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What is Apraxia? What is Apathy?

Katrina: This is a two part question. What is a apraxia and what is apathy? That's the first part. The second part is are there good medicines for someone having apathy?

Dr. Sam Frank: Those are two very different questions built into one. Apraxia is the medical term for basically forgetting how to do something that you used to know how to do. It can take many different forms. It can be, forgetting how to put on your pants, for example. Or what order to, to put your clothes on. That's a very practical kind of apraxia.

There is a smaller scale apraxia. I usually like to use the example of reaching for a glass . When you reach out for a glass, you shape your hand in the, about the, what the glasses, looks like. And you know about how heavy you expect it to be based on how much water is gonna be in there. When you reach out to pick up that glass to take a sip, that's a very complex, coordinated movement. When that breaks down, [00:01:00] that can be apraxia, whether you're not shaping your hand correctly and you knock over the glass. You overreach, you think that it's heavy but it's light and so it flies up. Those are the kinds of things that can happen with apraxia.

Really it's a lack of motor planning, when you are, doing a specific activity. It's usually how we think about, Apraxia. There are lots of different forms, but it's more of a cognitive, aspect of the motor side of many different neurologic diseases.

Apathy, totally different, not related to the motor, or cognitive side, much at all, but more on the emotional and behavioral aspect. Think of it as a lack of motivation, but not in the laziness kind of way. More in a medically induced type of way. If someone used to, on a Saturday, spend hours doing gardening and yard work, and now, they just don't feel like doing that anymore. They don't have the motivation to do it. That's typically what we think about in terms of [00:02:00] apathy.

Unfortunately there are not good medicines when it comes to apathy. Sometimes we try stimulants, sometimes we try different ways. There's really not a good medication, I would say, in terms of helping apathy. Now, there are medicines that can cause apathy. Those are some of the same medicines that we use to reduce chorea in Huntington's Disease. Many of the neuroleptics, for example, a side effect is apathy. There are some people who say that when we use a neuroleptic for behavioral dyscontrol, we're not actually getting at the behavioral issue. We're just causing apathy. Sometimes backing off on medications can help with apathy.

The other thing that I found is not necessarily a medicine, but getting people into a routine. Routines are so helpful in so many different ways. Apathy is one of the aspects of Huntington's Disease, and again, other neurologic diseases that routine might be able to help with. If it's not necessarily a motivational issue but just what you do every day, then it can help to reduce, those barriers of [00:03:00] somebody getting off the couch and doing something.

Lisa Mooney: Sometimes families have a difficult time distinguishing between apathy and depression, 'cause it can look very, very similar. Apathy is different from depression, because usually the person is very content sitting on the couch and not raking the leaves [laughs] anymore. Whereas depression, they can be profoundly depressed, sad, they just don't have the energy, they maybe want to, but they just don't have the desire anymore. It's sort of a state of overwhelming sadness for them which is why they can't get off the couch.

Depression meds can sometimes help them, and then they would return to their normal behavior, whereas apathy, most of those patients that have apathy are perfectly happy, perfectly content just laying there and sitting on the couch and watching TV and doing nothing. It is hard to distinguish. You don't necessarily have to do that as the caregiver, but it is important to reach out to your care team , like Dr. Frank said, to discuss what those are, and then we can work with you on deciding is [00:04:00] this apathy? Is it depression? What are some of the things that you can do to minimize those symptoms a little bit?

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