Apathy and its treatment

Apathy is a common problem observed in numerous neurologic, psychiatric, and other medical conditions. It is independent from other symptoms and has been associated with a variety of negative outcomes. However, little empirical research has been conducted on potential psychologic or pharmacologic treatments for apathy. The impact of several different medications has been investigated, but very few reports have used well-controlled study designs. At present, agents that potentiate dopamine release and/or delay dopamine reuptake in the central nervous system appear promising for use in apathy. Among these, atypical antipsychotics and methylphenidate have received the greatest attention, and both have been demonstrated to reduce apathy in several patient populations. These findings appear consistent with evidence supporting a role for frontal-subcortical circuitry abnormality in the etiology of apathy. Another class of medication that has been the subject of a larger number of investigations is the acetylcholinesterase inhibitors. These have been reported to reduce apathy in patients with dementia and individuals with traumatic brain injury. Several psychologic interventions have been assessed, largely in geriatric populations, but most have been the subject of only one or a very small number of studies. With this caveat, interventions that have shown promise include participation in discussion groups and cognitive stimulation. Despite some promising findings, further large-scale, well-controlled clinical trials of potentially helpful pharmacologic and psychologic interventions for apathy are essential before any firm recommendations can be made. In the interim, careful evaluation of possible psychosocial and biological contributors to apathy in any given patient is suggested, with treatment planning based accordingly.