Because there is no cure for dementia, accurately predicting who will go on to develop it is vital to minimize its impact. According to a new review, apathy may hold the key
Dementia overwhelmingly impacts older adults. Although scientists know about some risk factors, predicting who will eventually develop dementia is challenging.
As people age, cognitive abilities tend to decline, and 5–20 percent of those over 65 years old will develop mild cognitive impairment.
Older adults with a mild cognitive impairment who visit memory clinics — which are centers dedicated to diagnosing memory problems — often fear that they will receive a dementia diagnosis.
In reality, most individuals' memories will either return to normal levels of functioning or not deteriorate any further.
However, while the person is in the clinic, doctors are keen to understand who is most at risk. There is no cure for dementia, so early detection is the best way to ensure the best care.
Observing changes in behavior might be a useful way to assess an individual who might otherwise fly under the radar.
One behavior of interest is apathy, which is defined as a loss of motivation, a lack of interest, and reduced emotional expression. If apathy is related to an increased chance of developing dementia, it might become a relatively easy way to identify increased risk — even in a short consultation.
Already, researchers have noted that apathy is a common feature of dementia, occurring in around half of the people with Alzheimer's disease. To date, studying the role of apathy before dementia develops has received little attention.
Recently, researchers set out to see whether apathy could become an early marker for dementia. To do this, they dipped into the findings from previous studies and carried out a fresh analysis of the pooled data. As the authors explain:
"We aimed to systematically review and meta-analyze the evidence from longitudinal cohorts for the association between apathy in older people and the risk of incident dementia."
In total, the researchers assessed and collated data from 16 studies, including 7,365 participants. Their results were published earlier this month in JAMA Psychiatry.
Researchers saw a particularly pronounced effect in younger, healthier individuals because it was easier to detect apathy in them.
Older people tend to withdraw for a range of reasons, such as physical or cognitive constraints, rather than apathy. When a younger individual becomes withdrawn, it is perhaps more unexpected, making it more obvious.
Changes in apathy could be useful for doctors, helping them gauge the potential risk of developing dementia, alongside standard clinical tests; the authors explain further:
"Apathy is a relevant, noninvasive, cheap, and easily implementable prognostic factor prodromal to dementia." They go on:
"It has important clinical significance because patients are vulnerable and tend to withdraw from care, requiring an active caregiving approach from clinicians."
Recent research has focused on developing biomarkers for dementia risk, including MRI and the analysis of cerebrospinal fluid. Compared with these high-tech options, assessing apathy would be much quicker and more cost-effective.
As ever, more research is required to gather more detail on this relationship. The authors also note that it is important to remember that not every older adult with apathy will go on to develop dementia.
However, they also write that older adults with apathy "represent a medically highly vulnerable group that tends to withdraw from care."
As the United States population ages, the early detection of dementia is more important than ever. Assessing an individual's level of apathy might soon become a part of the clinician's range of predictive tools.