Apathy

Do you or a loved one with Parkinson’s disease (PD) experience a lack of interest, motivation or enthusiasm for participating in daily activities?

This could be apathy, which the medical community increasingly recognizes as a common symptom of Parkinson’s disease — affecting about 40 percent of people with Parkinson's without cognitive impairment and 60 percent of people with PD with cognitive impairment. Older men with more severe PD symptoms are particularly likely to experience apathy.

Apathy, similar to PD movement symptoms, is thought to result from a loss of dopamine in the brain. It can develop before a PD diagnosis, or at any stage of disease progression. It can be very frustrating for the person with Parkinson’s disease, and for care partners and loved ones who do not understand it. Loved ones might assume their partner is lazy or purposefully trying to be difficult.

Understanding apathy as a symptom of PD and finding ways to cope with it are key to ensuring a good quality of life both for people with PD and for maintaining good relationships with their care partners, family and friends.

Symptoms

In addition to apathy, people with PD also commonly experience depression and fatigue. Together, all of these can take away a person’s energy, and it can be difficult to separate how each contributes to a person’s mood.

Depression vs. apathy

  • Depression brings about feelings of worthlessness or guilt; a person with apathy does not feel sad, but rather feels no mood, or emotionally flat.
  • With both depression and apathy, a person may no longer enjoy things they used to like to do.

A person with apathy:

  • May feel that it takes extreme effort to get off the couch or out of bed to participate in daily activities.
  • Requires constant prompting to do anything.
  • Does not want to go anywhere.
  • Feels they “can’t be bothered.”
  • If left alone, without a goal, support or encouragement, may just sit on the couch or watch television.
  • Is not motivated to do things.

Therapies

There are no medications proven specifically to help apathy. Overcoming apathy starts with being in the best possible health, and ruling out other causes for feeling sluggish. With your doctor:

  • Evaluate and optimize your PD medications — better movement may reduce apathy.
  • Get tested for both depression and apathy — standard rating scales can help you and your doctor find the cause of your mood. If you have depression, get treatment.
  • Discuss ways to get the most restful sleep possible — sleep difficulties are common with PD, and contribute to fatigue.
  • Discuss other treatment options — there are no approved medications to treat apathy, but some patients may benefit from cholinesterase inhibitors (rivastigmine, etc.), stimulants, or certain types of antidepressants.

Tips for Living With Apathy

  • Ask for support from care partners, friends and family members as you try to be active, maintain social relationships, and regain enjoyment in daily activities.
  • Create a daily schedule of activities, including both chores and things that you enjoy. Ask someone to help you make this plan. Be realistic about what you can accomplish. Then give yourself a small reward when you cross activities off your list.
  • Create weekly goals for leisure activities—doing a hobby, or going to a restaurant, for example. Try to get out of the house.
  • Focus on one task, or part of one task; success can help lead you on to the next step.
  • Exercise—walk, garden, dance—whatever appeals to you.
  • Get enough sleep.