Apathy

Apathy is a state of indifference, characterised by a lack of emotion, motivation or interest. The term comes from a Greek phrase meaning ‘without passion’. A person who is experiencing apathy lacks interest in both their own situation and the wider world. He or she may feel a lack of purpose and that life has little meaning.

People with depression commonly feel sad and low. In contrast, a person with apathy shows a lack of emotion, either happy or sad. You may feel that even everyday activities such as walking are not worth the effort. Carers, family members or strangers may feel that the person is being lazy, difficult or uncaring. In fact, apathy is a symptom of Parkinson’s, and you cannot voluntarily change the way you feel.

Apathy and Parkinson's

It is important to recognise that apathy is a non-motor symptom of Parkinson’s. The exact cause is unclear, but researchers believe that apathy is related to chemical changes that occur in the brain as a result of Parkinson’s. 

Parkinson’s is caused by reduced levels of dopamine in the brain. This neurotransmitter not only regulates movement but also affects motivation and feelings of enjoyment. Without this ‘feel-good’ chemical, people with Parkinson’s are more vulnerable to apathy.

If you have Parkinson’s, you may find social contact more difficult because of reduced mobility and communication problems; this may also prompt feelings of apathy. Apathy can also make you disinterested in hobbies and activities you enjoyed before, and also in therapies such as physiotherapy, that help to manage symptoms. This can place a strain on relationships with carers, family and friends as well as with healthcare professionals. 

In the past, many professionals believed that apathy and depression were very closely related. However, a 2006 study revealed that people with Parkinson’s may experience apathy without being clinically depressed. The study1 compared people with Parkinson’s with others with dystonia, another movement disorder. The results showed that people with Parkinson’s were more likely to suffer from apathy. Although the occurrence of depression was similar in both groups, 29% of those with Parkinson’s experienced apathy with no depression, compared to none of those with dystonia. These results highlight the importance of screening for both apathy and depression to ensure correct diagnosis, and to avoid prescribing treatment for depression when the person is not depressed. 

References

  1. Disassociating Apathy and Depression in Parkinson’s Disease – Neurology 2006 3;67:33-38 - view abstract.

Diagnosis

Diagnosis can be tricky in people with Parkinson’s, particularly as people with feelings of apathy tend not to complain – by definition, they do not care about their condition and usually do little to deal with it. As a result, it is often family and carers who act and seek help from a doctor or another health professional.

Your doctor will assess you for apathy by asking about your mood, motivation and other indications. There are several recognised rating scales, such as the Marin Apathy Evaluation Scale 1 and Beck Depression Inventory 2. The assessment involves questions designed to find out whether you are self-motivated or need to be told what to do, and whether you like to see tasks through or not. Responses are measured using a points system which can help to distinguish apathy from depression.

References

  1. Marin Apathy Evaluation Scale - view scale
  2. Beck, AT, CH Ward, M Mendelson, J Mock, and J Erbaugh. 1961. An inventory for measuring depression. Arch Gen Psychiatry 4: 561-571 - view abstract.

What treatment is available?

Medication

Your doctor may decide to prescribe a traditional antidepressant, or medication that activates dopamine and/or enhances what is called cholinergic function. These treatments are not always effective so the doctor will need to monitor your response.

Important! Don’t stop your medication or change the dose suddenly without first talking to your doctor or Parkinson’s Disease Nurse Specialist.

The information in this website is not a substitute for advice from your doctor, pharmacist or other healthcare professional.

Counselling

Cognitive behavioural therapy (CBT) can be effective in treating depression, but it may not help to overcome feelings of apathy. Individual counselling with an experienced professional can help to develop a strategy to promote a more positive attitude and greater motivation, but it is important to review progress to see if it helps.

If medications are not effective, or if apathy is severe, your doctor may refer you to a psychiatrist, psychologist or psychotherapist to help you feel more motivated and positive. Sometimes it may be useful if your partner or carer is included in consultations.

It may be helpful to combine psychological approaches with medication – they are not mutually exclusive. 

Other help

Various groups and organisations such as telephone helplines offer emotional support and/or practical help. Your doctor or social worker will be able to help you identify such organisations, or you may find contact details on the Internet.

How can I help myself?

It is important to remember that apathy is a common symptom of Parkinson’s and can be effectively treated. Feelings of indifference and lack of motivation may become a vicious circle if untreated, so it is important that you seek help and accept support that is offered to you, both by professionals and your family and carer.

Below are some suggestions that you may find helpful:

  • Educate yourself about Parkinson’s, its cause and treatment. Being informed generally helps you to feel more in control.
  • Try to take an active role in managing your illness.
  • Make information available to your carers so that they understand that apathy is the reason for your apparent lack of interest or emotion. For carers, it will be important to continue with their own activities to avoid becoming dispirited by the person’s apathy.
  • Be open with your doctor and other healthcare professionals – this will make it easier for them to help you.
  • Try to continue with activities you enjoy. If you have stopped most activities, restart them one at a time. Research shows that keeping active can improve your mood and make you feel more positive about yourself. 
  • Don’t take on too much – consider which activities are manageable. Ask your carer to help you plan your time.
  • Try to stay relaxed. Complementary therapies such as yoga and Tai Chi may help with this.
  • Accept help when you need it.
  • Contact your local Parkinson’s organisation or other support groups.
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