University Gothenburg logoAlterations in white matter of the brain are common among the elderly and dementia patients. They often seem to appear as foggy patches on CT and MRI images. A new patient study conducted by the Sahlgrenska Academy and Sahlgrenska University Hospital reveals that apathy could be common among dementia patients having certain type of changes in their brain’s white matter as against those who don’t.

One of the most common psychological problems related with dementia is supposedly apathy. With emotional blunting, nearly over half of all dementia patients are found to also lack motivation and initiative.

“A likely explanation for the changes is that the small blood vessels that supply the white matter are not working as they should,” shares Michael Jonsson, PhD-student at the Sahlgrenska Academy and consultant psychiatrist at Sahlgrenska University Hospital’s memory clinic. “This results in that the long nerve fibres and their fatty sheaths degenerate.”

Patients having characteristic modifications in the brain could have higher chances of showing apathy suggest the study. Irrespective of which type of dementia a patient has, this experts believe could indicate a common biological reason behind this apathy. Situated deep in the brain, these changes could primarily be affecting the neural pathways that run from this part of the brain to the frontal lobes. The pathways are known to be significant for taking the initiative and the ability to plan.

“Even though we think we know a bit about which pathways are affected in cases of apathy, we still need to find out more about the anatomy and chemistry behind the development of these symptoms,” mentions Jonsson. “This is vital if we are to develop medication to treat apathy.”

Around 176 patients with Alzheimer’s, vascular dementia or mixed dementia were included in the study. Nearly 82 per cent of the patients who showed alterations in their white matter were found to be apathetic by the investigators. Seemingly approximately 58 percent of all the dementia patients showed apathy.

Apathy could lower the quality of life for patients having dementia and also augment the threat of institutionalization. Hence experts believe that a large amount of work is under way for a possible treatment. Escalated physical exercise, cognitive stimulation, massage and other treatments that leave out medication apparently do not work in such cases.

“Some studies have shown that the medicines currently used for Alzheimer’s can have a positive impact on apathy in other types of dementia too,” concludes Jonsson. “Other medicines may also be of interest, but we need to carry out more research in this area.”

Forgetfulness, impaired speech and problems with recognition and orientation are considered to be the most common symptoms of dementia. Affecting all our mental faculties, the condition seems to be more common among older people.

This finding has been published in the International Journal of Geriatric Psychiatry.