Can You Suppress the Onset of Dementia by Treating Apathy?

After many moves and achieving the rank of colonel in the Air Force, Ken had big plans for retirement. His already full bucket list was getting even longer, as he thought of new things he wanted to do with his wife. As an avid runner, Ken planned on training for his first half marathon, visiting his wife’s family in the Isle of Skye in Scotland, and touring the Colosseum in Rome.

When the time came for Ken to retire, sadly, most of his big dreams and bucket list items fell by the wayside. Once an enthusiastic person with lots of personality who was liked by everyone, Ken became withdrawn and apathetic. He even stopped running, after running 9 miles a week for twenty years! His wife thought maybe he missed working, but after volunteering several times she realized that that wasn’t it. It was a mystery to everyone what happened to Ken!

After a visit to the neurologist, Ken was diagnosed with mild cognitive impairment (MCI). The condition is typically marked by memory loss, confusion, mood swings, and other challenges that can disrupt daily life. At least 15% of people with MCI who are age 65 and older eventually acquire full-blown dementia. If someone with MCI also suffers apathy, that person is up to seven times more likely to develop dementia, compared to those without apathy, says Dr. Prasad Padala, a geriatric psychiatrist for the Department of Veteran’s Affairs (VA) Healthcare System.

Apathy and Dementia

Apathy is a common problem in patients with MCI and those who have been diagnosed with Alzheimer’s and other forms of dementia. Apathy can be described as a profound loss of motivation and initiative. An example would be someone who is reluctant to get out of bed and spends the day sitting around doing nothing.

Dr. Padala has been researching apathy in patients with dementia for about 15 years. Currently, he’s leading a study that’s aimed at delaying the onset of Alzheimer’s in people with apathy via brain stimulation therapy he calls repetitive transcranial magnetic stimulation (rTMS). He and his team are hoping that the stimulation will stop the progression of MCI to dementia by improving the symptoms of apathy.

How the Study Works

Padala recruited 125 veterans with mild cognitive impairment for his four-year study, several of whom will belong to the rTMS group and others who will undergo a sham stimulation. Apathy will be rated according to a scale that measures cognitive, behavioral, and emotional components of motivation.

Each participating veteran will receive 20 sessions of rTMS over four weeks, with 3,000 stimulations each session. The researchers will pay special attention to how each Veteran responds to the treatment of the first session. At the end of the study, researchers will once again test if the biomarker and cognition changed since starting therapy. At that point, they can figure out which veterans are likely to respond. At the end of four years, researchers hope to know for sure if this treatment works for apathy and improves memory or not.

rTMS Targets Brain Region Linked to Motivation and Pleasure

Dr. Padala is confident about the rTMS as a tool for brain stimulation therapy because it has been tested for similar conditions in pilot studies. According to Dr. Padala, what makes the therapy appropriate for this study is that it offers the option of targeting a specific area of the brain and adjusting the strength of the simulation for each veteran.

The U.S. Food and Drug Administration has approved rTMS for treating depression in patients who have been resistant to other forms of therapy. But rTMS is only in the investigational stages for treating apathy in people with MCI.

Veterans are at a Higher Risk for Mild Cognitive Impairment

Dr. Padala is one of many VA researchers who are interested in a therapy for patients with MCI and dementia. He explains that veterans have a much higher risk of MCI than the general public partly because their rate of diabetes is three times higher. Research has shown that older adults with poorly controlled diabetes are at greater risk for dementia and other forms of dementia.

Dr. Padala believes that if his ongoing study is successful, it will lead to a new treatment option for apathy in people with MCI.

What You Can Do to Help Loved Ones with Apathy

Do you have a loved one who, similar to Ken in our example, is experiencing apathy? There are things you can do to help:

  • Try tasks and activities that the person can do, and that he or she truly enjoys and finds meaningful.
  • Don’t blame your loved one for being lazy, unhelpful, or not caring – it’s not their choice. If you feel frustrated, try to remain calm. The person may pick up a negative mood.
  • Challenge your loved one’s feelings of indifference and passivity with action. Introduce new exciting elements to his or her life. Help them enjoy the little things and hopefully, reawaken!

If your doctor finds that your loved one’s apathy is a sign of an underlying disease, such as MCI, medication can be used to treat the illness and this unfortunate effect. In fact, Dr. Padala tested the stimulant methylphenidate (commonly contained in Ritalin and used to treat attention deficit hyperactivity disorder and narcolepsy) in a small group of VA patients. He and his team concluded that Ritalin (and similar drugs) improved motivation, cognition, functional status, depression, and caregiver burden. He did find that, unfortunately, VA patients are generally poor candidates for this medication due to its cardiovascular risks.

Planning for a Loved One with Dementia

Here at the Farr Law Firm, we work with persons with dementia and their families, including veterans and their spouses, to plan for special legal and financial needs. We are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones. We help protect your family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance.

Living Trust Plus for Veterans

The Living Trust Plus® asset protection trust is often the best option for Veterans asset protection plan, as well as Medicaid asset protection planning. The Living Trust Plus® is a special type of irrevocable asset protection trust that you create while you are living that allows you to retain full control over all of the trust assets, including the right to live in or use any trust-owned real estate. Read more about Living Trust Plus® here.

Applying for veteran’s benefits can be confusing and arduous. Here at the Farr Law Firm, we work with veterans and their spouses to evaluate whether they qualify or may in the future qualify for the Veterans Aid and Attendance Benefit and/or Medicaid, and we deal with all the paperwork. Please call us at any time to make an appointment for a consultation:

Veteran’s Aid and Attendance Attorney Fairfax: 703-691-1888
Veteran’s Aid and Attendance Attorney Fredericksburg: 540-479-1435
Veteran’s Aid and Attendance Attorney Rockville: 301-519-8041
Veteran’s Aid and Attendance Attorney Washington, D.C.: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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