Abstract
Apathy is a highly prevalent and disabling neuropsychiatric syndrome, but its multi-dimensional structure is a challenge for progress towards better identification and treatment. A crucial unresolved question is whether social disengagement reflects a distinct deficit in social motivation or a by-product of diminished initiative or emotional blunting. Previous studies have been constrained by modest sample sizes and limited use of apathy-specific instruments or phenotypically narrow cohorts. Here, we analysed item-level data from 11,243 individuals recruited across multiple centres, including 1154 neurological patients with Alzheimer’s disease, Parkinson’s disease, frontotemporal dementia, autoimmune encephalitis and small vessel disease, alongside people with depression and healthy adults. Across exploratory and confirmatory factor analyses, symptom-level network modelling, and lifespan analyses, social apathy consistently emerged as a coherent and separable dimension. This pattern was preserved across health, psychiatric, and neurocognitive cohorts, from adolescence through late life. Recognising social apathy as an independent domain reframes a central aspect of mental health—the motivation to connect, care, and act for others—and provides a foundation for more precise assessment and for interventions targeting both social and neurobiological mechanisms.
References
Miller DS, Robert P, Ereshefsky L, Adler L, Bateman D, Cummings J, et al. Diagnostic criteria for apathy in neurocognitive disorders. Alzheimers Dement. 2021;17:1892–904.
Robert P, Onyike CU, Leentjens AFG, Dujardin K, Aalten P, Starkstein S, et al. Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. Eur Psychiatry. 2009;24:98–104.
Malpetti M, Jones PS, Tsvetanov KA, Rittman T, van Swieten JC, Borroni B, et al. Apathy in presymptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes. Alzheimers Dement. 2021;17:969–83.
van Dalen JW, Van Wanrooij LL, Moll van Charante EP, Richard E, van Gool WA. Apathy is associated with incident dementia in community-dwelling older people. Neurology. 2018;90:e82–e89.
van Dalen JW, van Wanrooij LL, Moll van Charante EP, Brayne C, van Gool WA, Richard E. Association of apathy with risk of incident dementia: a systematic review and meta-analysis. JAMA Psychiatry. 2018;75:1012–21.
Harrison F, Mortby ME, Mather KA, Sachdev PS, Brodaty H. Apathy as a determinant of health behaviors in older adults: Implications for dementia risk reduction. Alzheimers Dement Diagn Assess Dis Monit. 2023;15:e12505.
Dolphin H, Dyer AH, McHale C, O’Dowd S, Kennelly SP. An update on apathy in Alzheimer’s disease. Geriatrics. 2023;8:75.
Connors MH, Teixeira-Pinto A, Ames D, Woodward M, Brodaty H. Apathy and depression in mild cognitive impairment: distinct longitudinal trajectories and clinical outcomes. Int Psychogeriatr. 2023;35:633–42.
Murley AG, Rouse MA, Coyle-Gilchrist ITS, Jones PS, Li W, Wiggins J, et al. Predicting loss of independence and mortality in frontotemporal lobar degeneration syndromes. J Neurol Neurosurg Psychiatry. 2021;92:737–44.
Zhao S, Ye R, Sen A, Li M, Karataş KF, Lockwood P, et al. On the relationships between apathy, depression and anhedonia. J Neurol Neurosurg Psychiatry. 2026 https://doi.org/10.1136/jnnp-2025-337245.
Hewitt SRC, Norbury A, Huys QJM, Hauser TU. Day-to-day fluctuations in motivation drive effort-based decision-making. Proc Natl Acad Sci. 2025;122:e2417964122.
Husain M, Roiser JP. Neuroscience of apathy and anhedonia: a transdiagnostic approach. Nat Rev Neurosci. 2018;19:470–84.
Rizvi SJ, Pizzagalli DA, Sproule BA, Kennedy SH. Assessing anhedonia in depression: Potentials and pitfalls. Neurosci Biobehav Rev. 2016;65:21–35.
Starkstein SE, Ingram L, Garau ML, Mizrahi R. On the overlap between apathy and depression in dementia. J Neurol Neurosurg Psychiatry. 2005;76:1070–4.
Mortby ME, Maercker A, Forstmeier S. Apathy: a separate syndrome from depression in dementia? A critical review. Aging Clin Exp Res. 2012;24:305–16.
Lanctôt KL, Ismail Z, Bawa KK, Cummings JL, Husain M, Mortby ME, et al. Distinguishing apathy from depression: A review differentiating the behavioral, neuroanatomic, and treatment-related aspects of apathy from depression in neurocognitive disorders. Int J Geriatr Psychiatry. 2023;38:e5882.
Levy ML, Cummings JL, Fairbanks LA, Masterman D, Miller BL, Craig AH, et al. Apathy is not depression. J Neuropsychiatry Clin Neurosci. 1998;10:314–9.
Masdrakis VG, Markianos M, Baldwin DS. Apathy associated with antidepressant drugs: a systematic review. Acta Neuropsychiatr. 2023;35:189–204.
