Apathy may predict onset of dementia years earlier than different signs

Apathy could predict onset of dementia years before other symptoms

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Apathy – a lack of interest or motivation – could predict the onset of some forms of dementia many years before symptoms begin, and provide a "window of opportunity" for early treatment for the disease, according to new research by a scientist-led team of scientists by Professor James Rowe at the University of Cambridge.

Frontotemporal dementia is a major cause of dementia in younger people. It is often diagnosed between the ages of 45 and 65. It alters behavior, language, and personality, leading to impulsivity, socially inappropriate behavior, and repetitive or compulsive behaviors.

A common characteristic of frontotemporal dementia is apathy with a loss of motivation, initiative, and interest in things. It's not depression or laziness, but it can be confused with them. Research into scanning the brain has shown that in people with frontotemporal dementia, it is caused by shrinkage in specific locations on the front of the brain – and the stronger the shrinkage, the worse the apathy. However, apathy can begin decades before other symptoms and be a sign of future problems.

"Apathy is one of the most common symptoms in people with frontotemporal dementia. It is associated with dysfunction, decreased quality of life, loss of independence and poor survival," said Maura Malpetti, cognitive scientist in the Department of Clinical Neurosciences at Cambridge University.

"The more we learn about the earliest effects of frontotemporal dementia when people are still feeling good, the better we can manage symptoms and delay or even prevent dementia."

Frontotemporal dementia can be genetic. About a third of patients have a family history. The new discovery on the importance of early apathy comes from the Genetic Frontotemporal Dementia Initiative (GENFI), a collaboration between scientists across Europe and Canada. Over 1,000 people from families with a genetic cause for frontotemporal dementia participate in GENFI.

In a study published today in Alzheimer & Dementia: The Journal of the Alzheimer Association, Professor Rowe and colleagues showed how apathy predicts cognitive decline even before the symptoms of dementia appear.

The new study included 304 healthy people who carry a faulty gene that causes frontotemporal dementia and 296 of their relatives who have normal genes. The participants were observed for several years. None of them had dementia, and most of the people in the study didn't know whether they had a faulty gene or not. The researchers looked for changes in apathy, memory tests, and MRIs of the brain.

"By examining people over time, rather than just taking a snapshot, we showed how even subtle changes in apathy predicted a change in cognition, but not the other way around," explained Malpetti, lead author of the study. "We also noticed local brain shrinkage in areas that support motivation and initiative many years before symptoms were expected to appear."

People with genetic mutations had more apathy than other family members, which increased much more over two years than people with normal genetics. The apathy predicted a cognitive decline that accelerated as they neared the estimated age of onset of symptoms.

Professor Rogier Kievit of the Donders Institute, Radboud University Medical Center in Nijmegen and the MRC Cognition and Brain Sciences Unit in Cambridge said: "Apathy progresses in people who we know are at greater risk of developing frontotemporal dementia progressed much faster and this is related to the onset of greater atrophy in the brain. Although participants with a genetic mutation were comfortable and had no symptoms, they showed higher levels of apathy at the start. The level of apathy predicted cognitive levels Problems in the years to come. "

"We know from other research that apathy in patients with frontotemporal dementia is a bad sign of independent living and survival. Here we show its importance in the decades before symptoms began," said Professor James Rowe of the Department of Clinical Neurosciences, shared senior author.

Professor Rowe said the study underscores the importance of studying why someone has apathy. "There are many reasons someone might feel apathetic. Treating a condition such as low thyroid hormone levels or a psychiatric condition such as depression can be easy. However, doctors must consider the possibility of apathy that heralds dementia and Increase the chances of developing dementia if left untreated, especially if someone has a family history of dementia.

"Treating dementia is challenging, but the earlier we can diagnose the disease, the greater our window of opportunity to try to intervene and slow or stop its progress."

A lack of interest combined with an increased risk of dementia

More information:
Malpetti, M, et al. Apathy in pre-symptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes. Alzheimer's & Dementia; December 14, 2020; DOI: 10.1002 / alz.12252

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