Early Signs: New Research into Apathy as an Early Symptom of Dementia

Depression has long been considered an early warning sign of dementia. However, recent research is disrupting that perception. What clinicians have historically been identifying as depression may, in fact, be better classified as apathy.

Apathy refers to a general lack of emotion, indifference to one’s situation, and a drop in goal-directed behavior. While it is often seen in depressed people, it can also exist separate from a depression diagnosis. To better understand how apathy is distinguished from depression, and how it appears among patients with dementia, we’ll look more closely at the two recent studies.

Apathy and Vascular Dementia

In July 2020, the Journal of Neurology, Neurosurgery & Psychiatry[1] published an article examining apathy in people with small vessel disease (SVD), which is the leading cause of vascular dementia. The study looked at 624 participants in England and the Netherlands.

Over 5 years, patients were assessed for apathy and depression. While higher initial levels of apathy and rising apathy over time were associated with higher risk of dementia, the same was not true of depression.

As to how depression had been mistakenly identified as an early symptom, the study’s authors had a theory. Many of the clinical assessments used to diagnose depression also, in part, assess apathy. As a result, a false correlation may have been drawn between depression and risk of developing dementia.

Health, Aging and Body Composition Study

In October 2020, a separate study on apathy and dementia was published in Neurology[2], the journal of The American Academy of Neurology. Researchers looked at information collected from 2,018 community-dwelling older adults.

Over the course of nine years, researchers found that 381 of the participants had developed probable dementia. Of those 381, 25% had experienced severe apathy versus just 14% that had experienced low levels of apathy. Once again, the data is supportive of the theory that apathy is a key dementia predictor.

Treating Apathy

While it’s beneficial to understand that apathy, not depression, is a more reliable indicator of early stage dementia, it also presents a new problem. Effective treatment of apathy on its own is not as well researched as the treatment of depression. That being said, there are still a number of promising evidence-based approaches.

The UK based Alzheimer’s Society[3] recommends starting with non-drug therapies. This may include music therapy, group art therapy, or doll therapy. Other mentally and creatively stimulating activities, guided by a qualified professional, are generally believed to be beneficial as well.

Medication has less evidence for effectiveness, but may still play a role in treatment. There are people who experience relief of apathy when taking Alzheimer’s or mixed dementia medication. Doctors may also offer antidepressant drugs, however, there is minimal proof that these are beneficial for apathy.

Arthur’s Approach to Apathy

There are many facets of our approach to memory care that help with treating apathy. Above all, our staff are our best and most valuable resource. Their extensive training and the innovative social activities they lead help to foster a stimulating, social and supportive environment.

To learn more about navigating relationships affected by Alzheimer’s disease and dementia, check out Insights from Arthur’s, a video series from Arthur’s Senior Care Consultant Deb Nygaard.

[1] https://jnnp.bmj.com/content/91/9/953

[2] https://n.neurology.org/content/early/2020/10/14/WNL.0000000000010951

[3] https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/anxiety#content-start