APATHY In Alzheimer's disease: A state of no feeling in the world of fading memories

Abstract

Apathy is a common neuropsychiatric symptom (NPS) characterized by a loss of motivation, emotional reactivity, and initiative. It is one of the most prevalent, stable, and persistent NPS observed across the neurocognitive disorders (NCD) spectrum. Apathy in NCD is linked to poorer disease outcome, reduced daily functioning, higher levels of caregiver distress, and an increased risk of mortality. Apathy is common in NCD such as Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) and its prevalence increases linearly with disease and time progression. Cross-sectionally, apathy in non-demented groups is associated with executive dysfunction, poorer quality of life, olfactory disturbance, subjective impairments in physical functioning, impairment in instrumental activities of daily living, and greater family caregiver burden. Longitudinally, apathy in non-demented individuals is associated with functional decline, slowed gait and frailty, and incident cognitive decline and dementia. Differentiating points between apathy and depression will be discussed. Building on initial attempts to define and operationalize diagnostic criteria for apathy, an international consensus proposed initial diagnostic criteria for the syndrome apathy to be applied in clinical practice independently of its etiology. Diagnostic criteria of 2008, 2018 and 2021 to be discussed and the revisions to be discussed. Pharmacotherapies include acetylcholinesterase inhibitors, gingko biloba, memantine, and stimulants. Non-pharmacological strategies include multisensory stimulation, music therapy, cognitive stimulation, pet therapy. The threshold of initiating pharmacotherapy is not defined and varies with factors such as excess disability of the patient, potential for improvement in quality of life, distress/burden to caregivers.