Is Apathy an Early Sign of Dementia?

WEDNESDAY, Oct. 14, 2020 — Older adults who aren’t interested or enthusiastic about their usual activities may have a higher risk of developing dementia, new research suggests.

The nine-year study of more than 2,000 older adults — average age 74 — found that people with severe apathy (a lack of interest or concern) were 80% more likely to develop dementia during the study period than those with low apathy.

“Apathy is not subtle. It’s something that families can pick up on. More research is needed, but this is another potential red flag symptom of the prodromal (early) phase of dementia,” said the study’s lead author, Dr. Meredith Bock. She’s a clinical fellow in neurology at the University of California, San Francisco Institute for Neurosciences.

The prevalence of dementia (including Alzheimer’s disease) is on the rise, and researchers are trying to find new ways to identify who’s at risk of the disease. Mood and behavior symptoms, such as depression or irritability, are examples of changes that may be clues to an impending dementia diagnosis.

Previous studies have also linked mild cognitive impairment (a potential precursor to dementia) and apathy, but the researchers wanted to look at a group of people who had no known memory or thinking issues yet.

The current study included people aged 70 to 79. None had dementia at the start. The researchers also had medical records, including medication use, hospitalizations and cognitive testing.

To evaluate apathy levels, the study participants answered questions, such as:

• In the past four weeks, how often have you been interested in leaving your home and going out?
• In the past four weeks, how often have you been interested in doing your usual activities?

After nine years, the researchers found that 381 people had developed dementia. In the low apathy group, 14% developed dementia. For those with moderate apathy levels, that number was 19%. But one in four — 25% — in the severe apathy group had dementia by the end of the study.

When the researchers controlled the data for age, education, heart and blood vessel disease, depression and genetic risk of Alzheimer’s disease, they reported that people with severe apathy at the start of the study had 80% higher odds of having dementia later in life.

Bock said by asking about apathy, doctors might be able to learn which patients have a higher risk of dementia. The information could be particularly helpful in research trials, she added.

Rebecca Edelmayer, director of scientific engagement at the Alzheimer’s Association, said, “This type of research is critical to help us identify who is at risk. We are driving towards being able to identify people with a higher risk as soon as possible as we strive for treatments that will be transformational for patients and their families. But it’s too soon to say if only looking at apathy can identify who is at risk of dementia.”

Edelmayer explained that it can be difficult to tease out apathy from other changes that may be happening, such as depression or isolation.

She said if you have concerns about your own or a loved one’s memory or behavior, you should speak with your doctor or call the Alzheimer’s Association’s 24/7 helpline at 1-800-272-3900.

The study findings were published online Oct. 14 in Neurology.

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