September 20, 2017

Apathy Predicts Physical Function Decline in Older Adults

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Emmeline Ayers, MPH

Albert Einstein College of Medicine, Bronx, New York​​​


Apathy is a common neuropsychiatric symptom in older adults that becomes increasingly prevalent with advancing age. It presents clinically as lack of motivation and reduced emotional, cognitive, and energetic behavior. Although clinically apathy appears to be related to depression, apathy is considered a distinct neuropsychiatric condition that can occur with or without depression. Apathy has been identified as a prominent behavioral symptom in Alzheimer’s disease and predicts decline in physical function in individuals with dementia. However, little is known about apathy as a marker of functional decline in healthy older adults.

Identifying early risk factors for functional decline in community-dwelling older adults is particularly important, as these individuals may derive the most benefit from targeted interventions that can delay or prevent future functional decline. While depression has been extensively studied as a predictor of functional decline in healthy older adults, little is known about the predictive validity of apathy in this population. To address this gap in knowledge, my colleagues and I prospectively examined apathy as a predictor of 3 common outcomes of physical function decline in community-dwelling older adults: slow gait, frailty, and disability.

Participants were recruited from 2 prospective ongoing studies at the Albert Einstein College of Medicine. Results showed that individuals with apathy at baseline had a more than 2-fold risk of developing slow gait and frailty, and a more than 3-fold risk of becoming disabled. These associations were independent of depressive symptoms and remained robust after adjusting for potential confounders.

There are several possible explanations for the relationship between apathy and subsequent functional decline. Apathetic individuals may be more susceptible to frailty and disability due to lifestyle factors. For example, they may have reduced physical leisure activity participation and poor social support due to low energy and motivation. Another possible explanation is that apathy is an early symptom of frailty and disability, such that individuals may show symptoms of apathy before other behavioral markers manifest.

From a clinical perspective, our findings indicate that apathy screenings may help to identify those at high risk for functional decline and should become a routine part of psychiatric visits with older adults. Apathy can be screened for quickly and inexpensively at routine clinical visits (such as with 3 items on the Geriatric Depression Scale), offering a cost-effective strategy to reduce the risk of future functional decline for older adults.

Financial disclosure:Ms Ayers has no relevant personal financial relationships to report.

Category: Dementia , Depression , Older Adults
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2 thoughts on “Apathy Predicts Physical Function Decline in Older Adults

  1. Agreed that apathy in dementia is related to overall patient decline and although screening is helpful in diagnosing it an a fairly simple manner as outlined in the article, here in the UK treatment of apathy in the elderly is ignored due to a reluctance to use drugs to treat the symptoms, such as methylphenidate. Studies done in the USA have determined such drugs to be beneficial and well tolerated amongst the elderly but this knowledge unfortunately has not been transported across the pond to the UK. As a result premature death amongst the elderly occurs due to functional decline and as importantly for those relatives who have to watch this decline, much avoidable distress is caused. So, by all means ensure appropriate screening takes place but only do so if there is a willingness to treat the symptoms to improve the quality of life of the individual concerned.

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