Alzheimer’s most common and distressing symptoms being missed

Some of the most distressing symptoms of Alzheimer’s disease are those that are least recognized and most challenging to treat, contributing to decreased quality of life and earlier institutionalization, say experts.

“Neuropsychiatric symptoms are hallmarks of Alzheimer’s disease (AD) and are among the earliest warning signs and symptoms of most dementias and mental decline, and yet often go unrecognized,” says Dr. Krista Lanctôt, lead author of a new report and a clinical pharmacologist and senior scientist at Sunnybrook. “New treatments for these symptoms are desperately needed and sufficient research support is necessary to develop this in order to improve the quality of life for people with dementia and their care partners.”

Neuropsychiatric symptoms of AD are:

• Psychotic symptoms (delusions and hallucinations)· Agitation (excessive motor activity or verbal and physical aggression associated with emotional distress)
• Apathy (lack of motivation, decreased initiative, akinesia, and emotional indifference),
• Depression
• Sleep disturbances

The effects of these symptoms on both patients and caregivers are severe: they are associated with impairment in activities of daily living, poor quality of life, earlier institutionalization, accelerated disease progression, increased mortality, caregiver stress, and increased costs of care.

There are very few treatment options for neuropsychiatric treatments, and they are limited to the psychotic and agitation categories of symptoms. Even then, these treatments have little impact on alleviating the symptoms yet can have devastating side effects that can lead to faster mental and functional decline, unnecessary strokes and accelerated death rates.

The authors of the report are part of an international Research Roundtable convened by the Alzheimer’s Association and chaired by Dr. Lanctôt to advance the development of effective new therapies for neuropsychiatric symptoms in dementia.

The committee stresses that new drugs and new non-drug interventions are urgently needed in order to improve treatment of these distressing symptoms to millions of people worldwide.

Published in the August 2017 issue of Alzheimer's & Dementia: Translational Research & Clinical Interventions, the paper calls for new approaches to clinical trials to produce effective new treatments and to find alternatives to highly damaging existing treatments.

The authors of the report are part of an international Research Roundtable convened by the Alzheimer’s Association and chaired by Dr. Lanctôt to advance the development of effective new therapies for neuropsychiatric symptoms in dementia. In order to do this, they aim to facilitate a better understanding of the underlying mechanisms of these symptoms.

The committee stresses that new drugs and new non-drug interventions are urgently needed in order to improve treatment of these distressing symptoms to millions of people worldwide.