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Apathy and Dementia

One of the more common psychological problems associated with dementia is apathy, with just over half of all persons with dementia affected.  These individuals are plagued by a blunting of the emotions, and a decrease in motivation and initiative.  Quality of life is significantly involved, with the person lacking the drive to care for herself or to attempt compensatory strategies to deal with the problems she might have in doing so.  Changes have been noted in persons with many different forms of dementia.

Apathy is a behavior that can be seen in depression, but it can also be seen in the absence of depression.  It can actually hasten cognitive decline, because the person is not motivated to participate in activities of daily living, or other activities that can provide stimulation.  It can also increase caregiver distress, and can lead to interpersonal difficulties between the person with dementia and her caregiver.  Compliance with various treatment modalities can be affected, and can lead to institutionalization.

There has been a large body of research to determine what changes take place in the brain that contribute to apathy and other psychological problems.  The areas that have been found to be associated with atrophy include the right frontal and temporal lobes, caudate, anterior cingulate gyrus, and the orbital-frontal cortex.  One study showed that, for patients with fronto-temporal dementia or dementia of Alzheimer’s type, the most common type of apathy was a decrease in spontaneous activity.  Of these two groups, persons with fronto-temporal dementia were found to be more likely to have apathy than those with Alzheimer’s.

Three types of apathy were identified:  affective apathy (emotional blunting), behavioral apathy (lack of spontaneous initiation), and cognitive apathy (lack of interest in engaging in new cognitive activity).  For both types of dementia, many patients had all three forms of apathy, with many showing at least two.  Those who exhibited affective apathy also demonstrated behaviors such as impulsivity, separation anxiety, and resistant behavior.

Another study showed that the presence of apathy could be a predictive factor for determining which persons with Mild Cognitive Impairment will develop Alzheimer’s disease.

Some have speculated that treatment for apathy should be based on which sub-type is most prominent.  Persons with affective apathy might respond better to antidepressant medication.  Psychostimulants might be recommended for those with behavioral apathy, while cholinesterase inhibitors have been shown to be effective for persons with cognitive apathy.  However, there has also been research into whether some medications, including antipsychotics and sedatives, might actually cause apathy in persons with dementia.

Another possible explanation for apathy in persons with dementia is that they are using this withdrawal as a coping mechanism when they are overwhelmed by what’s going on around them, or when things are too complicated.  If this is the case, one solution is to find activities that they can manage, and that will not be too stressful.  Activities that involve movement are especially beneficial, and may help them feel more cheerful.  Try praising them for what they have done, instead of questioning what they have not.  Don’t force them to do something if they resist.

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