Existentialism and Metamorphosis Essay Essay Example

Existentialism and Metamorphosis Essay Essay Example Existentialism and Metamorphosis Essay Essay Existentialism and Metamorphosis Essay Essay Essay Topic: Notes From Underground The Metamorphosis Existentialism is defined as a modern philosophical motion emphasizing the importance of one’s experience and answerability. Its focal point is the brand on the personal contemplations that these do on the person. who is seen as a free agent in a deterministic and apparently nonmeaningful existence. Its doctrine is punctilious that. in a nutshell. advocates a diverse armory of responses and solutions to the ‘existentialist attitude’ ; which. basically. is what an single feels when confronted by the absurdness of life. Throughout humanity. contemplation and self-proclaimed ‘ultimate’ truths have assumed assorted signifiers: poesy. faith. and legion other philosophies and textual plants. In The Metamorphosis. Franz Kafka narrates the branchings of a metabolism in which the topic and supporter. a adult male named Gregor Samsa. is transformed into a bug. Despite the novella’s literary methods and influences. the most outstanding being the manner Kafka so coolly describes such abnormality in his life. The Metamorphosis is besides hailed as a premier textual work of existential philosophy. the antecedently mentioned philosophical motion. Both anterior and subsequent to the transmutation. Kafka portrays Gregor as a adult male who seems lost within himself. and missing individuality. The reminiscences of his yesteryear are neither nostalgic nor affecting: his human life is seen to go around entirely around fiddling affairs. His societal life pays the monetary value from this. his failure to asseverate a concrete and consistent being. The extent of his deficiency of individualism is farther exemplified by his reaction to the metabolism: determination himself â€Å"t ransformed in his bed into a mammoth insect† ( Kafka. 296 ) . he prioritizes work over all else. even in his freshly equated insect signifier. Furthermore. he panics because â€Å"the following train went at seven o’clock ; to catch that he would necessitate to travel rapidly like mad and his samples weren’t even packed up† ( 297 ) . Gregor’s individuality crisis is a device for conveying Kafka’s belief of an impersonal society where individuality is drastically mitigated as a consequence of inordinate philistinism. Gregor. in the context of Fyodor Dostoyevsky’s Notes from Underground analogy. would be the ‘ant’ in the anthill- therefore rendering his metabolism ironically. Another dominant subject prevalent throughout the novelette is the absurd state of affairs Gregor is confronted by. These absurd occurrences ( 296-327 ) reflect the universe as seen from the existential philosopher position: a universe absent of a rational and comprehensive aim. Jean-Paul Sartre postulated that ‘every bing thing is born without ground. prolongs itself out of failing. and dies by chance’ . This nonsense is exactly what Gregor is victim to in the microcosm of society that Kafka generates: Gregor flounders about. beleaguered by absurdness and weakness. presumptively because he is incognizant of Nietzsche and Kierkegaard’s slightly comforting decisions that one must invent significance for one’s ain being ex nihilo. Once once more. Kafka utilizes a combination of secret plan and character to convey his angst refering an seemingly unpointed being. Freedom- or instead the deficiency thereof- is another existentialist dogma that Kafka addresses. Gregor is depicted as person constrained by self-imposed loads. the most demanding being the function as the fiscal pillar of the household. Despite holding the freedom to disown this function. Gregor alternatively pursues it with hectic ardour to the extent that it becomes his ‘sole desire’ ( 310 ) . Yet his rant sing his calling ( 297-298 ) reveals that this is non due to personal desire. but instead the belief that he must replace his male parent financially. regardless of penchant. Gregor’s psychotic belief sing an absence of pick contradicts what Kafka perceives as the truth: that freedom is omnipresent in malice of any ethical duties we may be expected to adhere to. and that the single defines his or herself via one’s determinations. A quasi-motto of existential philosophy coined by Sartre. ‘existence precedes essence’ . In decision. Kafka employs the fictional literary elements he constructs to turn to the really non-fictional. existentialist facets of society and life. Akin to Dostoyevsky’s Notes from Underground. it can be interpreted as both a contemplation and philippic against impersonal communities. limitation of freedom. and the absurdness of life.

What Is a Republic vs a Democracy Understanding the Difference

What Is a Republic vs a Democracy Understanding the Difference SAT / ACT Prep Online Guides and Tips If you look closely at the United States Pledge of Allegiance, you’ll see that it calls the United States a republic. It reads: "I pledge allegiance to the flag of the United States of America, and to the republic for which it stands, one nation under God, indivisible, with liberty and justice for all.† So what does that mean, exactly? Can the United States be both a democracy and a republic? And what is the difference between a democracy and republic, anyway? As it turns out, there are subtle, but important, differences between a democracy and a republic, and that the definitions aren’t mutually exclusive. In other words, it’s complicated. But don’t worry! Knowing the differences between a republic vs a democracy is important for tons of AP exams, including both history tests (U.S. and world) and both government and politics tests (U.S. and comparative). That’s why we’ve put this guide together for you. By the end of this article, you’ll know the definitions of a democracy and a republic, how they operate, the differences between them, and where the United States fits into the discussion. So let’s get started! What Is a Democracy? The term â€Å"democracy† comes from the combination of two Greek words: â€Å"demos,† meaning â€Å"the people,† and â€Å"kratia,† which means â€Å"power or authority.† Thus, a democracy refers to a type of government where the power to govern rests with a country’s people rather than a ruling family (a monarchy) or a single individual (totalitarianism). That means that citizens control how their government operates, usually through voting. The Origins of Democracy The term â€Å"democracy† first pops up in the 5th century BCE to refer to the government in Athens, Greece. Between 508 BCE and 322 BCE, Athenians governed themselves in what is now referred to as a pure democracy. (Don’t worry...we’ll go into that a little later.) Ancient Athenians didn’t have anyone to represent them in government; instead, everyone had a voice- literally. Debates on topics of governance were held publicly in what was referred to as The Athenian Assembly, and every male Athenian citizen had individual voting rights. Not only that, but qualified citizens were given time off of work and a stipend to help make sure every voice was heard! Through the Assembly, every voice could weigh in on every issue, and all laws and rules of governance were established based on majority rule. While this type of democracy would eventually be replaced by a more representative form of government, the underlying idea- that government works best when it's run by its citizens- would go on to influence the governance of most of the Western world, including the United States. The 3 Major Types of Democracies With growing populations and more complex systems of government, the Athenian method of one voice, one vote doesn’t always work. So as the world has changed, democracy has changed with it. Here are the three major types of democracies seen in the world today. Direct Democracy Also known as pure democracy, direct democracy is democracy in its most basic form. Just like the Athenians at the Assembly, direct democracy lets each qualified individual shape policy by casting a direct vote. In other words, citizens are directly involved in the political process! In this system, political decisions are made based on what the majority of voters decide. Each qualified person casts a vote, and the category with the most number of votes wins. The benefits to a direct democracy are that it lets each person, regardless of class, race, or economic position have a voice. However, in practice, direct democracies often exclude certain groups. For instance, in ancient Athens, only male citizens had the right to participate in direct democracy. Women, criminals, and slaves- even though they were subject to Athens’ laws and policies- were denied a voice. Additionally, direct democracy doesn’t always work well on a large scale. That’s because there are an overwhelming number of decisions that need to be made to keep governments running. Examples of Direct Democracy in Action Because direct democracy can be unwieldy on the national level, there are few countries that use it as a primary governmental system. But that doesn’t mean direct democracy doesn’t exist anymore! Here are some examples of where you can see direct democracy in action. Switzerland: Switzerland, a country of roughly 8.2 million people, uses direct democracy to run its local, regional, and federal governments. Every citizen over the age of 18 weighs in on how the country should be run, and because votes are so important, they are held four times a year and scheduled decades in advance. Also, as a direct democracy Switzerland lacks an elected Head of State. Instead, the country has a Federal Council which is elected by the Federal Assembly (which works like the Athenian Assembly) every four years. Each year, a new person from the Federal Council is elected to serve as president! Local Elections in the U.S.: Because the populations are much smaller, local, municipal, and county elections often rely on direct democracy to make sure government is serving the will of the people. Local laws and referendums are often put up for a majority vote where every vote counts. State Elections in the U.S.: Fourteen states allow citizens to design legislation and put it up for a vote through what are called ballot initiatives. Each state lets an individual citizen create a ballot initiative, and if it gets enough signatures via petition, it gets put on a statewide ballot where it passes by majority vote. The catch? In order to go on the ballot, each initiative must be ruled constitutional by the state courts, too! Representative Democracy The second type of democracy is a representative democracy (sometimes called indirect democracy). In this system of government, certain individuals are elected to represent the will of the people. These people, often referred to as elected officials, are chosen to vote on behalf of a specific group of citizens. These groups can be defined in many ways. Sometimes people are grouped by neighborhood, by city, by county, or even by province or state. The idea behind a representative democracy is to streamline the process of government. Because elections where everyone weighs in are logistically difficult, having a small number of people representing the desires of the majority allow for much faster decision making. This is especially important when governments are representing a large number of people, and it’s one of the reasons why many federal governments use indirect democracy to operate. But representative democracy comes with drawbacks, too. One of the biggest problems is that in most cases, representatives aren’t required (by law, constitution, etc.) to actually represent the will of their constituents. They’re able to make their own decisions, which can mean that elected officials are more prone to corruption. Additionally, there’s the problem of the vocal minority. Have you ever heard the term, â€Å"the squeaky wheel gets the grease†? It just means that the people who complain the loudest are often the ones who get the most attention. So sometimes a few people who complain loudly are mistaken for representing the majority of their community. Examples of Representational Democracy in Action Because representational democracy works best on a larger scale, most Western governments operate this way (if the country is democratic, of course). Here are a few examples of representational democracy in action. The U.S. Legislature: The U.S. Legislature is a federal representational government, meaning that the representatives who serve create laws that apply to the entirety of the United States. The legislative branch is split into two houses: the Senate and the House of Representatives. In the Senate, each state elects two people to represent their interests on the national level. In the House of Representatives, the number of representatives from each state is determined by population, so bigger states have more representatives. In both cases, all the representatives are elected by majority vote in their respective states. (Note: this is different than other representative democracies, like the United Kingdom parliament, where one house is elected and the other house is appointed by the Prime Minister or President.) U.S. State Legislatures: U.S. state legislatures work exactly like the federal legislature, only on a smaller scale. Each state has both a senate and a house of representatives, and the state’s residents elect representatives based on the districts they live in. This allows each state’s residents to have a say in how their state is governed. The Canadian Government: Like the United States, Canada holds popular elections where a handful of representatives are chosen to represent the citizenry at both the provincial and the national level. The elected officials serve in The House of Commons, which is similar to Congress in the United States. Each of Canada’s 10 provinces are also representative democracies where elected officials represent the will of their province’s citizens. Constitutional Democracy A constitutional democracy is the third major type of democracy in operation today. Constitutional democracies are characterized by having structures in place that limit the power of the majority. Put another way, constitutional democracies have constitutions or other governing documents that help regulate the power of those elected to office. To do this, constitutional democracies function based on a combination of democratic principles and the rule of law. The nation’s constitution serves as the highest form of law and outlines people’s rights as well as what the government can and can’t do. (You might say that the constitution puts limits on the government’s power in order to protect citizens freedom.) As a result, a constitutional democracy government must both uphold the constitution and still represent the will of its people. The benefit of a constitutional democracy is that it gives a country a set of principles to use as a guide for all other decisions. It also protects the citizens by guaranteeing them a certain set of rights. (For the United States, that’s â€Å"Life, Liberty, and the Pursuit of Happiness.