Dickson SS, Husain M. Are there distinct dimensions of apathy? The argument for reappraisal. Cortex. 2022;149:246–56.
Marin RS. Differential diagnosis and classification of apathy. Am J Psychiatry. 1990;147:22–30.
Levy R, Dubois B. Apathy and the functional anatomy of the prefrontal cortex–basal ganglia circuits. Cereb Cortex. 2006;16:916–28.
Robert P, Lanctôt KL, Agüera-Ortiz L, Aalten P, Bremond F, Defrancesco M, et al. Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group. Eur Psychiatry J Assoc Eur Psychiatr. 2018;54:1–76.
Ang Y-S, Lockwood P, Apps MAJ, Muhammed K, Husain M. Distinct subtypes of apathy revealed by the apathy motivation index. PLoS ONE. 2017;12:e0169938.
Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the apathy evaluation scale. Psychiatry Res. 1991;38:143–62.
Radakovic R, Abrahams S. Multidimensional apathy: evidence from neurodegenerative disease. Curr Opin Behav Sci. 2018;22:42–9.
Zhao S, Scholcz A, Rouse MA, Klar VS, Ganse-Dumrath A, Toniolo S, et al. Self- versus caregiver-reported apathy across neurological disorders. Brain Commun. 2025;7:fcaf235.
Steffens DC, Fahed M, Manning KJ, Wang L. The neurobiology of apathy in depression and neurocognitive impairment in older adults: a review of epidemiological, clinical, neuropsychological and biological research. Transl Psychiatry. 2022;12:1–16.
Zhao Q-F, Tan L, Wang H-F, Jiang T, Tan M-S, Tan L, et al. The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: Systematic review and meta-analysis. J Affect Disord. 2016;190:264–71.
Thompson J, Bi M, Murchison AG, Makuch M, Bien CG, Chu K, et al. The importance of early immunotherapy in patients with faciobrachial dystonic seizures. Brain. 2018;141:348–56.
Ceronie B, Strippel C, Uy C, Paneva S, Makuch M, Soleimani B, et al. Immunotherapy-resistant neuropathic pain and fatigue predict quality-of-life in contactin-associated protein-like 2 antibody disease. Ann Neurol. 2025;97:521–8.
MacAskill MR, Pitcher TL, Melzer TR, Myall DJ, Horne K-L, Shoorangiz R, et al. The New Zealand Parkinson’s progression programme. J R Soc N Z. 2023;53:466–88.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Beck AT, Steer RA, Brown G Manual for the beck depression inventory-II. 1996. https://doi.org/10.1037/t00742-000.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.
Radakovic R, Starr JM, Abrahams S. A novel assessment and profiling of multidimensional apathy in Alzheimer’s disease. J Alzheimer’s Dis. 2017;60:57–67.
Hsieh S, Schubert S, Hoon C, Mioshi E, Hodges JR. Validation of the addenbrooke’s cognitive examination III in frontotemporal dementia and Alzheimer’s disease. Dement Geriatr Cogn Disord. 2013;36:242–50.
Cohen J Statistical Power Analysis for the Behavioral Sciences. 2nd edn Routledge: New York, 1988 https://doi.org/10.4324/9780203771587.
Klar VS, Ang Y-S, Lockwood P, Attaallah B, Dickson S, Drew D, et al. Assessment of apathy in neurological patients using the apathy motivation index caregiver version. J Neuropsychol. 2022;16:236–58.
Fried EI, van Borkulo CD, Cramer AOJ, Boschloo L, Schoevers RA, Borsboom D. Mental disorders as networks of problems: a review of recent insights. Soc Psychiatry Psychiatr Epidemiol. 2017;52:1–10.
Briganti G, Scutari M, Epskamp S, Borsboom D, Hoekstra RHA, Golino HF, et al. Network analysis: An overview for mental health research. Int J Methods Psychiatr Res. 2024;33:e2034.
Blondel VD, Guillaume J-L, Lambiotte R, Lefebvre E. Fast unfolding of communities in large networks. J Stat Mech Theory Exp. 2008;2008:P10008.
Traag V, Waltman L, Eck NJ, van. From louvain to leiden: guaranteeing well-connected communities. Sci Rep. 2019;9:5233.
Le Heron C, Holroyd CB, Salamone J, Husain M. Brain mechanisms underlying apathy. J Neurol Neurosurg Psychiatry. 2019;90:302–12.
Tay J, Tuladhar AM, Hollocks MJ, Brookes RL, Tozer DJ, Barrick TR, et al. Apathy is associated with large-scale white matter network disruption in small vessel disease. Neurology. 2019;92:e1157–e1167.
Apps MAJ, Rushworth MFS, Chang SWC. The anterior cingulate gyrus and social cognition: tracking the motivation of others. Neuron. 2016;90:692–707.
Lockwood PL, Wittmann MK, Nili H, Matsumoto-Ryan M, Abdurahman A, Cutler J, et al. Distinct neural representations for prosocial and self-benefiting effort. Curr Biol. 2022;32:4172.e7.
