The why, how, and what: apathy in dementia

Apathy in Dementia

Apathetic behaviors are the most common “neuropsychiatric symptoms” associated with dementia, and occur in up to 90% of people with dementia at some point in their illness. These behaviors can cause significant stress for the caregiver, as these patients often require extra time and effort to provide care for. Even when a patient still retains the cognitive abilities to do self-care activities like bathing, dressing, grooming etc., they may not engage in these activities because of apathy.

What is Apathy?

Understanding apathy in dementia is key in knowing how to reduce it.

Apathy is a lack of interest in life activities and/or interacting with others. It can affect your ability to keep a job, maintain personal relationships, and enjoy life. Everybody experiences apathy from time to time. You may occasionally feel unmotivated or uninterested in daily tasks. This type of situational apathy is normal. Apathy becomes more dangerous if you have a chronic condition and are unmotivated to treat it. Apathy is a symptom of a number of neurological disorders, such as Alzheimer’s disease.

Apathetic behaviors can also be mistaken for other neuropsychiatric symptoms like depression or resistiveness to care, which require different forms of treatment. Apathy has only recently become a focus of research. In fact, it was less than 10 years ago, that diagnostic criteria for apathy in Alzheimer’s disease and other dementias were first proposed. These criteria describe apathy as a loss or diminished motivation compared to the patient’s previous level of function, with the presence of symptoms in the following areas:

1    Goal-directed behaviors (e.g. starting and/or participating in conversations, doing activities of daily living, seeking social activities etc.),

2    Cognitive activities (e.g. loss of interest in news, personal, community or family affairs etc.),

3    Emotions (e.g. diminished or absent emotional responses to positive or negative events etc.).

These criteria have been used in a growing body of research studies which suggest that apathetic behaviors have a biological basis and arise from changes in brain chemicals and brain function as a result of the damage caused by the dementia.

But is it depression?

Apathy is frequently confused with depression. Many patients with depression will also display apathetic behaviors, but most dementia patients with apathy will not have other symptoms of depression such as sad mood, hopelessness, guilt, and suicidal thoughts. It is important for the doctor to distinguish apathy from depression, as many antidepressants will be ineffective for the treatment of apathy, and some may even worsen symptoms.

Navigating apathy

The good news is that apathy is potentially treatable. Treatment begins by attempting to enrich the environment and daily activities of the person with dementia. Generally, experts prescribe “gentle nagging” for the caregiver, stopping short if the patient becomes agitated. Attempting to engage them in a variety of activities they previously enjoyed (keeping in mind diminished cognitive capacity) is key. At times, the patient may respond better to non-family caregivers when it comes to initiating and participating in activities. Attending community-based day programs is a great way to engage patients in a variety of social, cognitive and physical activities. It’s often recommended to hire a personal trainer to develop an exercise program, and then allowing the trainer to initiate and monitor the program, acting as the external motivating factor for the patient. Everyday technologies can be extremely helpful, such as an interactive table, video calling, wireless headphones, and voice activated assistants. Providing positive feedback and “rewards” for engaging in activities can often help to ensure sustainability of benefits. All these types of suggestions are readily accessible to caregivers from the Alzheimer’s Society education and support groups.

In summary, we should not be apathetic about apathetic behaviors in dementia. They are very common, they represent a significant source of disability to the patient and a source of stress to the caregiver, they are often confused with other neuropsychiatric symptoms, and they are potentially treatable with appropriate environmental and behavioral therapies.


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