Apathy and dementia

Learn about the symptoms and causes of apathy, and possible ways to treat it for someone who is living with dementia.

Many people sometimes have less energy or ‘drive’, or lose their ‘spark’. However apathy is different. If a person has apathy they will have little or no motivation to do things that they would usually find meaningful and worthwhile.

Apathy is much more common in people with dementia than in older people who don’t have dementia. About 2–5% of older people without dementia have apathy, but about 50–70% of people with dementia have apathy. People who have any type of dementia can have apathy. However, it is particularly common in people with frontotemporal dementia (FTD).

People with dementia tend to become more likely to develop apathy as their condition progresses. However, apathy can start during the very early stages in some types of dementia – such as frontotemporal dementia, dementia with Lewy bodies (DLB) or Parkinson’s disease dementia. Once a person has apathy it tends to continue, rather than coming and going.

Causes of apathy

People with dementia often develop apathy due to damage to the frontal lobes of their brain. This part of the brain controls our motivation, planning and sequencing of tasks.

If a person with apathy is withdrawn, stops doing things and loses their confidence and abilities, their apathy can get worse. People who are close to them may be able to help prevent this. 

Symptoms of apathy

A person with dementia who has apathy will be less motivated to do things. They may also:

  • have no energy or motivation to do routine or daily tasks, such as brushing their teeth or having a shower
  • rely on other people to suggest and organise activities
  • not be interested in joining conversations or talking to new people
  • not be worried about their own problems
  • have unemotional responses to news or personal events – they may seem to be uninterested or detached.

Differences between depression and apathy

Some of these symptoms are also common in people who have depression, such as losing interest in things and lacking energy. This is why it can be hard to know whether a person has depression or apathy, even for a doctor. The main difference is that a person with depression will feel sad, tearful, hopeless or have low self-esteem (see the section 'Depression and dementia'). A person with apathy will not have these symptoms of low mood. Instead they will feel that they have no energy or ‘spark’.

A person with dementia who has apathy often won’t be worried by their symptoms. However their symptoms can make their life less enjoyable. Their symptoms can also put a strain on those who are helping and supporting them. It can be frustrating when you’re caring for someone who needs more support with daily tasks and is withdrawn and unresponsive.

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Treatment for apathy

Compared with depression and anxiety there is less evidence about what treatments can help a person with dementia who has apathy.

Drugs only play a small part in treating apathy. Some people who take medication for Alzheimer’s disease or mixed dementia (for example donepezil, rivastigmine or galantamine) are more motivated and have better memory and concentration. A person with apathy may also be offered an antidepressant drug. However, there isn’t much evidence that antidepressants help people with apathy who have Alzheimer’s disease, mixed dementia or vascular dementia. In fact, there is some evidence that these drugs make apathy worse.

Therefore non-drug approaches should generally be tried first. For example, music therapy, group art therapy, reminiscence and cognitive stimulation that are delivered by a trained professional can help. However, these therapies are not available everywhere. Contact your local dementia support worker or adult social services to find out what is available in your area.

People with dementia who have apathy may also benefit from doing general creative activities, such as music and art, rather than a specific therapy with a trained professional. Even if they find it difficult to take an active role in these activities, they can still benefit from being involved.

How to support a person with dementia who has apathy

  • Try to find tasks and activities the person will enjoy and find meaningful.
    — They may find it helpful to have a daily routine.
  • Break tasks down into simple steps.
    — They may find it easier to do several small steps rather than one big step.
    — This can also help them feel they are achieving things.
  • Gently prompt or help the person to start an activity, such as dressing.
    — Give lots of encouragement to keep them engaged, but try not to fuss over them.
    — Be positive and focus on what they have achieved.
  • Don’t blame the person for being ‘lazy’, unhelpful or uncaring.
    — The person is not choosing to have apathy.
    — If you feel frustrated, try to remain as calm as you can to avoid the person reacting negatively.
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