Differentiating Subtypes of Apathy to Improve Person-Centered Care in Frontotemporal Degeneration

Apathy, a reduction in goal-directed behavior (GDB), affects 90% of individuals with behavioral variant frontotemporal degeneration, which is a common cause of early onset neurodegenerative disease. The cognitive and neural impairments associated with apathy make it difficult to initiate, plan, and self-motivate activities toward a specific goal, such as dressing or bathing. These impairments are associated with significant decline in functional ability, caregiver burden, and increased cost of care due to early institutionalization. The current article reviews the evidence suggesting that apathy arises from the interruption of one or any combination of three GDB processes: initiation, planning, and motivation. From this perspective, three subtypes of apathy related to dysfunction at the level of GDB and the corresponding neuroanatomy are explored. Further research is required to confirm and measure these subtypes of apathy for use in clinical and research settings. A more precise classification of apathy by subtype will allow implementation of the most appropriate person-centered, individualized therapy. [Journal of Gerontological Nursing, 40(10), 58–65.] Dr. Massimo is Postdoctoral Fellow, and Dr. Grossman is Professor and Director, Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania Perelman School of Medicine; and Dr. Evans is Professor Emerita, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Massimo is also Postdoctoral Fellow, College of Nursing, The Pennsylvania State University, University Park, Pennsylvania. The authors have disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Lauren Massimo, PhD, APRN, Postdoctoral Fellow, Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 3 West Gates, Philadelphia, PA 19104; e-mail: lauren.massimo@uphs.upenn.edu. Received: May 01, 2014 Accepted: August 05, 2014 Posted Online: September 8, 2014