Distinguishing apathy from depression: A review differentiating the behavioral, neuroanatomic, and treatment‐related aspects of apathy from depression in neurocognitive disorders

Abstract

Objectives This narrative review describes the clinical features of apathy and depression in individuals with neurocognitive disorders (NCDs), with the goal of differentiating the two syndromes on the basis of clinical presentation, diagnostic criteria, neuropathological features, and contrasting responses to treatments. Methods Literature was identified using PubMed, with search terms to capture medical conditions of interest; additional references were also included based on our collective experience and knowledge of the literature. Results Evidence from current literature supports the distinction between the two disorders; apathy and depression occur with varying prevalence in individuals with NCDs, pose different risks of progression to dementia, and have distinct, if overlapping, neurobiological underpinnings. Although apathy is a distinct neuropsychiatric syndrome, distinguishing apathy from depression can be challenging, as both conditions may occur concurrently and share several overlapping features. Apathy is associated with unfavorable outcomes, especially those with neurodegenerative etiologies (e.g., Alzheimer's disease) and is associated with an increased burden for both patients and caregivers. Diagnosing apathy is important not only to serve as the basis for appropriate treatment, but also for the development of novel targeted interventions for this condition. Although there are currently no approved pharmacologic treatments for apathy, the research described in this review supports apathy as a distinct neuropsychiatric condition that warrants specific treatments aimed at alleviating patient disability. Conclusions Despite differences between these disorders, both apathy and depression pose significant challenges to patients, their families, and caregivers; better diagnostics are needed to develop more tailored treatment and support.

Apathy as a determinant of health behaviors in older adults: Implications for dementia risk reduction

“…These findings underscore the importance of apathy as a separate entity from depression 10 . This is relatively well understood in psychogeriatrics, where apathy is considered a stand‐alone syndrome, with distinct clinical profile, neurobiology, and treatment, which heralds a poorer prognosis 10,11 . We extend this knowledge, by showing differential relations with multiple health behaviors.…”

“…10 This is relatively well understood in psychogeriatrics, where apathy is considered a stand-alone syndrome, with distinct clinical profile, neurobiology, and treatment, which heralds a poorer prognosis. 10,11 We extend this knowledge, by showing differential relations with multiple health behaviors. Apathy appeared to be a risk factor, whereas depression was potentially protective, although this direction of relationship remains to be confirmed with longitudinal data.…”

“…10 Apathy and depression differ in neurobiology, treatment, and prognosis, despite being commonly comorbid. 11 Apathy, in particular, warrants consideration as a determinant of health behaviors. It is a symptom or syndrome defined as a reduction in motivation or goal-directed behavior that occurs across the neurocognitive spectrum.…”

“…As these symptoms overlap and are often subsumed in standard depression questionnaires, 9 yet have important differences, it is critical to consider them separately 10 . Apathy and depression differ in neurobiology, treatment, and prognosis, despite being commonly comorbid 11 …”

Effects of Mindfulness-Based Interventions (MBIs) in Patients with Early-Stage Alzheimer’s Disease: A Pilot Study

“…The consequences of apathy are functional impairment, a reduced response to treatment, and increased mortality. Moreover, it is directly correlated with depression, with which some symptoms coincide but are not fully superimposable [ 43 , 44 ], as emerged from a data-driven examination of apathy and depressive symptoms in dementia with independent replication.…”