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Spring 2015 Centre for Addiction
and Mental Health

Preventing Alzheimer’s dementia in older adults


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Preventing Alzheimer’s dementia in older adults


Is it possible to slow down or delay the dementia symptoms that occur with Alzheimer’s disease?

CAMH’s Physician-in-Chief, Dr. Benoit Mulsant, believes so. Dr. Mulsant is leading a study that combines two innovative treatments that aim to alter the brain’s plasticity to improve memory and learning, and maintain these changes to delay the onset of dementia symptoms.

“There is no cure for Alzheimer’s disease, only management of symptoms, so our best chance is to try and prevent it, to reduce the burden of disease as the population ages,” says Dr. Mulsant, who is also Senior Scientist in the Campbell Family Mental Health Research Institute at CAMH. According to the Alzheimer Society of Canada, 747,000 Canadians were living with the disease in 2011, and this number is projected to increase to 1.4 million by 2031.

A two-pronged approach

The study treatment involves a brain stimulation method called transcranial direct current stimulation (tDCS). Study participants will receive painless electrical pulses that alter the strength of connections between neurons – the “wiring” that underpins our ability to learn and remember. To reinforce these brain changes, a therapist will then lead participants in completing computer-based memory and thinking exercises. This second technique is called cognitive remediation.

“Our goal is to delay the onset of dementia by five years,” says Dr. Mulsant of the study, which is called PACt-MD: Prevention of Alzheimer’s Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation in Mild Cognitive Impairment and Depression.

Behind the study

The target is older adults who have one of two specific conditions that increase their risk of developing dementia: those 65 or older with late-life depression, or those aged 60 or older with mild cognitive impairment.

A wealth of research backs the concept behind the study, which Dr. Mulsant developed with co-investigators Dr. Tarek Rajji, CAMH’s Chief of Geriatric Psychiatry, and Dr. Bruce G. Pollock, Vice President of Research at CAMH. Yet this is the first time this combination of techniques is being formally evaluated through research, thanks to funding by Brain Canada and the Chagnon Family.

Study participants will be randomly assigned to one of two groups: one group will receive the combination of treatments, and the other will serve as the comparison or control group that receives placebo treatment. Participants will be monitored for five years through regular follow-up visits to determine if this treatment combination delays the onset of dementia symptoms.

The study sites are at CAMH and Sunnybrook Health Sciences Centre, with co-investigators at three other major Toronto hospitals: Baycrest, St. Michael’s Hospital and University Health Network.

 

What is mild cognitive impairment?      

​Mild cognitive impairment is a significant decline in a person’s cognitive abilities – such as memory, learning, attention, planning – that is noticeable in daily life but is not so severe that it interferes with independent living. Some cognitive lapses are a normal part of aging. For example, it's normal to momentarily forget a person’s name, or where you put your keys. Frequent lapses, or more serious lapses, such as forgetting conversations or appointments, may be symptoms of mild cognitive impairment. In some, but not all, cases, mild cognitive impairment is an early warning sign of dementia.

 
 

What is cognitive remediation?

Cognitive remediation (CR) is a form of cognitive therapy in which a therapist guides a small group through a series of brain training exercises. It is used to enhance cognitive skills such as learning, memory, attention and planning.​​

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    Dr. Benoit Mulsant

 

 Join the study

 

The PACt-MD research team is seeking participants aged 65 or older with depression or 60 and older with mild cognitive impairment. If you are interested, please email pact.md@camh.ca or call 416-583-1350.

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