Apathy

What is apathy?

“Apathy” is a term healthcare professionals use to describe a lack of goal-directed activity and motivation compared to previous behavior. It can also look like a lack of spontaneity, interest or emotional expression. Apathy is a symptom and/or complication of several neurological conditions. Some experts consider it to be a syndrome (a collection of symptoms that often happen together, but aren’t necessarily a specific condition).

In everyday life, people often consider apathy to be the opposite of empathy (the ability to understand and share the feelings of others). However, in a medical context, apathy isn’t just a lack of feeling or concern toward other people and their situations. It’s a lack of motivation and interest in general. In addition, apathy in the medical sense is something you have no control over — it’s not laziness or a choice of personal indifference.

Psychological or situational apathy

In the fields of psychiatry and psychology, apathy has a slightly different meaning. It usually describes emotional detachment and a reduced ability to experience pleasure (anhedonia). It typically doesn’t include a lack of motivation to do activities or daily tasks, as the neurological definition of apathy does.

People may experience episodes of apathy with certain psychological conditions, such as major depression and schizophrenia.

In addition, people who experience traumatic events may develop apathy syndrome (indifference and emotional detachment) as a way to protect themselves mentally and prevent further distress. This is common in survivors of catastrophes or prisoners of war. And it can be part of post-traumatic stress disorder (PTSD).

What are the signs of apathy?

Signs of apathy include:

• Disengaging or withdrawing from work, hobbies or spending time with loved ones. However, people with apathy appear to enjoy spending time with loved ones if they’re pushed or persuaded to do so.
• A lack of concern that they’ve disengaged from activities they used to enjoy. Family members and loved ones are more likely to notice the change in their behavior and be concerned about it.
• Relying on others to help them fulfill daily activities. This isn’t because they’re mentally or physically unable to do the tasks (like brushing their teeth or paying bills, for example) but because they lack the self-directed motivation to do them.
• A decrease in or lack of expression of both positive and negative emotions (emotional blunting).They may not feel strong emotions or emotionally react to situations as expected.

Is apathy a form of depression?

Apathy can resemble depression, but they’re distinct conditions. People with apathy don’t have the feelings of low mood or sadness that people with depression do. But a person can have both depression and apathy.

What are the most common causes of apathy?

Researchers have found that severe or chronic apathy typically results from damage to specific parts of your brain, including your:

• Frontal lobe.
• Dorsal anterior cingulate cortex (a region of your cerebral cortex that helps with cognition and movement control).
• Ventral striatum (a part of your brain that plays a large role in social behaviors).

Together, these regions of your brain are crucial in processing how rewards motivate behaviors.

Apathy is most commonly involved with the following neurodegenerative conditions:

• Alzheimer’s disease (AD): Apathy is one of the most common symptoms of AD. It affects about 49% of people with AD.
• Parkinson’s disease (PD): Apathy rates in people with PD can range from 25% in the earlier stages to 60% as the disease worsens.
• Pick’s disease: Pick’s disease is a type of frontotemporal dementia (FTD), specifically behavioral variant frontotemporal dementia. Apathy affects 54% to 96% of people with Pick’s disease.

Apathy can also be a symptom or complication of other brain conditions, including:

• Cerebral small vessel disease (CSVD).
• Corticobasal degeneration.
• Huntington’s disease.
• Progressive supranuclear palsy.
• Stroke. Apathy is a complication of about one-third of hemorrhagic and ischemic stroke cases.
• Traumatic brain injury.
• Tumors in certain parts of your brain.
• Vascular dementia.

Psychological conditions, like mood disorders and PTSD, can lead to more mild or short-term episodes of apathy.

How is apathy treated?

There’s no go-to treatment for apathy. This is mainly because most studies on apathy are in relation to a specific condition, such as Alzheimer’s disease (AD) or dementia.

Some medications that may help include:

• Cholinesterase inhibitors: Studies show that cholinesterase inhibitors, such as donepezil, galantamine and rivastigmine, may help improve apathy in people with AD.
• Stimulants (psychostimulants): Studies show that stimulant medications — mainly methylphenidate (the active ingredient in Ritalin®) — have had some positive effects in people with apathy in the setting of AD, vascular dementia, Parkinson’s disease and frontotemporal dementia.
• Antidepressants: Antidepressants may help some people with apathy, especially if they also have depression. However, some antidepressants can make apathy worse.

Researchers are also studying transcranial magnetic stimulation (TMS) as a treatment for apathy. In a 2017 study, people with AD who received five weeks of TMS had an improvement in apathy that continued for as long as six months.

Family education

Family education is also important for those with a loved one who has apathy. Friends and family members should:

• Learn about apathy and understand that it’s something their loved one can’t control.
• Initiate activities on their loved one’s behalf and encourage them to participate in activities.
• Maintain a regular routine with their loved one.

What are the possible complications of apathy?

Apathy can lead to a worsened quality of life. It can also cause caregiver distress. If you care for a person with apathy, it’s important to take care of yourself as well. Consider joining a support group or seeing a mental health professional, such as a psychologist if the situation is causing you distress.

Can apathy be prevented?

Unfortunately, there isn’t anything you can do to prevent apathy that’s due to a neurological condition. It’s typically part of a neurodegenerative disease or a result of brain damage.

When should I see a healthcare provider about apathy?

If you notice a change in your loved one’s behavior, such as a decrease or lack of emotional expression or disengaging from previously enjoyed activities, you should encourage them to see a healthcare provider. Apathy can be a sign or the result of a serious brain condition.

Your loved one may initially avoid or protest seeing a provider because they don’t think there’s anything wrong with their behavior. Encouraging them — kindly and supportively — to see a provider may help them change their mind. Offering to go with them may also help them feel more comfortable seeking professional care.

A note from Cleveland Clinic

Medically, apathy is a lack of goal-directed activity. It also presents as a lack of interest and emotional expression. Caring for a loved one with apathy can be distressing. It’s important to remember that it’s something they can’t control. Know that their healthcare team is ready to provide education, support and care for them and your family. Ask their team for information on local support groups, as well. Support groups can be very helpful for sharing care tips and providing comfort in knowing you’re not alone.