Krista Lanctôt, PhD, Sunnybrook Research Institute & University of Toronto, Toronto, ON, Canada, discusses apathy in dementia. While often overlooked, neuropsychiatric symptoms occur commonly in dementia, of which apathy is the most prevalent. Apathy is seen in an estimated 49% of all Alzheimer’s disease cases and gets more frequent with disease and time progression. It is associated with decreased quality of life, increased mortality, more rapid cognitive decline, and increased risk of conversion. On top of the impact on patients themselves, studies have shown apathy to have a significant impact on caregiver burden. Despite its impact and prevalence, there are no approved therapies to treat apathy. There is an ongoing need to identify key mechanisms and treatment targets. This interview took place at the Alzheimer’s Association International Conference (AAIC) 2022 in San Diego, CA.
Transcript (edited for clarity)
Alzheimer’s disease is defined by the presence of difficulties with memory and learning and other cognitive difficulties. There’s another group of symptoms that occur in people with dementia, neuropsychiatric symptoms, and that term refers to the host of behavioral and mood symptoms that accompany Alzheimer’s, like apathy and agitation. Apathy is the most frequent of these. It’s a big contributor to lower quality of life...
Alzheimer’s disease is defined by the presence of difficulties with memory and learning and other cognitive difficulties. There’s another group of symptoms that occur in people with dementia, neuropsychiatric symptoms, and that term refers to the host of behavioral and mood symptoms that accompany Alzheimer’s, like apathy and agitation. Apathy is the most frequent of these. It’s a big contributor to lower quality of life. The frequency, impact and lack of approved treatments are what drew me to focus on this particular symptom. Apathy has a big negative impact on persons with dementia and their caregivers. For persons with dementia, it’s known to be associated with decreased quality of life. And also whether you develop apathy when you’re cognitively normal, or when you have mild cognitive impairment, or even if you already have dementia, it’s associated with an increased mortality and an increased risk of conversion to the next state. So if you’re cognitively normal, it doubles your risk of converting to becoming mild cognitive impairment and mild cognitive impairment again, it doubles your risk of converting. So it’s associated with conversion.
For the caregiver because people with dementia lack insight and have decreased initiative, it’s also a big predictor of caregiver distress and a reason for institutionalization. A person who still has the cognitive abilities to do their own self care and take care of themselves, may just sit in a darkened room every day and not do everything. And also because of the emotional blunting, the caregiver can feel that the patient no longer cares about them, because they don’t respond emotionally to things that the caregiver are doing. So studies have shown that out of the neuropsychiatric symptoms, apathy is one of the biggest predictors of caregiver burden.
Dr Lanctôt gratefully acknowledges support from the Canadian Institutes of Health Research (PJ2-179753, PJT-183584), Pooler Charitable Fund, Canadian Consortium for Neurodegeneration in Aging (CNA 163902), Alzheimer’s Association Part the Cloud (PTCG-20-700751, PTC-18-543823), Weston Foundation (CT190002), and Alzheimer’s Drug Discovery Foundation (201808-2016354). Consultant or Advisory Board: BioXcel Therapeutics, Cerevel Therapeutics, Eisai Co., Ltd., ICG Pharma, Jazz Pharmaceuticals, Kondor Pharma, H LundbeckA/S, Merck Sharp Dohme, Novo Nordisk, Praxis Therapeutics, Sumitomo.