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Video: Vascular Dementia – Understanding Apathy and Depression

Vascular dementia (VaD), the decline of cognitive skills due to reduced blood flow to the brain, can be particularly challenging to caregivers due to its unpredictability.  

View the video below to learn with dementia expert Teepa Snow why people with ​VaD can lose all motivation, a condition called "apathy."


View the full length program "Understanding Vascular Dementia" online and get 2+ hours worth of practical tips and skill-building information. Available in two convenient formats:



Video transcript:

…And I can have sudden spike in emotion. Because what we’re going to see then, is my mood and my affect shift suddenly. These sudden shifts, they’re called “emotional lability.” Suddenly I’m like “Wow, what just happened there?” I don’t know why she got so upset. So we’re going to demonstrate some of that, but then we’re going to show you the flip side, which is flatness. It’s called apathy.

It’s not true depression. It’s “I can’t care.” I can’t care about anything. I can’t care about a relationship. I can’t care about an activity. I can’t care about my body, I can’t care about time, I can’t care about anything. And I’m using deliberate word “Can’t,” I can’t care. Because the part of my brain that allows me to care about things isn’t working. I don’t care.

And it’s not that I’m not trying to care, it’s that I simply can’t care about things

So I have a ‘flatness’ to me, and it feel like you’re moving lead pipe to get me to do anything

“I don’t want to” is often what I say, but the answer is really “I can’t want to”. Because the part of my brain that creates the want, creates the desire, creates that drive to do things, that allowed me to build the company I built, that allowed me to have the relationships that I had, that allowed me to eat my meal, to dress myself well, to look groomed and put together, that part of my brain isn’t there anymore; it is not telling me to go do stuff. It’s not giving me any drive, none. And it just deadly for those around.

Because it is so hard to try to figure out how to get me “motivated” to do anything.

And it is probably one of the most significant symptoms in vascular dementia. We see it in some of the Frontotemporal dementias, but we definitely see it in vascular dementia a lot.

It sometimes gets mistaken for depression. The problem is…it is not depression, and an anti-depressant won’t touch it. Doesn’t do a thing for it, because it is not depression. It is not the same chemistry, it is not the same part of the brain. It is a part of the brain that has to be driven, and it is not driven anymore.

It is part of the very core limbic system. “I don’t care. I don’t care if I get up and go to the bathroom, I don’t care if I pee on myself, I don’t care if I’m chafed, or if you are mad at me, I don’t care.”

I don’t care, and it’s not because I don’t want to care. And that is the most important thing for us to take away from this. If I think it’s a deliberate choice on the other person’s part… Turn and look at the person next to you. “You are doing this on purpose.”

And we think if we just tried harder, we could get them to want this again. And the hard part for us…is letting go of that as a think. If you can quit thinking that way, then it won’t hurt so bad. Because it hurts, because you think it’s a deliberate act against you. And it’s not, it’s just where their brain has died.

That part of their brain is very vulnerable to vascular problems, and that is a really significant part.


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