Elderly apathy

Dementia. In the elderly, you may have difficulty distinguishing depression from the early stages of dementia. Depressed patients often report memory problems and may even ask, Do 1 have Alzheimer s disease It is usually not that their memory itself is impaired. Their forgetfulness is more the result of apathy and poor concentration that leads them to overlook the things going on around them. The result is a false dementia or pseudodementia. On the other hand, patients with true dementia often become depressed as well. 

AD subjects have a higher prevalence of sleep disturbances than normal elderly, including sleep fragmentation, advancement of the sleep-wake cycle, and decreased amounts of slow wave and rapid-eye movement (REM) sleep (Prinz et al., 1982 Reynolds et al., 1988 Bliwise et al., 1989). Sleep-wake cycle disruption in AD has been associated with a greater burden of neuropsychiatric disturbances (Rebok et al., 1991 Ancoli-Israel et al., 1994), particularly apathy and delusions (Kaufer et al., 2001). Several studies have observed a relationship between the degree of intellectual impairment and REM sleep abnormalities (Prinz et al., 1982 Vitiello et al., 1984 Moe et al., 1995), underscoring the role of REM sleep in memory consolidation (Wilson McNaughton, 1994). 

There also has been great interest in the use of stimulants to treat depressive symptoms. Small case series suggest the potential usefulness of adding stimulants to antidepressant therapy in treatment-resistant depression (Masand et al. 1998 Stoll et al. 1996). Stimulants also have been used in the treatment of depressive symptoms in medically ill elderly patients (see reviews by Challman and Lipsky 2000 and Masand and Tesar 1996). Short-term use of stimulants may rapidly improve symptoms of apathy and social withdrawal in these patients. 

Alzheimer s disease (AD) is the most common neurodegenerative disease in the elderly. Prevalence increases with age and by the year 2050 it has been estimated that world-wide 1 out of 85 persons will suffer from AD (Brookmeyer et ah, 2007). AD is clinically characterized by progressive memory deficits, speech problems, and visuospatial orientation. As the disease advances, the patient my develop apraxia (loss of the ability to execute or cany out learned purposeful movements), and requires help in performing activities of daily living. In moderate and severe stages of the disease, AD patients may show signs of neuropsychiatric syndromes like labile affect, aggression, hallucinations, sleep disturbances, and apathy. 

Wongpakaran, N., van Reekum, R., Wongpakaran, T., Clarke, D. (2007). Selective serotonin reuptake inhibitor use associates with apathy among depressed elderly A case-control study. Annals of General Psychiatry, 6(7), 1-6. 

If treatment A/ith antidepressants fails to improve apathy and depressed mood in the elderly, it is possible that this represents early Alzheimer disease and a cholinesterase inhibitor like galantamine may be helpful... 

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