apathy (indifference)

Introduction

Indifference. A lack of interest in one's environment, including social interactions.

Etiology

• cerebral disease
  • dementia including Alzheimer's disease
  • anterior cingulate syndrome
• depression

Pathology

• disruptions of circuits regulating basic drives:
  • sexual satisfaction
  • food
  • curiosity
  • pleasure
• disrupted circuits include
  • mesolimbic system
  • mesocortical dopaminergic circuits

Clinical manifestations

• reduction in psychomotor activity
• often perceived as a personality change by family
• affects ADLs beyond the level of cognitive impairment

Management

• little evidence to support specific therapy
• cholinesterase inhibitors may be of some benefit
• methylphenidate may be of benefit in community-dwelling elderly with mild to moderate Alzheimer's disease
  • may improve motivation, cognition, mood, functioning, & caregiver burden
  • does not affect patients' function or quality of life

More general terms

• sign/symptom