A single symptom affects a high proportion of patients with all forms of dementia.

In fact, it’s been described as the most common neuropsychiatric symptom of dementia, with a bigger impact on function than memory loss.

Apathy – meaning a lack of motivation or loss of initiative – can be an early warning sign and possible predictor of cognitive decline. You’ll be shocked at its impact. . .

Evidence has been accumulating for some years to show that apathy is linked to cognitive decline and dementia. But it’s often overlooked in clinical practice because doctors assume apathy only comes with depression.

Actually, apathy can appear by itself without any other obvious mental health concern and without cognitive impairment. Apathy all by itself – in a person otherwise happy and with a well-functioning memory – has been shown to increase the risk of dementia and mortality.

Doubles Dementia Risk

Last year, researchers from the Netherlands concluded that apathy “might be used in general practice to identify individuals without cognitive impairment at increased risk of dementia.”

Their investigation, published in Neurology, included 3,499 community dwelling men and women aged 70 to 78 who were free of dementia at the start of the study. Data was collected on their medical history, medication use, cardiovascular risk factors, cognitive status, depression and apathy profiles, and disability.

After six to eight years follow-up, and adjusting the stats to take into account all the above factors, the researchers found seniors who had the highest apathy scores had nearly double the risk of dementia and more than twice the risk of death than those with no apathy symptoms,

Later in 2018 the same Dutch group carried out a review of 16 trials which included 7,365 patients ranging in age from 69 to 82. Findings were similar to their own study. The authors wrote:

“Apathy was associated with an approximately twofold increased risk of dementia…

“Apathy deserves more attention as a relevant, cheap, noninvasive, and easily measurable marker of increased risk of [the onset of] dementia with high clinical relevance…”

Under-Researched and Often Ignored

The most recent meta-analysis was conducted by the University of Exeter in England and presented in July at the Alzheimer’s Association International conference in Los Angeles.

The reviewers looked at 20 trials to see the course of apathy over time in 4,320 people with Alzheimer’s.

They found apathy was present in almost half those with the disease, and confirmed that it’s often distinct from depression. This suggests it has its own unique clinical and biological profile.

According to a member of the research team, Miguel da Silva Vasconcelos, PhD student at the University of Exeter and King’s College London, “Apathy is an under-researched and often ignored symptom of dementia. It can be overlooked because people with apathy seem less disruptive and less engaging, but it has a huge impact on the quality of life of people living with dementia and their families.

“Where people withdraw from activities it can accelerate cognitive decline, and we know that there are higher mortality rates in people with apathy. It’s now time this symptom was recognized and prioritized in research and understanding.”

Professor Clive Ballard, of the University of Exeter Medical School, added:

“Apathy is the forgotten symptom of dementia, yet it can have devastating consequences. Our research shows just how common apathy is in people with dementia, and we now need to understand it better so we can find effective new treatments.”

I don’t know of any medical or psychiatric treatments for apathy. And for that matter, conventional medicine doesn’t really have any treatments for Alzheimer’s.

However, there are alternative treatments for dementia that we discuss in this newsletter and in our video series Awakening from Alzheimer’s.  If a loved one suddenly starts showing symptoms of apathy – even while otherwise healthy – it would be wise to see a functional/integrative doctor who knows how to treat dementia.


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754645/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233800/
  3. https://www.exeter.ac.uk/news/research/title_725251_en.html

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