CAMHblog

Dr. Tarek Rajji, Chief of Geriatric Psychiatry, discusses CAMH’s clinical services as they relate to Alzheimer disease.       

Alzheimer disease (AD) is the most common single cause of dementia. It affects more than half a million Canadians, five million Americans, and many more millions around the world. These numbers are likely to double within the next two decades. The cause of AD is still unknown. Current treatments are unsatisfactory. Yet we are increasing our knowledge every day, and investigating new treatments that may improve outcomes. Promising research—including cutting edge work currently being done at CAMH—gives us every reason to be hopeful.

Before discussing this research, let me describe CAMH’s clinical services as they relate to Alzheimer disease. Our Geriatric Mental Health Services and Memory Clinic offer - within two weeks of a referral by a physician or a self-referral - assessment, care, and education to individuals with AD, their families, and other stakeholders, such as long-term care facilities. The approach is interprofessional and integrates various disciplines: geriatric psychiatry, neurology, neuropsychiatry, neuropsychology, nursing, occupational therapy, and social work.

At CAMH, we have a number of ongoing, externally funded research studies that aim at understanding the causes and courses of AD, developing novel interventions to treat both its cognitive and psychiatric symptoms, and addressing end-of-life issues for individuals with AD and their families.

Using PET imaging to measure brain amyloid plaques or deposits, one of the core features of AD, one study aims at understanding the relationship between these deposits and the psychiatric manifestation of late-onset fronto-temporal dementia compared to AD (Principal Investigator: Dr. Tiffany Chow; Support: US National Institute of Aging). Another PET brain imaging study aims at understanding the role of neuro-inflammation in AD (Principal Investigator: Dr. Romina Mizrahi; Support: Alzheimer Society of Canada, and W. Garfield Weston Foundation).

We know we need better treatments, especially ones that can work with the brain’s own abilities to change. Towards the development of novel treatments, one brain stimulation study aims at assessing and enhancing frontal lobes neuro-plasticity and function in individuals with AD (Principal Investigator: Dr. Tarek Rajji; Support: W. Garfield Weston Foundation).

The psychiatric symptoms of AD are among its most distressing features. While our knowledge is limited on how to treat them, one large multi-site study aims at evaluating the efficacy and safety of the antidepressant citalopram in the treatment of agitation in individuals with AD (Principal Investigator: Dr. Bruce Pollock; Support: US National Institute of Aging).

Given the challenges that individuals with AD and their families face during the late stages of this illness, one study aims at evaluating the impact of brief education on older people’s attitudes and preferences for medical interventions for common, serious health problems that typically occur during different stages of AD (Principal Investigator: Dr. Robyn Waxman; Support: PSI Foundation).

Finally, a substantial portion of a large Canada Foundation for Innovation-Leading Edge Fund grant recently awarded to CAMH (Project Leader: Dr. Bruce Pollock) will be dedicated to the study of AD. In collaboration with Dr. Peter St. George-Hyslop at U of T’s Tanz Centre for Research in Neurodegenerative Diseases, this will include the establishment of a brain bank to collect and distribute donor tissue to researchers. Several other projects are trying to elucidate the relationship among aging, severe mental illness, and cognitive decline.

With a population close to 7 million senior Canadians by 2021, CAMH is setting itself in a strong position to address the challenges that older Canadians will face with Alzheimer disease.
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