†) However, a constitutional democracy also limits an individual citizen’s ability to participate in government since there are strict legal parameters around what people can and can’t do. Additionally, constitutions are very hard to change. In the United States, it takes a two-thirds majority vote in Congress or a constitutional convention (or joint meeting) called for by two-thirds of the states’ governments in order to amend the Constitution! That can be a big problem, especially when aspects of the Constitution are out of date. (Check out the 13th Amendment, which prohibits slavery, or the 19th Amendment, which gives women the right to vote, to see this in action.) Examples of Constitutional Democracy in Action Constitutional democracies are a popular form of democracy around the world. We’ll talk about a few countries that use constitutional democracy below, but if you’re interested in a full list, you can find that here. The United States: Of course, the United States relies on the Constitution and the Bill of Rights to create all new legislation. It’s the job of the judicial branch- including the Supreme Court- to determine whether new laws violate the Constitution or Americans’ constitutional rights. In fact, did you know can go to school to study constitutional law? You can! Check out the Constitutional Law Reporter to learn more about how constitutional law is practiced in America today. Germany: After World War II, Germany was split into essentially two different countries, East Germany and West Germany. When West Germany was set up by the Allies, it was formed as a constitutional democracy. It wasn’t until the fall of the Berlin Wall in 1991 that Germany was unified under a single constitution. Mexico: The United States’ southern neighbor is also a constitutional democracy. The Constitution of Mexico, which was ratified in 1917, was the first constitution in the world to create guidelines for social rights for its citizens, like a right to an education. (Remember: the United States initially did this through the Bill of Rights, which are the first ten amendments to the Constitution.) But Wait...Can a Country Be More Than One Type of Democracy? As you were reading through this section, you probably realized that the United States, along with many other countries, fall into more than one democratic category. That’s because a democratic country can use more than one type of democracy to run its government. For instance, a city can use direct democracy to vote in new laws and select state and federal representatives. Those representatives then participate in representative democracy, where they speak- and vote!- on behalf of their constituents. And finally, all of these actions- policy decisions, government structure, citizens’ rights, and the creation of new laws- are governed by the constitution. That means the United States is a constitutional democracy as well. This is possible because all democracies, regardless of their organizational structure, operate on a shared set of principles. Let’s take a closer look at those now. Voting is a key component of democracy Characteristics of Democracies Beyond just structure, democracies are also characterized by a shared ideology, or system of beliefs. According to Larry Diamond, a professor at Stanford and one of the foremost scholars in democracy studies, democracies have four foundational characteristics. We’ll talk about each principle in more depth below. #1: Free and Fair Elections In order to make sure that people’s voices are being heard accurately, democracies have to ensure that all voting processes are â€Å"free and fair.† But what does that mean? In order for an election to be â€Å"free and fair,† it has to be administered in a way that allows its citizens to vote and treats all political parties and candidates equally. That means the process 1) needs to be accessible to everyone who meets voting qualifications and 2) as unbiased as possible. Furthermore, in order to be as fair, these elections need to occur at a regular interval. If elections are only happening every two decades, that denies people the ability to make their voices heard! Free and fair elections are important to democracy because the voting process is the way that citizens voice their opinions and, in representative forms of government, choose the people who will represent them in higher levels of government. It also puts an important check on power. If representatives are coming up for reelection regularly, it puts pressure on them to vote in line with their constituents. Otherwise they could lose their position during the next voting cycle. #2: Citizen Participation In order for democracy to function, its citizens have to participate in the process of government. That means people have to run for office, create ballot initiatives, petition for laws and causes they believe in, and vote. Remember that the term â€Å"democracy† means that the power to rule belongs to the people. Only by exercising that power can a nation’s citizens ensure that their will is reflected in the country’s laws and structures. It’s also important that in a democracy, all citizens are given an equal right to participate regardless of where they live, what they do for work, or what culture they come from. If civic participation is limited to a certain class or race, the system becomes an oligarchy instead. (In oligarchies, a small group of unelected people hold all the governing power.) When everyone has a chance to participate, it ensures that the government accurately reflects the populace, that minority populations have a voice, and that new laws are fair for everyone. #3: Protection of Citizens’ Human Rights Perhaps most notably, democracies believe in freedom. Citizens should have the right to express their opinions and participate in democracy without fear or intimidation. Not only do democratic societies believe that creates a better life for its citizens, it also helps keep governmental power in check. If people can freely- but peacefully- express their opinions, it makes it clear when elected representatives aren’t listening to the will of the people. Even more importantly, democracies believe in the protection of people’s basic human rights. In the United States, these are outlined in the Bill of Rights, and they include the right to free speech, the right to bear arms, protection from the illegal seizure of property, and the right to a trial by jury. (Not familiar with the Bill of Rights? The Bill of Rights Institute breaks it down for you!) In other words, democracies guarantee fundamental protections to individual citizens which allows them to live in safety, freedom, and peace. #4: Equal Rule of Law Finally, the last thing all systems of democracy have in common is the rule of law. According to Dr. Diamond, the rule of law is fundamentally important to democracy because it protects the rights of citizens, maintains order, and limits the power of government. In other words, if elections are how citizens make their voices heard, then laws are the ways that citizens’ desires are enforced. It’s pretty clear how laws work in a constitutional or representative form of democracy. In a constitutional democracy, the constitution itself lays out some fundamental laws, and no other legislation can violate them. In a representational democracy, laws are created by the elected officials in order to make sure that their constituents’ concerns are being addressed. But what about a direct democracy where everyone has a voice? Well, even in ancient Athens, the oldest direct democracy, had laws to help govern the city-state. The whole point of The Assembly was to create new policies and laws that the majority of people could agree on, and those policies would govern the entire populace! Laws, then, are a tool people can use to make sure the ideals of democracy- like freedom and basic human rights- are maintained. Nick Youngson/Alpha Stock Images What Is a Republic? Whew! Now you know a lot about how democracies function and their core ideals. Now it’s time to look at a republic vs. a democracy. How are they different? Well, the answer is a little bit complicated. The term â€Å"republic† comes from theGreek word politeia, which means the â€Å"rights of citizens.† (It also comes from the Latin res publica, which means â€Å"public affair.†) In modern English, a republic is a government system where the power rests with a nation’s citizens. To do this, republics use elected officials to represent the will of their citizens within the government. In other words, republics rely on a representational form of government, just like the representational democracies we talked about earlier! Additionally, in order for a country to qualify as a republic, its head of state has to be an elected official. That means that while countries like France and Germany- which have elected presidents as heads of state- are republics. Countries with a monarch as the head of state, like Canada and the United Kingdom, are not. So to summarize: a republic is a form of government where the power a) rests with the people, b) is exercised through representative government, and c) has an elected head of state. The Origins of Republics While many ancient states were republics, one of the most notable was the Roman Republic that existed between 500 BCE and 27 BCE. During this time, Rome had expanded to encompass most of modern-day Europe along with parts of Asia and Africa. That meant that Rome was home to many different cultures, and its citizens spoke 21 different languages! This time period also marked Rome’s switch from a monarchy- where a king ruled the nation- to a constitutional government. In 509 BCE, the last Roman King, Lucius Tarquinius Superbus was overthrown and sent into exile. The Roman Senate, which was comprised of Rome’s noble families, decided to institute a new type of government. The country would now be led by two elected consuls who had equal power and would serve one-year terms. These consuls were elected by legislative assemblies made up of male citizens of Rome. These assemblies also voted on laws developed by the Roman Senate. The Roman Senate was comprised of Patricians, which were members of Rome’s noble class. The Senators were appointed by the Roman consuls, and they served as senators for life. The Senate’s job was to draft new laws that would be voted on by the Assembly. Over the next few centuries, the government of Rome would develop a set of guidelines and principles to govern the expanding country, which would coalesce into the Roman Constitution. The Constitution would remain one of the foundational governing documents of the Roman Empire up until its collapse in the 5th century CE. The countries in blue, orange, yellow, and green are all classified as republics. Types of Republics Today Remember that a republic is a nation where governmental power rests with its citizens, uses a representational government, and has an elected head of state. These are pretty general criteria, so that means there are quite a few republics today. In fact, as of 2017, 159 of the world’s 206 countries use the word â€Å"republic† as part of their official names! Additionally, the loose definition of a republic means there many different types of republics functioning today. We’ll briefly discuss the major types of republics here, but you can find more in-depth information about each one by following the links in each description. Constitutional Republic In a constitutional republic, the government is limited by laws established by a formal constitution, which is generally secular in nature. Additionally, the government is run by elected officials who are voted on by the population, and those officials are required to follow the rules of government laid out by that country’s constitution. (For more information about republics based on religion, see the section on â€Å"theological republics.†) Examples of modern constitutional republics include the countries like India and South Africa. Parliamentary Republic A parliamentary republic uses a parliamentary form of government in which the head of state runs the executive branch of government and the head of parliament runs the legislature. The legislature itself is comprised of elected officials that are voted into office by the country’s citizens. Examples of parliamentary republics include Greece, Hungary, and Malta. Presidential Republic A presidential republic allows its citizens to elect a president to serve as the country’s head of state. However, in a presidential republic, the president also serves as the head of the government, too! This is different from a monarchy, where the king or queen serves as the head of state while a prime minister or president runs the day-to-day operations of the government. Examples of presidential republics today include Brazil, Mexico, and Indonesia. Federal Republic Federal republics are countries that are actually a union of states, all of which operate on a republican form of government. In order to qualify as a federal republic, states have to have independence to make their own laws and decisions, as long as those laws don’t conflict with policies established for the entire country on the federal level. (In this way, states function as a mini-republic, complete with elected officials and an elected head of state, like a governor!) Examples of federal republics include the United States, Germany, and Switzerland. Theocratic Republic These types of republics are governed primarily by religious law. In this case, religious texts become the backbone of the nation’s governing structure and are often drafted into a religious governing constitution. That means that additional laws and policies developed by the government must also be in line with religious law. Additionally, in order to qualify as a republic, these theocracies must have an elected head of state rather than a monarchy. Examples of modern theocratic republics include Iran, Afghanistan, and Pakistan. Can a Country Be More Than One Type of Republic? Just like a country can be more than one type of democracy, a country can also be more than one type of republic! For example, Iran has a parliament- making it a parliamentary republic- but it also bases its governing structure on religious law, making it a theocratic republic. The same is true for a country like Germany, which operates on the principles of both a parliamentary republic and a federal republic. In other words, much like democracies, the types of republics we discussed above are not mutually exclusive. In fact, in order for a government to run efficiently, it must often combine governing structures. Russia is a republic but is notdemocratic Republic Vs. Democracy: What’s the Difference? You’ve probably already noticed that republics and democracies have a lot in common, namely that they both are systems where the power to govern rests