Apathy and Depression in Dementia: A Care Staff Guide to Telling Them Apart

A resident with dementia who used to enjoy the garden now sits in the same chair all day. They do not join in, do not start conversations and seem to have lost interest in things they once loved. Staff may wonder whether this is depression, or whether the dementia itself is taking away their drive. The two can look alike, but they are different problems and call for different responses.

This guide explains the difference between apathy and depression in dementia, what they have in common, and how care staff can respond. It draws on two Alzheimer's Society pages: one on apathy and dementia, updated in June 2025, and one on depression and dementia, which shows no review date.

What is apathy in dementia?

The Alzheimer's Society describes apathy as a loss of motivation or drive. It is most common in the later stages of dementia, but it can start earlier in dementia with Lewy bodies, Parkinson's disease dementia and frontotemporal dementia. Our guide to frontotemporal dementia explains why that type can bring changes in behaviour and motivation early on.

Signs of apathy listed by the Alzheimer's Society include:

• Long periods of inactivity.
• Relying on others to plan activities.
• Less interest in conversation.
• Flat or detached emotional responses.
• Little energy for routine tasks, such as washing.
• Sleeping during the day.

The Alzheimer's Society says causes can include an emotional response to the difficulties dementia brings, withdrawing from shame or embarrassment, brain changes that affect effort and reward, and trouble starting or finishing tasks.

What is depression in dementia?

The Alzheimer's Society says depression is common in people with dementia. It is often diagnosed early but can occur at any stage, and it can make memory and thinking problems worse. The risk is higher for people who have had depression before, and care home residents seem to be at particular risk. The Alzheimer's Society also notes that dementia raises the risk of suicide, especially in the first months after diagnosis. Our guide to depression screening for older adults covers screening tools for older people in care homes.

How to tell them apart

Both apathy and depression can involve losing interest and having low energy. The Alzheimer's Society draws these distinctions:

• Depression includes more negative feelings, such as sadness or guilt. The Alzheimer's Society lists losing interest in enjoyed activities, guilt or worthlessness, tearfulness and giving up easily as typical of depression.
• Apathy is more about a lack of drive. People with apathy often seem unbothered by their symptoms.

The Alzheimer's Society lists poor concentration, forgetfulness, tiredness, sleep problems, irritability and self-neglect among the signs of depression. Several of these can also be caused by dementia itself, which is one reason the two are easy to confuse. In older adults, depression can also show as more agitation, health anxiety and physical aches, and in later-stage dementia as tearfulness and poor appetite. Because the picture is confusing, staff should not try to decide between them. Describe what you see and report it so a GP or mental health professional can assess.

Why the difference matters

Treatment for the two is quite different. For apathy, the Alzheimer's Society says it is difficult to treat with medicines or talking therapies, and that the main approach is to keep the person active and build their confidence. It adds that there is little evidence that antidepressants help apathy, and some evidence that they may make it worse.

For depression, the Alzheimer's Society says mild symptoms may be helped by support groups or self-help. For severe or persistent depression, a GP or mental health professional may prescribe antidepressants alongside talking therapy, though antidepressants do not seem to be as effective in dementia, and talking therapies can be effective in the early to middle stages. Our guide to dementia medicines covers other medicines used in dementia care.

How care staff can help with apathy

The Alzheimer's Society suggests:

• Keeping a daily and weekly routine.
• Choosing activities that suit the person and give them some control.
• Creating accepting spaces where mistakes are fine.
• Breaking tasks into small steps.
• Avoiding taking over, which can erode confidence and skills.
• Staying patient and calm, and not blaming the person.

It also points to dementia groups, cafes and Singing for the Brain, and to structured therapies such as music, art, reminiscence and cognitive stimulation where they are available.

How care staff can help with depression

The Alzheimer's Society suggests involving the person in decisions, listening patiently instead of urging them to cheer up, encouraging social contact and one-to-one time, promoting regular physical activity (ideally outdoors), offering life story work and creative or group activities, supporting healthy eating, building routines and purpose, and reducing clutter and improving lighting. It also advises that people should keep taking prescribed medicines and not stop suddenly, and that complementary therapies should be checked with a GP first because some, such as St John's wort and CBD, can interact with other drugs.

When to escalate

The following points are general good practice, not drawn from the Alzheimer's Society pages. Report promptly if a person talks about wanting to die or harm themselves, stops eating or drinking, sleeps much more or less than usual, or has a sudden change in mood or behaviour. Follow your organisation's risk procedures and speak to a senior colleague, the GP or the mental health team the same day. The Alzheimer's Society suggests contacting the Samaritans if suicidal thoughts are a concern.

Training and CPD

Telling apathy from depression takes observation and teamwork. Record what you learn in your CPD log, discuss real examples in supervision, and browse the options on our CPD pages.

Key points to remember

• Apathy is a loss of motivation; depression brings sadness, guilt or worthlessness. They can look alike and can occur together.
• Apathy is hard to treat with medicines or talking therapies; keeping the person active and confident is the main approach.
• Antidepressants show little evidence of benefit for apathy and may make it worse.
• Depression is common in dementia and raises the risk of suicide, especially soon after diagnosis.
• Describe and report changes rather than deciding which it is.

Frequently asked questions

Can a person have both apathy and depression?

Yes. The Alzheimer's Society covers apathy and depression on separate pages because they can look similar, and staff should report changes so both can be assessed.

Should staff try to cheer the person up?

No. The Alzheimer's Society advises listening patiently instead of urging someone with depression to cheer up.

Are antidepressants the answer for apathy?

The Alzheimer's Society says there is little evidence that they help apathy and some evidence that they may make it worse, so any medicine decision belongs to the prescriber.

This guide is for general information and is not a substitute for clinical advice or your organisation's policies.