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Disorders of Diminished Motivation

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Lack of motivation can be one of the most frustrating aspects of caregiving.

How do you motivate somebody to do more, engage more, or initiate more in the presence of dementia?  Why is it that your father, who is physically capable of performing his own self care tasks, just won’t bother to bathe or change his clothes?  Why won’t your mother walk herself to the bathroom before it’s too late?   It’s easy to label her “lazy” or “attention seeking”, but it is important to consider the impact of the disease on the parts of the brain that regulate motivation and initation.

In terms of Frontal Lobe Dementia (FTD) and Alzheimer’s disease, there are three terms that describe a lack of motivation:

Apathy

  • The mildest form of motivational dysfunction, apathy is common in early stage Alzheimer’s disease
  • May mimic depression
  • Withdrawal from interests and social interaction
  • Flat emotional expressions

Aboulia

  • Usually seen in moderate/mid stage Alzheimer’s or FTD (and other neurogenerative diseases as well).
  • Decreased desire to move or sustain movement
  • Passive interactions, disregard for survival functions
  • Dependent on caregivers
  • Little to no emotional response

Akinetic Mutism

  • Unable to speak or move
  • Awareness is usually perserved, unlike “locked in syndrome” or “persistive vegetative state”
  • No facial expressions or gestures
  • Severe frontal lobe damage or diffuse brain atrophy

Having a clearer understanding of the impact of Alzheimer’s disease on functions like motivation and initiation can help caregivers understand the difficult behaviors that frequently accompany disease progression.  Researchers continue to look for medications that may help enhance some motivational qualities (as seen in Parkinson’s disease), but for now caregivers can only use this information to lessen frustration while caring for someone with Alzheimer’s.

 

References and good reads:

Aboulia: Neurobehavioral Dysfuntion.
Mutism in the Older Adult
Nages Nagaratnam, MD, FRCP, FRACP, FRCPA, FACC, Gowrie Pavan, MBBS, FRAGP
Disclosures
Geriatrics and Aging. 2005;8(8):61-68. 
Apathy a Common Problem in Alzheimer’s
What is aboulia: Causes and Symptoms
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4 comments

  1. Rachelle Norman

    I’ve certainly seen these symptoms among the older adults I serve, but I’ve never seen these particular terms. It makes a lot of sense! Do you know how the brain might be functioning differently in each of these stages?

    As a music therapist, I would be remiss if I didn’t mention that music can help provide the motivational piece to help with completing ADLs. Fascinating!

    • According to the research, the degree of motivational decline is consistent with the amount of damage to the frontal lobe cortex in Alzheimer’s disease. Basal ganglia dysfunction, as seen in Parkinson’s and other diseases, also causes similar symptoms.

      Hey I’m a huge fan of music therapy! Sometimes that’s the only thing that gets me out the door in the morning- great for motivation!

      Thanks for commenting Rachelle…

  2. This is what I am dealing with right now. My ex husband age 61 has all these non emotions. It’s difficult for me, I understand it by reading about it however it doesn’t make it any easier when you know how they used to be. I do thank you for the information because had I not done my research I would still be confused.

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