Featured Researcher: Professor Krista Lanctot

Dr. Krista Lanctot is a professor Psychiatry and Pharmacology at the University of Toronto. Dr. Lanctot it the executive director of MORE research group at Sunnybrook Health Sciences Centre. She has her PhD Clinical Pharmacologist and is working in the Hurvitz Brain Sciences Research Program. She is known for clinical trials involving patients with dementia and the treatment of agitation and aggression, as well as apathy. We were fortunate to be able to talk to Dr. Lanctot about her work in the questions below.

1. What sparked you interest in dementia research? Can you tell us more about the research you do?

When I first came to Sunnybrook, there were no medications for Alzheimer’s disease, and people with behavioural problems were still being given sedating medications.  With my PhD in Clinical Pharmacology, I thought that there must be a better way to help these people. I decided that the key missing pieces were understanding the underlying neurobiology of the behaviours, and personalizing treatment. I lead a large lab whose goal is to optimize drug treatments by doing just that.  We look at the behaviours, brain and biomarkers, and use that information to suggest and test new treatments for Alzheimer’s disease and other dementias.  My group also looks at early neurobiologic changes that precede dementia, and are now testing an intervention that may prevent these devasting yet common diseases.

2. What is the most challenging part about your research?

The most challenging part is the ongoing need to secure funding in this era of increasing budgets and complexity with shrinking availability of research funds.

3. Over the years, how have you seen the treatment of agitation and aggression improve? What is currently being done to treat these symptoms in people with dementia?

We are now using a wider armamentarium of medications, and no longer rely on sedation. There have been big improvements.  We are also testing new medications, but now use the more personalized and rational approach that my group and others have now championed. Our most recent discovery was that low doses of synthetic THC can help with agitation and aggression.

4. Apathy is a common issue faced when working with people with dementia. What is the underlying cause? What can be done to engage them?  

There are lots of underlying causes of apathy because whole brain circuits have to be in tact to promote motivated and goal-directed behavior.  The first step is always looking at the environment.  After that has been optimized, we also look at prescribing medications. My group showed that the deficits in the dopaminergic brain reward system were contributing to apathy, and more recently that the pro-dopaminergic drug methylphenidate could help some dementia people by improving apathy.

Read more about Dr. Krista Lanctot here: https://sunnybrook.ca/research/team/member.asp?t=11&page=172&m=102

Research Update: Using Synthetic Cannabis as Treatment for Agitated Alzheimer's Patients

In July 2018, Canadian researchers from Sunnybrook Health Sciences Centre presented some encouraging data which suggested that a synthetic form of cannabis, called nabilone, may help calm agitated patients with Alzheimer’s.

Approximately one-quarter of patients with advanced Alzheimer’s experience agitation – where they can become angry, restless, and verbally or physically abusive – and thus are often the primary reason that patients are sent to hospitals or institutions. Current treatments for agitation use anti-psychotic drugs; however, these drugs have only modest effects and are associated with a number of side effects, such as higher risks of strokes, falls, and death.

The team of scientists at Sunnybrook tested the efficacy of the synthetic cannabis in 38 patients with moderate to severe Alzheimer’s who had noticeable agitation over a 14-week trial. They found that while patients were on the nabilone, both agitation and overall behavioral symptoms improved significantly, in comparison to the placebo. In fact, “They wouldn’t strike out, they wouldn’t get stiff when care was being provided. They were easier to examine and were calmer and more comfortable,” said Dr. Nathan Herrmann – a psychiatrist and scientist with Sunnybrook and the University of Toronto. Moreover, the synthetic cannabis seemed to also have a positive effect on caregivers by reducing their stress of looking after the patient.

The Canadian researchers have said that their next steps are to plan a larger study with more patients and to determine the correct dose of nabilone for patients, in order to minimize sedation.  

More information about Sunnybrook’s research can be found here: https://www.ctvnews.ca/health/form-of-cannabis-may-have-calming-effect-on-agitated-alzheimer-s-patients-1.4025475

Featured Researcher: Professor Carole Cohen

Professor Carole Cohen is a University of Toronto Professor of Psychiatry and Head of the Division of Geriatric Psychiatry. She is an affiliate scientist in the Evaluative Clinical Sciences, Hurvitz Brain Research Program at the Sunnybrook Research Institute. Professor Cohen’s work and research is focused on helping patients, their families, and their professional caregivers manage dementia diagnoses making her an expert in dementia service care. She is well known for her involvement and advocacy for dementia patients in legal capacity and consent issues. 

We were fortunate to have the opportunity to interview Professor Cohen about her work: 

1. Can you tell us about your research with dementia caregivers? 

My research started out with a study examining risk factors for individuals with dementia moving from home into another care setting. As part of this study, I had the opportunity to visit people with dementia living at home and talk with those assisting them. I became interested in the caregiver’s experience and how it affected not only their health but the experience of those they cared for. It became clear that not all caregiver experiences were negative and many found great comfort and meaning from their caregiving role. I worked with others to better understand these positive effects of caring and how they might influence caregiver decisions. I was also part of a team that studied pathways to diagnosis for families from different cultural backgrounds across Canada.

2. What is the most rewarding part of your work in this field as a scientist? 

For me personally learning from individuals with dementia and their families and being able to share my knowledge with others is the most rewarding aspect of my work. I enjoy translating research findings into accessible language to help clinicians, policy-makers and other researchers better understand the dementia experience. 