with the people. So what’s the difference in a republic vs. a democracy? The major difference between a democracy and a republic is that a republic is a form of government whereas a democracy is an ideology that helps shape how a government is run. Put another way: a republic is the system of government that allows a country to be democratic! So while people tend to use the terms â€Å"democracy† and â€Å"republic† interchangeably, they aren’t exactly the same thing. The best way to understand this difference is to look at examples where a republic style of government isn’t democratic. To do this, let’s talk about two non-democratic republics: Russia and North Korea. Russia The Russian government, like many other nations, is set up like a republic. According to the Russian Constitution, the Russian president- which is elected by the Russian populace- is the head of state and runs the executive branch of government. It’s the president’s job to appoint a prime minister, whose job it is to run the government on a day-to-day basis. But in reality, Russia has operated more like a dictatorship than a democracy under current President Vladimir Putin. Although the president and other government officials are elected by popular vote, the Russian government also limits Russian citizens’ freedom, including suppressing free speech and controlling access to objective information. North Korea North Korea’s government is set up much like the United States’ and is split into three branches: the executive branch, the judicial branch, and the legislative branch. By law, the citizens in North Korea elect officials to the legislative branch through popular vote, and the legislative branch passes laws on behalf of the people. (That’s why North Korea’s full name is the Democratic People's Republic of Korea.) In actuality, North Korea is classified as a dictatorship. The current president, Kim Jong-Un, inherited his position from his father. Additionally, elections in North Korea are largely for show- only one candidate runs for each position, so people really have no choice in their representation. Beyond that, the government severely limits people’s ability to travel, so much so that many North Koreans have to pay people to smuggle them out of the country. So despite having a republican government structure- and having the term â€Å"democratic† in their country’s name- North Korea doesn’t function like a democracy on a day-to-day basis. The United States: A Democratic Republic So that leaves us with one final question: what type of government is the United States? Where does the U.S. fall in the republic vs. democracy debate? The answer is that the United States is both a democracy and a republic! The U.S. as a Republic When the founding fathers were writing the U.S. Constitution, they envisioned the United States as a republic. Alexander Hamilton and James Madison made this clear in The Federalist Papers, where they make it clear that the federal government will be made up of elected officials who represent the will of the people. In fact, many of the United States’ founders believed that a direct democracy would result in nothing more than â€Å"...instability, injustice, and confusion.† As a result, the U.S. Constitution outlines a system of government that allows people to fairly vote on representatives, and those representatives make laws in accordance to the people’s will. Each of the states’ governments are set up in the same way, which means that the states are mini-republics, too! Additionally, in order to be a republic, people must elect the person who will serve as the head of state. This is certainly true in the U.S., where citizens vote on who will serve as president of the country every four years (though whether this is a direct or indirect vote is a subject of debate thanks to the electoral college). Considering all of this, the United States works as a combination of a constitutional, presidential, and federal republic! The U.S as a Democracy Remember that the difference between a republic and a democracy comes in how each of those ideas functions in government. So if the United States is a republic because of how the government operates, it’s a democracy because of why it operates. In other words, the U.S. runs its government like a republic, but it bases its government on democratic ideals. In order to operate as a democracy, the United States has to have free and fair elections, citizen participation in government, protect citizens’ human rights, and honor the rule of law. The United States meets all four the criteria to qualify as a democracy. In terms of elections, the U.S. holds regular elections for its elected officials at regular intervals, and any qualified U.S. citizen is allowed to cast their vote for their representatives. Additionally, these representatives are other U.S. citizens. Roles in government aren’t passed down from family to family- all citizens in good standing are welcome to run for office regardless of class, gender, or culture. But what about guaranteeing human rights? One look at the Bill of Rights makes this clear. Not only do the amendments to the U.S. Constitution make guarantees about equality and freedom, they also serve as a set of protections for all U.S. citizens from the overreach of government power. And finally, the U.S Constitution serves as the country’s guiding legal document. All other laws must first uphold the laws and rights outlined in the Constitution first! So Now What? Are you reading this post in preparation for the U.S. History AP Exam? If so, you should also check out some of our other resources! We have subject-specific posts like our NATO overview (coming soon!) and a complete guide to AP U.S. History books. If you’re a freshman, sophomore, or junior, you might consider adding a few more AP classes to your schedule. Here’s a complete list of AP courses and tests to help you choose classes that are perfect for you. Are you also considering taking the SAT subject tests in addition to- or instead of!- an AP exam? Make sure you get the inside information on both before you make your decision.

The Impact of Workplace Bullying Research Paper Example | Topics and Well Written Essays - 750 words

The Impact of Workplace Bullying - Research Paper Example This practice is costing institutions and organizations the labor and cost that might have been used in ensuring the organization’s growth. This paper shall dissect the impact of workplace bullying on both the victim and the organization, and some of the steps taken to curb the prevalence of such practices. The article Workplace Bullying: Costly and Preventable by Terry Wiedmer talks of some of the impacts of bullying in the workplace and its costly nature on the organization. The author explains the emergence of bullying in the workplace as a targeted and pervasive effort that is carried out with or without the knowledge of senior management. The responsibilities and duties of senior management are to ensure that there is the creation of a harassment-free working environment for any and all employees in an organization. The author goes on to indicate that nobody is free from being subjected to the torments that occur in the workplace, and that the outcome of such actions may be immeasurable (Wiedmer, 2010). The psychological harassment of employees in the workplace only works to demoralize them from performing their duties and tasks as assigned. In the long run, their optimum potential is not achieved or attained, hence; bringing down the organization’s objectives. As individuals, their morale levels are lowered, and their self-belief and confidence is affected to the point where they might not be able to perform other functions away from work (Einarsen, Hoel, & Zapf, 2010). In one case, in the past, an employee was once admitted in a healthcare facility for having high work related stress that resulted in high blood pressure. He was failing to meet set targets and was the constant thing in most jokes around the workplace. He would be stressed out and started taking alcohol to numb some of the feelings of despair, but this only made things worse. The drinking affected his work

Marketing case Study Example | Topics and Well Written Essays - 500 words

Marketing - Case Study Example The market estimates were most informative to the company because it was a new market they were venturing in and the estimates were going to help them with making the final decision about potentiality of profits before making the big move. The research was really effective as it unveiled from the discharge permits of the two states information about the water and sewage released from the city and municipality. The information the company lacked earlier about the number of pumping stations for the waste water and their growth rate which was the most important information of all was obtained from the research and this sealed the deal about the market potential in the two states and that the company would make a profit with the move based on these statistics. The sample size used was too small and lacked utility managers and engineers from New York only those from Pennsylvania. It therefore paid much concentration to the individuals as opposed to the technocrats. In the research, there also lacked information about the competitors in the business or what their marketing tactics and strategies might be and this was really important information. There is still much which is unknown about the market in the US and especially whether expansion from these two cities of New York and Pennsylvania is possible or it will prove to be a lost cause. The lack of enough information about the competitors is a huge risk because this might lead to Dillon not making enough profit to break even. On the other hand, the US was a new market and many new markets are fairly high on potentiality. Based on the information from Pennsylvania, the computerized system was highly appreciated by the residents and even utility managers and engineers were positive about the new system and were eager to have it as it would save the city costs. Lack of growth of the business is one recipe for

Harvard business review Essay Example for Free

Harvard business review Essay For each team, by submitting the document online, you claim that the document is original from your own idea. Each team must work on the assignments independently. All the materials submitted will be checked for plagiarism electronically. For more information, please refer to http://www.plagiarism.org/ Should you have questions and concerns in regards to plagiarism, you should contact the course coordinator immediately. Content Tutorial III consists of two parts. The first part includes case discussion while the second part focuses on the feedback to the common mistakes in the intermediate exam. Requirements First, all the students are required to be present and participate in the discussion. Second, all the students are required to read the following two cases: Case Part A: Toyota—Under†the†Radar Recall Response on Page 346 of the textbook; Case – Quality Parts Company on Page 426 of the textbook. Each team is required to write a case note for these two cases. In the case note, you need to give answers to the questions proposed in the corresponding cases. The length of the case note is at most three A4 pages with font size 12 and 1.5 line space, excluding the figure of value stream mapping. For Case – Quality Parts Company, you are NOT required to answer Question 2 and 3. Instead, you need to draw a value stream map for the production process of Model Z based on the symbols which can be found in exhibit 12.3 on Page 409 in the text book. Suppose that customers order every month. After orders are realized, Quality Parts Company orders from suppliers every month. The company does weekly delivery. Inspection is immediately executed after assembly. Every week a production plan is generated which serves as a template for the daily planning activities performed by the production manager. How much value-added time and how much non-value-added time can be found in the production process? Note that you have to ï ¿ ¼Ã¯ ¿ ¼1 use Microsoft Visio 2010 to draw the VSM. Otherwise, no mark is given. You can directly copy the diagram from Visio to Word. Presentation Team 7 of all the groups and Team 12 of IEM groups should present Toyota. Team 8 of all the groups and Team 13 of IEM groups should present Quality Parts. Team 9 of Group 2, 5, 7 should present Quality Parts. The teams present separately. Each presentation takes five minutes. Please use Microsoft Powerpoint to prepare your presentation and the number of slides is at most 5. Please copy your powerpoint file into a USB stick and bring it to the tutorial. To prepare the presentation for cases, you need to present the solutions to the questions proposed in the case description and give a convincing argument for your solutions. The performance of your presentation will be counted for class participation. Submission Your assignment will be graded only if it is submitted online in the fold of Assignment on Nestor by the deadline and a hard copy is passed to your tutorial teacher in class. The deadline is by 24:00 on October 15. Note that write down your names and student numbers at the first page of your document. For the case note, please name your file as groupnumber_teamnumber_case, such as g1_t1_case. Please print your file with a double†sided format. For your presentation file, you only need to give the hard copy of your slides to your tutorial teacher. Topic

Poker Essay -- essays research papers

Poker: Draw Vs. Hold 'em As the room fills with smoke from cigars and cigarettes, I look across the table at the last guy in the hand. I think to myself, â€Å"Why did he just raise me?† I just raised the pot $25 on two pair. The other guy re-raised the pot another $25. My heart is beating like a freight train racing down the tracks, I’m doing everything in my power to stop from sweating and I’m trying to keep my face stone cold straight as to not give myself away. I’m pretty sure at this point that this guy is trying buy the pot, but it still makes me nervous. I decide to call his raise and when the cards are turned over I realize that I had just made the right call. I won the pot and fought off his bluff. Poker is a card game that has been around for hundreds of years. Although the origin of the game and the name itself are debatable, the game of Poker is played more than any other card game in the world. The scenario I explained took place during a game of Five Card Draw. This is a very popular rendition of Poker. Poker has evolved over the years and hence has numerous types of games that still fall under the Poker category. My favorite games are Five Card Draw and Texas Hold ‘em. Both games are similar because they derive from the original game of Poker, involves betting, and using playing cards. They also differ because of the betting, the number of cards used and the way the cards are dealt. Five Card Draw is o...

