By Patrick Callan, Communications Coordinator
Alzheimer’s disease—the most common form of dementia—is widely known to cause memory loss and reduce a person’s ability to perform daily activities. There are currently more than 747,000 Canadians living with Alzheimer’s disease and this number is projected to increase to 1.4 million by 2031.
A lesser known fact about Alzheimer’s is that other symptoms of the disease can significantly impact a person’s mental health. While there is no cure, CAMH is conducting ground-breaking research on how to prevent the onset of Alzheimer’s in high-risk individuals and to treat those living with the disease.
In 2014, CAMH received the largest-ever grant for Alzheimer’s prevention—$10 million over 5 years—for a study called PACt-MD (Preventing Alzheimer's dementia with Cognitive remediation plus tDCS in MCI and Depression).
The study originated at CAMH and now includes four of Toronto’s other leading research hospitals: Baycrest, St. Michael’s, Sunnybrook and University Health Network. It involves eight weeks of brain stimulation and computer-based brain training with people 60 and older who have a high risk of developing Alzheimer’s.
Before someone is diagnosed with Alzheimer’s they have a condition known as Mild Cognitive Impairment (MCI), which means they have memory problems but not enough for a for a dementia diagnosis, explains Dr. Benoit Mulsant, Clinician Scientist in the Campbell Family Mental Health Research Institute at CAMH and Labatt Family Chair of the Department of Psychiatry in the Faculty of Medicine at the University of Toronto.
“With PACt-MD we are trying to see if over three to eight years we are going to be able to slow down the progression from MCI to dementia,” he says. “The study is not finished, but what we have seen is that the people who participated in the research are doing very well as a group.”
In related work, a successful CAMH model to treat the more than 80 per cent of people with Alzheimer’s disease who experience agitation or show aggression is now being expanded to seven sites across Canada.
The Integrated Care Pathway model outlines a step-by-step treatment process, using standardized assessments and specific measures and thresholds for prescribing and changing medications.
In the pilot phase, CAMH saw some very important results in terms of reducing rates of polypharmacy (i.e., patients using multiple medications), says Dr. Tarek Rajji, Chief of the Adult Neurodevelopment and Geriatric Psychiatry Division at CAMH.
“Psychotropic polypharmacy is a major problem in seniors including those living with dementia,” he says. “Our pilot work showed that we can reduce polypharmacy to four per cent while still being effective in treating agitation in Alzheimer’s dementia. We also saw some promising results in reducing rates of falls and length of stay.”
One of the most common misconceptions with the study of Alzheimer’s disease is that it is often considered to be separate from mental illness.
Dr. Mulsant says when people are diagnosed with Alzheimer’s disease they will typically live eight to ten years as they go through the stages from mild to moderate to severe.
“When people think of Alzheimer’s disease they think of the defining manifestations, which is memory problems and memory loss,” he says. “In the early stages of Alzheimer’s more than 50 per cent of people will develop anxiety or depression and as they move to the moderate to severe range, they will develop psychosis, agitation and aggression.”
Another common misconception is that Alzheimer’s disease is part of aging, adds Dr. Rajji.
“As we get older our cognitive abilities decline, including memory, but this is different from having Alzheimer’s disease. In Alzheimer’s disease, there is a significant decline in our abilities to function independently and often in our behaviours,” he says. “These behavioural symptoms include personality changes, mood symptoms, anxiety symptoms, psychosis, and agitation.”
Future research and treatment
“We have come to the realization that once people have the outwards symptoms of Alzheimer’s dementia it’s probably too late. If we really want to affect the brain, we need to move way earlier before the brain is destroyed,” says Dr. Mulsant. “The entire field of Alzheimer’s research is going through a bit of a reset and moving to treating the disease long before you develop the symptoms. That’s where PACt-MD positions itself.”
In addition to PACt-MD and the ICP, CAMH is working towards completing a number of other ongoing large research studies on Alzheimer’s disease, says Dr. Rajji.
The long-term goal is to establish a multidisciplinary centre that aims at discovering the links between aging, mental health and dementia, and to develop comprehensive treatments for dementia and interventions to prevent it, he adds.
“Our vision is aging without dementia,” he says. “In theory, a large proportion of people living with dementia could have had their dementia prevented. We have a lot of ideas of how we can prevent it. We need to test these ideas using state-of-the-art scientific methods.”