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apathy (indifference)

Indifference. A lack of interest in one's environment, including social interactions. Etiology: 1) cerebral disease a) dementia including Alzheimer's disease b) anterior cingulate syndrome 2) depression Epidemiology: - most common neurobehavioral symptom in dementia Pathology: 1) disruptions of circuits regulating basic drives: a) sexual satisfaction b) food c) curiosity d) pleasure 2) disrupted circuits include a) mesolimbic system b) mesocortical dopaminergic circuits Clinical manifestations: 1) reduction in psychomotor activity 2) often perceived as a personality change by family 3) affects ADLs beyond the level of cognitive impairment 4) suspicion of other residents & staff may be present [3] 5) appearance of sadness at times may be present [3] 6) appetite, weight, & sleep patterns may be unchanged [3] Diagnostic criteria: - Association Francaise de Psychiatrie Biologique (AFPB) & European Psychiatric Association (EPA) task force criteria for apathy in Alzheimer disease & other neuropsychiatric disorders - presence of quantitative reduction of goal-directed activity either in the behavioral, cognitive, emotional or social dimension in comparison to the patient's previous level of functioning - minimum duration of 4 weeks - symptoms need to present in 2 or 3 domains - behavior & cognition, emotion, & social interaction - functional impairment - not explained by or due to major changes in the patient's environment [3] Complications: - associated with a faster rate of cognitive decline & functional decline in Alzheimer disease Management: - little evidence to support specific therapy [3,4] - cholinesterase inhibitors may be of some benefit [4] - methylphenidate may be of benefit in community-dwelling elderly with mild to moderate Alzheimer's disease [5,6] - may improve motivation, cognition, mood, functioning, & caregiver burden - does not affect patients' function or quality of life [6]

General

sign/symptom

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  2. Principles of Neurology, 4th ed, Adams RD & Victor M (eds) McGraw-Hill, Inc, New York, 1989
  3. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  4. Berman K, Brodaty H, Withall A, Seeher K Pharmacologic treatment of apathy in dementia. Am J Geriatr Psychiatry. 2012 Feb;20(2):104-22. Review. PMID: 21841459
  5. Padala PR, Padala KP, Lensing SY et al. Methylphenidate for apathy in community-dwelling older veterans with mild Alzheimer's disease: A double-blind, randomized, placebo-controlled trial. Am J Psychiatry 2017 Sep 15 PMID: 28945120
  6. George J Stimulant Reduces Apathy in Alzheimer's Disease Twice daily methylphenidate showed modest effect size. MedPage Today September 27, 2021 https://www.medpagetoday.com/neurology/alzheimersdisease/94722 - Mintzer J, Lanctot KL, Scherer RW et al Effect of Methylphenidate on Apathy in Patients With Alzheimer Disease. The ADMET 2 Randomized Clinical Trial. JAMA Neurol. Published online September 27, 2021. PMID: 34570180 https://jamanetwork.com/journals/jamaneurology/fullarticle/2784538 - Fredericks C Methylphenidate for Apathy in Alzheimer Disease - Why Should We Care? JAMA Neurol. Published online September 27, 2021 PMID: 34570178 https://jamanetwork.com/journals/jamaneurology/fullarticle/2784541
  7. Robert P, Lanctot KL, Aguera-Ortiz L et al. Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group. Eur Psychiatry. 2018;54:71-76 PMID: 30125783 Free article https://www.cambridge.org/core/journals/european-psychiatry/article/is-it-time-to-revise-the-diagnostic-criteria-for-apathy-in-brain-disorders-the-2018-international-consensus-group/5A3A2F39C4A322DCCAD6B044B4AF5CB1