Cognitive Impairment And Alzheimers Disease Health And Social Care Essay

Apathy is one of the commonest symptoms in Alzheimers disease and is associated with frontal lobe disfunction. Apathy is associated with high health professional load and has several negative effects.Purposes:The primary purpose of this survey is to analyze an association between apathy and frontal lobe disfunction in patients with memory jobs. We besides aimed to look into the association between apathy badness and health professional load along with the relationship between apathy and practiceMethods:This was a retrospective cross sectional survey. We selected 162 back-to-back patients diagnosed with Alzheimer ‘s dementedness and Amnestic Mild Cognitive Impairment who had comprehensive battery of neuropsychological trials and a behavior evaluation graduated table of involvement for this survey recorded in the database. Correlation between apathy with and without depression were tested against frontal lobe trial including Trail doing A, Trial doing B, Letter Fluency, Ideationa l Fluency, Category eloquence, Abstract Thinking and Executive working subtest of CAMGOG-R. Similarly correlativity analysis was besides done to look into association between apathy and caregiver load every bit good as practice.Consequences:Statistically important relationship were found between apathy and executive map tonss, conceptional eloquence tonss, abstract thought and class eloquence tonss. Relationship between apathy and health professional load were extremely important. Further bomber analysis, found apathy to be significantly associated with health professional load in both AD and aMCI patients.DecisionsApathy is associated with frontal lobe disfunction particularly impaired executive map and conceptional eloquence even when controlled for depression. It is extremely associated with health professional load both in AD & A ; aMCI.Hence early acknowledgment and direction of apathy is of import bettering the forecast of patients with AD & A ; aMCI.Table OF CONTENTSABSTRACT 3Chapter 1: Overview OF APATHY 5- 18Chapter 2: Introduction 19 – 20Chapter 3: AIMS & A ; OBJECTIVES 21Chapter 4: Methodology 21 – 28Chapter 5: RESULTS 28- 40Chapter 6: DISCUSSION & A ; CONCLUSIONS 40 – 44REFERENCES 45 -48APPENDIX A: Clinical RESEARCH PROTOCOLAPPENDIX B: ETHIC APPROVAL LETTERAPPENDIX C: NHS R & A ; D APPROVAL LETTEROVERVIEW OF APATHYDefinitionApathy is derived from the Grecian term apatheia intending deficiency of poignancy, or passions, and is normally referred as absence of feeling, emotions, involvement, or concern. ( Marin, 1990 ) Marin was the first to gestate apathy at both symptomatological and syndromal degrees and defined apathy as â€Å" deficiency of motive non attributable to decrease degree of consciousness, cognitive damage, or emotional hurt † ( Marin, 1990 ) .Motivation is a psychological construct and therefore it hard to quantify and measure up it.Hence to do it more clinically qualifiable and quantifiable, Apathy was proposed as a behavioral alteration from the person ‘s baseline and measured as a decrease in spontaneous and purposeful activity. ( Levy and Dubois, 2006 ) . A Starkstein and co-workers have developed a set of diagnostic standards for apathyA these standards specify the undermentioned as nucleus characteristics of apathy: lessened motive, inaugural and involvement, and blunting of emotions ( Starkstein and Leentjens, 2008 ) . In malice of assorted definitions of apathy being proposed, confusion continue to reign sing the nosological place of apathy.Nevertheless progressively apathy is being recognised as an of import constituent of neuropsychiatric research and that ‘s why dependable instance description and designation is necessary, to help communicating, research and intervention. This led to the development of consensus diagnostic standards for apathy in Alzheimer ‘s disease and other neuropsychiatric upsets ( Robert et al. , 2009 ) .DIAGNOSTIC CRITERIAThe revised consensus standards for apathy follow the same general construction as the standards proposed by Starkstein et Al in 2001 ( Robert et al. , 2009 ) . For a diagnosing of Apathy the patient should carry through the standards A, B, C and DStandards ALoss of or diminished motive in comparing to the patient ‘s old degree of operation and which is non consistent with his age or civilization. These alterations in motive may be reported by the patient himself or by the observations of others.Criteria BPresence of at least one symptom in at least two of the three following spheres for a period of at least four hebdomads and present most of the clipDomain B1: Loss of, or diminished, purposive behavior as evidenced by at least one of the followers: Loss of self-initiated behavior ( for illustration: starting conversation, making basic undertakings of daily life, seeking societal activities, pass oning picks ) Loss of environment-stimulated behavior ( for illustration: responding to conversation, take parting in societal activities )Domain B2: Loss of, or diminished, purposive cognitive activity as evidenced by at least one of the followers: Loss of self-generated thoughts and wonder for modus operandi and new events ( i.e. , disputing undertakings, recent intelligence, societal chances, personal/family and societal personal businesss ) . Loss of environment-stimulated thoughts and wonder for modus operandi and new events ( i.e. , in the individuals abode, vicinity or community )Domain B3: Loss of, or diminished, emotion as evidenced by at least one of the followers: Loss of self-generated emotion, observed or self-reported ( for illustration, subjective feeling of weak or absent emotions, or observation by others of a dulled affect ) Loss of emotional reactivity to positive or negative stimulations or events ( for illustration, observer-reports of unchanging affect, or of small emotional reaction to exciting events, personal loss, serious unwellness, emotional-laden intelligence )Criteria CThese symptoms ( A-B ) cause clinically important damage in personal, societal, occupational, or other of import countries of operation.Criteria DThe symptoms ( A-B ) are non entirely explained or due to physical disablements ( e.g. sightlessness and loss of hearing ) , to drive disablements, to decrease degree of consciousness or to the direct physiological effects of a substance ( e.g. drug of maltreatment, a medicine ) .PrevalenceApathy is an of import and often happening symptom in a assortment of neuropsychiatric upsets. Dementia and schizophrenic disorders are among the common causes of apathy ( ref ) . The prevalence for apathy in Alzheimer ‘s disease ranged between 32.1 % ( Holthoff et al. , 2005 ) and 93.2 % ( Sr ikanth et al. , 2005 ) . Point prevalence for apathy in Alzheimer ‘s disease ranged from 32.1 % 19A to 58.7 % ( Aharon-Peretz et al. , 2000, Holthoff et al. , 2005 ) . Table 1: Prevalence of Apathy Across Disorders ( Ishii et al. , 2009 )DisordersPrevalenceMild Cognitive Impairment 14.7 % a?’39.8 % Parkinson ‘s disease 17.0 % a?’45.7 % Progressive supranuclear paralysis 22 % a?’91 % Huntington ‘s disease 59 % a?’82 % Corticobasal devolution 40 % A Frontotemporal dementedness 89 % a?’100 % Dementia with Lewy organic structure 52 % Multiple induration 20 % a?’31 % Stroke 15.2 % a?’42 % Vascular dementedness 22.6 % a?’93.6 % Traumatic encephalon hurt 20 % a?’70 % Amyotrophic sidelong induration 55.6 % Hiv 12 % Cardiovascular disease 29 %CONDITIONS ASSOCIATED WITH APATHYApathy can be a symptom in a figure of neurological or psychiatric syndromes. Neurological Disorders include Traumatic encephalon hurt, Stroke affecting the frontal-subcortical circuit, Alzheimer ‘s disease ( AD ) , Dementia with Lewy organic structure ( DLB ) , Creutzfeldt-Jakob disease, Frontotemporal dementedness ( FTD ) , HIV dementedness, Parkinson ‘s disease ( PD ) , Progressive supranuclear paralysis, Anoxic brain disorder, Cerebral tumor, Chronic subdural haematoma, Huntington ‘s disease, Limbic phrenitis, Multiple induration, Bingwanger ‘s encephalopathy, Wernicke-Korsakoff syndrome, Kluver Bucy syndrome, Hydrocephalus, Delirium Psychiatric Disorders such as Depression, Schizophrenia, Psychoses and Adjustment upset Psychotropic drugs: . Dopamine adversaries are by and large associated with lessened motive, whilst agonists can increase it. Cannabis dependance, pep pill and cocaine backdown have all been implicated as a causative factor. An amotivational, or apathy, syndrome has been reported in a figure of patients having selective 5-hydroxytryptamines reuptake inhibitor ( SSRI ) intervention over the last decennary. This inauspicious consequence has been noted to be dose-dependent and reversible, but is frequently unrecognised ( Garland and Baerg, 2001 ) . Medical Disorders such as Apathetic thyrotoxicosis, Drug intoxications/withdrawal, Hypothyroidism, Lyme disease, Pseudoparahypothyroidism, Chronic weariness syndrome, Testosterone lack, Vitamin B12 lack, Other enfeebling conditions ( eg, malignance, CCF, nephritic or hepatic failure ) .IS APATHY AND DEPRESSION THE SAME?Apathy has frequently been treated as a portion of depression and it can frequently be diagnostically disputing to distinguish between the two due to frequent carbon monoxide morbidities and a considerable convergence in cardinal symptoms. However they are different concepts and it is of import to distinguish them because of predictive and intervention deductions. Apathy can besides ensue from the intervention for depression. There are theoretical concern that serotonergic re-uptake inhibitors ( SSRIs ) may impact the counterweight of 5-hydroxytryptamine and Dopastat, which can take to apathy, and SSRI-induced apathy has been progressively reported.Table 2: Differences and convergences in the clinical symptoms of apathy and depression ( table adapted from Landes et al. , 2005 )Apathy SymptomsDepressive SymptomsShared SymptomsLack of emotional response Indifference Diminished motive Lack of productiveness Poor Persistence Low societal & amp ; occupational battle Person is by and large satisfied Low temper Feelingss of guilt, Suicidal ideations Insomnia Reduced appetency Pessimism Self-criticism Hopelessness Worthlessness Loss of involvement Psychomotor deceleration Fatigue/hypersomnia Lack of penetrationEffectss of ApathyApathy has important negative effects and therefore early designation and diagnose is critical. In Alzheimer ‘s Disease ( AD ) patients, apathy is associated with hapless penetration into cognitive and behavioral alterations ( Derouesne et al. , 1999 ) along with greater cognitive every bit good as functional diminution ( Holtta et al. , 2012 ) . Apathetic patients are frequently misperceived as lazy by the household taking to increasing resentfulness. Apathy may impact patient perceptual experience of quality of life ( Gerritsen et al. , 2005 ) and is significantly associated with activities of day-to-day life ( ADLs ) damage ensuing in increased patient and health professional distress.. It is besides significantly associated with older age and a higher incidence of depression and craze ( Holtta et al. , 2012 ) . Apathy has been shown to be associated with frontal lobe disfunction particularly executive map in dementedness ( Ready et al. , 