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DownloadDOC: Apathy-Dr.Paulsen
IV. Common Behaviour Concerns in HD
Definition/Problems With Initiation/Apathy/Possible Causes/Coping With Apathy


Apathy is similar to inattention, indifference, and lethargy. Apathy is present when individuals with HD seem to have diminished concern for things about which they used to demonstrate a great deal of care and concern.

A lack of initiation often accompanies apathy, but can also occur by itself in the absence of apathy. The ability to begin, or initiate, behaviours, conversation, or activity is a very complex function which is frequently compromised in persons with various types of brain dysfunction, including mild head injury, Parkinson disease, multiple sclerosis, stroke, and, of course, HD.

Possible Causes

The circuits in the middle and bottom sections of the frontal lobes are very well-connected to the limbic system, or the "emotional lobe", of the brain. The caudate degeneration can result in disconnections in these circuits, causing the frontal lobe boss to be disconnected from the "feelings" of the brain.

Possible causes continued
A common, and normal, response to having HD is sadness, but this sadness can sometimes be a warning sign of a more serious problem called depression. Oftentimes when individuals become depressed, they also have reduced concern and energy for other aspects of life.

Coping Strategies for Apathy

  • Do not interpret a lack of initiation or activity as "laziness".
  • Educate family members and friends about the inability to begin or "initiate" behaviours and
    ask others to encourage participation in activities.
  • Gently guide behaviours, but respect "no".
  • Use calendars and routines as suggested earlier (see pages 12, 27, 28).