Apathy is a lack of enthusiasm, interest, or motivation for things you used to enjoy, and it is a common non-motor symptom of Parkinson’s.

Apathy can be challenging but is manageable through optimising your medications, staying social and continuing to do the things you used to do.

Apathy & lack of motivation in Parkinson’s

Apathy is a common non-motor symptom, affecting up to 40% of people living with Parkinson’s. It is characterised by a lack of interest, enthusiasm, or motivation to do the things you used to do, which can significantly impact daily life and relationships. Unlike depression, apathy is not associated with feelings of sadness or guilt but rather a general emotional flatness and difficulty starting activities.

Progression of apathy in Parkinson’s

When does apathy appear?

Apathy can show up even before a formal Parkinson’s diagnosis, during the prodromal (early) phase, and tends to become more common as the condition progresses.

What does apathy look like?

It’s not just “lack of motivation.” Apathy is a multidimensional experience that can affect:

  • Behaviour, with reduced initiative or engagement in activities
  • Social interaction, with withdrawal or reduced interest in connecting with others
  • Emotional response, although emotional sensitivity may remain intact in some people, other aspects may be dulled.

Some people with apathy in Parkinson’s may still feel emotions deeply, but they might struggle to express them or act on them. Apathy affects motivation and initiative, not necessarily empathy or emotional awareness.

However, in some cases, especially when apathy is combined with executive dysfunction or cognitive decline, a person might appear:

  • Indifferent or emotionally flat
  • Less responsive to others’ feelings or social cues
  • Occasionally frustrated or irritable, especially if they’re misunderstood or overwhelmed.

But this doesn’t mean they become intentionally insensitive or belligerent. These behaviours are often a reflection of neurological changes, not personality or intent. However, it is still frustrating for the person affected and those around them.

Is apathy the same as depression?

While apathy and depression can overlap, they’re distinct conditions. Apathy is more closely tied to cognitive changes, especially difficulties with executive function, like planning, decision-making, and goal-setting. People with apathy feel indifferent or not bothered. Depression is more closely tied to mood changes, such as persistent sadness, hopelessness, and negative thoughts about the future, rather than the motivational and cognitive deficits that define apathy.

Why addressing apathy matters

Apathy can interfere with effective management of Parkinson’s symptoms, as people may struggle to stick to their medication schedules, maintain physical activity, or engage in social interactions. This can lead to a decline in overall health and wellbeing.

Strategies for managing apathy

Apathy manifests in three forms:

  1. cognitive (loss of interest in new things)
  2. emotional (reduced emotional response)
  3. behavioural (difficulty initiating activities).

While there are no specific medications approved for treating apathy, structured activities, social engagement, and regular exercise can help. Care partners play a crucial role in recognising apathy and encouraging their loved ones to seek support from their care team.

By understanding apathy as a symptom of Parkinson’s, you,  your friends and family can take step to ensure you stay engaged and active in doing the things you love despite this frustrating symptom.

Key Statistics

  1. Apathy affects up to 40% of people with Parkinson’s disease, making it one of the most common non-motor symptoms (den Brok et al., 2015).
  2. Apathy is strongly associated with executive dysfunction, particularly difficulties in planning and goal-directed behavior (Kulisevsky et al., 2013).
  3. Meta-analyses confirm apathy is independent of depression, though they may co-occur, highlighting the need for distinct treatment approaches (Foley & Cipolotti, 2021).
  4. Apathy significantly reduces participation in daily activities and is linked to poorer disease outcomes and caregiver burden (Mele et al., 2020).

Strategies for managing apathy

While there are no specific medications approved for treating apathy, structured activities, social engagement, and regular exercise can help. Care partners play a crucial role in recognising apathy and encouraging their loved ones to seek support from their care team.

Apathy in Parkinson’s can be challenging, but there are strategies to manage it. SBe open about your apathy to friends and family, stay engaged socially, exercise, and optimise medications, lifestyle and treatments.

Here are our top ten tips:

