Apathy is the most common behavioral problem in dementia and affects between 60 to 80 percent of sufferers (dementia refers to a group of symptoms that accompany certain diseases or conditions, like Alzheimer’s disease). Apathy describes the absence or suppression of emotion, feeling, or concern, and of motivation characterised by a lack of goal-centered activity. Apathy differs from depression in that depression affects mood as well as motivation.
Caregivers Often do not Realize the Cause of People’s Inactivity is Apathy
Apathy is a major problem because it interferes with the ability to carry out even the most basic self-care and impairs people’s ability to join in social and therapeutic activities. Their lack of interest means they can find starting or taking part in conversation difficult or impossible.
Caregivers often describe their loved ones as stubborn. They may believe they are suffering from depression. People with apathy are unable to show concern for their situation or the problems it causes others. It can often lead to conflict as caregivers feel they have to initiate all activity. Caregivers find themselves instructing, nagging, getting angry as their interactions become more burdensome and their caregiving responsibilities increase and increase.
Apathy is the Often the Result of Brain Damage in Alzheimer’s Disease
Apathy can be the result of damage to one or more areas of the brain such as the frontal cortex, the thalamus, striatum and the amygdala. In most cases direct damage to the frontal lobes or the subcortical nuclei that have connections to the frontal lobes, cause apathy.
Differentiating apathy from depression is one of the key areas to getting a diagnosis of apathy. The doctor will evaluate the person’s recent psychiatric history and look for symptoms that are common to depression but rare in apathy, (for example suicidal ideas, sleep problems, anxiety, labile moods). People with apathy display symptoms such as flat, blunted and placid moods. The way a person presents is also markedly different. Depressed people will cry, may refuse to answer questions, be impatient, irritable and become upset. People with apathy will sit and stare, answering questions reluctantly.
Treatments for Apathy
Apathy associated with Alzheimer’s disease is very difficult to treat. Apathy, by its very nature, means that behavioural and psychotherapeutic treatments do not work well. Medications are often used to try to get some improvement. Antidepressants such as bupropion or SSRIs are often treatments of choice. Psychostimulants may also be of benefit and increase motivation and activity. Acetylcholinesterase inhibitors such as Aricept may also be prescribed but treat the underlying cause, Alzheimer’s disease, rather than the apathy directly.
Caregiver Tips for Dealing with Apathy
It is important to realise that no amount of nagging or persuasion will motivate someone with apathy. It is important to try to encourage them to maintain their hygiene and not take over things they can do themselves (even if it takes more time). Physical exercise is needed in order to maintain physical health and this should be part of their daily routine. Try to engage them in some daily activity, listening to music, a drive out, going for a coffee.
Do not raise your voice or point out their lack of interest as it will not improve the situation. If you find yourself getting angry leave the area and come back to a task later. It is important to get relatives to support you and give you time to yourself if possible. Contact your local Alzheimer’s association for support.
Day-care centers for respite care, a day or two a week, may be very helpful to you, the caregiver, and to your loved one.