Apathy

Managing apathy, with or without medication, requires a good strategy and dedicated teamwork

Scenario

A wife, whose husband is apathetic as a result of dementia, wants him to get washed and dressed to participate in a day program. He has no interest whatsoever and sees no point. Motivating him day after day is becoming difficult and frustrating and is wearing her down.

Apathy is different from other symptoms of dementia. It can go unnoticed. Caregivers may mistake apathy for laziness or as a negative act – in protest – aimed at them. It can be extremely challenging for all involved.

Characterized by a lack of initiative and motivation it can occur in different types of dementia. It is not deliberate. A person with apathy has little interest in their surroundings or interacting with their environment or other people they simply don’t feel like, or see a point, in doing things.

There is a tract in the front part of the brain that can be affected by dementia. A problem in this area of the brain causes apathy and may happen with Alzheimer’s disease as well as other types of dementia such as fronto-temporal dementia (FTD) or dementia due to strokes.

Apathy reduces functionality and the quality of life for the individual. It can be very distressing on the caregiver(s).

Keeping your loved one busy is important as both a distraction and to help them stay active and continue to function. Studies show that structured therapeutic activities can be an effective way of helping individuals with dementia experiencing apathy. However once the activity ends, the apathy will return.

Medication for treating apathy

One type of medication used as treatment for dementia may include cholinesterase inhibitors. These medications help slow the breakdown of the brain chemical acetylcholine that helps with memory and thinking. There is still research to be done in this area. One of the following medications could be the first to be prescribed:

Cholinesterase inhibitors

  • Rivastigmine
  • Donepezil
  • Galantamine

If cholinesterase inhibitors are not effective, another option might be a stimulant such as:

  • Methylphenidate (also known as Ritalin)

Stimulants are used for individuals with hyperactivity or attention deficit disorders and there is some evidence that this medication could provide energy or trigger initiative to those suffering with apathy from dementia.

Managing apathy, with or without medication, requires a good strategy and dedicated teamwork.