Apathy: The Misunderstood Dementia Symptom

“He just sits there all day.”

“She doesn’t want to do anything.”

“She doesn’t want to get dressed.”

I hear these complaints a lot from my patients’ caregivers and I heard them from my own mother when she would talk about my dad. It drove my mom crazy that all my dad ever wanted to do was sit and look out the front window.

This common dementia symptom is often mistaken for depression. On the surface there is a lot of similarity: a once vibrant person lacks energy and motivation, they don’t talk as much, they don’t seem to care as much. They can seem tired, bored, disengaged. Look deeper though, and what you DON’T see with apathy that you DO see with depression is sadness, emotional distress, hopelessness, irritability. Now, to be clear, a person can have both apathy and depression but it is important to distinguish between the two because they are treated differently.

What Is It?

Though it can appear at any time, apathy usually appears early in dementia and tends to persist throughout. It is associated with longer illness duration and it worsens as dementia progresses. Common symptoms include:

• Neglected hygiene and self-care

• Lack of emotion when good or bad things happen

• Loss of curiosity to learn new things

• Failure to finish activities that have been started

• Lack of interest in initiating activities

• Relying on others to plan or start activities

• Less interest in socializing

• Lack of ability to adapt to daily routines

What Can We Do About It?

There isn’t a lot of evidence to support the use of medication for apathy. Some medications that treat Alzheimer’s itself (like Aricept) can help with apathy as it will help with energy and motivation. The important difference is that you are treating the underlying cause of the apathy and not the apathy itself. It is common that people are prescribed antidepressants for apathy that is mistakenly diagnosed as depression. Seniors with dementia may struggle with therapy so this is why we more commonly see medications used as the only treatment for depression in this group. Medications can have unwanted side effects (like increased risk of falls and fractures) so we have to be judicious in their use.

To help someone experiencing apathy you can try to:

• Engage in activities that have previously brought them joy. Even playing their favorite music can help.

• Reminisce about memories from the past. Since long term memories are sometimes easier to access for people with dementia this can evoke good feelings and boost confidence.

• Introduce activities in small increments. A large task can feel overwhelming. Don’t focus too much on the outcome; try to enjoy and be flexible with the process.

• Go for walks outside as both exercise being outdoors engages the senses.

• Spend time with a pet- it's hard to resist a cuddly, furry buddy.

• Focus on the Positive. Try to engage in activities they can do and like to do. Make sure they feel included, even if they don’t participate much.

Please take note that caregiver distress is also significantly higher among those caring for individuals with apathy as compared with those caring for people who do not have apathy. It is hard to be a cheerleader to an unenthused crowd. It is frustrating to have to implore people over and over to engage in the mundane activities of life like eating or bathing. Don’t forget to have patience with yourself AND the person you are caring for.