2003 ) and these frontal lobe maps are indispensable to a individual ‘s ability to transport out mundane planning and determination devising along with health-promoting behaviors, such as medicine direction, dietetic and lifestyle alterations, self-monitoring of responses, and follow-up with wellness attention professionals ( Kuo and Lipsitz, 2004 ) . Apathy affects the quality and degree of familiarity in a relationship and hence enjoyment of each other ‘s company. This leads to impairment of the relationship, increased health professional load and an increased the hazard of institutionalisation ( Spruytte et al. , 2001 ) ( de Vugt et al. , 2003 ) . Apathy besides has of import diagnostic and intervention deductions.It may forestall patients from seeking an early formal appraisal and may interfere with attachment to pharmacologic intervention for memory loss and engagement in compensatory schemes, such as keeping an accurate and up-to-date memory notebook ( Ready et al. , 2003 ) . Apathy may hold important predictive value.Apathy has been described to increase the hazard of patterned advance from MCI to dementia. In nursing place patients with Alzheimer ‘s dementedness, apathy has been associated with physical damage, dependence, hapless nutritionary position and significantly increased 2-year mortality rates ( Holtta et al. , 2012 ) .PATHO-PHYSIOLOGY OF APATHYApathy has been shown to be associated with a break of the frontal-subcortical neural circuit. Assorted surveies have concluded that the neural circuit that originates from the anterior cingulate cerebral mantle, so proceeds to the ventral striate body, globus pallidus, and thalamus, with a concluding cringle back to the anterior cingulate cerebral mantle is related to apathy ( Bonelli and Cummings, 2007 ) .Autopsy surveies have shown that neurofibrillary tangles load were significantly higher in the anterior cingulate cerebral mantle in apathy ( Marshall et al. , 2006 ) .Similarly structural magne tic resonance imagination ( MRI ) surveies have shown that apathy badness correlated with wasting of bilateral anterior cingulate and left auxiliary motor country ( Apostolova et al. , 2007 ) .Studies with Single photon emanation imaging have besides shown that apathetic AD patients had significantly decreased perfusion in the anterior cingulate, the inferior and median convolution frontalis and the orbito frontal convolution ( Robert et al. , 2006 )FigureA 1.A Behavioural and cognitive alterations associated with break of specific frontal-subcortical circuits ( Ball et al. , 2010 ) .Dopamine is the principle neurotransmitter of purposive behaviour, modulating motive, rousing, motor response, and sensorimotor integrating. There is a strong relationship between D2 receptor stimulation and anterior cingulated cortex metamorphosis. The anterior cingulate cerebral mantle appears to be of importance in motive and wages ( Devinsky et al. , 1995 ) and receives exceptionally heavy dopaminer gic ( DA ) excitation originating from ventral tegmental country ( VTA ) nerve cells ( Williams and Goldman-Rakic, 1998 ) . Cholinergic and serotonergic tracts besides play a neuromodulatory function in the motivational circuitry. Acetylcholine ( ACh ) and DA systems appear to organize striatal wages map in a feed-forward, complementary mode ( Williams and Adinoff, 2008, Zhou et al. , 2003 ) . Serotonin is chiefly an repressive neurotransmitter can straight impact frontal lobe activities and they can indirectly modulate frontal lobe activity by suppressing the release of Dopastat ( Daw et al. , 2002 ) . Positron Emission Tomography surveies have important decreases of 5-HT2AA receptor densitiesA in the frontal lobe in patients with apathy ( Franceschi et al. , 2005 ) .ASSESSMENT OF APATHYThere are assorted graduated tables available to determine and quantify apathy. A recent literature reappraisal has identified around 14 graduated tables of which seven were full apathy graduated ta bles and eight were apathy subscales embedded in larger graduated tables ( Clarke et al. , 2011 ) . The most widely used graduated table were the Apathy Evaluation Scale AES ) and the Neuropsychiatric Inventory ( NPI ) .Neuropsychiatric Inventory ( NPI )The NPI is a graduated table that assesses and quantifies neurobehavioral perturbations in dementedness patients and besides quantify health professional hurt caused by such behaviors ( Clarke et al. , 2011, Cummings et al. , 1994 ) . The NPI has an apathy subscale, which consists of a general screen point rated on a yes-versus-no footing. If the symptom is found to be present, seven extra apathy inquiries are administered and scored on a yes-versus-no footing. The overall frequence ( rated as 1-4 ) and badness ( rated as 1-3 ) of apathy is so rated. Tonss on the NPI apathy subscale scope from 0 to 12 with higher tonss bespeaking more terrible apathy ( Cummings et al. , 1994 ) . The NPI, and therefore the NPI-apathy subscale, is depe ndable, widely used, and has been validated in many different scenes.Apathy rating graduated table ( AES )The AES is an Eighteen-item graduated table capturing symptomatology over last 4 hebdomads. This scale buttockss and quantifies the affectional, behavioural, and cognitive spheres of apathy. It specifically assesses apathy and discriminates it from depression. Each point can be rated on the 4 point likert Scale. It takes around 10-20 min to be completed by a trained interviewer. This trial has a good interrater dependability and is widely usedPOTENTIAL TREATMENT OPTIONS FOR APATHYNonpharmacologic Treatment of ApathyThere are many non pharmacological intercessions that have anecdotal and qualitative grounds of effectivity in the apathy but merely a few of them has quality research confirmation in footings of effectivity ( Brodaty and Burns, 2011 ) . Open-label surveies have shown that multisensory behavior therapy and music therapy have positive consequence in cut downing apathy and could hike the consequence of anti dementedness drugs ( Ferrero-Arias et al. , 2011, Staal et al. , 2007 ) . Cognitive stimulation therapy that provides activities affecting cognitive processing, within a societal context, with an accent on enjoyment has been shown to be effectual in cut downing apathy in early Alzheimer ‘s Disease ( Buettner et al. , 2011 ) . Treatment of apathy requires multidisciplinary attack along with health professional psycho instruction about the pathological nature of apathetic province. The health professionals should besides be encouraged to present new beginnings of pleasances, involvements and stimulation along with increasing chance for socialization. It is besides of import that the patient ‘s general medical conditions are assertively treated and centripetal shortages corrected along with environmental alterations such as usage of adaptative devices such as wheelchair, seeable Clocks, calendars and equal lighting to increase the reward potency of the environment and thereby enhance motive. Although there is presently lack of research grounds, it is possible the other non pharmacological intercessions such as originative activities, cookery, Montessori methods, and behavioural elements, frequently separately tailored, exercising, multisensory stimulation, favored therapy, and particular attention unit s have the possible to cut down apathy ( Brodaty and Burns, 2011 ) .Pharmacologic Treatment of ApathyAcetylcholinesterase InhibitorsAChIs are chiefly used for handling cognitive symptoms in dementedness but recent surveies have shown positive effects on noncognitive symptoms such as apathy, depression, anxiousness, and purposeless motor behaviours. Consequences from randomized controlled tests have shown that AChIs including donepezil, galantamine and rivastigmine are clearly good in the intervention of apathy. There is no clear indicant that any one AChI is superior.NDMA Receptor AntagonistMemantine is a specificA N-methyl-D-aspartate receptor adversary and is the lone drug approved for handling terrible AD.A It appears to work by modulating the activity of glutamate, leting a controlled sum of Ca to flux into nerve cells ( enabling information processing, storage, and retrievalA 98 ) protecting nerve cells against glutamatergic excitotoxicity and, potentially, holding a neuroprote ctive consequence by cut downing toxic Ca inflow. There is grounds from randomized, double-blind, placebo-controlled tests, which indicated important betterments in apathy degrees for patients treated with MemantineMajor tranquilizersTypical Consequences from Randomized, double-blind, placebo-controlled test in nondepressed inmates with dementedness found no alteration in apathy degrees Atypical Surveies look intoing the effects of untypical major tranquilizers on apathy have reported important betterments in symptomsA farther 12-week open-label survey 130 of risperidone in 135 patients with AD showed increasing and important betterment in apathy. An RCT of 652 nursing place occupants with terrible AD reported betterment in apathy for occupants treated with olanzapine 5 mg/day but non with 1, 2.5, or 7.5 mg/day, and there was no accommodation for multiple comparingsAntidepressantsBupropion is aA dopamineA andA norepinephrine re-uptake inhibitorA and releaser. It is approximately twice as potent an inhibitor of Dopastat re-uptake than of norepinephrine reuptake.A Besides reuptake suppression of Dopastat and noradrenaline, bupropion besides causes the release of Dopastat and noradrenaline. Hence theoretically should profit apathy but there have been no good quality tests with Bupropion. There is grounds signifier clinical instance series that bupropion may profit apathy ( Corc oran et al. , 2004 ) Assorted tests of antidepressants in the interventions of apathy have mostly been negative, supplying extra support that depression and apathy are different concepts. There is good quality grounds from assorted randomised controlled trails that antidepressants do no alteration in apathy degrees. Interestingly apathy syndrome has been reported in a figure of patients having selective 5-hydroxytryptamines reuptake inhibitor ( SSRI ) intervention over the last decennary and hence SSRI must be used with cautiousnesss clinicians need to be proactive in supervising for this inauspicious consequence ( Barnhart et al. , 2004 )PsychostimulantsEvidence from instance studies and little open-label surveies in non demented populations suggests that psychostimulants such as dextroamphetamine and Ritalin may be effectual in the intervention of apathy.Results from a recent double-blind, randomized, placebo-controlled crossing over test of Ritalin for the intervention of apathy suggest modest benefit s in a subset of AD patients, but that tolerability may be a concern in this population ( Herrmann et al. , 2008 ) .A There are instance studies that have reported that Modai ¬?nil may profit apathy syndrome in the older patients and is more tolerable ( Camargos and Quintas, 2011 )Dopaminergic agentsThere are merely few surveies on the effectivity of dopaminergic agents as a intervention for apathy and such surveies have been chiefly focussed on Parkinson ‘s disease and station shot conditions.Bromocriptine, aA Dopastat agonist, in case-series studiesA have been found