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Apathy: Why Care?

Received June 20, 2003; revised February 27, 2003; accepted March 13, 2002. From the Department of Psychiatry and Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, and the Division of Geriatric Psychiatry, University of Toronto, Toronto, Ontario; the Rotman Research Institute, Baycrest Centre for Geriatric Care, and Departments of Medicine (Neurology, Rehabilitation Science) and Psychology, University of Toronto, Toronto, Ontario; and the Department of Psychiatry, Baycrest Centre for Geriatric Care. Address correspondence to Dr. van Reekum at Baycrest Centre for Geriatric Care, 3560 Bathurst St., Toronto, Ontario, M6A 2E1, Canada; rvanreekum{at}baycrest.org (E-mail).

This review presents data showing that apathy is common across a number of disorders. Apathy is not only common, but is also associated with significant problems: reduced functional level, decreased response to treatment, poor illness outcome, caregiver distress, and chronicity. Preliminary evidence of treatment efficacy exists for dopaminergic drugs and for amphetamines. Strong evidence of efficacy exists for acetylcholinesterase inhibitors in Alzheimer’s disease, and for atypical antipsychotics in schizophrenia. Frontal-subcortical system(s) dysfunction is implicated in the causation of apathy; apathy subtypes based on the various frontal-subcortical loops may thus exist. Further research involving diagnosis, pathophysiology, and treatment is suggested.

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