Chapter 5-Physician's Guide to Management of HD~Psychiatric
Apathy is common in HD and is probably related to frontal lobe dysfunction.
Apathetic patients become unmotivated and uninterested in their surroundings. They lose enthusiasm and spontaneity. Performance
at work or school becomes sluggish.
The symptom of apathy can be very troubling to families, if they see
the active person they knew slipping away. It can be a source of conflict for caregivers, who know the person is physically
capable of activities but "won't" do them.
Families need much education and support in this regard and should
learn to practice a combination of exhortation and accommodation.
While apathetic patients have trouble initiating actions, they will
often participate if someone else suggests an activity and works along with them to sustain energy and attention. For example,
a man with HD had always loved fishing, but when his brother came to take him fishing for his birthday he wanted to stay home
in front of the television. The brother insisted, and when they left the house, he had a good time fishing all day. When he
returned, he immediately turned the television back on.
Apathy can be hard to distinguish from depression. Apathetic patients,
like those with depression, may be sluggish, quiet, and disengaged. They may
talk slowly, or not at all.
By and large apathetic patients will deny being sad, but in distinguishing
the two it is important to ask not only about the patient's mood, but about other depressive symptoms as well, such as a change
in sleeping or eating patterns, feelings of guilt, or suicidal thoughts.
Neuroleptics and benzodiazepines can cause or worsen apathy. The need
for these medications should be reexamined if the patient is apathetic.