16 December 2020

Apathy predicts some forms of dementia years before the first symptoms appear. This is the main finding of Rogier Kievit of Radboudumc and colleagues from the University of Cambridge in their publication today in Alzheimer's & Dementia. With this knowledge, potential treatment can be started considerably earlier.

Fronto-temporal dementia is an important form of dementia in humans, and is often first diagnosed between the ages of 45 and 65. This type of dementia changes people's behaviour, language and personality. Typical symptoms are: impulsive, socially inappropriate and repetitive, compulsive behaviour. Apathy - a lack of interest, initiative and motivation - is also a general characteristic of this disorder. Apathy reduces functioning, independence and quality of life and is often accompanied by lower life expectancy.

Shrinkage

Brain scans in these patients suggest that the cause of this condition is related to the shrinkage of specific brain parts at the front of the brain. Rogier Kievit, Professor of Developmental Neuroscience at Radboudumc and the Donders Institute: "The stronger the shrinkage, the stronger the apathy. By the way, apathy should not be confused with depression or laziness. The interesting thing about our findings is that apathy often occurs years earlier than the other symptoms of the disease. This potentially makes it possible to treat and inhibit the disease and its symptoms much earlier. It shows how essential it is to be able to monitor these processes in large groups of people over time."

In the family

Fronto-temporal dementia often has a genetic cause. In about a third of patients it runs in the family. The study, led by Kievit, Maura Malpetti and James Rowe (University of Cambridge), monitored 600 people for several years, looking at changes in apathy, memory test results and brain scans.

More than three hundred people (304) had the gene variant that increased the risk of the disease, but were still healthy. The other half of the group (296) were family members without the gene variant. Nobody had dementia. Most people did not know whether or not they were carriers of the pathogenic gene.

Old Dementia

Maura Malpetti, first author of the article, said: "People with the genetic mutation that increases the risk of fronto-temporal dementia were more apathetic than their families and the severity of the apathy also increased more rapidly during the research period. We saw the brain areas involved in motivation and initiative shrink years before the other symptoms of dementia appeared. Apathy is a clear predictor of cognitive decline, which also accelerates as the symptom formation approaches".

Wake-up-call

The study reveals that apathy is an important early predictor of fronto-temporal dementia. At the same time, it must be clear where apathy comes from. Rowe: "Apathy can have various causes, such as a lack of thyroid hormone in the blood or depression. But this research is a wake-up call. It shows that it's good to include the risk of dementia in the considerations."

Kievit: "Especially if it is known that fronto-temporal dementia has occurred in the family before. We do not yet have good, effective medication against the condition, but the period in which we can intervene has now been considerably increased by our research."

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