Apathy: a possible risk factor for dementia progression

Apathy, which can resemble depression, increases in patients with mild cognitive impairment and is associated with worse clinical outcomes according to a new three-year study led by the Centre for Healthy Brain Ageing (CHeBA).

UNSW Sydney’s CHeBA conducted the research, published in International Psychogeriatrics, which included 185 participants selected from nine memory clinics across Australia.

All participants had a diagnosis of mild cognitive impairment, defined by deficits in cognition that are noticeable to the person or family members and can be confirmed on testing, but do not significantly interfere with functioning.

The condition affects 10–35% of people aged over 65 and is considered an intermediate stage between normal aging and dementia — although it is not a guaranteed progression.

The study, combined with other recent research, suggests that apathy is a marker for poor clinical outcomes in older people and across different neurocognitive disorders.

Lead author of the study Dr Michael Connors said that apathy — a disorder of motivation and goal-directed behaviour — is a common symptom in dementia, although it can also be experienced by older people without dementia.

The research also indicates the need to distinguish apathy and depression, with depression appearing less closely tied to the progression to dementia.

“Apathy can be difficult to recognise and is sometimes confused with depression, which it resembles,” Connors said.

According to the researchers, little research has examined apathy in people with mild cognitive impairment. In addition, very little research has assessed how apathy might change over time.

Approximately 2.5–7.5% of patients with mild cognitive impairment in the community and 10–15% attending memory clinics develop dementia every year. With such a high incidence of dementia, significant attention has focused on identifying risk factors for progression. Apathy may predict such progression to dementia.

“In this study, we assessed both apathy and depression in people with mild cognitive impairment over a three-year period to be able to better distinguish the two symptoms,” Connors said.

Senior author and Co-Director of CHeBA Professor Henry Brodaty said that “there is a need to consider those with apathy to be at high risk of further cognitive decline and to plan for such contingencies”.

“Given apathy’s prevalence and burden, this remains an important direction for future research,” Brodaty said.

Image credit: iStock.com/Anchiy