This Early Symptom Affects 45 Percent of Dementia Patients, Study Says


The aging process typically involves accommodating changes to your body over time. For many, the first sign of sore joints or a heart health event can be some of the first physical changes. But when it comes to how the mind can be affected by the aging process, the indicators can be a little less straightforward—especially when it comes to dementia. And while memory loss or confusion can be the first change people expect to see, research has shown that there's one symptom that affects just under half of all dementia patients early on. Read on to see what could be one of the first indicators of cognitive decline.

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Apathy can be one of the earliest symptoms of dementia, affecting 45 percent of patients.

In 2019, a team of researchers from the University of Exeter in the U.K. analyzed data from over 4,320 participants with Alzheimer's disease collected across 20 cohort studies to present at the Alzheimer's Association International Conference. Specifically, the team hoped to examine the relationship between dementia and apathy as a potential early symptom of the condition. According to Healthline, apathy in dementia patients can be defined as feeling "listless," often displayed as losing interest in former hobbies and activities or not wanting to go out or have fun.

Results of the analysis found that 45 percent of the participants presented with apathy at the beginning of the study and that 20 percent had persistent apathy over time. Interestingly, they also found that many participants showed signs of apathy without being diagnosed as depressed, meaning that the symptom could likely be the result of another biological or physical change compared to those who become apathetic as a result of depression.

The onset of apathy can actually accelerate cognitive decline.
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The study's findings shed light on a vital early warning sign of cognitive decline. According to the Alzheimer's Association, about two to five percent of older people without dementia have apathy, but about 50 to 70 percent of people with dementia have apathy. Unfortunately, many confuse the early symptom as a sign of depression—which it defines more as having a "low mood" rather than "losing the spark" defined by apathy—that can potentially lead to misdiagnosis.

"Apathy is an under-researched and often ignored symptom of dementia. It can be overlooked because people with apathy seem less disruptive and less engaging, but it has a huge impact on the quality of life of people living with dementia, and their families," Miguel de Silva Vasconcelos, a PhD student at the University of Exeter and King's College London who worked on the study, said in a statement. "Where people withdraw from activities, it can accelerate cognitive decline and we know that there are higher mortality rates in people with apathy. It's now time this symptom was recognized and prioritized in research and understanding."

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The symptom could arrive early enough to help treat the onset of dementia.

Ultimately, the researchers concluded that their data could help guide treatments for cognitive decline in the future. "Apathy is the forgotten symptom of dementia, yet it can have devastating consequences. Our research shows just how common apathy is in people with dementia, and we now need to understand it better so we can find effective new treatments," Clive Ballard, PhD, a professor at the University of Exeter Medical School, said in a statement.

"Our [Well-being and Health for People Living with Dementia] WHELD study to improve care home staff training through personalized care and social interaction included an exercise program that improved apathy, so we know we can make a difference," he said, referencing his previous research. "This is a real opportunity for interventions that could significantly benefit thousands of people with dementia. "

Other studies have found a link between dementia and apathy.

Other recent research has explored apathy as an early symptom of dementia. According to a study conducted by researchers at the University of Cambridge published in Dec. 2020 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, increased apathy is positively associated with frontotemporal dementia (FTD) and some of its worst outcomes. These include "functional decline, decreased quality of life, loss of independence, and poorer survival," according to Maura Malpetti, a co-author of the study and a postdoctoral researcher in the Department of Clinical Neurosciences at Cambridge.

The Cambridge researchers also said that FTD is associated with significant alterations in behavior. Personality changes may include increased impulsivity, socially inappropriate behavior, language changes, or the development of compulsive or repetitive habits. Far too often, these signs of dementia are mistakenly attributed not to brain degeneration but to depression, laziness, or a lack of social skills. Unfortunately, this delays diagnosis of the real issue at hand for many patients.

However, James Rowe, MD, PhD, a professor from the Department of Clinical Neurosciences at Cambridge and a joint senior author on the study, points out that when behavior changes like apathy are recognized, they can predict FTD full decades prior to the emergence of other symptoms. "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," Rowe said.

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