Alzheimer’s doctors presented research into new treatments at the Alzheimer’s Association International Conference in Chicago this week.
They addressed non-drug treatments, the disease’s side effects, and using a new synthetic cannabinoid to soothe agitation.
The Problem With Drug Treatment
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 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.
For Alzheimer’s patients, the problem with drug treatment is that there is no specific drug treatment.
At this time, the U.S. Food and Drug Administration (FDA) has not approved any drug treatments for these symptoms in people with Alzheimer’s dementia.
All drug treatments currently used are approved for other indications and prescribed for people with Alzheimer’s “off-label.”
The Alzheimer’s Association recommends non-drug approaches for the treatment of dementia-related behaviors. These therapies include validation therapy, reminiscing and other personalized psychosocial interventions.
● Validate that the person seems to be upset over something.
● Separate the person from what seems to be upsetting.
● Engage in regular physical activity to potentially reduce irritability and aggressive behavior.
● Assess for the presence of pain, constipation or another physical problem.
Psychotropic medications (antipsychotics, antidepressants, anticonvulsants and others) may need to be considered when the dementia-related behavior has not responded to non-drug approaches, especially if it is causing physical or emotional harm to the person with dementia or caregivers,.
Unfortunately, the FDA has found that using antipsychotics to treat dementia in elderly persons was associated with increased mortality.
Change the Lighting
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 behavior 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,” Figueiro said.
With lighting intervention, researchers found that study participants who experienced high-circadian stimulus (bright light to no light) showed a significant decrease in sleep disturbance, depression and agitation.
“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.
Her team of researchers studied the effects on agitation of a synthetic cannabinoid called nabilone.
They observed less agitation and improved behavior in patients in their study.
“Currently prescribed treatments for agitation in Alzheimer’s do not work in everybody, and when they do work the effect is small and they increase risk of harmful side effects, including increased risk of death. As a result, there is an urgent need for safer medication options,” Lanctôt said.
Marijuana is an untested drug in Alzheimer’s. It is not approved by the FDA for the treatment or management of Alzheimer's or other dementias.
Doctors say it is important to point out that much about its use in people with Alzheimer’s or other dementias is unknown.
There is currently no robust, consistent clinical trial data supporting the use of marijuana for treatment of Alzheimer's disease dementia — nor for related issues. The Alzheimer’s Association said it believes that more research in this area is needed.