Patients and caregivers suffering from the agitation that often accompanies Alzheimer’s disease may find much-needed relief from a pair of interventional studies led by a Western researcher.
Schulich School of Medicine and Dentistry (Psychiatry and Medicine) professor Amer Burhan said agitation with Alzheimer’s is a significant source of stress and can be difficult to treat.
Often, someone with the degenerative neurological disease will become irrational, annoyed or angry. They may verbally or physically lash out with no apparent provocation.
“We’re now more certain it is a symptom of the changes in the brain,” said Burhan, a scientist at Lawson Health Research Institute and geriatric neuropsychiatrist at St. Joseph’s Health Care London. “In general, the agitation gets worse as the illness progresses, which means people become less and less aware and, therefore, become more and more agitated.”
And even if caregivers are primed to expect this symptom, few are trained to manage it: the frustration of dealing with a suddenly irascible loved one may be more difficult emotionally than dealing with other aspects of the patient’s cognitive decline.
“Understanding the complexity of this illness, beyond just the memory problem is important,” said Burhan. “You can probably live with the fact your loved one kind of forgets things here and there, but it’s much more difficult to deal with being insulted by someone you love and care for – and they’ve never been like this before. It’s a dramatic change in their personality. It’s not a choice they’re making, it’s a change in their brain,” he said.
Western has become a Canadian leader in working towards better prevention, diagnosis, treatment and care – across the spectrum of research, medical and psychosocial efforts – for families living with Alzheimer’s disease.
And Parkwood Institute, a part of St. Joseph’s, is one of multiple sites across Canada and the United States to participate in two major studies aimed at helping both the patient and their family.
The first identifies patients early in their diagnosis and applies a psychosocial approach to manage agitation.
Burhan’s research team will connect with families soon after diagnosis and provide tools and support at home: to help them understand possible reasons for agitation and offer interventions such as calm communication, scheduling meaningful activities and maintaining routine in life.
The study is funded by the National Institute of Aging, in collaboration with John Hopkins University and multiple United States and Canadian centres.
If the agitation persists or increases, patients will be randomly selected to receive either a placebo or medication known as S-Citalopram to treat agitation while both groups continue to receive psychosocial care.
Participants will also continue to receive care from their primary physician and care teams, in addition to the research team’s interventions.
The second study aims to standardize care for agitated patients whose disease has progressed to the point where they are in hospital or in long-term care. It is funded by Brain Canada and the Centre of Aging and Brain Health Innovation, in collaboration with Canadian Association of Mental Health, University of Toronto, McGill University and the University of Calgary.
Patients will continue receiving either their current treatment plan for agitation, or receive a care pathway that includes step-by-step, methodical changes.
These may include washing out medications that have not helped; adding individualized behavioural and environmental supports; and, if medications are needed, using the drugs and dosages suggested by best evidence, added Burhan.
“It’s a structured approach we need to help people deal with this,” said Burhan.
“We want to modify this symptom it in a way that will make it less likely to impact quality of life and allow them to live the best possible way,” he continued. “While I’d love to see those living with this illness have longer lives, it’s not just about living longer. You want to be able to give them quality, or you’re just prolonging the suffering. So, if I can help people reduce their burden, and the burden on their family, that is the best-case scenario.”