Apathy

Man laying on bed looking at phone with sad expression

Apathy describes a lack of interest, enthusiasm or motivation. It interferes with the effective management of Parkinson’s disease (PD) symptoms, since apathetic people are less inclined to do things like exercise and follow their medication schedules.

You may be experiencing apathy if you feel that it is increasingly harder to get up and participate in life’s activities. Report this to your health care provider and work with your team to determine the best course of action.

In addition to apathy, people with PD also commonly experience depression and fatigue. Apathy is not the same as depression. In some cases, apathy is part of a depressive disorder or related to cognitive decline. Apathy coupled with depression can diminish a person’s energy and make it difficult to separate how each affects a person’s mood. Depression brings about feelings of worthlessness or guilt, whereas a person with apathy feels no mood or emotionally flat.

Apathy can be frustrating for people with PD, care partners and loved ones. Understanding apathy as a symptom of PD and finding ways to cope with it are key to ensuring a good quality of life and for maintaining good relationships with caregivers, family and friends.

Therapies

Currently, there are no proven effective treatments for apathy — no pills or special therapies — but structured activities and opportunities for socialization are a useful approach. A regular routine, continuing to socialize and exercise even if you don’t feel like it, taking your medications on time every time and avoiding isolation all help manage apathy. Talking to your family and friends or taking part in a support group may also help you to stay engaged and motivated.

People experiencing apathy are encouraged to meet with their doctor to:

Evaluate and optimize PD medications — better movement may reduce apathy.
Get tested for depression and apathy — standard rating scales can help you and your doctor find the cause of your mood. If you have depression, get treatment.
Discuss ways to get the most restful sleep possible — sleep difficulties contribute to fatigue.
Explore other treatment options — there are no approved medications to treat apathy, but some people may benefit from cholinesterase inhibitors (medicines that block the breakdown of the enzyme acetylcholine, such as rivastigmine, etc.), stimulants or certain types of antidepressants.

Tips for Living with Apathy

Getting ahead of apathy can help you live optimally. Strategies to help you tackle it include:

Ask for support from caregivers, friends and family members as you try to be active, maintain social relationships and regain enjoyment in daily activities.
Create a daily schedule of activities, including chores and things you enjoy. Be realistic about what you can accomplish. Give yourself a small reward for each activity accomplished.
Create weekly goals for leisure activities— doing a hobby or going to a restaurant, for example. Try to get out of the house.
Focus on one task, or part of one task. Success can help lead you on to the next step.
Exercise — walk, garden, dance — whatever appeals to you.
Get enough sleep.

Apathy and Care Partners

Apathy can be one of the most frustrating Parkinson’s symptoms a loved one or care partner will encounter. Research has shown that people with apathy require more from their care partners. It is difficult to see your loved one ignore or refuse to do things you both know are helpful for his or her Parkinson’s, such as exercise. Remember that apathy is a symptom of the disease and the person with PD is not necessarily being lazy or making excuses.

Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson's Foundation Center of Excellence.