Weekly Newsletter:

May 28, 2025

 An occasional loss of interest or motivation is a common occurrence that everyone experiences from time to time. But what happens when apathy is a symptom of serious cognitive decline? According to a 2018 article published in Current Opinion in Behavioral Sciences, apathy is the most common neuropsychiatric symptom in patients with Alzheimer's disease. Brianna Garrison, professor at Baylor University's Diana R. Garland School of Social Work and an expert in mental health for older adults, says that "apathy can cause a rapid decline in the functioning of patients and affect quality of life, resulting in older adults not being able to care for themselves."

Garrison describes apathy as "a loss of interest in life activities or interactions with others, which can manifest in those with dementia. A person with dementia, a degenerative condition marked by memory loss and cognitive decline, may develop apathy over time-and apathy may not always be obvious." Persons experiencing this symptom can become unmotivated to perform regular tasks and appear indifferent to regular, previous routines. Impairment of daily functioning becomes progressive. "People with dementia who experience apathy are more likely to be impaired in daily activities - such as dressing, bathing, using the bathroom, walking, or eating - than those who don't." Garrison explained. "Additionally, it can make them less likely to comply with treatment."

Garrison identifies three types of apathy related to dementia:

• AFFECTIVE APATHY:  Presents as a lack of emotion, an appearance of indifference, and devoid of empathy. Individuals with affective apathy may seem as if they don't care about others or may lack the warmth previously exhibited.
• BEHAVIORAL APATHY:  Presents as physical inactivity, such as an indifference toward completing tasks. Individuals with behavioral apathy may not walk around very much or may ignore tasks such as laundry or showering even if they are able to do so.
• COGNITIVE APATHY:  Presents as a notable disconnection to surroundings. Persons with cognitive apathy may not initiate speech or activities or may display an absence of interest in the activities of others. They may require prompting for conversation and social engagement or appear "zoned out."

It is important to note significant changes in behavior from the usual baseline of the person. If they lose interest in an activity, such as playing cards, it is important to be aware when they suddenly lose interest or have forgotten how to play. A loss of interest in connecting with close, familiar friends and relatives can be concerning. There may also be a shift in their ability to communicate or understand what is being said to them.

SUPPORTING LOVED ONES EXPERIENCING APATHY CAUSED BY DEMENTIA:

IDENTIFY WHERE THEY FIND JOY. Art can be a great way to engage. 

Favorite music, played or sung along to, can be helpful.  

REMINISCE AND ASK QUESTIONS ABOUT THE PAST. Photos from childhood and trips and vacations from the past can stimulate interest as well.

INTRODUCE SMALL AMOUNTS OF ACTIVITY AT A TIME. If an activity seems overwhelming, learn to be flexible and adjust it. Short periods of time that involve engagement can be quite rewarding if one is in tune with a pace that is responsive to the moment. Coming back to it later can also be effective. Sensitivity to interest level is key.

EMPHASIZE THE PROCESS OVER THE OUTCOME. Help them to initiate and allow them to enjoy the process. Working on a puzzle, as an example, can be collaborative and mutually enjoyable. The goal to keep in sight: quality of connection and engagement as the end game. Collaboration over competition.

HAVE PATIENCE: Avoid expressing frustration or disappointment. Be clear in communicating; use a gentle tone. Focus on what they CAN do, not what they CAN'T.

PROVIDE POSITIVE FEEDBACK: Set them up for success. Focus on what they like to do, what they are good at doing. Make sure they feel included and rewarded for trying to participate.

These strategies can help the person experiencing apathy related to dementia feel less alienated and more valuable and productive. It is important to take into consideration the cognitive and physical functioning variables of each individual. "Flexibility in the process, with a willingness to experiment using gentle engagement, can be mutually rewarding.

Above all, we must be mindful not to set them up for failure, which can further the experience of apathy," Garrison said. It is essential to take a person-centered approach and emphasize individualized, meaningful activities tailored to a person's strengths and interests. When they do withdraw, try to distinguish the difference by figuring out if the person with dementia is withdrawing from an activity as the result of apathy or because they cannot actually engage in the activity anymore. "Meeting the person where they are is key to ensuring that we consider their dignity and worth above all else," Garrison emphasized. It is another example, often stated in our DayBreak Support Groups: "We must be willing to step into their world when they can no longer step into ours."

— Karen Kelleher, MA

Family Caregiver Support Coordinator at DayBreak

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