Dementia: Apathy could predict dementia years before other symptoms show up

Dementia: Expert discusses the signs and symptoms

Dementia research aims to identify the onset of dementia as early as possible in order to forestall brain decline. Mapping out the possible symptoms is instrumental to this effort. A new study published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association suggests apathy may predict the onset of dementia years in advance of other symptoms.

Apathy is commonly associated with frontotemporal dementia, an uncommon type of dementia that causes problems with behaviour and language.

The symptom is typically defined as a loss of motivation, initiative and interest in things.

Apathy’s association with frontotemporal dementia has long been established but what the new study highlights is how early the symptom can show up.

Apathy can begin decades before other symptoms, and be a sign of problems to come.

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The new discovery comes from the Genetic Frontotemporal dementia Initiative (GENFI), a collaboration between scientists across Europe and Canada.

Over 1,000 people are taking part in GENFI, from families where there is a genetic cause of Frontotemporal dementia.

Research led by Professor James Rowe at the University of Cambridge and colleagues have shown how apathy predicts cognitive decline even before the dementia symptoms emerge.

The new study involved 304 healthy people who carry a faulty gene that causes frontotemporal dementia, and 296 of their relatives who have normal genes. The participants were followed over several years.

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None had dementia, and most people in the study did not know whether they carry a faulty gene or not.

The researchers looked for changes in apathy, memory tests and MRI scans of the brain.

“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,” explained Maura Malpetti, a cognitive scientist at the Department of Clinical Neurosciences, University of Cambridge and the study’s first author.

“We also saw local brain shrinkage in areas that support motivation and initiative, many years before the expected 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 an easy to treat medical condition, such as low levels of thyroid hormone, or a psychiatric illness such as depression,” he said.

“But doctors need to keep in mind the possibility of apathy heralding a dementia, and increasing the chance of dementia if left unaddressed, particularly if someone has a family history of dementia.”

What other symptoms should I be on the lookout for?

Many people with frontotemporal dementia develop a number of unusual behaviours they’re not aware of.

According to the NHS, these include:

  • Repetitive behaviours, such as humming, hand-rubbing and foot-tapping, or routines such as walking exactly the same route repetitively
  • A change in food preferences, such as suddenly liking sweet foods, and poor table manners
  • Compulsive eating, alcohol drinking and/or smoking
  • neglecting personal hygiene.

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