Neurologists frequently hear patients say they chalked up early dementia signs to something else entirely.
“Many early cognitive changes—such as slower processing speed [and] reduced comprehension—are often dismissed as natural aging rather than indicators of dementia,” reports Dr. Adel Aziz, MD, a neurologist with JFK University Medical Center.
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However, symptoms like memory loss (that are more frequently linked to dementia) aren’t the only ones to know about.
“Understanding lesser-known signs of neurodegenerative disorders can help with earlier recognition and diagnosis by a medical provider,” says Dr. Tara Carlisle, MD, a behavioral neurologist at UCHealth.
While there’s no cure for dementia, sometimes, cognitive decline can be slowed, especially when caught early. Here, neurologists reveal the silent dementia sign that’s often overlooked.
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The No. 1 Overlooked Sign of Dementia, Neurologists Warn
Neurologists warn that apathy is a silent sign of dementia.
“Apathy, or the loss of goal-directed thought and behavior, is one of the earliest signs in some types of dementia, especially frontotemporal dementia, but it’s often overlooked because it doesn’t manifest as active distress,” Dr. Aziz says.
Unlike forgetting how to get home, Dr. Aziz explains that people often mask apathy as preference for solo time, tiredness, shyness or natural aging. “A person who once planned outings or made social calls may simply stop engaging,” he says.
And sadly, loved ones may feel silently hurt by the changes. “It can appear that the person does not care or is depressed when this is not the case,” points out Dr. Katherine D. Amodeo, MD, an assistant professor of neurology at New York Medical College.
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The Link Between Apathy and Dementia
Neurologists report that there are several potential reasons why a person with dementia can become apathetic. Dr. Amodeo shares that the chemical changes and cell losses in parts of the brain associated with motivation can impact a person’s desire to participate in activities they once loved.
Dr. Daniel Lesley, MD, a board-certified neurologist at Remo Health, says situational factors may also contribute to apathy. “Individuals may feel that everything is so much harder, making it seem ‘not worth the effort,'” he explains. “Additionally, they might feel ‘useless’ or like ‘a burden.'”
According to Dr. Amodeo, apathy is associated with several types of dementia, including:
- Alzheimer’s Disease
- Lewy body dementia (LBD)
- Vascular dementia
- Frontotemporal dementia
Apathy’s place as a symptom of that fourth one, frontotemporal dementia, has gotten more attention lately. Frontotemporal dementia is often diagnosed early (between the ages of 45 and 65). A 2020 study indicated that apathy could predict frontotemporal dementia years before symptoms start.
“It may be more commonly associated with frontotemporal dementia because those with this disease typically show changes in personality or mood as an early feature [because of] the function of the frontal lobe of the brain—the part of the brain disproportionately impacted in frontotemporal dementia,” Dr. Amodeo says.
Researchers also note that apathy predicted a faster decline. “Apathy may be associated with a faster decline in function, because it reduces the person’s ability to adapt and cope with their decreased function,” Dr. Lesley explains. “Also, it takes away some of the situations that tend to support cognitive health—social activities, exercise, cognitive activities like reading, and getting adequate nutrition and good sleep.”
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Common Signs of Apathy
Dr. Lesley explains that apathy is not a condition but rather a description of a feeling, or lack thereof. He reveals that common signs of apathy include:
- Loss of interest or joy in things that used to be fun
- Less motivation to do things (even those that are important for survival, like paying bills or eating)
- Less Goal-directed activity can all be associated with apathy
- Loss of motivation to participate in self-care, including personal and home hygiene (not brushing teeth or cleaning the home)
However, neurologists say it’s important to understand that apathy has numerous triggers. If you or a loved one is experiencing apathy, it may not be dementia.
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“Just because a person seems apathetic, they may not necessarily have dementia or be at risk for dementia,” Dr. Amodeo says. “It can be observed in other [conditions], such as depression. A diagnosis of dementia would not be based on having this one feature alone.”
According to Dr. Amodeo, additional symptoms that signify that the apathy might be connected to dementia include:
- Gradual and progressive changes in cognitive function, including memory, language, attention and focus
- Hallucinations or delusions
- Sleep changes, such as insomnia or dream enactment
- Changes in confusion or alertness (Dr. Amodeo explains a person might be confused later in the day, which is called “sundowning”)
- Mood or personality changes
Related: This Subtle Behavior Change Could Be an Early Sign of Dementia
What To Do if You’re Concerned
Experts say speaking to a primary care physician is a great start. If they’re concerned about cognitive decline, they’ll order testing to learn more.
Dr. Carlisle notes that there is no cure for dementia, but there is hope. “There are medications aimed at treating the symptoms,” she explains. “There are a number of lifestyle modifications that can slow cognitive decline.”
She shares that these shifts include:
- Regular moderate-level exercise
- Following a Mediterranean-style diet
- Participating in socially and cognitively engaging activities
- Reducing stress
- Getting high-quality sleep
- Treating vision and hearing issues
A dementia diagnosis can be hard on someone (and worsen apathy). Additionally, apathy may be a sign of a mental health condition exclusively. Either way, Dr. Amodeo shares that you deserve support for your mental well-being.
“I would recommend reaching out to their provider, such as their primary care provider, who may refer them to a psychiatrist or psychologist,” she says, adding that Psychology Today is a good resource for finding therapists.
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Sources:
- Dr. Adel Aziz, MD, a neurologist with JFK University Medical Center
- Dr. Tara Carlisle, MD, a behavioral neurologist at UCHealth
- Dr. Katherine D. Amodeo, MD, an assistant professor of neurology at New York Medical College
- Dr. Daniel Lesley, MD, a board-certified neurologist at Remo Health
- Apathy in presymptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes. Alzheimer’s & Dementia.
