which allowed us to assess behavior under ecological conditions. The platform was transformed into a furnished waiting room containing specific objects that provided opportunities to interact with the environment.
The waiting room (PRISME, ICM) setup with different areas and specific objects that encourage a variety of activities. The waiting room has a surface area of 24 m2 and is set up with several areas that encourage a variety of activities. The kitchen area is composed of kitchen furniture, food and drink, a cooler, a sink and an electric kettle. The sitting area is composed of a sofa with two cushions and two chairs. Games, such as a puzzle, Kapla, Sudoku, crosswords and a Rubik’s cube, are scattered on a table in the center of the room. In one corner of the room, a furniture (4 drawer units) contains books and magazines, as well as candies. In the back of the room, a window with the blinds up overlooks the forecourt of the ICM building.
The PRISME platform is equipped with a six-ceiling camera system (not hidden) covering the entire waiting room. The Media Recorder® software (NOLDUS Information Technology, Wageningen, the Netherlands) enables synchronous video recordings from multiple cameras over the network. During the experiment, individuals’ behavior was video-recorded, and their movement acceleration was measured using a wireless body sensor (Move II® triaxial accelerometer, Movisens GmbH, Karlsruhe, Germany) worn on the right hip. An eye-tracking system (SMI Eye Tracking Glasses 2 Wireless, ®SensoMotoric Instruments, Teltow, Germany) was added to the multimodal recording system, and the subjects wore eye-tracking glasses for a 7-minute period during the 45-minute experimental session. The subjects were informed at the time of initial consent that their behavior would be tracked and recorded by video cameras located in the room.
The ECOCAPTURE paradigm of apathy assessment is driven by a 45-minute structured scenario. A general outline of the ECOCAPTURE scenario is schematically presented in the figure below. Outside of the waiting room, the examiner equipped the participant with an accelerometer, and then the participant was asked to wait in the room prior to the subsequent experimental tests. The subject was explicitly encouraged to make himself/herself comfortable and to enjoy the room, using the space, as well as the objects at his or her own convenience (“as if he/she was at home”). These guidelines were designed to promote the ecological validity of the behavior tracking method (i.e., how the research context is representative of the real-life situation in which individuals’ behaviors were recorded). The scenario began with a phase called the free phase (FP), starting when the examiner left the room, with the subject left alone in the waiting room for a 7-minute period. Since no specific goal-directed activity was suggested by the examiner in this FP, the participants were mostly tested on their ability to self-initiate activities. This first phase (FP) was followed by several other phases, including a guided phase (GP) lasting 10 minutes, in which the participants were asked by the examiner to complete a questionnaire.
The 45-minute structured scenario ECOCAPTURE with phase onsets (after the examiner intervention) and phase terminations (after a fixed period). The scenario consists of five phases in the following order: a 7-minute free phase; a 7-minute free phase with eye-tracking glasses; a 7-minute sound stimulus phase (positive stimulus such as favorite music); a 10-minute guided phase (devoted to completing the questionnaire); and a 7-minute sound stimulus phase (negative stimulus such as crackling noise).
The ECOCAPTURE apathy ethogram includes 13 behaviors and 31 modifiers divided in two behavioral categories: motor patterns, activity states. The ECOCAPTURE disinhibition ethogram includes 16 behaviors divided in three disinhibition categories: compulsivity, impulsivity, social disinhibition.
See the full detailed ECOCAPTURE apathy ethogram at Mendeley Data: https://data.mendeley.com/datasets/mv8hndcd95/2
Batrancourt, Bénédicte; Migliaccio, Raffaella (Lara); Tanguy, Delphine; Sezer, Idil; Godefroy, Valerie; Bouzigues, Arabella (2022), “The ECOCAPTURE ethograms: apathy ethogram and disinhibition ethogram”, Mendeley Data, V2, doi: 10.17632/mv8hndcd95.2
References
Peltier C, Lejeune FX, Jorgensen LGT, Rametti-Lacroux A, Tanguy D, Godefroy V, Bendetowicz D, Carle G, Cognat E, Bombois S, Migliaccio R, Levy R, Marin F, Batrancourt B; ECOCAPTURE study group (2022). A temporal classification method based on behavior time series data in patients with behavioral variant of frontotemporal dementia and apathy. J Neurosci Methods. 376:109625. doi: 10.1016/j.jneumeth.2022.109625
Tanguy D, Batrancourt B, Estudillo-Romero A, Baxter JSH, Le Ber I, Bouzigues A, Godefroy V, Funkiewiez A, Chamayou C, Volle E, Saracino D, Rametti-Lacroux A, Morandi X, Jannin P, Levy R, and Migliaccio R; ECOCAPTURE study group (2022). An ecological approach to identify distinct neural correlates of disinhibition in frontotemporal dementia. NeuroImage: Clinical. 2022, 103079, doi: 10.1016/j.nicl.2022.103079
Godefroy V, Batrancourt B, Charron S, Bouzigues A, Bendetowicz D, Carle G, Rametti-Lacroux A, Bombois S, Cognat E, Migliaccio R, Levy R (2022). Functional connectivity correlates of reduced goal-directed behaviors in behavioural variant frontotemporal dementia. Brain Struct Funct. doi: 10.1007/s00429-022-02519-5
Godefroy V, Tanguy D, Bouzigues A, Sezer I, Ferrand‐Verdejo J, Azuar C, Bendetowicz D, Carle G, Rametti‐Lacroux A, Bombois S, Cognat E, Jannin P, Morandi X, Le Ber I, Levy R, Batrancourt B, Migliaccio R (2021). Frontotemporal dementia subtypes based on behavioral inhibition deficits. Alzheimers Dement. Diagn. Assess. Dis. Monit. 13: e12178. doi: 10.1002/dad2.12178.
Batrancourt B, Lecouturier K, Ferrand-Verdejo J, Guillemot V, Azuar C, Bendetowicz D, Migliaccio R, Rametti-Lacroux A, Dubois B and Levy R (2019). Exploration Deficits Under Ecological Conditions as a Marker of Apathy in Frontotemporal Dementia. Front. Neurol 10:941. doi: 10.3389/fneur.2019.00941.
Liu Y, Batrancourt B, Marin F, Levy R (2018). Evaluation of apathy by single 3D accelerometer in ecological condition : Case of patients with behavioral variant of fronto-temporal dementia, in: 2018 IEEE 20th International Conference on E-Health Networking, Applications and Services (Healthcom), pp. 1–4. doi: 10.1109/HealthCom.2018.8531167.
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