In a recent narrative literature review, Lanctôt, Ismail, Bawa, Cummings, Husain, Mortby and Robert compared the clinical features of apathy and depression in people with neurocognitive disorders, to systematically differentiate the two syndromes from one another across clinical presentation, diagnostic criteria, neuropathological features and responses to treatments. The literature reviewed includes studies identified through PubMed searches, together with additional references added based on the authors’ expertise.
Based on the literature, the authors concluded that apathy and depression are distinct and may be differentiated by behavioural features, underlying neurobiology (as reflected in brain imaging), and their responses to specific treatments. Apathy and depression occur with varying prevalence, meaning that their frequency differs across individuals and types of neurocognitive disorders, such as Alzheimer’s disease. They also carry different risks of progression to dementia and have distinct, though sometimes overlapping, neurobiological foundations. For example, apathy is primarily characterised by reduced motivation, lack of initiation and diminished emotional responsiveness, whereas depression involves persistent sadness, guilt, hopelessness or emotional distress. At the same time, both conditions may share outward signs such as social withdrawal or reduced engagement, contributing to the difficulty in distinguishing them.
Unlike apathy, depression has well defined diagnostic criteria presented in the DSM 5. Apathy is associated with particularly unfavourable outcomes, especially in people with neurodegenerative conditions such as Alzheimer’s disease. It contributes to a higher burden for both patients and caregivers. Identifying apathy accurately is not only essential for guiding appropriate care, but also for supporting the development of targeted interventions. Although no approved pharmacological treatments for apathy currently exist, the review reinforces its status as a distinct neuropsychiatric condition that requires dedicated therapeutic approaches aimed at reducing its impact on daily functioning. In simple terms, recognising apathy as separate from depression helps ensure that people receive care tailored to their specific difficulties, rather than relying on treatments intended for a different condition.
The authors highlighted that improving how apathy is evaluated and treated is an urgent priority in dementia care. Given the lack of specific tools and treatments, better identification of apathy is essential. They emphasised that accurate diagnosis and recognising apathy as a distinct syndrome are key steps toward developing targeted therapies and advancing clinical trials. Ultimately this may contribute to reduce the burden on people with dementia and their caregivers.
Full article: https://pubmed.ncbi.nlm.nih.gov/36739588/
