Apathy and PD
One of the most challenging and puzzling non-motor symptoms of Parkinson’s disease (PD) is apathy
Apathy is defined as a feeling of indifference or a general lack of interest or motivation in activities. People with PD may feel that they have lost their “get up and go”, and can’t muster enthusiasm for anything – even things they once engaged in and enjoyed. Apathy can be a very frustrating non-motor symptom of Parkinson’s disease (PD) not only for the person with PD but also for care partners, friends and family.
Apathy can be a frustrating non-motor symptom of PD.
Apathy can be accompanied by depression and/or cognitive decline, it can also mimic depression and cognitive decline, and it can also occur independently of these other non-motor symptoms. This can make apathy confusing to distinguish and identify.
Discuss this and all other symptoms with your doctor as he/she may want to evaluate you for other non-motor symptoms and may want to check for some medical conditions as well.
Although there are no medications approved for apathy, lifestyle modifications can help, including the establishment of a non-negotiable, regular routine.
Apathy is defined as a lack of motivation. In PD, it shows up in three forms:
• Cognitive. Loss of interest/curiosity in new things.
• Emotional. A lack of passion or reaction to news or situations that normally would evoke an emotion.
• Behavioral. Trouble initiating activity, a need for others to prompt one to complete tasks.
The first thing a person with PD and his or her care partner should do upon experiencing apathy is to consult the movement disorder specialist to ensure that PD medications are working optimally.
Download the fact sheet https://www.parkinson.org/sites/default/files/documents/apathy-and-parkinsons.pdf
Apathy can have wide-ranging effects. For the individual experiencing it, apathy may lead to less physical activity (which can worsen already impaired mobility) and fewer social interactions (which could lead to depressive symptoms). Apathy has also been shown to correlate with a poorer adherence to medication regimens and/or response to treatment (as after deep brain stimulation surgery, for example).
The friends and family of someone with apathy are also impacted — relationships may be stressed as loved ones take on more caregiving efforts.
People with apathy usually don’t realize there is a problem. Instead, friends and family notice behavior or personality changes and bring these to the doctor’s attention. It’s important to do so because the physician can do tests and have you fill out questionnaires to figure out if the symptoms are due to apathy, depression and/or another medical condition.
If the diagnosis of apathy is confirmed, lifestyle adjustments may be recommended:
Maintain a regular sleep and wake schedule.
Create a schedule that incorporates physical, social and cognitive (memory and thinking) activities. List what you will do each day and at what time.
Set personal goals. Start small, with objectives you are confident you can achieve.
Exercise. Physical activity is probably the last thing you want to do when you’re tired and unmotivated. It sounds counterintuitive, but exercise is actually helpful for apathy.
Medication options to treat apathy are, unfortunately, limited. Increasing dopamine replacement therapies (dopamine agonists and/or levodopa) is beneficial in some people but, of course, must be done carefully. Other drugs, including those used for dementia (such as rivastigmine, or Exelon) and depression (namely if the person is depressed) can be helpful in individual cases. All medications work best in conjunction with the above behavioral adjustments.