Alzheimer’s – why apathy should not be ignored

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Aggression, sleep problems, anxiety and agitation are the behaviours that usually draw the most attention in those living with Alzheimer’s. But apathy is another common effect of the disease. When families begin to realise that their loved one seems emotionally blunted and no longer seems interested in things, it may be the first sign that something is wrong.

As Alzheimer’s disease progresses, accompanying behaviour changes can cause distress for family members. It’s important to know that these so-called “behaviours” are an expression of loved one’s needs.

The effect of apathy on Alzheimer’s

A recent in-depth study* reported that 90 percent of people with dementia will experience apathy. It cautioned that apathy is not to be ignored. People living with dementia who suffer from apathy are more likely to experience a rapid decline from mild dementia into severe memory loss.

Apathy should be discussed with a patient’s healthcare provider. It’s important to rule out depression; although apathy can be a symptom of depression, it can exist on its own. Dr. Yonas Geda of the Mayo Clinic, explained, “Depression causes changes in mood, thinking, physical well-being and behaviour, while apathy is loss of motivation without associated feelings of being depressed or blue.”

Ying-Ling Jao, Assistant Professor of Nursing at Penn State University, explains, “My interest in apathy was mainly driven by my clinical observations in nursing homes when I was a nurse practitioner student. I remember that no matter which nursing home I visited, I often saw a crowd of residents sitting in the living room or hallway with no interest in the surroundings and no emotional expression.”

How to engage with someone living with Alzheimer’s

The opposite of apathy is engagement—a sense of connection and interest. Jao set out to discover what could promote engagement in people with dementia. She recommended “clear and strong environmental stimulation” that is “intense, persistent and interesting.” Jao explained, “Clear stimulus is found in an environment without competing background noise, and with a single straightforward stimulus. A good example of this is a therapist leading a music therapy program for residents in an otherwise quiet room.”

This research suggests that when selecting mentally stimulating activities for your loved one, look for the happy medium—activities that hold your loved one’s attention without being overstimulating and confusing. An activity that is comfortable and inviting for one person might be overwhelming for another, so be attuned to clues as to whether your loved one is withdrawing or responding.

Keep in mind, say experts, that active participation is not always necessary; sometimes your loved one will be content to observe. Also keep in mind that as the disease progresses, your loved one may enjoy things they might have dismissed as “boring” in the past—while old favourites might cause frustration and a sense of failure.

Six ideas for dementia-friendly activities

Here are some suggestions for activities that provide gentle stimulation for those living with dementia:

Household chores. Doing household chores can boost your loved one’s self-esteem. Your loved one could wash dishes, set the table, help prepare food, sweep the floor, polish shoes, sort socks and fold laundry, and help with cooking and baking. Emphasise the process, not the result.

Children. Being around grandchildren and other young people often gives people with dementia a mood boost. It may bring back happy memories and can help them realise how much they still can love others and be loved. Visit family members who have small children, or invite them to your home. Your loved one can read to children or have children read or tell stories to them.

Music and dancing. Music can bring back happy memories and feelings. Some people feel the rhythm and may want to dance. Others enjoy listening to or talking about their favourite music. People who have trouble speaking may still be able to sing songs from the past. You might play recordings of well-known songs, talk about the music and the performer, and what your loved one was doing when the song was popular.

Pets. Many people with Alzheimer’s disease enjoy spending time with dogs, cats, birds and other animals. Living creatures can bring people out of their shell. They offer a chance to succeed—a cat who loves to be petted and a person who enjoys the tactile sensation of fur and the sound of purring is a win-win. Pets offer unconditional love and reduce feelings of anxiety. Your loved one might help care for, feed, groom or walk a pet.

Gardening. Gardening is a way to be part of nature. It may also help people remember past days and fun times. Your loved one can help take care of indoor or outdoor plants, plant flowers and vegetables with you, and discuss this garden and those of the past.

Going out. In the earlier stages of Alzheimer’s disease, your loved one may still enjoy the same kinds of outings they enjoyed in the past. Keep going on these outings as long as you are comfortable doing them. Your loved one might enjoy trips to a favourite restaurant, the zoo, a museum or a park. Plan outings for the time of day when your loved one is at their best. Don’t stay out too long; be sensitive to whether your loved one is getting tired after a certain amount of time.

Learn about local programs for people with dementia

The local support for people living with dementia and their carers is increasing. Right at Home GF runs the Sunflower Cafe support group every Monday morning in Farnham, and also funds weekly Singing for the Mind sessions at Farnham Maltings. Farnham Museum offers dementia friendly tours. For more information on current events, visit our Events Calendar.

*Research conducted but Penn State University.

Related articles:

Visiting loved ones who have dementia is so important

Is it dementia or simply old age?

Signs a loved one’s needs are changing

Caring for clients with dementia at home

Mental exercise helps the brain work around the damage of Alzheimer’s

Dementia – what do we tell the children?

Research behind the Dementia Delay Programme


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