Conquering Apathy
Apathy is not just the lack of motivation. Apathy doesn’t just occur out of hopelessness.
Apathy is defined as the reduction in goal-oriented behavior as a result of lessened interest and lessened emotional response.
I feel we are seeing more and more of this especially during these trying times.
Those with Parkinson’s disease are more susceptible to developing apathy. Once someone has apathy, they are less likely to feel motivated in doing anything, especially things that are known to help improve symptoms or delay progression like exercise or being socially engaged. Prolonged apathy can be a harbinger of further executive dysfunction and cognitive decline.
This can be terribly frustrating to a loved one or a care partner who recognizes the apathy but feels powerless to help.
Here are a few things that we can do to help overcome this issue and not derail a patient.
1. Recognize the symptoms of apathy and bring this to the attention of the neurologist or a mental health provider.
2. Recognize that the apathetic patient is not “lazy” or intentionally refusing to participate in activities—instead, understand that it is a symptom of his or her disease.
3. Recognize that even though apathy and depression have symptoms that frequently overlap, they are NOT the same and can exist independently. Some symptoms that differentiate apathy from depression include emotional indifference (a lack of interest or concern), denying feelings of persistent sadness, and a diminished drive to initiate action across multiple domains (e.g. cognitive, motor, gait).
4. When apathy is identified, nonpharmacological treatment should be tried first. These include activity-based interventions aimed at mobilizing patients, improving quality of life, and alleviating feelings of social isolation. One simple change could be to reflect on your treatment from the perspective of GOALS rather than SYMPTOMS– for example, “my goal is to get back on the golf course” rather than “my goal is to reduce my tremors.”
5. Pharmacological treatment for the nondepressed apathetic patient may include adjusting dopaminergic medications (e.g. if apathy is due to non-motor “off” states) or using other medications such as bupropion or amantadine that indirectly increase dopamine transmission. Other options may include stimulants (e.g. methylphenidate) or atypical stimulants/wakefulness promoting agents (e.g. modafinil)—and lastly, acetylcholinesterase inhibitors (donepezil, rivastigmine) are also alternatives.
6. Despite these pharmacological options, it is important to note that the evidence to guide pharmacologic treatment of apathy is limited; the focus of treatment should be individualized to the patient and his or her support system and should include multidisciplinary input.
Bottom line: Socially Engage, Socially Engage, Socially Engage – via video or physically distanced when in-person – and reach out to your local PD support group.
Suketu M. Khandhar, MD is a neurologist and movement disorder specialist at Kaiser Permanente in Northern California. He was a faculty member at the 5th World Parkinson Congress in Kyoto Japan as well as the 4th World Parkinson Congress in Portland, Oregon. He is currently involved as a program committee member for the 6th World Parkinson Congress in Barcelona.
Michel Medina, MD is a neuropsychiatrist, fellowship trained at Stanford and part of the Psychiatry Department at Kaiser Sacramento.
Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not necessarily reflect the opinions of the World Parkinson Coalition®