3. How has dementia management evolved in your years of working as a researcher?

Dementia management has evolved dramatically since I started practising. Whereas it was initially difficult to find dementia specific services, they now exist everywhere in Ontario. They are more likely to put the individual with dementia at the centre of care planning with programs for those with special needs (such as early-onset dementia) and focus on personhood and dignity. Support groups and advocacy groups for individuals with dementia are relatively new. Holistic approaches that focus not only on anti-dementia medications but diet, exercise, appropriate activities are more readily available. Programs also provide assistance for longer periods of time with earlier diagnosis and increased attention to needs at the end of life. 

4. Dementia is an illness that not only impacts the individual, but it also impacts family members. From your experience, what advice would you give to our readers who have a loved one with dementia?

Family members play a vital role in supporting individuals with dementia. It can be a rewarding and exhausting role. In dementia care families have to simultaneously optimize the current situation and plan for a future when the disease will progress and the person with dementia needs will change. I would urge family members to be mindful of three major areas they should address. Firstly, they need to understand what dementia as an illness means, how it affects their family member and how it is likely to progress. Education and knowledge are important if one is to understand why a relative is behaving in certain ways and how to best support them. Secondly, family members need to address their own psychological and physical needs – caregiving can be stressful and caregivers need to take time for themselves and learn how to cope with these demands. This may mean learning new techniques such as Mindfulness, accessing individual or group counselling and paying attention to their physical health, diet and exercise. This leads to the last part of the triad which is asking for help and ensuring that caregivers have adequate social support. Caregivers need to build a support team of professionals, family and friends and learn how to effectively ask them for help. 

Read more about Professor Cohen here: 

https://sunnybrook.ca/research/team/member.asp?t=10&m=47&page=527 

Welcome Back from Professor Nathan Herrmann and Student Executive Team

Since September 2016, a group of students from Havergal College in Toronto, Canada have established and grown the Dementia Awareness Program in partnership with Professor Nathan Herrmann. Professor Herrmann is the Richard Lewar Chair in Geriatric Psychiatry at Sunnybrook Health Sciences Centre and the University of Toronto. At Sunnybrook, he is Head of the Division of Geriatric Psychiatry, co-director of the Clinical Neuropharmacology Laboratory, and a scientist in the Hurvitz Brain Sciences Research Program and the Center for Stroke Recovery. With over 530 publications and 130 research grants, Dr. Herrmann is a world leading expert on dementia and Alzheimer’s.

Under the mentorship of Professor Herrmann, we established the Dementia Awareness Program in 2016. The purpose of our program to raise awareness of and reduce the stigma surrounding dementia both within and beyond our community, while also providing the opportunity for high school students to volunteer weekly with individuals with dementia.

We have used our blog these past two years as an avenue to share our experience working with people with dementia, as well as sharing the knowledge we have learned about dementia as we stay up to date with current research in the field. Since the inception of our blog in 2016, we are proud to say that we have increased awareness of dementia worldwide – with over 3,000 visits from readers across the world.

We are thrilled to be gearing up for the third year of the Dementia Awareness Program by continuing both our blog here and the community partnership between Havergal College students and a local seniors’ residence. This year, our monthly blog series will feature exciting new research developments regarding dementia, as well as local female dementia experts and researchers who are world-renowned for their work.

We sincerely hope that this will be of interest to you and the community. Together, we can learn more about this important cause and the ground-breaking research in this field.

You can also follow Professor Herrmann’s “Memory Doctor” blog for dementia caregivers at: http://health.sunnybrook.ca/memory-doctor/

Professor Nathan Herrmann and Student Executive Team

Chair                Selina Chow

Vice-Chair        Clarissa Yu

Vice-Chair        Olivia Nadalini

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair, Geriatric Psychiatry

Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre

Concluding Remarks by Professor Nathan Herrmann and Student Chair Selina Chow

This past school year, we have continued the Dementia Awareness Program through our weekly blog posts and volunteer work with seniors with dementia. At the beginning of this year, we were met with an overwhelming number of students interested in joining the program and have ultimately formed a group of 10 dedicated student volunteers. Each student has been paired with a resident with dementia at Briton House – a seniors residence in Toronto.

Since October 2017, we have visited our partners at Briton House weekly to provide companionship and engage in mentally-stimulating activities, such as arts and crafts. While we all had varying degrees of experience, with some students who had no prior experience with seniors with dementia to others who were involved with this program last year, we were able to successfully engage the residents in conversation, activities, and even holiday-themed parties. Although there were challenges at times, we have learned to problem solve and ultimately improved our communication skills when working with individuals with dementia. It has been a privilege to work with these amazing seniors and we are honoured to have made a difference in their lives, as they never fail to let us know how much joy we bring to their day.

As our time at Briton House comes to a close for this year, we want to thank the residents for letting us into their lives. We will miss them dearly and look forward to seeing them again soon. We would also like to thank the staff at Briton House for supporting us weekly and helping us to organize all the activities we did with the seniors. Last but not least, we are grateful to Dr. Herrmann for his leadership of the Dementia Awareness Program and his mentorship throughout our learning process this year.

To our readers, thank you for following our blog posts again this year, and we hope that you have been able to deepen your understanding of dementia through the ‘Ask the Expert’ segments and the bi-weekly updates on current research in this field. For additional information on dementia, you can also follow Dr. Herrmann’s “Memory Doctor” blog for dementia caregivers at: http://health.sunnybrook.ca/memory-doctor/

On behalf of all the Havergal College students involved in this program, thank you for your continued support of the Dementia Awareness Program. It has been another successful year of this community initiative, following its inaugural year last year, and we hope to continue enriching the lives of individuals with dementia, advocating for this important cause, and de-stigmatizing the illness.

Professor Nathan Herrmann and Selina Chow (Student Chair)

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair in Geriatric Psychiatry

Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre