MENTAL WELLBEING | Managing apathy

Apathy is a common non-motor symptom of Parkinson’s, characterised by a lack of interest, enthusiasm, or motivation.

Apathy is a common non-motor symptom, affecting up to 40% of people living with Parkinson’s. It can significantly impact daily life and relationships. Unlike depression, apathy is not associated with feelings of sadness or guilt but rather a general emotional flatness and difficulty initiating activities.

When does apathy appear?

Apathy can show up even before a formal Parkinson’s diagnosis, during the prodromal (early) phase, and tends to become more common as the condition progresses.

What does apathy look like?

It’s not just “lack of motivation.” Apathy is a multidimensional experience that can affect:

• Behaviour: reduced initiative or engagement in activities
• Social interaction: withdrawal or reduced interest in connecting with others
• Emotional response: although emotional sensitivity may remain intact in some people, other aspects may be dulled.

Is apathy the same as depression?

While apathy and depression can overlap, they’re distinct conditions. Apathy is more closely tied to cognitive changes, especially difficulties with executive function, like planning, decision-making, and goal-setting. Unlike depression, which involves feelings of sadness and guilt, apathy is an emotional flatness and a general disinterest in life. You may feel less inclined to exercise, follow medication schedules, or engage in social activities, which can worsen symptoms.

Why addressing apathy matters

Losing interest in new activities, lacking emotional response to situations, and difficulty starting or completing tasks are common signs of apathy. Apathy can interfere with effective management of Parkinson’s, as people may struggle to stick to medication schedules, maintain physical activity, or engage in social interactions. This can lead to a decline in overall health and wellbeing.

Strategies for managing apathy

While there are no specific medications approved for treating apathy, structured activities, social engagement, and regular exercise can help. Care partners play a crucial role in recognising apathy and encouraging their loved ones to seek support from their care team.

Apathy in Parkinson’s can be challenging, but there are strategies to manage it. Stay engaged socially, exercise, and optimise medications and treatments.

Here are our top ten tips:

1. Reflect on your feelings: Consider why you feel apathetic and try to see things differently. Focus on what you can still do rather than what you can’t. If you’re feeling low or anxious, find ways to improve your mood, like being physically active or doing something you love.
2. Reconnect with past enjoyments: Re-engage in activities you used to enjoy, reconnect with friends, or revisit exercise classes. Remember, these past enjoyments can bring back a sense of joy and purpose, helping you to feel more hopeful and motivated.
3. Follow a routine: Having a routine reduces the need for excessive planning and effort.
4. Stick to your plans: Even if you’re feeling apathetic, meeting friends or doing activities can positively impact your mental health.
5. Set realistic goals: Break down larger tasks into smaller steps to make them achievable. This approach can empower you, giving you a sense of control over your tasks and helping you to feel more accomplished.
6. Manage energy levels: Plan enjoyable activities when you have the most energy and feel energetic. Exercise, eat well, hydrate, and practice good sleep hygiene.
7. Stay social and active: Physical activity benefits physical and mental health in Parkinson’s. Consider going on a walk or to the gym with friends. Engaging in physical activities promotes a healthy lifestyle and provides an opportunity for social interaction, which can help combat apathy.
8. Talk to family and friends: It’s crucial to share your feelings with loved ones and let them know that apathy is a common symptom you may need help with. They can provide support and positive feedback, which can be instrumental in managing apathy. Remember, you’re not alone in this journey.
9. Consult your specialist or Parkinson’s Nurse: If you’re struggling with apathy, it’s essential to seek professional advice. Your specialist or Parkinson’s Nurse can provide personalised strategies to address apathy effectively. Don’t hesitate to reach out to your state Parkinson’s organisation for help.
10. Consider telehealth services: Telehealth or virtual appointments allow you to connect with mental health professionals remotely. You can have video consultations, phone calls, or chat sessions from home. This convenient and supportive service is beneficial if you have mobility issues or live in a regional, rural or remote area. Remember that seeking professional help is a positive step toward better mental wellbeing, and telehealth can support you.

References:

Luo, R., Qi, Y., He, J., Zheng, X., Ren, W., & Chang, Y. (2022). Analysis of Influencing Factors of Apathy in Patients with Parkinson’s Disease. Brain Sciences. https://doi.org/10.3390/brainsci12101343

Maggi, G., Vitale, C., Delle Curti, A., Amboni, M. and Santangelo, G., 2023. Unawareness of apathy in Parkinson’s disease: the role of executive dysfunction on symptom recognition. Brain Sciences, 13(6), p.964.

Maher, S., Donlon, E., Mullane, G., Walsh, R., Lynch, T. and Fearon, C., 2024. Treatment of Apathy in Parkinson’s Disease and Implications for Underlying Pathophysiology. Journal of Clinical Medicine, 13(8), p.2216.

Mele, B., Van, S., Holroyd-Leduc, J., Ismail, Z., Pringsheim, T. and Goodarzi, Z., 2020. Diagnosis, treatment and management of apathy in Parkinson’s disease: a scoping review. BMJ open, 10(9), p.e037632.