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

Epidemiology

• most common neurobehavioral symptom in dementia

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
• suspicion of other residents & staff may be present
• appearance of sadness at times may be present
• appetite, weight, & sleep patterns may be unchanged

Diagnostic criteria

• Association Francaise de Psychiatrie Biologique (AFPB) & European Psychiatric Association (EPA) task force criteria for apathy in Alzheimer disease & other neuropsychiatric disorders
  • presence of quantitative reduction of goal-directed activity either in the behavioral, cognitive, emotional or social dimension in comparison to the patient's previous level of functioning
  • minimum duration of 4 weeks
  • symptoms need to present in 2 or 3 domains
    • behavior & cognition, emotion, & social interaction
  • functional impairment
  • not explained by or due to major changes in the patient's environment

Complications

• associated with a faster rate of cognitive decline & functional decline in Alzheimer disease

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