A monthly article brought to you by Senior Services Memory Support Programs

People with dementia are often more likely to develop apathy as their condition progresses.

Many people sometimes have less energy or ‘drive’, or lose their ‘spark’. However, apathy is different. If a person has apathy, they will have little or no motivation to do things that they would usually find meaningful and worthwhile.

Apathy is much more common in people with dementia than in older people who don’t have dementia. About 2-5% of older people without dementia have apathy, but about 50-70% of people with dementia have apathy. People who have any type of dementia can have apathy. However, it is particularly common in people with frontotemporal dementia (FTD).

People with dementia are more likely to develop apathy as their condition progresses. However, apathy can start during the very early stages in some types of dementia – such as frontotemporal dementia, dementia with Lewy bodies (LBD) or Parkinson’s disease dementia. Once a person has apathy it tends to continue, rather than coming and going.

Causes of apathy in a person with dementia:

People with dementia often develop apathy due to damage to the frontal lobes of their brain. This part of the brain controls our motivation, planning and sequencing of tasks. If a person with apathy is withdrawn, stops doing things and loses their confidence and abilities, their apathy can get worse.

Symptoms of apathy in a person with dementia:

• A person with dementia who has apathy will be less motivated to do things. They may also:
• Have no energy or motivation to do routine or daily tasks, such as brushing their teeth or taking a shower
• Rely on other people to suggest and organize activities
• Not be interested in joining conversations or talking to new people
• Not be worried about their own problems
• Have unemotional responses to news or personal events – they may seem to be uninterested or detached

What is the difference between depression and apathy:

Some of these symptoms are also common in people who have depression, such as losing interest in things and lacking energy. This is why it can be hard to know whether a person has depression or apathy, even for a doctor. The main difference is that a person with depression will feel sad, tearful, hopeless or have low self-esteem. A person with apathy will not have these symptoms of low mood. Instead they will feel that they have no energy or ‘spark.’

A person with dementia who has apathy often won’t be worried by their symptoms. However, their symptoms can make their life less enjoyable. It can also put a strain on those who are helping and supporting them. It can be frustrating when you’re caring for someone who needs more support with daily tasks and is withdrawn and unresponsive.

Treatment for apathy in a person with dementia:

Compared with depression and anxiety there is less evidence about what treatments can help a person with dementia who has apathy.

Medications only play a small part in treating apathy. A person with apathy may also be offered an antidepressant. However, there isn’t much evidence that antidepressants help people with apathy who have Alzheimer’s disease, mixed dementia or vascular dementia. In fact, there is some evidence that these medications make apathy worse.

Therefore non-medicinal approaches should generally be tried first, for example, music therapy, group art therapy, reminiscence and cognitive stimulation. Even if they find it difficult to take an active role in these activities, they can still benefit from being involved.

How to support a person with dementia who has apathy:

Try to find tasks and activities the person will enjoy and find meaningful.
— They may find it helpful to have a daily routine.

Break tasks down into simple steps.
— They may find it easier to do several small steps rather than one big step.
— This can also help them feel they are achieving things.

Gently prompt or help the person to start an activity, such as dressing.
— Give lots of encouragement to keep them engaged.
— Be positive and focus on what they have achieved.

Don’t blame the person for being ‘lazy’, unhelpful or uncaring.
— The person is not choosing to have apathy.
— If you feel frustrated, try to remain as calm as you can to avoid the person reacting negatively.

When you start to notice memory changes, seeking early detection is key. Senior Services offers an array of memory support programs including confidential memory screenings to obtain a cognitive baseline, educational classes as well as support from Seasons Adult Day Health Services. If you or someone you know is experiencing increasing changes with their memory and could benefit from additional services, please contact Amy Sheridan, Family Support and Activity Manager at 989-633-3764.

Check out our section, Our Mind Matters, next month.