Alzheimer’s ABC’s: Cognitive Changes II (Apathy, Delusion)

Cognitive Changes in AD: Apathy and Delusion

In the last post we considered the cognitive change of depression, and how it can affect those with Alzheimer’s disease (AD), as well as some tips to help discern between pure depression and AD.

Today we’ll consider other cognitive change often seen along with AD – apathy and delusion.

Some AD patients develop frustration, agitation or combativeness, which can be extremely difficult to treat and manage (if you are a caregiver for an AD patient with these symptoms, you are all too aware of the strain this can create). Sometimes change in personality with agitated features can be an early manifestation of AD so pay close attention to this.

One aspect of very early changes in AD is apathy.  The topic of apathy with AD has been somewhat neglected in the past, but there are a number of recent articles that focus on this (you can research Jeffrey Cummings of UCLA, who has authored several articles on apathy and AD).

Apathy has been largely underrated as a feature of AD, but it is not an uncommon symptom, especially in the early stages of the disease.  An individual will spend hours sitting in a chair and watching TV, or lying in bed or being inactive most of the day.

Delusion can be associated with AD as well.  I have had many patients with AD who continuously (even in the face of clear cut evidence) are unable to recall that a loved one has recently died.  One recent patient had 2 sisters die within a month of each other, but the patient still felt they were alive (even though she had attended their funerals).  The mechanism for storing historical information is not working properly so she was unable to focus on the idea that the sisters were, in fact, deceased.

Many patients persistently believe a deceased spouse is still living and is still in the home with them.  This type of delusion can be one of the emotional and behavioral manifestations of early AD as well.

If you are seeing signs of apathy, delusion, or both with your loved one your concerns may be valid, and you should consider a full evaluation by a physician. You can also access the early warning screening test for AD which I developed, to help determine if further evaluation should be conducted.  You can access the ALZselftest here.  If your loved one does not have basic computer skills, you or another trusted friend or family member may facilitate the test, as long as you do not provide any assistance answering the questions.

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