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," saidMichael 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.
By www.ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.
Source: M. Jonsson, A. Edman, K. Lind, et al: “Apathy is a Prominent Neuropsychiatric Feature of Radiological White-matter Changes in Patients with Dementia.” Internatinal Journal of Geriatric Psychiatry, 22 Oct 2009 [Epub ahead of print]
Stewart Cooper.
- 3/11/2010
I know from experience what sufferers of Alzhiemers are going through I cannot even spell properly, I am on my third year of the disease, it frightens me, when I see the love and sympathy extended by my family and close friends, I feel I do not deserve their love, I feel counterfeit why should they go through this hurt for me. Sometimes I get ostreporous, I can't help it, but I am rebutted by thier love and sympathy, this makes me feel counterfeit and I hate myself for it, you will see that my spelling is atrocious, I find it difficult to concentrate. I reflect back to my past career, with my own engineering company, mostly involved in Power Generation,for manby years. now my memory won't reach back to thos halycon days, Yet my wife never complains she takes all in her stride. Also our faith in God is special, I do not blame anyone including any of this. I know the hurt my wife and children bear for me. So they make sure I have my music, all the great composer are a tonic for me. So God is good, and he gave me a loving wife. So for them I have to fight this disease and not succomb to it. Self-pity in no answer. I hope this has some benefit to those who suffer
Annonymous
- 2/5/2010
As a caregiver for my husband who has Alzheimers' disease, I agree with the comments of annonymous 2/3/2010. It is often not for the want of trying to do things, the brain just won't get around the task needing to be done, they need to have someone alongside them showing them how to do the particular task.My husband is not apathic. just can't do the required task by himself.
Annonymous
- 2/3/2010
When people with dementia cannot figure out what to do or how to do it, I think it is unfair to characterize this as lack of motivation or apathy, as thought they just aren't trying. If they are not doing anything it is because they can't. I remember one fellow with vascular dementia saying to me that the worst thing about his disease was his boredom, because he was unable to do things. People with dementia will often participate if we ask them to, stay with them, show them what to do and do it alongside them.
- 1/30/2010
This info should be emphasized with medical providers. They prescribe meds for depression instead of a drug for apathy.
Annonymous
- 1/29/2010
This is likely a superficial impromptu response, but as a caregiver I would often prefer apathy to agitation, particularly dealing with incontinence--which elicits a response way beyond apathy.
This project was supported, in part, by a grant, number 90AZ2791, from the Administration on Aging,
Department of Health and Human Services, Washington, D.C. 20201.
Grantees undertaking projects under government sponsorship are
encouraged to express freely their findings and conclusions. Points of
view or opinions do not, therefore, necessarily represent official Administration on Aging policy.
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