to be effectual in cut downing apathy symptoms in shot and hypoxic encephalon hurt patients ( Barrett, 1991, Debette et al. , 2002, Krishnamoorthy and Craufurd, 2011 ) . There is nevertheless no good quality research grounds of their effectivity in handling apathy in Alzheimer ‘s disease ( van Reekum et al. , 2005 ) .Amantadine is aA N-methyl-D-aspartic acid receptor adversary, which may indirectly height en dopaminergic transmittal and confer neuroprotective effects, similar to its parallel, memantine has been shown to be effectual in bettering executive map and apathy symptoms in chronic encephalon hurt, dementedness and Parkinson ‘s disease ( Drayton et al. , 2004, Wu and Garmel, 2005 ) . Levodopa/carbidopa besides appears to better motive in assorted neurological and psychiatric upsets harmonizing to instance surveies of patients ( Bakheit et al. , 2011, Drubach et al. , 1995 ) Pramipexole, another Dopastat agonist with D3-preferring receptor adhering profile, is used in the early-stage Parkinson ‘s disease ( PD ) .A meta-analysis of placebo-controlled surveies have shown good consequence on temper and motivational symptoms in PD patients ( Leentjens et al. , 2009 ) . Similarly Ropinirole, Dopastat D2/D3 receptor agonist been reported to better apathy and temper in patients with Parkinson disease ( Czernecki et al. , 2008 )IntroductionApathy is a neurobehavioral syndrome which is defined as quantitative decrease of voluntary, purposive behavior ( Levy and Dubois, 2006 ) .It extremely prevailing across a big assortment of neurological, psychiatric, and medical conditions and is the most common neuropsychiatric symptom of Alzheimer ‘s disease with an mean point prevalence of 60 % in outpatients with Alzheimers Disease. ( Clarke et al. , 2011, Robert et al. , 2004 ) Apathy is a major hazard factor for transition to dementia in MCI topics and follow up surveies have shown that rates of transition to dementia in MCI with apathetic symptoms were up to 60 % as compared to 24 % for MCI without apathy and depression ( Vicini Chilovi et al. , 2009 ) . Apathy was thought to be upset of sub cortical encephalon construction but interestingly it appears to be really commoner in cortical encephalon upsets with averaged point prevalence of about 60 % as compared to 40 % in upsets of sub cortical constructions ( van Reekum et al. , 2005 ) . The frontal lobes play an of import function in back uping higher-level cognitive map, dwelling of executive accomplishments and working memory. Executive maps are higher-order cognitive procedures that orchestrate simple thoughts, motions and actions into complex purposive behaviors. They include be aftering, induction, coincident information processing, ordinance, judgement, abstraction, and job resolution. Damage of executive working consequences in disinhibition, concrete thought, perseveration, deficiency of enterprise, apathy, and loss of cognitive i ¬Ã¢â‚¬Å¡exibility ( Tsoi et al. , 2008a ) . A significant organic structure of grounds suggests that apathy typically occur following harm to prefrontal cortical-striatal circuits in the encephalon, and are seen in many neurological and psychiatric upsets, including all of the common signifiers of dementedness: Alzheimer disease ( AD ) , vascular dementedness ( VaD ) , and Frontotemporal dementedness. ( Craig et al. , 1996 ) .Studies have shown that Apathy in AD patients was associated with more terrible hypoperfusion in frontal parts on functional imagination ( Craig et al. , 1996 ) . A few surveies have tried to look into the relationship between apathy in dementedness and frontal lobe disfunction. Apathy in AD has been shown to be significantly associated with hapless public presentation on executive map trials, such as the Trail-Making Test and the Stroop colour intervention trial ( McPherson et al. , 2002 ) . Executive disfunction, particularly shortages impacting verbal eloquence and conceptional eloquence, was a important forecaster of apathy in dementedness ( Tsoi et al. , 2008a ) . There has been really small literature about relationship between practice and apathy in Alzheimer ‘s disease. It is known that frontal systems behavioral jobs are associated with higher health professional load after commanding for dementedness badness and health professional depression. There has been conflicting studies about part of apathy towards caregiver burden. Few surveies have shown that apathy was associated with greater grade of health professional load ( Chow et al. , 2009 ) ( Leroi et al. , 2012 ) while another survey showed that it was the behaviors associated with executive disfunction and disinhibition that were prognostic of load and apathy was considered less troublesome to health professionals ( Davis and Tremont, 2007 )AIMS & A ; OBJECTIVES:The primary purpose of this survey is to analyze the association between apathy with or without depression and frontal lobe disfunction in patients with memory jobs. The secondary purpose is to look into association between apathy badness and the health professional load In add-on, this survey will look into the association between apathy and practice in AD and MCI as there are presently limited surveies that have looked into association between them.DESIGN/ METHODOLOGY:Ethical motives Approval: A The survey was approved by The National ResearchA EthicsA Service ( NRES ) Committee for East of England, King College London every bit good as the NEPFT NHS R & A ; D officePutingThe survey was done at the West Essex Neurocognitive Clinic which is third referral Centre and is based at three locations viz. St Margaret ‘s Hospital, Epping, Princess Alexandra Hospital, Harlow and Rectory Lane Health Centre, Loughton. The catchment country serves population of aged people of greater London and Essex, UK. The Clinic provides a specialised, multidisciplinary, hospital-based appraisal for people with cognitive jobs Majority of the patient ‘s referred are those with mild cognitive damages or patients hard to name due to combination of medical, neurolog ical, societal and neuropsychological factors. The clinic is focused on research and preparation and is involved in assorted imagination, cognitive and intervention surveies, every bit good as encephalon contribution programme. Referral standards are based on a history of cognitive damage, which is likely to be caused by degenerative alterations of the encephalon with the MMSE mark of at least 20/30, complex presentations due to interplay of varying degrees medical, neurological and neuropsychological factors and hard to name instances. Patients must be aged in surplus of 40 old ages ( reflecting appropriate referral of people with possible immature onset dementedness ) and must be able to give informed consent. The appraisal is done by a trained and experient clinician along with a psychologist/assistant psychologist. Assessment encompasses a assortment of trials aimed at set uping diagnosing and badness of unwellness. The appraisals of involvement for this survey includes A standard psychiatric interview Behavioural Pathology in Alzheimer ‘s Disease Scale ( BEHAVE-AD ) sum 75 where higher mark indicates more disturbed behavior ; Apathy/Indifference sub-scale ( NPI ) total/12 – higher mark indicates greater apathy ; Hospital Anxiety and Depression Scale ( HADS ) -total on each scale/21 -score of 7 or less indicates no important symptoms, mark of 8 – 10 indicates mild symptoms, mark of 11 + indicates moderate symptoms ; Instrumental Activities of Daily Living Scale ( IADL ) total/31 -higher tonss indicates increased dependence upon the source or ‘carer ‘ ; Clinical Dementia Rating ( CDR ) total/5 -higher mark indicates more badly affected cognitive and occupational/social operation ; Screen for Caregiver Burden ( SCB ) total/100 – higher mark indicates client is perceived to be a greater load by the source or ‘carer ‘ ; Neuropsychometric Assessment is done by the Psychologist/Assistant psychologist. The battery of neuropsychometric trials done of involvement to this survey includes: Estimated pre-morbid rational operation ( National Adult Reading Test – NART ) , Cambridge Cognitive Examination-Revised ( CAMCOG-R ) Trail doing A & A ; Trial devising B Letter Fluency, Category eloquence, Ideational Fluency Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking ) Subjects: This was a retrospective Cross-sectional survey. The survey population comprised 160 back-to-back patients with newly-diagnosed Alzheimer ‘s disease and amnestic-MCI, All the patients at the clip of their initial neurocognitive clinic appraisal had a thorough neurological and psychiatric scrutiny by a trained and experiences clinician along with extended neuropsychometric appraisal by a psychologist. Health professionals and next-of-kin were besides interviewed.At the clip of the appraisal all patients had capacity to give an informed consent to undergo the appraisal. Their capacity was assessed by a member of clinical squad familiar with, and trained in usage of the Mental Capacity Act. In add-on, patients have either agreed or disagreed to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. Eligibility standards: All patients diagnosed with Alzheimer ‘s disease and amnesic Mild Cognitive Impairment who had the undermentioned probes recorded on database: NPI apathy mark, frontal lobe map trial i.e Trail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking, CAMCOG-R, age, gender, HAD Depression mark, Care giver load and Praxis. All these patients would be eligible to take a portion in the survey. Inclusion standards: Eligible patients who gave an informed consent to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. This is considered to be patients presumed wants. Exclusion standards: Patients who did non consent to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. This is considered to be patients presumed wants. Patients whose depression scores on HAD were more than 8 were besides excluded.MeasuresApathy will be measured as the apathy sub-score on the NPI. The NPI was developed to measure and quantify neurobehavioral perturbations in dementedness patients and to quantify health professional hurt caused by such behaviours. The NPI has an apathy subscale, which consists of a general screen point rated on a yes-versus-no footing. If the symptom is found to be present, seven extra apathy inquiries are administered and scored on a yes-versus-no footing. The overall frequence ( rated as 1-4 ) and badness ( rated as 1-3 ) of apathy is so rated. Tonss on the NPI apathy subscale scope from 0 to 12 with higher tonss bespeaking more terrible apathy. The NPI, and therefore the NPI-apathy subscale, is widely used and has been validated in many different samples such as ambulatory patients with dementedness, outpatients with AD, multicultural samples, and nursing place occupants. Cognitive damage will be measured by the mark on Cambridge Cognitive Examination-Revised ( CAMCOG-R ) . This neuropsychological battery steps cognitive shortage in a figure of cognitive spheres – mark & lt ; 80/105 suggests the presence of a dementedness, mark of 80-90/105 is fringy. Frontal Lobe disfunction will be measured by the tonss obtained from the undermentioned frontal lobe map trial