To anyone with a loved one who has been diagnosed with Alzheimer’s disease we geriatric care managers work to give them options in the midst of losing their loved one a day at a time as the condition worsens. We get a profound sense of their feeling of loss, because the person they are seeing looks the same on the outside, but there is the continuing erosion on the inside. But what about the patient, the one who has the awful diagnosis? What do they feel? Clinicians tell us that in addition to the confusion, they will feel indifference, lack of interest, lack of enthusiasm, lack of concern, disinterestedness, unresponsiveness, impassivity, dispassion, lethargy, languor, ennui.
And that detachment, that apathy, hastens the progression of the neurodegeneration of AD and leads to a lack of self-care and motivation. So, apathy may be a side effect of AD, but it also speeds up the neurodegeneration of the disease. “We have to look more closely at apathy, which is easy to miss because the apathetic patient is not the squeaky wheel,” Prasad R. Padala, MD, associate professor, Department of Psychiatry, University of Arkansas, and associate director for clinical programs, Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, told Medscape Medical News. Not only that, but there is hope for a treatment that can actually address the apathy and therefore the disease’s progression.
It’s called methylphenidate (brand name Ritalin) and has been used for attention deficit disorder. It directly addresses and reduces the apathy, and in research it has been shown to improve cognition in older, community-dwelling male veterans with mild AD, some new research shows. Those in the study also showed improved functional status and fewer signs of depression versus those who were given placebo, or sugar pill.
Researchers in the past have tried to treat AD patients’ depression in an effort to motivate patients, but they have had limited success. And there had been some other studies of methylphenidate, but the trials lasted only half or month or month and a half. The new study cited by Dr. Padala was a three month study and utilized a number of cognitive tests to assess changes during that time. Patients who received the agent showed improvement at both the two month and three month mark versus those receiving placebo.
“Ritalin [methylphenidate] is used in children with attention- deficit/hyperactivity disorder, so we know it improves attention, but this really caught us by surprise, because it was much more than just attention,” said Dr Padala. Scientists are looking to see if the results also can be found when methylphenidate is used with other dementias as well as if it works equally well among women and men. (The research here was just among men.).
In this post and throughout the National Alzheimer’s Awareness month we will be offering a $10 discount off the 
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Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.
