Recognizing Apathy as a Possible Warning Sign of Dementia

How to Identify and Respond to Apathy in Dementia

Man displaying apathy in dementia
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Apathy is often present in Alzheimer's disease and other types of dementia. Sometimes, it can be an early warning sign of—or even a risk factor for—dementia. But what exactly is apathy, and how is it different from depression?

What Is Apathy?

Apathy is a lack of interest or motivation that can be observed in a person's affect (mood), behavior and cognition. Apathy is one of several symptoms of depression, but it can occur without depression as well.

It's important to note that apathy is not the same as depression. People with apathy don't typically have feelings of sadness or hopelessness. They might simply appear or feel uninterested, disengaged, or unexcited.

Three Types of Apathy in Dementia

Affective apathy: This type of apathy involves a lack of emotions, the appearance of indifference, and the absence of empathy. The person may appear not to care about others or lack the warmth with which he used to greet you. He might appear unaffected emotionally, rarely showing happiness or sadness about what's happening around him. "Affective" refers to mood and emotions.

Behavioral apathy: Apathy in behaviors include physical inactivity and tasks left uncompleted. Someone experiencing behavioral apathy might not walk around very much at home and ignore tasks such as housekeeping or laundry, even though she is physically able to perform them.

Cognitive Apathy: Cognitive apathy includes the lack of initiating speech and mental activity, and the absence of interest in others' activities. If you're experiencing cognitive apathy, you might need prompting in conversation and may appear "zoned out" and uninterested in what's occurring around you.

Apathy and Dementia

Research has shown that apathy is quite prevalent in dementia. Specifically, one study found that 56 percent of the study's participants with an Alzheimer's diagnosis were apathetic, while 72 percent of the participants with frontotemporal dementia demonstrated apathy. Apathy is also common in progressive supranuclear palsy and vascular dementia.

Increased apathy has been correlated with a decline in functioning (such as in activities of daily living) and in cognition in those with dementia. The brains of those who demonstrate apathy also show greater changes, including greater atrophy, neurofibrillary tangles, and white matter changes.

Apathy has been tied to the development of dementia in those who have Parkinson's disease. The relationship between Parkinson's and apathy may be complicated, however, since a flat facial expression is one symptom of Parkinson's.

Some research also found that in those with mild cognitive impairment, the presence of apathy was a predictor of progression to dementia. In other words, apathy was a risk for further cognitive decline.

While apathy is often not as difficult to cope with as other challenging behaviors in dementia (such as hoardingparanoia or agitation), it can affect the individual's quality of life, safety and ability to live independently.

Apathy Without Dementia?

In general, the presence of apathy has been correlated with lower cognitive functioning. For example, one study found that apathy in older adults with normal cognition was associated with worse performance on cognitive tests, despite still falling into the "normal" category of cognition.

However, other research points out that apathy is not uncommon for older adults in general, including those whose cognition is intact and those with impaired cognition.

Responding to Apathy in Dementia

Like many of the challenging behaviors in dementia, apathy should first be identified and treated with non-pharmaceutical approaches.

Individualized Activities

Some research has demonstrated that apathy in dementia can be successfully reduced through programmed interventions. For example, one study found a significant difference in the level of apathy in nursing home residents with dementia who were involved in activities once a week for 10 months, as compared to a group of residents who were not involved in those activities.

Offering and engaging the person in meaningful activities is important to ward off apathy. Remember that what is meaningful for one person might not be meaningful for the next. Thus, a person-centered approach is a must to be able to identify and target the interests of each person.

Sports

The inclusion of sports in therapeutic activities has also been connected with a reduction in apathy. Sports memories often go way back to childhood and may provide a strong stimulus to fight apathy.

Reminiscing

People with dementia often struggle with loneliness and boredom, which can contribute to apathy. Taking a few minutes to sincerely chat with someone could be helpful in reducing apathy. Reminiscing can be an effective way to increase engagement and reduce apathy.

Music and Art

Research has also shown that music and art are effective ways to engage someone with dementia who appears apathetic. You will want to research what his or her favorite music has been throughout her life and find a recording of these songs to play for her.

Be Flexible

When looking for the right type of activity to ward off apathy, it's important to be flexible and evaluate if the activity is providing periods of success and joy to the person, or if it's too overwhelming and needs to be broken down or adjusted further for her.

Medications

Finally, although non-drug approaches are generally preferred, research has also shown some benefit from acetylcholinesterase inhibitors for improving apathy in dementia.

A Word From Verywell

When we notice the signs of apathy in ourselves or a loved one, it may be helpful to evaluate if other signs of dementia are present. Early diagnosis of dementia is important for early treatment and planning for the future.

Additionally, understanding how to respond to apathy in dementia may help with the goal of providing quality of life for those living with dementia.

Sources:

Alzheimer Society Canada. Apathy. http://www.alzheimer.ca/en/Living-with-dementia/Understanding-behaviour/Apathy

Archives of Neurology. 2009 Jul; 66(7): 888–893. Apathy Symptom Profile and Behavioral Associations in Frontotemporal Dementia vs. Alzheimer's Disease. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875777/

Cleveland Clinic. If You Have Apathy You Might Be At Risk for Dementia. June 2, 2014.http://health.clevelandclinic.org/2014/06/does-mom-have-apathy-she-might-be-at-risk-for-dementia/

Journal of Geriatric Psychiatry 2012; 20(2): 104-122. Pharmacologic treatment of apathy in dementia.http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0034284/

Lanctôt, K., Agüera-Ortiz, L., Brodaty, H., et al (2017). Apathy associated with neurocognitive disorders: Recent progress and future directionsAlzheimer's & Dementia, 13(1), pp.84-100.

Psychiatry. February 2015, Volume 30, Issue 2, Pages 251–257. Apathy in nursing home residents with dementia: Results from a cluster-randomized controlled trial. http://www.europsy-journal.com/article/S0924-9338%2814%2900022-4/abstract

Richard, E., Schmand, B., Eikelenboom, P., et al. (2012). Symptoms of Apathy Are Associated with Progression from Mild Cognitive Impairment to Alzheimer’s Disease in Non-Depressed SubjectsDementia and Geriatric Cognitive Disorders, 33(2-3), pp.204-209.

Ruthirakuhan MT, Herrmann N, Abraham EH, Lanctôt KL. Pharmacological interventions for apathy in Alzheimer's disease (Protocol). Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD012197. DOI: 10.1002/14651858.CD012197.

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