Impact of Alzheimer's disease treatments on apathy

Krista Lanctôt, PhD, University of Toronto, Toronto, ON, Canada, discusses the efficacy of Alzheimer's disease (AD) treatments for the management of apathy. Cholinesterase inhibitors are the most common symptomatic treatment option for AD, including mild, moderate, and severe cases. Studies looking at apathy as a secondary outcome have evidenced that treatment with cholinesterase inhibitors have only a small effect on apathy. Long-term follow-up studies have shown a decreased emergence of apathy in people receiving cholinesterase inhibitors, suggesting they are more efficacious in preventing onset, rather than treating patients with AD with established apathy. The same can be said for memantine as a treatment for moderate to severe AD, as studies have shown that there was no significant difference in apathy between the use of memantine and placebo. A study from the EMERGE trial (NCT02484547) looked at aducanumab in 1600 participants, which affected neuropsychiatric symptoms overall but still was not an effective treatment for apathy. Therefore, it is important to carry out clinical trials that focus on apathy as a symptom of AD and not just a secondary outcome. The ADMET2 trial (NCT02346201) of the effect of methylphenidate on apathy achieved this by only recruiting participants with clinically significant apathy and adding the treatment onto a psychosocial intervention. This interview took place at the Alzheimer’s Association International Conference (AAIC) 2022 in San Diego, CA.