Apathy is a non-motor symptom of Parkinson’s disease characterized by a loss of interest, enthusiasm, and motivation. If you are no longer finding enjoyment in general activities, friends or family, you may be suffering from apathy, a condition that may not be easily recognized or treated. Many people with PD experience apathy at some point, also characterized as having no interest in living in the moment or seeking gratification.1,2
Indeed, with any chronic debilitative illness you may feel grief, loss or hopelessness at some point. However, those could be symptoms of depression, which is a treatable condition. Depression can occur occasionally or be a condition that can interfere with daily functioning. Depressive symptoms can be treated with medications and other kinds of therapies, often to complete remission.3,6
Apathy vs. depression
Some people think apathy is a symptom of depression. They are separate disorders with some similar symptoms. People with depression are likely to also develop apathy. Effective management of apathy and depression involves the participation of caregivers and a health care team.
People experiencing apathy may be unaware there is a problem. It may be due in part to a depletion of dopamine.4 They may not recognize their loss of interest or enjoyment in social activities or the need for rallying increased energy to undertake everyday routines.4 Attitudes perceived as indifference or inflexibility can be misunderstood. Caregivers may recognize signs of apathy and, if correctly diagnosed, can play an important role in urging the person with PD to seek help. The ability to identify apathy and distinguish it from other conditions generally requires professional input.5
PD mood changes
Chemical changes in the brain that cause trouble with movement can also affect mood changes. 40% of people with PD may experience apathy at some point and 50% may experience depression. PD depression can be experienced in different ways, ranging from classic major depression that can last from weeks to years to shorter episodes that come and go and even briefer mood fluctuations related to dopamine medications.3,4
There are multiple categories of apathy:
Cognitive – a loss of interest in new things
Emotional – a lack of passion or emotional reaction
Behavioral – difficulty initiating activities
Decreased physical and social activity can impact movement, medication adherence, and relationships. Being active and getting good rest are important tools in managing apathy. Medications are not typically effective for treatment of apathy. Better results have been achieved by4:
Keeping a consistent sleep schedule
Pursuing physical, social and cognitive activities
Setting personal goals
Getting regular exercise
Learning to recognize and understand apathy as a symptom of PD and identifying ways to cope with it is elemental to maintaining quality of life and quality relationships with caregivers, family, and friends.2 Apathetic attitudes can put a strain on relationships requiring additional patience, care, and intervention. Non-pharmaceutical treatments like exercise and cognitive behavioral therapy have demonstrated improvements in apathy.4
Levels of apathy in PD appear to be unrelated to disease progression, according to several research studies. They are considered a physiological component of the disease rather than a psychological reaction. Other studies have found that apathetic PD patients had more severe cognitive symptoms identified by a significantly lower global cognitive status and reduced executive function than non-apathetic patients.7 These findings suggest that PD apathy, in people with no prior depression or dementia, may be predictive of future dementia and cognitive decline.
Tips to stay motivated
Keeping motivated is important for both the person with apathy and their caregivers. There can be social and emotional tolls on both. Following these tips can help both groups meet the challenges2,6:
Get support– allow friends and family to help you maintain social and leisure activities and find renewed joy in life
Follow a schedule that includes fun and enjoyable activities rewarding yourself for participation
Set attainable goals for getting out of the house and doing fun things
Exercise and get plenty of sleep. Activity is good for the motor symptoms of Parkinson’s and will also make you more tired, helping to maintain a good sleep schedule.
Apathy can be frustrating for people with PD and those that care for them. Focus on achieving realistic steps along the way.2 The lack of motivation that is characteristic of apathy can be addressed by teamwork, trying to make things fun again. Examples of positive activities include cooking or dining out for a favorite meal, watching a movie, and pursuing enjoyable hobbies. It’s important to remember apathy is a symptom of Parkinson’s disease. The person with PD is not being intentionally difficult, lazy or making excuses.
De Leon, M. Top 3 Reasons for Loss of Interest in PD. Available at: https://parkinsonsdisease.net/living/reasons-for-loss-of-interest/. Accessed 1.12.19.
Apathy. Available at: https://parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms-Apathy. Accessed 1.12.19.
Minton, L, Perepezko, K, Pontone, G. Mood: A mind’s Guide to Parkinson’s Disease. Available at: https://f5h3y5n7.stackpathcdn.com/sites/default/files/attachments/Mood.pdf. Accessed 1.12.19
Dolhun, R. Apathy and Parkinson’s Disease. Available at: https://www.michaeljfox.org/foundation/news-detail.php?ask-the-md-apathy-and-parkinson-disease. Accessed 1.12.19.
Karl R. Caring About Apathy. Available at: https://parkinsonsdisease.net/living/caring-about-apathy/. Accessed 1.12.19.
Pluck, GC, Brown, RG. Apathy in Parkinson’s disease. Available at: https://jnnp.bmj.com/content/73/6/636. Accessed 1.12.19
Dujardin, K., Sockeel, P. et al. Review: Apathy may herald cognitive decline and dementia in Parkinson's disease. Available at: https://www.movementdisorders.org/MDS/Resources/Podcasts/Editors-Choice-Article-Archives/Review-Apathy-may-herald-cognitive-decline-and-dementia-in-Parkinsons-disease-.htm. Accessed 1.12.19.