I am happy to report that apathy is NOT one of the Parkinson’s Disease (PD) symptoms that has hit me, at least for now (but one never knows if apathy might be lurking around the corner). In fact, I may have the opposite problem of caring too much, but that’s another story.
Features of Apathy
Hubert H. Fernandez, MD from the National Parkinson Foundation’s Center of Excellence at the University of Florida in Gainesville, discussed apathy at the Colorado Neurological Institute’s program on January 24, 2009.
Apathy is defined as a dulled emotional tone associated with detachment or indifference. The apathetic patient’s typical response when asked a question such as what he wants to do or eat is “I don’t care.”
It is normal to have specific disinterests in life, such as not caring about sports, money, or politics. However, with apathy, the patient loses interest in all aspects of life, including areas of former interest. An apathetic patient is typically a couch potato.
Joseph H. Friedman, MD (a former mentor to Dr. Fernandez) in his book, Making the Connection between Brain and Behavior, states that apathy encompasses a behavioral pattern of:
- Loss of interest in events
- Reduced spontaneous interaction with people and pets
- Decreased concern or seeming indifference to friends and family
- Muted emotional tone
- Loss of interest in hobbies
- Loss of enjoyment
- Loss of distress at hearing bad news
- Loss of motivation
Apathy is Different from Depression
Dr. Friedman described some of the similarities and differences between depression and apathy.
Depressed and apathetic patients frequently share these similarities:
- Anhedonia (absence of enjoyment)
- Loss of motivation
- Lack of interest
Depressed patients often have the following symptoms while apathetic patients rarely experience these symptoms:
- Reduced effort
- Sleep disturbances
It is also possible to have the dual diagnosis of depression and apathy.
How Apathy Affects Caregivers and Family
Dr. Fernandez indicated that depression tends to drive the patient crazy, whereas apathy can drive the patient’s family crazy. Apathy becomes more of a problem for the caregivers, family and friends than for the PD patient.
Apathetic patients participate less in activities that help them function. This results in a greater burden on the caregiver which requires more understanding, patience and effort. A less responsive patient provides little satisfaction for the caregiver.
How Apathy Affects the PD Patient
Both physicians agreed that the apathetic patient doesn’t care that he doesn’t care. The “I don’t care” attitude provides a protection from the grief and loss suffered by the PD patient. It might be preferable for the apathetic patient to not care versus feeling frustrated and disgusted with one’s loss of functioning. Not caring conserves energy that the apathetic patient might not have to expend.
Treatment of Apathy
Although there is treatment for depression, there is currently no treatment for apathy. Dr. Fernandez stated that research is being conducted using pet therapy to help PD patients with apathy take some interest in life. Wouldn’t it be great if dogs could break the behavioral resistance and emotional barriers of apathy and allow PD patients to express some zest for life?