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Dementia
Published in Henry J. Woodford, Essential Geriatrics, 2022
Restlessness may be helped by giving the person something to fiddle with, such as a rummage box. Repetition may be helped by having important information written down on a board. Repeatedly responding ‘I just told you that' will not help. Shadowing (i.e. following their carer around and becoming distressed if can't see them) can be reduced by providing distracting tasks (e.g. folding laundry). Apathy can be addressed by encouraging activity and participation in tasks to keep the person mentally and physically active. Strategies for addressing incontinence are discussed in Chapters 11 and 12.
Changes in behaviour and emotions
Published in Marjolein de Vugt, Janet Carter, Understanding Young Onset Dementia, 2021
Joany Millenaar, Marjolein de Vugt
Apathy can be very common in people with YOD as well (van Vliet et al., 2012). It is characterised by loss of initiative, unresponsiveness and emotional indifference. As dementia becomes more severe, apathy often increases. Apathy is often present as a symptom of depression, but it can also be present without a depressed mood. This is one of the most difficult changes for family members because it becomes challenging to have contact. The person with dementia is often less interested in the world around them, does not feel like doing anything, has flattened emotions, and is more difficult to engage in social situations. Apathy increases the risk of institutionalisation for younger people with dementia (Bakker et al., 2013).
Self-relatedness, psychopathology, and the context: A clinical perspective
Published in Gerrit Glas, Person-Centered Care in Psychiatry, 2019
This is a crucial point in the diagnosis: Will the apathy be seen as merely the result of the interaction between the different factors or as the result of a process of internalization and consolidation that has transformed it into a personality characteristic? In the latter case, the attention of the clinician may shift to Peter’s personality, which occupies then the place of the original “disorder” [1]. “It is in dealing with his complaints …”
Emerging Symptomatic Treatment of Chronic Traumatic Encephalopathy (CTE): a narrative review
Published in Expert Opinion on Pharmacotherapy, 2023
Carlo Rossi, Nicole Campese, Carlo Colosimo
Apathy is a common distressing feature of CTE, but no evidence-based approaches are currently available to treat apathy in this disorder. A recent meta-analysis showed that cholinesterase inhibitors are effective in reducing apathy in AD but also in PD, FTD, and DLB, where evidence is limited to rivastigmine [86]. Similarly, memantine seems to reduce apathy in patients with AD [86]. Accordingly, memantine and cholinesterase inhibitors could be reasonably suggested to treat apathy in CTE, especially in those patients presenting with predominant cognitive features or overt dementia [87]. Alternatively, given the putative contribution of dopaminergic pathways dysregulation in determining apathy, levodopa and dopamine-agonists could be judiciously tried in CTE in selected patients [87]. In fact, the risk of side effects including hallucinations, delusions, confusion, sleepiness, orthostatic hypotension should be considered and balanced with the expected benefits of such treatments. Additionally, antidepressants could be helpful in managing apathy, especially in those patients with concomitant depression and anxiety. Stimulants, like methylphenidate and amphetamines have been proposed, especially in subjects with concomitant attention deficits, but the risk of agitation, psychosis, behavioral problems as well as of cardiac complications should be carefully considered [87].
Effectiveness of life story book intervention on apathy and verbal fluency in people with dementia
Published in Clinical Gerontologist, 2023
Tomoaki Asano, Chih-Wen Wang, Megumi Tsugaruya, Takashi Ishikawa
Apathy has symptoms that are also found in depression, such as lack of vigor. However, Boyle and Malloy (2004) differentiated between the two by highlighting the distinctive symptoms of apathy, namely, loss of motivation and initiation, lack of persistence, emotional indifference or diminished emotional reactivity, and decreased social engagement. The neural basis of apathy is thought to be reduced blood flow in the frontal and cingulate cortices and in reward system neural circuits related to motivation (Benoit et al., 2004; Migneco et al., 2001). In the present study, the apathy scores in the NPI–NH showed an improvement immediately after the LSB intervention in the participants with severe dementia. This suggests that even people with advanced dementia may retain the ability to respond to and enjoy appropriate external stimulus input.
Identifying emotional contributors to participation post-stroke
Published in Topics in Stroke Rehabilitation, 2023
Yejin Lee, Marjorie L. Nicholas, Lisa Tabor Connor
Emotional factors have distinctive features and agreed-upon definitions. Anxiety is defined as a subjective feeling of tension, nervousness, and worry associated with an arousal of the autonomic nervous system.28 Apathy is defined as lack of motivation accompanied by diminished goal-directed behavior (e.g. lack of effort), diminished goal-directed cognitive activity (e.g. lack of interest and concern), or diminished concomitants of goal-directed behavior (e.g. unchanging affect or lack of responsivity to positive or negative events).29 Depression includes emotional distress such as sadness, anxiety, agitation, insomnia, anorexia, feelings of worthlessness and hopelessness, and recurrent thoughts of death.30 As each emotional factor has distinctive aspects, it is possible that each emotional factor may play a different role in participation post-stroke. In fact, a previous study reported that depression was a strong correlate for participation in social activities, but not for family role and outdoor activity.31 Moreover, the distinction between depression and apathy also has been confirmed for functional recovery in persons with stroke: apathy, not depression, was associated with poorer functional recovery.32,33 Therefore, it is critical to explore the association that each emotional factor has with participation post-stroke. To further understand the extent to which emotions contribute to participation post-stroke, this study aimed to identify both the variety and strength of various emotional contributors to participation post-stroke.