Source: The Conversation – Canada – By Aderonke Agboji, Assistant Professor, University of Northern British Columbia
People with brain disorders, including Parkinson’s disease and dementia, are often misdiagnosed as having depression, when in fact what they’re experiencing is apathy. This can delay an accurate diagnosis, which has negative outcomes for patients as well as for their families and caregivers.
Apathy and depression may look alike from the outside, but they arise from different neurobiological pathways and have different implications for treatment, functioning and quality of life for those affected.
Understanding and identifying the differences is crucial. My recent research focused on developing a simple assessment tool to differentiate apathy from depression.
We will see more cases as people age
Brain disorders, particularly Alzheimer’s disease and other dementias, as well as Parkinson’s disease, are common in Canada.
According to a 2017 Public Health Agency of Canada (PHAC) report, an estimated 3.6 million Canadians have been diagnosed with brain disorders. More recently, the Canadian Brain Research Strategy estimates that one in five Canadians is affected by these conditions, with a total estimate of more than 7.5 million people currently living with brain conditions.
As the Canadian population ages due to demographic shifts and improved survival rates from once-fatal illnesses, the number of people living with these disorders will increase significantly.
As of January 2025, dementia alone affected 771,939 Canadians aged 65 and older. The prevalence of dementia increases with age. The likelihood of a diagnosis more than doubles every five years after age 65. We can therefore expect more than 1.7 million Canadians to be living with dementia by 2050.
Similarly, Parkinson’s disease currently affects more than 100,000 Canadians aged 40 and older, with about 38 new diagnoses each day. Current projections predict that by 2050, the rate may rise by nearly 70 per cent.
A growing body of evidence suggests Canada is not prepared for this reality. Expert reviews and health-system assessments highlight persistent barriers to care including limited specialist access, long diagnostic wait times, insufficient standardized care pathways and infrastructure gaps (for example, limited neuroimaging capacity) that constrain early and equitable diagnosis and treatment.
Why we must do better
The lack of Canada’s preparedness for the rapidly growing number of people with brain disorders is harmful in many ways. These include delayed diagnosis and missed opportunities for early intervention, as well as an unsustainable reliance on emergency departments when crises occur.
Fewer than half of Canadians currently living with dementia receive a formal diagnosis. In many regions, wait times for specialist assessments exceed one to two years, further delaying care planning and symptom management. These delays cause significant stress and strain on patients and their family members, many of whom are left to provide a high level of unpaid caregiving without sufficient supports or resources.
As a result, family caregivers often experience both mental and physical health issues that can profoundly reduce their quality of life and place further strain on existing health-care systems. One of the biggest sources of stress is a lack of diagnosis or misdiagnosis.
The key to diagnosis
One of the biggest barriers in accessing timely and accurate diagnoses is the fact that symptoms of brain disorders, particularly apathy, can present very similarly to symptoms of depression. While depression may accompany brain disorders, focusing too narrowly on the symptoms can lead to inappropriate care plans and unsuitable medications, as depression becomes the primary diagnosis while underlying brain disorders remain undetected and undiagnosed.
Understanding apathy is central in addressing current gaps treatment and prognosis. Research shows that symptoms traditionally associated with depression, such as reduced activity and social withdrawal, commonly manifest in people who have brain disorders but it does not always involve sadness or hopelessness, which are core features of depression.
Large international studies show that apathy on its own is linked to a higher risk of cognitive decline and dementia, even when depression is not present, meaning it’s an important warning sign that can be missed if symptoms are mislabelled. When apathy is mistaken for depression, people may receive treatments that worsen their apathy, leading to decreased daily functioning, higher caregiver stress, increased safety risks and poorer health over time.
What we can do to improve?
To improve differentiation between apathy and depression in people with brain disorders, we need targeted assessment tools that detect motivational decline separately from mood symptoms. Research shows that standard depression scales alone often fail to identify apathy because they focus on emotional distress rather than motivation and initiative.
One solution is to adopt a brief apathy-specific tool that is quick to administer in both care settings and at home. This tool consists of three questions:
- Have you dropped many of your activities and interests?
- Do you prefer to stay in your room/home rather than going out and doing new things? and
- Do you feel full of energy?
If the answers are “Yes” to question one or question two (or both) and “No” to question three, apathy — not depression — should be suspected.
Another important solution is to put training and awareness at the centre of clinical practice, education and caregiver support to improve care and quality of life for people with brain disorders.
Research shows that many clinicians, caregivers and health professionals lack specific training on how to recognize and differentiate apathy from depression, which contributes to misdiagnosis and suboptimal care.
Increasing education about apathy including how it presents, why it differs from mood disorders and how to use appropriate assessment tools helps clinicians make more accurate diagnoses and develop tailored care plans.
Training should also extend to multidisciplinary teams and family caregivers, because apathy often goes unrecognized in routine interactions and can be misinterpreted as laziness, resistance or depression.
In brain disorders where cognitive changes complicate the overlap of symptoms, differentiating between apathy and depression is essential to optimal living. Using appropriate screening tools to distinguish these symptoms can lead to better, more personalized care, improved use of health-care resources and, most importantly, can be lifesaving for people navigating complex brain disorders.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
– ref. Understanding the difference between apathy and depression can be lifesaving for people with brain disorders – https://theconversation.com/understanding-the-difference-between-apathy-and-depression-can-be-lifesaving-for-people-with-brain-disorders-273750