The loss of interest and motivation in daily life experienced with Alzheimer's disease was successfully decreased in patients in a recent trial.
"Apathy is one of the most common effects of Alzheimer's disease (AD). It decreases these patients' quality of life, it has been shown to worsen their ability to carry out activities of daily living, and it is often a key contributing factor to being institutionalized," says Dr. Krista Lanctôt, primary author of a new study and neuropsychopharmacologist at Sunnybrook Health Sciences Centre. "If we can treat the apathy, then we may be able to prevent this downward spiral and really, change the course of illness for someone with Alzheimer's disease."
Study participants randomized to receive treatment were treated for six weeks with the drug methylphenidate - a treatment that the Sunnybrook team had previously suggested might improve apathy based on neuroimaging findings and pilot data.
The participants showed a significant reduction in apathy symptoms, as well as some improvements in "global cognition" which includes attention, memory, language, learning, reasoning, problem solving and decision making.
"This treatment is promising as it appears to be effective and with minor side effects," says Dr. Nathan Herrmann, head of Geriatric Psychiatry at Sunnybrook and Professor of Psychiatry at University of Toronto. "We require further research."
Preliminary data were presented at the Alzheimer's Association International Conference in July 2012, and a manuscript is currently in press with The Journal of Clinical Psychiatry.
An army of dementia researchers are increasingly working at discovering ways to prevent, cure, and treat symptoms. This research work falls under the latter, which is essentially working to modify what the illness looks and acts like. With the failure of recent trials, this is an encouraging success.
"This research aims to understand and treat effects of the disease for those who are diagnosed with it," says Lanctôt, also a Professor of Psychiatry at the University of Toronto. "So that one may have Alzheimer's disease but maximize quality of life for a longer period of time."
In addition to the effects on the patient's quality of life and functional impairment, apathy in AD is also associated with greater caregiver burden and higher costs of care. AD is the major neurodegenerative disease of aging, affecting an estimated 481 thousand persons in Canada in 2008 and increasing to 1.1 million by 2038.
Funded by the National Institute on Aging, this study was a multicenter, randomized, placebo-controlled, double blind trial. The research was a collaborative effort by investigators from Johns Hopkins School of Medicine, Sunnybrook, John Hopkins Bloomberg School of Public Health, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center. We are grateful to the patients and families who participated in this research.