Clients with dementia are susceptible to a wide array of neuropsychiatric symptoms. Apathy is one of the most common and persistent. Apathy often starts early in the disease process and worsens as dementia progresses.
What is apathy?
Terminology can be vague,“apathy” and passivity” are sometimes used interchangeably in clinical environments. However, they make a careful distinction. Passivity is a lack of interaction between the client and environment. It can be characterized by a decrease in activity and social interaction.
Apathy is defined by an intrinsic lack of motivation that is not attributable to emotional distress, intellectual impairment, or diminished level of consciousness. It can be evident as reduced emotions and a reduction of self-generated voluntary and purposeful behaviors, which are observable and can be quantified and last at least four weeks.
In identifying symptoms of apathy, it’s important to rule out vision or hearing impairments, motor disabilities, diminished level of consciousness, or the effects of medications, such as antipsychotic medications. Up to 70% of patients with Alzheimer’s or Parkinson’s disease will experience apathy. It can be even more common in vascular dementia and frontotemporal dementia.
The mechanisms behind this symptom involve a complex interaction among neuroanatomy, neuropathology, neurochemistry, and genetics that can to an extent be measured through biomarkers and neuroimaging.
Adverse outcomes from apathy
When apathy is present in a dementia patient, it can be associated with a faster pace of cognitive decline, stress on families, reduced functionality in ADLs, and an increased risk of death. Keeping patients who have dementia engaged can help protect well-being.
Stimulation can help combat apathy
Researchers at Penn State found that the right level of stimulation can help prevent apathy. They explain, “Clear and strong environmental stimulation is related to lower apathy. They also found that over-stimulation with multiple inputs can be just as detrimental as lack of stimulation; both can lead to higher levels of apathy. An example they give of effective stimulation is a therapist leading a music therapy program for residents in an otherwise quiet room.
Researchers that help counter apathy have validated a number of effective interventions, including music therapy, art therapy, cognitive stimulation, pet therapy, exercise, reminiscence, and occupational therapies. Social activities such as mealtime conversation generally have a positive impact. However, a birthday party or holiday party could be over-stimulating and have a detrimental impact, according to the Penn State research.