Saturday, September 26, 2009

Apathy in PD

Dr. Fernandez

Joined: 20 Jan 2007
Posts: 90

Posted: Sun Sep 20, 2009 7:01 pm Post subject: Post of the Week: Apathy in PD


How is apathy different from depression?

Apathy is characterized by “diminished motivation, a lack or absence of feeling, emotion, interest or concern”. Technically, it has three components: cognitive (loss of interest in new experiences, lack of concern for one’s problems), behavioral (lack of effort and productivity, dependence on others for structuring daily activities) and affective (flattened affect and lack of response to positive and negative events). Thus, there is some overlap with the symptoms of depression. However, while the symptoms of apathy can also be seen in depression, they differ in the sense that depressed patients feel intrinsically “blue” or sad. They are very bothered by this condition. While apathetic patients do not feel sad, they are indifferent, and they simply “don’t care”. They are not bothered or worried by this condition, rather it is often their spouse who is irritated by their lack of concern or unwillingness to participate in activities. The incidence of apathy in Parkinson’s disease is approximately 45% (Isela et al, 2002). Apathy can therefore be a feature of depression or stand alone as a separate behavioral symptom.

Unfortunately, there have been no consistently reported effective treatments for apathy in Parkinson’s disease. Antidepressants may be tried, and improvement can be seen usually if apathy is a component of depression. But the best remedy is assurance and education. Caregivers need to be assured that their loved one’s “lack of care” does not mean lack of love, or sadness or frustration. Once the spouse is assured and the Parkinson’s patient confirms that this is indeed what he or she is feeling, tension in the household eases up significantly. There is a therapy called cognitive behavioral therapy that researchers are currently testing for treatment of apathy.
Hubert H. Fernandez

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