Lack of enthusiasm and interest signals higher risk of dementia

Dementia is the general term for many symptoms associated with brain decline that gets progressively worse over time. There is no known cure or way to prevent dementia but progress has been made to identify the underlying risk factors. These risk factors, if discovered early may help in mitigating the risk.

A new study suggests that certain attributes of an individual may put him/her at an increased risk of dementia. The decline of brain functions may be directly attributed to the health and lifestyle factors.

Older adults who aren’t interested or enthusiastic about their usual activities may have a higher risk of developing dementia.

Research published in the journal Neurology suggests those who lack interest in the world around them are at an increased risk of developing dementia. The research team looked to see whether developing dementia was linked to apathy.

People with apathy often have a lack of interest in the world around them, with signs of apathy including stopping taking part in normal activities, showing little emotion, and a lack of energy.

The nine-year study of more than 2,000 older adults — average age 74 — found that people with severe apathy (a lack of interest or concern) were 80% more likely to develop dementia during the study period than those with low apathy. In this study, the team used a questionnaire designed to evaluate apathy and to discriminate apathy from depression and anxiety.

According to Dr. Meredith Bock, clinical fellow in neurology at the University of California, San Francisco Institute for Neurosciences and the study’s lead author, “Apathy is not subtle. It’s something that families can pick up on. More research is needed, but this is another potential red flag symptom of the prodromal (early) phase of dementia”. The prevalence of dementia (including Alzheimer’s disease) is on the rise, and researchers are trying to find new ways to identify who’s at risk of the disease. Mood and behavior symptoms, such as depression or irritability, are examples of changes that may be clues to an impending dementia diagnosis.

Previous studies have also linked mild cognitive impairment (a potential precursor to dementia) and apathy, but the researchers wanted to look at a group of people who had no known memory or thinking issues yet.

The current study included people aged 70 to 79. None had dementia at the start. The researchers also had medical records, including medication use, hospitalizations, and cognitive testing.

They divided the volunteers into groups corresponding to low, moderate, or severe apathy.
To evaluate apathy levels, the study participants answered questions, such as:

 In the past four weeks, how often have you been interested in leaving your home and going out?
 In the past four weeks, how often have you been interested in doing your usual activities?

The study team followed the participants for over nine years and found that 381 people had developed dementia. In the low apathy group, 14% developed dementia. For those with moderate apathy levels, that number was 19%. But one in four — 25% — in the severe apathy group had dementia by the end of the study.

They found that severe apathy was linked with an increased risk of dementia compared to low apathy. Apathy was also associated with worse memory and thinking at the beginning of the study, but not rate of change over time.

When the researchers controlled the data for age, education, heart and blood vessel disease, depression, and genetic risk of Alzheimer’s disease, they reported that people with severe apathy at the start of the study had 80% higher odds of having dementia later in life.

Bock said by asking about apathy, doctors might be able to learn which patients have a higher risk of dementia. The information could be particularly helpful in research trials, she added.

Commenting on the findings, Dr Sara Imarisio, Head of Research at Alzheimer’s Research UK, said: “Symptoms of apathy and lack of interest are common in dementia and are not necessarily symptoms of depression. Many people with dementia are mistakenly diagnosed as having depression, particularly in the early stages. Building a better understanding of some of the less well-recognized symptoms of dementia, like apathy, could inform our efforts to develop better treatments for the condition.”

Rebecca Edelmayer, director of scientific engagement at the Alzheimer’s Association, said, “This type of research is critical to help us identify who is at risk. We are driving towards being able to identify people with a higher risk as soon as possible as we strive for treatments that will be transformational for patients and their families. But it’s too soon to say if only looking at apathy can identify who is at risk of dementia.”

Edelmayer explained that it can be difficult to tease out apathy from other changes that may be happening, such as depression or isolation.

The team determined whether people developed dementia with an algorithm based on information on dementia medication use, hospital records, or a significant decline in memory and thinking.

Although dementia cannot be fully treated but evidence shows there are things you can do to help reduce your own risk of developing dementia.

According to Alzheimer’s UK, doing regular physical activity is one of the best ways to reduce your risk of dementia. It’s good for your heart, circulation, weight and mental wellbeing.

Each week, you should aim for either:

 150 minutes of moderate aerobic activity, such as brisk walking, riding a bike or pushing a lawnmower, or
 75 minutes of vigorous aerobic activity, such as jogging, fast swimming or riding a bike up a hill.