i.e. Trail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking ) . The Trail Making Tests ( TMTs ) are popular neuropsychological instruments used either entirely as a showing instrument for observing neurological disease and neuropsychological damage or as portion of a larger battery of trials. The trials are believed to mensurate the cognitive spheres of treating velocity, sequencing, mental flexibleness and visual-motor accomplishments Part A is by and large presumed to be a trial of ocular hunt and motor velocity accomplishments, whereas portion B is considered besides to be a trial of higher degree cognitive accomplishments such as mental flexibleness. TMT-A requires chiefly visuoperceptual abilities, TMT-B chiefly reflects working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, supplying a comparatively pure index of executive control abilities.Average DeficientDrag A 29 seconds 78 seconds Trail B 75 seconds 273 seconds Letter Fluency undertakings require coevals of words get downing with specific letters within a limited clip it has been. Letters F, A, and S ( FAS ) version of the The Controlled Oral Word Association Test is used in this survey. The trial disposal takes about five proceedingss. The mark is the amount of all admissible words for the three letters ( Loonstra et al. , 2001 ) . Category Fluency undertaking require persons to bring forth examples of specific semantic classs such as the names of animate beings or fruits. CF trial is a really speedy ( normally taking 1 min ) , easy to administrate trial that proved to be utile in the diagnosing of mild AD. The most common version involves the semantic class of animate beings. Surveies have shown that tonss below 15 in the CF ( animals/min ) had a sensitiveness of 88 % and a specificity of 96 % , in distinguishing AD patients from normal controls, bespeaking that a 1-minute trial can be helpful to clinicians to place persons in the early phases of the disease ( Caning et al. , 2004 ) . Category Fluency and Letter Fluency require frontally mediated executive retrieval mechanisms. Both besides require entree to phonological/lexical shops. But, merely class eloquence besides requires entree to more widely distributed semantic shops as the topic searches for examples suiting the mark class ( Cerhan et al. , 2002 ) .Datas AnalysisDependent variable is Apathy mark. Independent variables are CAMCOG-R tonss, tonss of the undermentioned frontal lobe testsTrail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual concluding ) every bit good as tonss of health professional load and practice. All these variables will be analysed as uninterrupted informations. The consequences will be graphed to look into if the distribution is about normal and the spread secret plan used to measure the one-dimensionality of the association. Correlation analysis, measured as a correlativity coefficient R, will be used to look into for the presence, the strength and way of a relationship between these variables. Cut-off point of 0.4 will be considered to be important. Depending on the one-dimensionality one of the two correlativity coefficients will be calculated. Ranked correlativity will be used in the statistical analysis if the relationship between the two variables in non-linear. Rank correlativity coefficients, such as Spearman ‘s rank correlativity coefficient measures the extent to which, as one variable additions, the other variable tends to increase, without necessitating that addition to be represented by a additive relationship. If, as the one variable addition, the other lessenings, the rank correlativity coefficients will be negative. If the two variables appear to hold additive relationship Spearman correlativity coefficient will be calculated. The closer the coefficient is to either a?’1 or 1, the stronger the correlativity between the variables. Correlation Negative Positive Small a?’0.3 to a?’0.1 0.1 to 0.3 Medium a?’0.5 to a?’0.3 0.3 to 0.5 Large a?’1.0 to a?’0.5 0.5 to 1.0 If the variables are independent so the correlativity is 0. However, the antonym is non true because the correlativity coefficient detects merely additive dependences between two variables.Power computationStatisticalA powerA analysesA wasA doneA byA usingA G*PowerA 3.1 ( Faul et al. , 2009 ) TypeA IA error=0.05A TypeA IA error=0.01A TypeA IA error=0.001 Power=80 % A 34A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 56A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 84 Power=90 % A 47A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 72A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 106 Power=99 % A 85A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 117A A A A A A A A A A A A A A A A A A A A A A A A A A A 159 ThisA indicatesA thatA inA orderA toA determineA aA correlationA ofA magnitudeA 0.4A atA P & lt ; 0.05A atA aA powerA levelA ofA 80 % , A thisA studyA needsA aA minimumA ofA 34A participants.AConsequenceOne hundred and 60 patients with AD or amnesic MCI who met the above-described standards were enrolled in the survey. Of these 68 patients had a diagnosing of Alzheimer ‘s disease and 92 had a diagnosing of amnesic MCI. The demographic information of the topics are summarized in Table 1. No statistically important differences in age, instruction, gender, premorbid intelligence, or old ages in instruction consequences were observed between the two groups. However as expected, there was statistically important difference in footings of the IADL, CAMCOG-R, CDR & A ; MMSETable 1: Demographic and clinical featuresAverage AD ( SD )Average MCI ( SD )P valueNIADL10.34 ( 5.52 ) 8.11 ( 3.42 ) & lt ; .001 160CAMCOG-R76.8 ( 12.66 ) 86.98 ( 8.71 ) & lt ; .001 156MMSE22.19 ( 5.13 ) 25.81 ( 2.55 ) & lt ; .001 158NART105.33 ( 10.00 ) 106.26 ( 12.23 ) .319 124CDR0.82 ( 0.41 ) 0.55 ( 0.17 ) & lt ; .001 159Age74.37 ( 8.61 ) 73.37 ( 8.70 ) .339 160Old ages Ed.11.14 ( 2.91 ) 11.16 ( 2.60 ) .655 154AdMCIChi SquareP valuePercent female51.5 47.8 0.21 .65Percentage with intoxicant history63.2 65.9 1.47 .69Percentage with smoking history42.6 50.0 2.33 .31 The frequence distribution box secret plan suggested that NPI apathy bomber graduated tables are non usually distributed. We did normalcy trials to find whether apathy informations set is well-modelled by a normal distribution or non. We used the Shapiro-Wilk trial as our numerical agencies of measuring normalcy and found that the apathy informations significantly deviate from a normal distribution. Shapiro-Wilk Statistic df NPI Apathy sub graduated table .624 160 As our information ‘s were non parametric, utilizing the Spearman rho correlativity coefficient, correlativities between variables for whole group and subgroups was generated. The Spearman rho correlativity was repeated with depressive subgroups removed. All trials were one-tailed since hypotheses were directional. The exclusion to this was the trial look intoing the relationship between gender and apathy. These hypotheses were non-directional and therefore two-tailed trials were used.Executive map markAbstract believing markCaregiver loadCAMCOG-R markLetter FluencyClass EloquenceTrail Making Test A ( seconds ) Trail Making Test B ( seconds )Conceptional eloquence markPractice Correlation Coefficient-.222**-.180*.477**-.136*-.071-.166*.009 .010-.213**-.102 Sig. ( 1-tailed ).003.012.000.045.189.019.456 . 464.004.103 Nitrogen157157145156155157152 84156156ConsequencesTable 1: Correlations between variables for whole group and subgroupsCorrelations between variables for whole group and subgroups with depression removed.Executive map markAbstract believing markCaregiver loadCAMCOG-R markLetter Fluency Class Eloquence Trail Making Test A ( seconds ) Trail Making Test B ( seconds )Conceptional eloquence markPractice Correlation Coefficient-.169*-.125 .475** -.067 -.041 -.123 -.052 .089-.186*.019 Sig. ( 1-tailed ).027.077 .000 .223 .321 .080 .279 .229.017.417 Nitrogen131131 121 131 130 131 127 72130131Relationship between apathy and executive mapIn the combined sample ( AD and A-MCI ) , informations on executive map was available for 157 patients. In these patients, NPI apathy mark was significantly related to executive operation ( rs = -.222, P = .003 ) .When the group of patients with depressive symptoms were removed, the NPI apathy mark still remained significantly related to executive operation ( n=131, rs =-.169, p=.027 )Relationship between apathy and trail devising trialsIn the combined sample ( AD and A-MCI ) , informations on trail doing trial A was available for 152 patients. In these patients, NPI apathy mark was non significantly related to drag doing tonss ( rs = .009, P = .456 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to drag doing A tonss ( n=127, R -.052, p=.279 ) In the combined sample ( AD and A-MCI ) , informations on trail doing trial B was available for 84 patients. In these patients, NPI apathy mark was non significantly related to drag doing tonss ( rs = .010, P = .464 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to drag doing B tonss ( n=72, R.089, p=.229 )Relationship between apathy and verbal eloquenceIn the combined sample ( AD and A-MCI ) , informations on missive eloquence ( FAS ) was available for 150 patients. In these patients, NPI apathy mark was non significantly related to eloquence ( rs = -.047, P = .284 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to eloquence tonss ( n=130, R -.041, p=.321 )Relationship between apathy and class eloquenceIn the combined sample ( AD and A-MCI ) , informations on class eloquence ( animate beings ) was available for 157 patients. In thes e patients, NPI apathy mark was significantly related to category eloquence ( rs = -.166* , P = .019 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to category eloquence ( n=131, rs -.123, p=.080 )Relationship between apathy and conceptional eloquenceIn the combined sample ( AD and A-MCI ) , informations on conceptional eloquence was available for 156 patients. In these patients, NPI apathy mark was significantly related to conceptional eloquence ( rs = -.213** , P = .004 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained significantly related to on conceptional eloquence ( n=130, rs -.186* , p=.017 ) .Relationship between apathy and cognitive mapIn the combined sample ( AD and A-MCI ) , informations on CAMCOG-R was available for 156 patients. In these patients, NPI apathy mark was significantly related to cognitive operation ( rs = -.136* , P = .045 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained significantly related to on conceptional eloquence ( n=131, rs -.067, p=.223 )Relationship between apathy and abstract thoughtIn the combined sample ( AD and A-MCI ) , informations on abstract thought was available for 152 patients. In these patients, NPI apathy mark was significantly related to abstract thought ( rs = -.180, P = .013 ) .Relationship between apathy and health professional load.In the combined sample ( AD and A-MCI ) , informations on health professional load was available for 145 patients. In these patients, NPI apathy mark was significantly related to caregiver load ( rs = .477** , P = .000 ) . NPI apathy mark remained significantly related to caregiver burden even when the depressive subgroup of patient was removed ( n=121, rs =.475** , P = .000 ) . The correlativity between apathy and caregiver load were so tested in Alzheimer ‘s disease and amnesic MCI individually and in both subgroups NPI apathy mark was significantly related to caregiver loadNonparametric Correlations: NPI Apathy and Caregiver Burden in AD & A ; aMCIaMCIAdNPI Apathy sub graduated table Correlation Coefficient .458** .480** Sig. ( 1-tailed ) .000 .000 Nitrogen 68 53 A arrested development analysis was carried out to understand the relationship between a health professional load and MMSE, Depression Scores, Apathy, Behave -AD Scores, executive map mark, IADL.Arrested development Analysis CoefficientsaModel Unstandardized Coefficients Standardized Coefficients T Bacillus Std. Mistake BetaNPI Apathy sub graduated table1.130.240.3944.703IADL.360.167.1812.155Behave -AD mark .303 .211 .113 1.438 HADS-depression mark .016 .212 .006 .074 Executive map mark -.113 .200 -.047 -.566 MMSE mark .024 .193 .010 .125 a. Dependent Variable: Mark for ‘caregiver load ‘ questionnaire at baseline It is clear from the multiple arrested development analysis that merely NPI apathy tonss and IADL were significantly related to caregiver load. However the other variables which included Behave AD tonss, HADS depression tonss, Executive map tonss and MMSE were non significantly related to the health professional load tonssModel SummaryModel Roentgen R Square Adjusted R Square Std. Mistake of the Estimate Change Statisticss R Square Change F Change df1 df2 1 .542a .293 .288 7.668 .293 59.353 1 143 2 .592b .350 .341 7.377 .057 12.488 1 142 a. Forecasters: ( Constant ) , NPI Apathy sub graduated table b. Forecasters: ( Constant ) , NPI Apathy bomber graduated table, IADL at baseline ANOVAc Model Sum of Squares df Mean Square F 1 Arrested development 3489.675 1 3489.675 59.353 Residual 8407.663 143 58.795 Entire 11897.338 144 2 Arrested development 4169.290 2 2084.645 38.305 Residual 7728.048 142 54.423 Entire 11897.338 144 a. Forecasters: ( Constant ) , NPI Apathy sub graduated table b. Forecasters: ( Constant ) , NPI Apathy bomber graduated table, IADL at baseline c. Dependent Variable: Mark for ‘caregiver load ‘ questionnaire at baseline Further sub analysis suggests that NPI apathy contributes to about 29 % of the health professional load and IADL contributes to around 5 % of the health professional loadRelationship between apathy and practiceIn the combined sample ( AD and A-MCI ) , informations on executive map was available for 156 patients. In these patients, NPI apathy mark was non significantly related to praxis ( rs = -.102, P = .103 ) .When the group of patients with depressive symptoms were removed, the NPI apathy mark still remained non significantly related to praxis ( n=131, rs =.019, p=.417 )Relationship between apathy and genderMann-Whitney TrialRanksgenderNitrogenMean RankNPI Apathy sub graduated table male 81 85.38 female 79 75.50 Entire 160Test StatisticsaNPI Apathy sub graduated tableMann-Whitney U 2804.500 Wilcoxon W 5964.500 Omega -1.621 Asymp. Sig. ( 2-tailed ) .105 a. Grouping Variable: gender From the above saloon graph, with mistake bars, it appears that males have higher apathy tonss as compared to females. We used the Mann-Whitney U trial to look into if the relationship of apathy with gender is statistically important. However this did non accomplish statistically significance ( U = 2804.500, P = 0.105 )DiscussionApathy is one of the commonest symptoms in Alzheimer ‘s disease. Evidence from assorted clinical, radiological and neuropathological surveies suggests that apathy in Alzheimer ‘s disease is frontally mediated and has important negative deduction. Our survey is a realistic survey with moderate power affecting both Alzheimer Disease and Amnestic-MCI. This is the first survey as per our cognition in which the relationship of apathy with and without depression in a combined sample of AD & A ; aMCI were tested against a scope of frontal lobe map trials which included executive map mark, abstract believing mark, Category Fluency, missive Fluency, conceptional eloquence mark and test doing A & A ; B trials. Few surveies have at the same time investigated the relation of apathy with such a big scope of frontal lobe map trials.Relationship between apathy and executive mapWe found statistically important tie ining between apathy and executive map with and without depression corroborating findings from other surveies ( McPherson et al. , 2002 ) . Deficits in frontal lobe map were significantly worse when symptoms of apathy were combined with depression corroborating the determination from a Nipponese survey with a smaller figure of pati ents ( Nakaaki et al. , 2008 ) .This determination has of import clinical significance because hapless tonss in executive map influence memory abilities by forestalling people to use compensatory schemes that can assist them retrieve information and maintain functional abilities. It is besides associated with greater neuropsychiatric perturbations particularly a greater grade of agitated and disinhibited behaviors ( Chen et al. , 1998 ) . Assorted surveies have shown that impaired executive map is associated with increased pace variableness ensuing in higher incidence falls in patient with AD ( Allali et al. , 2010 ) . In Amnestic MCI, executive map damages is associated with early functional diminution in older grownups ( McGough et al. , 2011 ) . Badness of functional damage is good recognized forecasters of institutionalization ( Rozzini et al. , 2006 ) .Relationship between apathy and conceptional eloquenceSuccessful completion of Ideational eloquence undertakings require speede d productiveness every bit good as the accomplishments of self-monitoring, working memory, scheme coevals, and divergent thought ( Vannorsdall et al. , 2012 ) . We found statistically important tie ining between apathy and conceptional eloquence with and without depression.This is similar to the determination from another survey where Ideational Fluency was found to be significantly associated with apathy ( Tsoi et al. , 2008b )Relationship between apathy and Category FluencyWe found that NPI apathy mark was significantly related to category eloquence but when patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to category eloquence. There are conflicting consequences about the relationship between apathy and class eloquence. One survey ( n=72 ) found no important relationship ( McPherson et al. , 2002 ) but another more recent survey ( n=42 ) found statistically important relationship ( Tsoi et al. , 2008b ) .Relationship between ap athy and abstract thoughtWe found that NPI apathy mark was significantly related to abstract believing but when patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to abstract believingRelationship between apathy and cognitive mapSimilar to consequences from other surveies, NPI apathy mark was significantly related to cognitive working proposing that apathy was related to poorer cognitive map.However when the group of patients with depressive symptoms were removed, the NPI apathy did non stay score significantly related to cognitive map.Relationship between apathy and missive EloquenceNo statistically important relationship was found. This is consistent with current literature grounds ( McPherson et al. , 2002 )Relationship between apathy and test doing A & A ; B trialsNo statistically important relationship was found between apathy and both TMT- A & A ; TMT-B in our survey. However another survey had found a statistically important relationship between TMB trial and apathy tonss in Alzheimer ‘s dementedness ( McPherson et al. , 2002 ) In drumhead among the frontal lobe trial we found that statistically important relationship between apathy and executive map tonss, conceptional eloquence tonss, abstract thought and class eloquence tonss. When the groups were reanalysed after taking patients with depressive symptoms, the relation between apathy and abstract thought every bit good as category eloquence became non important.We think that this may be do the power of the survey has reduced when the depressive subgroups were removed.The 2nd possible ground is that apathy and depression portion many common symptoms and therefore the patients we removed utilizing a rigorous diagnostic standards of HAD depression standards were truly patients with apathy.Relationship between apathy and health professional loadIn our survey, series of explorative Spearman rho correlativity confirmed the important relationship between apathy and health professional load with and without depression. We did farther bomber analysis and found apa thy to be significantly related to caregiver load in both AD and aMCI patients. Our survey is the first as per our cognition that confirms that apathy is significantly related to caregiver load in amnestic MCI reverse to the popular belief. The relation of apathy to caregiver load was confirmed by other surveies ( Chow et al. , 2009, Leroi et al. , 2012 ) nevertheless another survey showed that it was the behaviors associated with executive disfunction and disinhibition that were most prognostic of load instead than apathy itself ( Davis and Tremont, 2007 ) . However we did a arrested development analysis and found that apathy approximately accounted for 30 % of health professional load but found no important relationship with behave AD tonss, HADS depression tonss, Executive map tonss and MMSE tonss We besides found a higher incidence of apathy in females as compared to males but farther statistical testing showed no important relationship. In our sample NPI apathy mark was significantly related to cognitive operation as confirmed by other surveies but when patients with depressive symptoms were removed the relationship with cognitive damage was nonsignificant. Our survey has few restrictions.First of all this was a retrospective cross sectional survey and so has its drawbacks, nevertheless it realistic, cross-sectional survey. Another possible job is that the subjective nature of the information ‘s nevertheless the information ‘s were collected as a portion of comprehensive neurocognitive appraisal in a third Centre by trained and experient clinicians. Prospective surveies would hold been better but would hold needed extended resources and clip. The sample size was moderate and consisted of assorted sample of Alzheimer ‘s disease and Amnestic MCI, nevertheless it was reasonably powered and amnesic MCI is considered as prodromic Alzheimer ‘s disease. We had used merely one graduated table for mensurating apathy.The NPI Apathy subscale is a portion of NPI devised to buttockss and quantifies neurobehavioral perturbations in dementedness and non specifically developed to mensurate apathy.AEP would hold been a better pic k as it is specifically developed to mensurate apathy, nevertheless the trial would necessitate preparation and would take a well longer period which would non hold been practical in a normal clinic scene This survey has shown high association of apathy with health professional load both in AD & A ; aMCI and given our anterior cognition of the significantly inauspicious effect, we would go on screen actively for apathy and utilize more specific apathy graduated table along with the NPI graduated table in future