Apathy

  • Introduction
  • Causes
  • How it Feels
  • What it Looks Like
  • How to Manage Apathy
  • Ways to Improve Your Brain Environment
  • References

 

Introduction

Apathy is a common problem for people after a brain injury

Studies have shown that around 60 % of people exhibit signs of apathy following traumatic brain injury, although it can also affect people following a stroke, neurosurgery and viral infection.

Apathy is frequently the result of neurological change rather than psychological problems with motivation and often has no relationship with depressive negative thinking – as distinct from depressed feelings. Whilst depression is also very common, affecting around 80% of people, and can also cause a loss of get-up-and-go, the two don’t necessarily always go together.

Damage to the frontal lobes affect executive functioning and in a model proposed by Stuss,¹ injury can change the amount of energy the brain assigns to certain functions. The ‘Doing Domain,’ manages initiation or getting started, along with maintaining energy for momentum and continuance of a task. He also proposes that this executive domain allows us to maintain alertness and appropriate thinking speed which help us to think things through. 

While apathy can be a barrier to engagement with neuropsychologist and other therapists, perhaps addressing the inflammatory cascade might be useful in helping people regain thought energy and metacognitive skills aiding these treatments.

Very often apathy is mistaken as laziness from those on the outside and this lack of knowledge and understanding can sometimes cause friction in relationships.

Causes

Apathy occurs as a result of neurological damage that stops information from flowing freely. It is also a symptom of the secondary biochemical cascade that occurs after a brain injury. The brain and body are clogged with inflammatory and other biochemical toxins making it difficult to manufacture neurotransmitters.

Very often those who notice impairments in memory struggle with apathy as the brain has a limited amount of energy each day for processing and is using lots of its’ background resources just trying to find and map data. 

How it feels

Sometimes people can’t get their thinking to start at all.
 
It is though there is a thick veil between the outside world and life all around and what is able to filter in from that. It feels as though the brain is unable to take notice of the external environment.

When something happens that should break this mist, such as someone speaking or entering a room, a person can still struggle to get their brain to receive incoming information. It is a bit like trying to wake someone from a daydream; only in this case, the person isn’t daydreaming at all.

Each time we enter into any thinking or communicating, the brain has an immediate activity to attend to. This leaves the brain with less energy to deal with purposeful or goal oriented activities.

Whilst some specialists see reduced motivation as the cause of apathy, and often associate life changes as leading to feelings of tremendous loss and subsequent difficulties with feeling inspired, spontaneous or incentivised, for many people it is literally about not being able to see what needs to be done. People can really struggle with recognising goals and associating needs with action which has no bearing on what a person thinks or believes. You can struggle to put mind before matter but it is as though there is a brain energy drought and the river has become a trickle – or a drip.

Although brain injury can cause problems with thinking and how we feel and behave, these outcomes are not necessarily always components of apathy.

In other words, apathy exists in some people post brain injury as a stand-alone element or symptom of the changed brain environment.

What it looks like

It looks as though the person is struggling psychologically and whilst this can often be the case and can be a contributing component, it is important for people in the immediate family and network to resist making assumptions.

It isn’t always the case that there is a lack of interest and in many ways problems with this, and other indicators such as emotional indifference and a loss of interest are best tackled on a singular basis. It is like segmenting an orange – each piece is unique and is yet part of the whole.

Apathy is characterised by lessened activity, initiative and a lack of concern about working towards and achieving goals. This problem impacts on rehabilitation outcome, independence, work, care for general health, and a loss of interest in relationships and daily activities.

How to manage apathy

When those on the outside truly understand how apathy can impact a person and the reasons why – rather than being muddled and confused by the complexity or led to judgement by observations – this can literally light a recognition fire in a way that other tactics fail to do.

Being understood can turn a light bulb on, but without persistent attention, this bulb can quickly dim again. Once the bulb has been switched on once it is faster at recognition and reaction so the more aggressively this is fuelled the faster the apathy veil will lift.

For scientists and clinicians apathy is one of the least understood aspects of brain behaviour relationships. It has been proposed as needing to be diagnosed in its own right – much like the orange segment description given above.

Whilst recognised here as also possibly being a secondary feature of other outcomes it is important to understand that it isn’t always necessarily linked to other conditions.

Apathy is seen as a neurobehavioural disorder and as such there is recognition that impairment in executive control of goal orientated behaviour can affect the way we learn both emotionally and by way of reward.

There is a perfect tool for this!

There is a new app on the market from Stroke Active that quickly becomes a focus point for people struggling with interest in their rehabilitation. There are a number of brain injury outcomes that affect the way people are able to interact with the world around them and this tool helps with them all.

The app is designed to be the centre of a communication hub between therapists and the person living with brain injury outcomes.

Although currently marketed for stroke patients it can work for anyone living with brain injury. Emotional rewards and recognition are much more immediate and intensive so they can create interest in rehabilitation where all else has failed.

We recognise that not everyone has access to therapists however it is always asking your doctor for a referral not matter how much time has passed since your injury. You may need a neuropsychological assessment first. Please, speak to your doctor and see what help is available.

Ways to improve your brain environment

One of the best ways to improve apathy is to tackle the causes at their root. This means addressing the cascade of bio-chemical changes that occur after injury and supporting your adrenals and gut biome to improve the manufacture of neurotransmitters.

The best supplements that help with this are:

  • a high grade quality omega 3 fish oil
  • blessed black seed oil
  • turmeric 

All of the other supplements we recommend add to these benefits and can be used for specific or multiple other symptoms.

Eating for nutrition also helps us to tackle the causes of fatigue and many of the other common symptoms at their root.

It is important to incorporate a whole body approach and to think about all bodily systems and bringing them all back to health. The cascade of negative chemicals, especially cortisol, can impact gut flora – impacting the immune system, and can cause adrenal fatigue (as discussed) – compounding the problems faced.

You can learn more about all of these, including alternative treatments, starting with ‘fixing your brain.’

You can make real changes yourself, and depending on whether you have other health problems, the length of time your fatigue has been going on and other factors, you may see results fairly quickly.

References

¹Cambridge University Press – Functions of the Frontal Lobes: Relation to Executive Functions, Donald T. Stuss, Ontario Brain Institute, Rotman Research Institute of Baycrest, University of Toronto

Science Direct Apathy following traumatic brain injury: A review