Apathy can be one of the most distressing symptoms of dementia. Seeing a loved one withdraw from the world and impossible to reach can be extremely worrying and upsetting for family.
Apathy makes it difficult for someone to enjoy life, and it can even accelerate cognitive decline and increase mortality rates.
Yet there is little research on the topic of apathy. And in care it is often overlooked, with the focus falling to more disruptive symptoms, such as aggression.
But new research from the University of Exeter is shedding light on the topic. The study has revealed that apathy is present in almost half of those living with Alzheimer’s disease. It has also revealed the condition is not always linked with depression, even though the two may appear similarly, opening up new avenues for treating someone who has apathy.
What is apathy?
Apathy is “a persistent loss of motivation to do things, or a lack of interest in things”, according to the Alzheimer’s Society. Apathy is the most common neuropsychiatric symptom of dementia, and can be one of the first signs someone has developed dementia. Apathy can have a more significant impact on how someone functions than memory loss.
Signs of apathy can include:
- Withdrawal from daily life
- Neglect of personal care
- Loss of interest in the world around them
- Loss of curiosity
- Dulled emotions
Nearly half of those with Alzheimer’s disease experience apathy
The University of Exeter research was presented at the Alzheimer’s Association International Conference held earlier week in Los Angeles.
The University analysed 4,320 people with Alzheimer’s disease to look at the prevalence of apathy over time. The study found 45 per cent of those with Alzheimer’s disease had apathy at the beginning of the study, while 20 per cent had persistent apathy over time.
Disruptive symptoms receive more focus in dementia care
Despite its prevalence among people living with dementia, apathy is often overlooked in caring for someone who is living with dementia, with more disruptive symptoms, such as agitation and aggression, more commonly receiving the focus.
But apathy can be extremely distressing for loved ones to witness, and is linked with more severe dementia and worse clinical outcomes.
Apathy not always associated with depression
Interestingly, the researchers found that a proportion of those with apathy did not have depression, suggesting apathy is its own condition.
Apathy can accelerate cognitive decline, associated with higher mortality rates
Professor Clive Ballard, of the University of Exeter Medical School, said, “Apathy is the forgotten symptom of dementia, yet it can have devastating consequences.
“Our research shows just how common apathy is in people with dementia, and we now need to understand it better so we can find effective new treatments.”
Miguel de Silva Vasconcelos, PhD student at the University of Exeter and King’s College London, said in a statement, “Apathy is an under-researched and often ignored symptom of dementia.
“It can be overlooked because people with apathy seem less disruptive and less engaging, but it has a huge impact on the quality of life of people living with dementia, and their families.
“Where people withdraw from activities, it can accelerate cognitive decline and we know that there are higher mortality rates in people with apathy.
“It’s now time this symptom was recognised and prioritised in research and understanding.”
How to help someone who is experiencing apathy
Prof Ballard said the university’s WHELD training course, which involved personalised care, social interaction, and exercise, improved apathy. Interventions could benefit thousands of people living with dementia, he said.
“We know we can make a difference,” said Prof Ballard.
Though there is only limited research in how to treat apathy in people living with dementia, there is evidence to suggest that music therapy, group art therapy, and cognitive stimulation delivered by a trained professional can help, according to the Alzheimer’s Society.
Advice for carers when looking after someone with apathy:
- Only give people tasks and activities they can do, that they enjoy, and that they find meaningful.
- Break down tasks into manageable sections so the person only has to navigate small steps at a time.
- Provide encouragement by letting the person know they are making progress, but don’t make too much of a fuss.
- Provide gentle prompts, start the activity yourself, or give help to get the ball rolling.
- If you begin to feel yourself becoming frustrated, don’t lash out or criticise the person. Remain calm.
- Take regular breaks.
- Use respite care services if available.