January 29, 2010
Most people think of memory loss when they think of Alzheimer's. But the disease can cause a wide range of behavioral and personality changes as well. One of the most common is apathy, or loss of motivation, and the condition seems to have a biological basis. Using brain scans, researchers in Sweden report that changes in the brain's white matter are a common feature in apathetic patients who have Alzheimer's or other forms of dementia.
Apathy is one of the most common psychological problems associated with dementia. Just over half of all people with Alzheimer's are emotionally blunted and lack motivation and initiative. As the disease worsens, apathy often grows worse.
Studies suggest there is a common biological reason behind apathy, irrespective of whether a person has Alzheimer's or other forms of dementia. The changes occurred in areas deep in the brain that are connected to the brain's frontal lobes, which are critical for taking initiatives and the ability to plan.
Apathy reduces the quality of life for patients with dementia and increases the workload for caregivers. It also increases the likelihood that someone with Alzheimer's will need to leave the home and enter a nursing home or other long-term care facility. Apathy is also a feature of other nervous system disorders like Parkinson's disease as well as mental health disorders like depression (which is also common in Alzheimer's).
Doctors are looking for better treatments to fight the listlessness and passivity of apathy. Current lifestyle recommendations like increased exercise may provide some benefit but they are generally very modest.
Medications to treat Alzheimer's may also provide some benefit, but the effects are limited. Antidepressants are sometimes tried. "Other medicines may also be of interest, but we need to carry out more research in this area," said Michael Jonsson, a consultant psychiatrist at Sahlgrenska University Hospital's memory clinic.
While only about 1 percent of the general healthy population suffers from apathy, the condition affects up to 70 percent of those with moderate Alzheimer's disease. Those with mild cognitive impairment, a form of serious memory loss that sometimes precedes Alzheimer's, are also more likely to exhibit the loss of motivation that occurs with apathy.
Those affected by apathy show a lack of motivation and often withdraw from social and other activities. The condition may resemble depression, but those who are depressed are often in a sad mood, with feelings of hopelessness, helplessness, guilt and shame. Those with apathy, on the other hand, tend to show emotional indifference rather than feeling depressed.
Making a diagnosis can be difficult in a patient with Alzheimer's. But a medical evaluation is important to check for apathy as well as other conditions like depression, since treatments may provide some relief.
M. Jonsson, A. Edman, K. Lind, et al: "Apathy is a Prominent Neuropsychiatric Feature of Radiological White-matter Changes in Patients with Dementia." International Journal of Geriatric Psychiatry, 22 Oct 2009