Apathy early marker of dementia

Apathy is an early marker of frontotemporal dementia (FTD) and predicts future cognitive decline, a new study has shown.

Results showed that apathy occurs early in the disease course of genetic FTD before cognitive decline, reflecting early brain changes and predicting individual future clinical trajectories of cognitive and executive function deterioration.

The researchers suggest that apathy may also be a modifiable factor in its own right, by pharmacological or nonpharmacological interventions, and it is therefore a potential target not only for symptomatic treatment but also for interventions to delay clinical decline in people at risk for FTD.

Apathy occurs in all types of dementia, but it is particularly common in FTD and is associated with a worse prognosis including reduced survival and being more likely to need nursing home care.

The study involved 304 presymptomatic carriers of MAPT, GRN or C9or f 72 mutations and 296 relatives without mutations. They all underwent clinical assessments and MRI scans at baseline, and then annually for 2 years. As part of the assessments, a family member, normally a spouse, was asked about apathy symptoms.

Results showed that apathy severity increased over time in presymptomatic carriers, but not in noncarriers. In presymptomatic carriers, baseline apathy predicted cognitive decline over 2 years, but not vice versa. Apathy progression was also associated with baseline low gray matter volume in frontal and cingulate regions.

It is estimated that one in three patients with FTD have a known gene variant. In the general Western population, around two in 100,000 have such gene variants.