The Spanish Society of Palliative Care (SECPAL) and the Spanish Confederation of Alzheimer’s and Other Dementias (CEAFA) have challenged the assumption that symptoms like apathy, anxiety, and social withdrawal in Alzheimer’s patients are inevitable. On May 25, 2026, psychologist Anna Escolá, a member of SECPAL’s Neuropalliative Group and the Spanish Society of Palliative Psychology (SEPP-Psicopalis), called for a deeper examination of the triggers behind these behaviors, arguing that they often stem from emotional, environmental, or even physical factors—not just the progression of dementia.
The symptoms discussed—apathy, anxiety, and social withdrawal—fall under the clinical umbrella of Behavioral and Psychological Symptoms of Dementia (BPSD). The World Health Organization (WHO) identifies BPSD as a primary driver of caregiver burden and a significant factor in the institutionalization of dementia patients.
Why Symptoms Aren’t Just “Part of Alzheimer’s”
For decades, apathy, agitation, and isolation in Alzheimer’s patients have been treated as natural consequences of cognitive decline. But Escolá’s analysis, presented during a webinar on the psychological and behavioral dimensions of dementia, flips that script. According to Diario Estrategia, she emphasizes that these symptoms often have identifiable causes—organic, emotional, or environmental—and that addressing them can significantly improve quality of life. “We must avoid interpreting them solely as an inevitable consequence of dementia,” she says, stressing the need to “analyze possible triggers” before assuming they are purely biological.
Clinical literature distinguishes between organic apathy, which results from neurobiological damage to the prefrontal cortex, and reactive apathy, which is a psychological response to environmental stressors. This distinction is fundamental to the approach advocated by Escolá, as reactive symptoms may respond to environmental modifications even when neurodegeneration continues.
This perspective is not just theoretical. Escolá’s work with the Equipo de Atención Psicosocial (EAPS) Mutuam-Barcelona has shown that even subtle changes in environment or interaction can shift a patient’s emotional state. For example, a patient’s sudden apathy might not be a sign of worsening dementia, but a reaction to a recent loss, a change in routine, or even the way caregivers communicate. “The moment of diagnosis and the appearance of the first symptoms can be experienced very differently by the affected person and their family,” she notes, highlighting how emotional responses vary widely.
The Equipo de Atención Psicosocial (EAPS) Mutuam-Barcelona utilizes a person-centered care framework. This model focuses on the individual’s remaining functional abilities and psychological needs rather than focusing solely on cognitive deficits, a standard supported by various international geriatric organizations.
What Triggers Anxiety, Agitation, and Apathy?
Escolá’s approach is rooted in observation and intervention. She advises caregivers to closely monitor situations that provoke anxiety or agitation—such as loud noises, crowded spaces, or confrontational interactions—and to adapt the environment accordingly. “Creating tranquil, pleasant surroundings and avoiding confrontation are key,” she states. “A soft tone of voice, maintaining eye contact, and not insisting when resistance is present can make a big difference.”
Clinical guidelines from organizations such as the American Geriatrics Society prioritize non-pharmacological interventions (NPIs) as the first line of defense for managing non-psychotic BPSD. This priority is driven by the documented risks of antipsychotic medications in dementia patients, including an increased risk of falls and mortality.
“Observar las situaciones que las provocan, para prevenirlas, crear entornos tranquilos y agradables, transmitir calma y evitar la confrontación.”
Her recommendations extend beyond immediate triggers. For apathy and isolation, Escolá stresses the importance of keeping patients engaged in activities they enjoy, without forcing participation. “Maintaining active lifestyles without pressure, encouraging hobbies, and fostering social connections are critical,” she explains. “Active listening and allowing them to express emotions are also vital.”
What’s striking is how these strategies align with broader trends in dementia care. Recent research has increasingly highlighted the role of non-pharmacological interventions—such as music therapy, art, and social engagement—in managing behavioral symptoms. Escolá’s emphasis on emotional and environmental factors reflects this shift, arguing that a holistic approach can mitigate symptoms that were once considered untreatable.
What Caregivers Should Avoid
Escolá’s advice also includes a clear list of what not to do. According to <a href="https://fuentesinformadas.
- Discussing or contradicting the patient
- Speaking to them in a condescending or childlike tone
- Constantly testing their memory
- Confronting them about their forgetfulness
Research in geriatric psychology has documented the impact of “elderspeak”—speech patterns characterized by simplified vocabulary and a high-pitched, condescending tone. Studies indicate that elderspeak can decrease a patient’s social engagement and exacerbate feelings of helplessness, contributing to the cycle of isolation observed in many Alzheimer’s cases.
These interactions, while often well-intentioned, can exacerbate feelings of shame or helplessness, worsening symptoms. Escolá’s message is clear: small adjustments in communication and environment can lead to meaningful improvements in a patient’s emotional well-being.
The Diagnosis Moment: A Turning Point
The webinar also shed light on how the diagnosis itself can be a pivotal moment—both for the patient and their loved ones. Escolá notes that reactions range from relief (“finally, we know what’s happening”) to fear and uncertainty. This variability underscores the need for personalized support during this critical phase. “The diagnosis and the first symptoms can be lived very differently by the affected person and their family,” she says, emphasizing that emotional support should be tailored to individual needs.
This aligns with broader calls in the medical community for more integrated care models that combine medical treatment with psychological and social support. Escolá advocates for interventions like physical activity, cognitive stimulation, and therapies such as music or intergenerational activities, all of which have been shown to enhance emotional resilience and quality of life.
While the evidence supports the efficacy of environmental and social adjustments in mitigating behavioral symptoms, readers cannot conclude that these interventions halt the underlying neurodegenerative process. There is a clear clinical distinction between managing the symptoms of Alzheimer’s and modifying the disease’s progression.
What This Means for Alzheimer’s Care
Escolá’s insights challenge a long-held assumption in dementia care: that symptoms like apathy and agitation are simply part of the disease’s progression. Instead, she argues, these behaviors often have specific causes that can be identified and addressed. This shift could have significant implications for how caregivers, clinicians, and families approach Alzheimer’s management.
Medical guidelines suggest that when a patient experiences a sudden, acute escalation in agitation or confusion, clinicians should perform a differential diagnosis to rule out non-psychological triggers. These triggers frequently include urinary tract infections (UTIs), dehydration, electrolyte imbalances, or adverse reactions to newly prescribed medications.
For caregivers, the takeaway is clear: pay attention to the environment, communication, and emotional triggers. Small changes—such as reducing noise, avoiding confrontational interactions, and encouraging gentle social engagement—can make a substantial difference. For clinicians, this perspective may lead to more personalized treatment plans that go beyond medication to address the emotional and environmental factors influencing symptoms.
Looking ahead, Escolá’s work could pave the way for more holistic approaches to dementia care. As Notimérica reports, her emphasis on identifying and mitigating triggers aligns with growing recognition that Alzheimer’s is not just a cognitive disorder but a complex interplay of physical, emotional, and social factors. By focusing on these underlying causes, caregivers and clinicians may unlock new avenues for improving the lives of those affected by dementia.
If individuals observe sudden changes in a patient’s behavioral patterns, they should consult a neurologist, geriatrician, or a neuropsychologist to rule out secondary medical causes or to discuss adjustments to a clinical care plan.
For now, the message is simple: when faced with symptoms like apathy or anxiety in a loved one with Alzheimer’s, don’t assume it’s just part of the disease. Ask questions, observe patterns, and adapt. The right approach could change everything.