Lockwood PL, Hamonet M, Zhang SH, Ratnavel A, Salmony FU, Husain M, et al. Prosocial apathy for helping others when effort is required. Nat Hum Behav. 2017;1:1–10.
Lockwood PL, Cutler J, Drew D, Abdurahman A, Jeyaretna DS, Apps MAJ, et al. Human ventromedial prefrontal cortex is necessary for prosocial motivation. Nat Hum Behav. 2024;8:1403–16.
Van Overwalle F. Social cognition and the brain: a meta-analysis. Hum Brain Mapp. 2009;30:829–58.
Adolphs R. The social brain: neural basis of social knowledge. Annu Rev Psychol. 2009;60:693–716.
Amodio DM, Frith CD. Meeting of minds: the medial frontal cortex and social cognition. Nat Rev Neurosci. 2006;7:268–77.
Kalenscher T, Lüpken LM, Stoop R, Terburg D, van Honk J. Steeper social discounting after human basolateral amygdala damage. Proc Natl Acad Sci. 2025;122:e2500692122.
Grabenhorst F, Báez-Mendoza R, Genest W, Deco G, Schultz W. Primate amygdala neurons simulate decision processes of social partners. Cell. 2019;177:986.e15.
Williams RS, Adams NE, Hughes LE, Rouse MA, Murley AG, Naessens M, et al. Syndromes associated with frontotemporal lobar degeneration change response patterns on visual analogue scales. Sci Rep. 2023;13:8939.
Acknowledgements
This work was supported by the Wellcome Trust and the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre. S.Z., S.T., M.J.B., and M.H. are funded by the Wellcome Trust [226645/Z/22/Z]. S.T., S.G.M. and M.H. are funded by and the NIHR Oxford Health BRC. S.G.M. is also supported by the NIHR Oxford BRC. J.B.R. is supported by the Medical Research Council [MC_UU_00030/14; SUAG/092 G116768], the Wellcome Trust [220258], the NIHR Cambridge Biomedical Research Centre [NIHR203312], and the Holt Fellowship. S.R.I. is supported by a Senior Clinical Fellowship from the Medical Research Council [MR/V007173/1], a Wellcome Trust Fellowship [104079/Z/14/Z], the Kogod Centre on Aging (Mayo Clinic), and the NIHR Oxford Biomedical Research Centre. R.Y. is supported by the National Natural Science Foundation of China [82171917, 82471271, U23A20424], the Anhui Provincial Natural Science Foundation [2408085Y047], and the Natural Science Research Project of Anhui Educational Committee [2023AH050592]. Q.Y.T. was funded by Guangdong and Hong Kong Universities “1 + 1 + 1” Joint Research Collaboration Scheme (2025A0505000011). C.L.H. is supported by a grant from the Canterbury Medical Research Foundation [02/2019]. B.A. is supported by an NIHR Academic Clinical Lectureship. We gratefully acknowledge all the participants, their families, and the staff at the Cognitive Disorders Clinic and the Autoimmune Neurology Clinic at John Radcliffe Hospital, Addenbrooke’s Hospital, St George’s Hospital, the New Zealand Brain Research Institute and the China Parkinson’s Disease Advanced Center for their dedication to this programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Author information
Authors and Affiliations
Contributions
SZ conceptualised and designed the study. MH supervised the project and acquired the funding. Patient recruitment and clinical data collection were carried out by SZ, RY, BA, STo, YS, MAR, PG, MJB, STh, SGM, SRI, YSA, PL, MAJA, PH, KW, JBR, CLH, and MH. SZ performed the formal data analysis and visualisation. QYT contributed proprietary software and analytical tools, and reviewed the analysis scripts. SZ and MH wrote the first draft of the manuscript. All authors reviewed and edited the manuscript, and approved the final submitted version.
Corresponding author
Ethics declarations
Competing interests
S.R.I. has received honoraria and/or research support from Amgen, Argenx, UCB, Roche, Janssen, IQVIA, Clarivate, Slingshot Insights, Cerebral Therapeutics, BioHaven Therapeutics, CSL Behring, and ONO Pharma. S.R.I. also receives licensed royalties on patent application WO/2010/046716 entitled Neurological Autoimmune Disorders, and has filed two other patents entitled Diagnostic Method and Therapy (WO2019211633; US App 17/051,930; PCT application WO202189788A1) and Biomarkers (WO202189788A1; US App 18/279,624; PCT/GB2022/050614). All other authors declare no competing interests.
Data sharing
Data from both healthy participants and patient cohorts were collected across multiple centres under separate local ethical approvals. Due to these ethical restrictions, not all data can be shared publicly. Patient data are available upon reasonable request, subject to approval from the original data providers (i.e. the researchers responsible for data collection) and compliance with relevant ethical, legal, and confidentiality requirements.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Zhao, S., Ye, R., Tang, QY. et al. The social dimension of apathy: evidence for a distinct domain from 11,243 individuals across health and neurocognitive disorders. Transl Psychiatry (2026). https://doi.org/10.1038/s41398-026-04023-4
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41398-026-04023-4
