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Mel Glenn, M.D., Spaulding/Partners at Harvard Medical School at

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Glenn, M. (2005). The Apathy Evaluation Scale. The Center for Outcome Measurement in Brain Injury.
combi/aes ( accessed ).






AES Syllabus

For the AES-S and AES-I, the person filling out the scale is instructed: “For each question, circle the answer that best describes your (his/her) thoughts, feelings, and actions during the past 4 weeks. “ (Marin, 1991) There are additional instructions for the interview done for the AES-C:

Instructions to patient: “I am going to ask you a series of questions about your thoughts, feelings, and activities. Base your answers on the last 4 weeks. To begin, tell me about your current interests. Tell me about anything that is of interest to you. For example, hobbies or work; activities you are involved in or that you would like to do; interest within the home or outside; with otheer people or alone; interests that you may be unable to pursue, but which are of interest to you—for example, swimming even though it’s winter.”

Intervieweer then notes: (1) Number of interests reported; (2) degree of detail reported for each interest; (3) affective aspects of expression (verbal and nonverbal).

Interviewer then states: “Now I’d like you to tell me about your average day. Start from the time you wake up and go to the time you go to sleep.” How the patient deals with this (and all other) questions is assumed to provide information about how other activities are dealt with (e.g., with initiative, exuberance, and energy). Therefore, prompting is indicated only if the subject seems not to understand what information is being sought or has forgotten the question.

Interviewer notes number of activities, degree of detail, intensity and duration of involvement, and affect associated with presentation of data.

Each item is now presented using the wording of the item itself. Additional information may be requested to clarify responses. Item 15, “Accurate understanding of problems,” is rated by appraising subject’s awareness and understanding of personal or, if present, clinical problems. Simple bridges between items may be used to preserve a conversational quality to the interview. Items are rated as they are presented using all information acquired. The response recorded is the clinician’s assessment of the subject’s response. Thus, if a subject states “a lot” but the clinician judges “somewhat,” the latter is used. The only exceptions are the self-evaluation (SE) items in [the interview] (#3, #8, #13, #16). For these items, the subject specifies which response code to use (e.g., Not at All, Slightly); the clinician rater’s appraisal is not considered for SE items.

All items are coded as follows:
1. Not at all characteristic.
2. Slightly characteristic (trivial, questionable, minimal).
3. Somewhat characteristic (moderate, definite).
4. Very characteristic (a great deal, strongly). Requires verbal or nonverbal evidence of intensity.
Note: Very characteristic is the level obtained by normal individuals.

The criteria for applying these codes are quantified for several items (#1, #2, #4, #5, #12). These quantifiable items (labeled Q in [the rating scale]) are rated by counting the number of instances cited by the subject for a particular item (e.g., number of interests, number of friends):
1. Not at all: 0 items
2. Slightly: 1-2 items
3. Somewhat: 2-3 items
4. Very: 3 or more

When there is difficulty in choosing between ratings, the following guidelines are used:
1. In general, rate toward the more apathetic score.
2. Consider the degree of differentiation of responses. For example, rate “Interest in things” as Slightly if a subject simply specifies “reading and television” as interest, but Somewhat if specific books or television programs can be specified. Similarly, if a subject is interested “only” in reading, but provides multiple examples of reading materias, rate Somewhat or Very, based on the number of examples given.
3. Consider the presence of verbal and nonberbal evidence of affect. For example, rate toward lower apathy if subject uses phrases such as “very much” or “tremendously,” or uses facial expression, gesture, or vocal intonation to suggest affect.
4. If still in doubt, ask the patient whether, for example, “Somewhat” or “Very” is the more appropriate descriptor. (Marin, 1991)

Items for the AES-I and AES-S are rated as follows:
Not at all true=1
Slightly true=1
Somewhat true=3
Very true=4
(Marin, 1991; Marin,1996)
Some items have positive and some have negative syntax. After the form is filled out, scoring is arranged so that greater apathy results in higher scores.

Detailed administration instructions for the AES may be obtained by contacting Dr. Robert Marin directly at



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