  1. Reflect on your feelings: Consider why you feel apathetic and try to see things differently. Focus on what you can still do rather than what you can’t. If you’re feeling low or anxious, find ways to improve your mood, like taking a walk or doing something else you love.
  2. Reconnect with past enjoyments: Re-engage in activities you used to enjoy, reconnect with friends, or revisit exercise classes. Remember, these past enjoyments can bring back a sense of joy and purpose, helping you to feel more hopeful and motivated.
  3. Follow a routine: Having a routine reduces the need for excessive planning and effort. Reduce decision-making by having a predictable schedule. 
  4. Stick to your plans: Even if you’re feeling apathetic, making yourself meet up with friends or going to support goups or your favourite activities can positively impact your mental health.
  5. Set realistic goals: Break down larger tasks into smaller steps to make them achievable and less overwhelming. This approach can empower you, giving you a sense of control over your tasks and helping you to feel more accomplished.
  6. Manage energy levels: Plan enjoyable activities around when you are “on” and have the most energy. Exercise, eat well, drink lots of water, and practice good sleep hygiene to maintain your energy levels.
  7. Stay social and active: Physical activity benefits physical and mental health in Parkinson’s. Consider going on a walk or to the gym with friends. Engaging in physical activities promotes a healthy lifestyle and provides an opportunity for social interaction, which can help combat apathy.
  8. Talk to family and friends: You need to share your feelings with loved ones and let them know that apathy is a common symptom of Parkinson’s and that you may need help staying motivated or getting out of the house. They can provide support and positive feedback, which can be key to managing apathy.
  9. Consult your specialist or Parkinson’s Nurse: If you’re struggling with apathy, it’s important to seek professional advice. Tell your specialist or Parkinson’s Nurse so they can provide strategies to address your apathy effectively. Don’t hesitate to reach out for help from your OT who can tailor time-management, motivation and planning interventions for you.
  10. Consider telehealth services: Telehealth or virtual appointments allow you to connect with mental health professionals remotely. You can have video consultations, phone calls, or chat sessions from home. This convenient and supportive service is beneficial if you have mobility issues or live in a regional, rural or remote area. Remember that seeking professional help is a positive step toward better mental wellbeing, and telehealth can support you.

Infosheet under review

References:

den Brok, M. G. H. E., van Dalen, J. W., van Gool, W. A., Moll van Charante, E. P., de Bie, R. M. A., & Richard, E. (2015). Apathy in Parkinson’s disease: A systematic review and meta-analysis. Movement Disorders, 30(6), 759–769. https://doi.org/10.1002/mds.26208

Foley, J. A., & Cipolotti, L. (2021). Apathy in Parkinson’s disease: Prevalence and relationship with mood, anxiety, and cognitive function. Frontiers in Psychology, 12, 749624. https://doi.org/10.3389/fpsyg.2021.749624

Gu, L, P Zhang, Y Wang, Y Zhu, H Li, H Shu (2025).  Prevalence, Contributing Factors, and Clinical Impact of Apathy in Parkinson’s Disease. Journal of Psychiatric Research.

Kulisevsky, J., Pagonabarraga, J., & Martinez-Horta, S. (2013). Apathy in Parkinson’s disease: More than just executive dysfunction. Journal of the International Neuropsychological Society, 19(5), 571–582. https://doi.org/10.1017/S1355617713000180

Luo, R., Qi, Y., He, J., Zheng, X., Ren, W., & Chang, Y. (2022). Analysis of Influencing Factors of Apathy in Patients with Parkinson’s Disease. Brain Sciences. https://doi.org/10.3390/brainsci12101343

Maggi, G., Vitale, C., Delle Curti, A., Amboni, M. and Santangelo, G., 2023. Unawareness of apathy in Parkinson’s disease: the role of executive dysfunction on symptom recognition. Brain Sciences, 13(6), p.964.

Maher, S., Donlon, E., Mullane, G., Walsh, R., Lynch, T. and Fearon, C., 2024. Treatment of Apathy in Parkinson’s Disease and Implications for Underlying Pathophysiology. Journal of Clinical Medicine, 13(8), p.2216.

Mele, B., Van, S., Holroyd-Leduc, J., Ismail, Z., Pringsheim, T. and Goodarzi, Z., 2020. Diagnosis, treatment and management of apathy in Parkinson’s disease: a scoping review. BMJ open, 10(9), p.e037632.

Seppi K, Ray Chaudhuri K, Coelho M, Fox SH, Katzenschlager R, Perez Lloret S, Weintraub D, Sampaio C; the collaborators of the Parkinson’s Disease Update on Non-Motor Symptoms Study Group on behalf of the Movement Disorders Society Evidence-Based Medicine Committee. Update on treatments for nonmotor symptoms of Parkinson’s disease-an evidence-based medicine review. Mov Disord. 2019 Feb;34(2):180-198. doi: 10.1002/mds.27602. Epub 2019 Jan 17. Erratum in: Mov Disord. 2019 May;34(5):765. doi: 10.1002/mds.27684. PMID: 30653247; PMCID: PMC6916382.

Steffens DC, Fahed M, Manning KJ, Wang L. The neurobiology of apathy in depression and neurocognitive impairment in older adults: a review of epidemiological, clinical, neuropsychological and biological research. Transl Psychiatry. 2022 Dec 26;12(1):525. doi: 10.1038/s41398-022-02292-3. PMID: 36572691; PMCID: PMC9792580.

Zhou Z, Müller MLTM, Kanel P, Chua J, Kotagal V, Kaufer DI, Albin RL, Frey KA, Bohnen NI. Apathy rating scores and β-amyloidopathy in patients with Parkinson disease at risk for cognitive decline. Neurology. 2020 Jan 28;94(4):e376-e383. doi: 10.1212/WNL.0000000000008683. Epub 2019 Nov 15. PMID: 31732566; PMCID: PMC7079689.

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