New research presented at the Alzheimer’s Association International Conference (AAIC) 2018 in Chicago focuses on the recent successes and ongoing challenges of drug and non-drug treatments for the non-cognitive symptoms experienced by people living with Alzheimer’s dementia.
While the memory and thinking symptoms associated with the disease are the most well known, it is the behavioral and psychological symptoms of dementia (BPSD) — agitation, anxiety, apathy, depression, wandering, hallucinations, insomnia, incontinence, disinhibition — that often cause the greatest caregiving challenges and are the leading causes for placement in assisted living or nursing homes. Left untreated, these symptoms can accelerate decline and reduce quality of life.
Maria Carrillo, PhD, Alzheimer’s Association Chief Science Officer, said: “These underrecognized and undertreated symptoms in people with Alzheimer’s and other dementias are often very difficult to live with and challenging to treat. One of the ‘untold stories’ of Alzheimer’s is the regular occurrence and overwhelming impact of these symptoms on the lives of people with Alzheimer’s, their family members and caregivers."
Results of a randomised, double-blind clinical trial suggest that nabilone — a synthetic cannabinoid — may be effective in treating agitation in people with Alzheimer’s disease.
“Agitation, including verbal or physical outbursts, general emotional distress, restlessness, pacing, is one of the most common behavioral changes associated with Alzheimer’s as it progresses, and can be a significant cause of caregiver stress,” said Krista L. Lanctôt, PhD, Senior Scientist at Sunnybrook Health Sciences Centre and Professor of Psychiatry and Pharmacology/Toxicology at the University of Toronto.
Lanctôt and colleagues investigated the potential benefits of nabilone for adults with moderate to severe Alzheimer’s dementia with clinically significant agitation. Over the 14-week trial duration, 39 participants (77% male, average age 87) received nabilone in capsule form (mean therapeutic dose=1.6 +/- .5 mg) for six weeks, followed by six weeks of placebo, with one week between each treatment period. In addition to measuring agitation, the researchers assessed overall behavioural symptoms, memory, physical changes and safety. They found that:
- Agitation improved significantly in those taking nabilone, compared to placebo, as measured by the Cohen-Mansfield Agitation Inventory (p=0.003).
- Nabilone also significantly improved overall behavioural symptoms, compared to placebo, as measured by the Neuropsychiatric Inventory (p=0.004).
The researchers also observed small benefits in cognition and nutrition during the study. More people in the study experienced sedation on nabilone (45%) compared to placebo (16%).
Another study looked at how lighting may improve sleep, mood and behaviour in people with Alzheimer's. Many people living with Alzheimer’s disease and other dementias experience changes in their sleep patterns, insomnia, and daytime sleepiness. Mariana G. Figueiro, PhD, Director of the Lighting Research Center at Rensselaer Polytechnic Institute in Troy, NY, and colleagues tested whether a tailored lighting system could help to improve sleep, mood and behaviour in people with Alzheimer’s disease in nursing homes.
“Given that light/dark patterns are a person’s primary cues to the current time, the constant dim light typically experienced by people living in residential care facilities may be an underlying cause of the sleep pattern disturbances so commonly found in this population,” said Figueiro.
To test this hypothesis, over a four-week period, lighting interventions were placed in areas where nursing home residents spent the majority of their waking hours and were left on from wake-up time until 6 pm. Forty-three (43) residents (31 female, 12 male) participated in the short-term study, and 37 residents (25 female, 12 male) have completed the long-term study so far, all recruited from 10 nursing homes in the New York Capital District, Bennington, VT, and South Bend, IN.
Study participants experienced alternating periods of lighting that provided either high- or low-circadian stimulus for four weeks (short-term study) and six months (long-term study, successive four-week periods spaced by a four-week washout). The circadian stimulus (CS) metric, developed by the Lighting Research Center, characterizes a light source’s effectiveness for stimulating the circadian system as measured by its capacity for acutely suppressing the body’s production of the hormone melatonin (a well-established marker of the circadian system) after a one-hour exposure.
Both arms of the study used either a custom-designed LED light table or individual room lighting to deliver the intervention, depending on where the participants spent the majority of their time. Personal light meters were used to measure the light exposures received at the participants’ eyes. Sleep disturbance, mood and agitation were also assessed using standardized questionnaires.
With the lighting intervention, researchers found that study participants who experienced the high-circadian stimulus showed a significant decrease in sleep disturbance, depression and agitation. Positive effects observed in the short-term study continued to improve over the long-term study.