Apathy Predicts Physical Function Decline in Older Adults

Apathy is a common neuropsychiatric symptom in older adults that becomes increasingly prevalent with advancing age. It presents clinically as lack of motivation and reduced emotional, cognitive, and energetic behavior. Although clinically apathy appears to be related to depression, apathy is considered a distinct neuropsychiatric condition that can occur with or without depression. Apathy has been identified as a prominent behavioral symptom in Alzheimer’s disease and predicts decline in physical function in individuals with dementia. However, little is known about apathy as a marker of functional decline in healthy older adults.

Identifying early risk factors for functional decline in community-dwelling older adults is particularly important, as these individuals may derive the most benefit from targeted interventions that can delay or prevent future functional decline. While depression has been extensively studied as a predictor of functional decline in healthy older adults, little is known about the predictive validity of apathy in this population. To address this gap in knowledge, my colleagues and I prospectively examined apathy as a predictor of 3 common outcomes of physical function decline in community-dwelling older adults: slow gait, frailty, and disability.

Participants were recruited from 2 prospective ongoing studies at the Albert Einstein College of Medicine. Results showed that individuals with apathy at baseline had a more than 2-fold risk of developing slow gait and frailty, and a more than 3-fold risk of becoming disabled. These associations were independent of depressive symptoms and remained robust after adjusting for potential confounders.

There are several possible explanations for the relationship between apathy and subsequent functional decline. Apathetic individuals may be more susceptible to frailty and disability due to lifestyle factors. For example, they may have reduced physical leisure activity participation and poor social support due to low energy and motivation. Another possible explanation is that apathy is an early symptom of frailty and disability, such that individuals may show symptoms of apathy before other behavioral markers manifest.

From a clinical perspective, our findings indicate that apathy screenings may help to identify those at high risk for functional decline and should become a routine part of psychiatric visits with older adults. Apathy can be screened for quickly and inexpensively at routine clinical visits (such as with 3 items on the Geriatric Depression Scale), offering a cost-effective strategy to reduce the risk of future functional decline for older adults.

Financial disclosure:Ms Ayers has no relevant personal financial relationships to report.