"The groundwork of all happiness is health." - Leigh Hunt

Apathy is usually a warning sign of Alzheimer's in some people

April 7, 2023 – Michael K, a retired salesman, began having memory problems in his late 60s. At first, it was little things, like losing his keys or forgetting where he parked the automobile. “Senior moments,” he called them. But his wife was concerned and asked him to see a physician, who diagnosed him with mild cognitive impairment (MCI).

Despite his failing memory, Michael continued to do the things he had at all times enjoyed, no less than for some time. He had at all times enjoyed hosting, and had especially prepared “little spreads” – salads and dips – for his relatives once they came around.

“Everyone appreciated the way my father would set the table beautifully for guests,” said his son Neal, a pc programmer from New Jersey who asked that his and his father's names not be mentioned in this text.

But his father step by step lost interest in these activities, Neal said.

“He no longer had any interest in interacting with the family and became more and more withdrawn,” he said.

Eventually, Michael was diagnosed with dementia.

“Looking back, I believe my father's apathy, along with some other personality changes, were part of the process that led to his dementia,” Neal said. “We just didn't recognize it at the time.”

Michael's experience isn't an isolated case, in line with a brand new study published in Journal of Alzheimer's Disease which specifically addressed apathy in individuals with MCI.

A team of researchers examined 1,092 people diagnosed with MCI. Slightly more women than men participated within the study (59%), and the common age of the participants was slightly below 72 years.

Over an eight-year period, researchers conducted nearly 2,900 observations, with study participants observed between 1 and 9 times (the standard participant was observed twice).

Family members and caregivers filled out a questionnaire asking about a spread of symptoms, including apathy, and participants also underwent quite a few brain tests.

158 of the participants suffered from apathy and 934 didn't.

During the study period, almost one-fifth of the people progressed from mild cognitive impairment to Alzheimer's. Of those with apathy, 36% developed Alzheimer's, in comparison with only 14% of those without apathy. The transition to Alzheimer's was also faster in those with apathy than in those without apathy (a median of just about 4 years in comparison with almost 7 years).

In individuals with apathy, the chance of Alzheimer's disease was 2.4 times higher.

“In older adults with MCI, we found that apathy was an indicator of who was more likely to develop Alzheimer's disease,” said lead study writer Antonio Teixeira, MD, PhD, professor of psychiatry and director of the neuropsychiatry program at McGovern Medical School, a part of UT Health in Houston.

Hispanic and non-Hispanic ethnicities

Previous studies have shown that apathy can predict the progression from mild cognitive impairment to dementia. However, these studies were largely conducted on non-Hispanic whites. According to Teixeira and his co-authors, this limits the generalizability of the outcomes to other populations.

For this reason, researchers studied individuals participating within the Texas Alzheimer's Research and Care Consortium (TARCC), which incorporates a major percentage of Hispanics, to also examine conversion rates from MCI to Alzheimer's on this population.

“A great novelty of our study is that we examined a heterogeneous population with a significant proportion of Hispanic research participants,” said Teixeira.

Apathy as a “red flag”

Neuropsychiatric symptoms equivalent to apathy may be present in as much as 85% of patients with MCI and likewise occur within the early stages of Alzheimer's disease.

Teixeira defined apathy as “loss of interest and decrease in goal-directed behavior” and identified that apathy is commonly related to depression and there is commonly a “great overlap,” however the two symptoms usually are not the identical.

“Depression and disability can increase apathy, but not all people with depression or disability become apathetic,” he said. Conversely, “not everyone with apathy has depression, and apathy can mean different things.”

Making assumptions in regards to the reason for a patient's apathy may be problematic because a disease equivalent to Alzheimer's may very well be missed or the patient might receive the flawed treatment, Teixeira said.

An vital message for members of the family and caregivers, in line with Teixeira, is that “apathy in the elderly can be a warning sign that the person is developing a neurodegenerative disease such as Alzheimer's.”

He advised those involved within the patient's care to “report apathy to a doctor, psychologist or other health professional” since the presence of apathy “could prompt either further investigation or at least closer observation.”

One of many aspects

Claire Sexton, DPhil, senior director of scientific programs and outreach on the Alzheimer's Association, said considered one of the strengths of this study is that the population is far more diverse than populations in previous studies of apathy, MCI and Alzheimer's.

“Based on the overall research evidence, it is still very likely that apathy is just one of many factors that affect the rate of progression from MCI to Alzheimer's dementia,” Sexton said. The Alzheimer's Association “believes it is important for physicians and caregivers to monitor and treat behavioral and neuropsychiatric symptoms, including apathy, throughout the disease course,” which “can be an important part of maintaining or improving everyone's quality of life,” she said.

Neil's father died on the age of 74; by this time the dementia was already very severe.

“I wish we had known more and gotten help for his apathy,” Neal said. “I hope the people reading this article are more proactive than we were. My dad's quality of life might have been better for longer.”