Apathy, a lack of interest or motivation- is a common and disabling feature of frontotemporal dementia (FTD). Frontotemporal dementia is a significant cause of dementia among younger people. It changes behavior, language, and personality, leading to impulsivity, socially inappropriate behavior, and repetitive or compulsive behaviors.
It is not depression or laziness, but it can be mistaken for them. But, Apathy can begin decades before other symptoms and be a sign of problems to come.
Now a new study by the University of Cambridge suggests that Apathy could predict the onset of some forms of dementia many years before symptoms start. This offers a chance to treat the disease at an early stage.
Maura Malpetti, a cognitive scientist at the Department of Clinical Neurosciences, University of Cambridge, said, “Apathy is one of the most common symptoms in patients with frontotemporal dementia. It is linked to functional decline, decreased quality of life, loss of independence, and poorer survival.”
“The more we discover about the earliest effects of frontotemporal dementia when people still feel well in themselves, the better we can treat symptoms and delay or even prevent dementia.”
The study was conducted on 304 healthy people who carry a faulty gene that causes frontotemporal dementia and 296 of their relatives who have normal genes. The members were followed over several years. None had dementia, and a great many people in the investigation didn’t know if they had a faulty gene or not. The analysts searched for changes in Apathy, memory tests, and MRI tests of the brain.
Malpetti, the study’s first author, said, “By studying people over time, rather than just taking a snapshot, we revealed how even subtle changes in Apathy predicted a change in cognition, but not the other way around. We also saw local brain shrinkage in areas that support motivation and initiative, many years before the expected onset of symptoms.”
People with genetic mutations had more Apathy than other family members, which over two years increased much more than in people with normal genetics. The Apathy predicted cognitive decline, and this accelerated as they approached the estimated age of onset of symptoms.
Professor Rogier Kievit from the Donders Institute, Radboud University Medical Center at Nijmegen and MRC Cognition and Brain Sciences Unit at Cambridge, said: “Apathy progresses much faster for those individuals who we know are at greater risk of developing frontotemporal dementia, and this is linked to greater atrophy in the brain. At the start, even though the participants with a genetic mutation felt well and had no symptoms, they were showing greater levels of Apathy. The amount of Apathy predicted cognitive problems in the years ahead.”
“From other research, we know that in patients with frontotemporal dementia, Apathy is a bad sign in terms of independent living and survival. Here we show its importance in the decades before symptoms begin,” said Professor James Rowe from the Department of Clinical Neurosciences, joint senior author.
Professor Rowe said the study highlights the importance of investigating why someone has Apathy. “There are many reasons why someone feels apathetic. It may well be easy to treat a medical condition, such as low thyroid hormone levels, or a psychiatric illness such as depression. But doctors need to keep in mind the possibility of Apathy heralding dementia, and increasing the chance of dementia if left unaddressed, particularly if someone has a family history of dementia.”
“Treating dementia is a challenge, but the sooner we can diagnose the disease, the greater our window of opportunity to try and intervene and slow or stop its progress.”
- Malpetti, M et al. Apathy in pre-symptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes. Alzheimer’s & Dementia; 14 Dec 2020; DOI: 10.1002/alz.12252