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Making the case for treatments for agitation in people with Alzheimer’s disease

Treatments to slow down or prevent the diseases that cause dementia are crucial if we are to successfully tackle this major global health challenge, and Alzheimer’s Research UK is committed to fulfilling this ambition.

But the continued development of medicines that address the symptoms of dementia are vitally important too. That’s why we’ve recently been working with the Medicines Discovery Catapult to increase the chances of much needed treatments becoming available for people with Alzheimer’s disease, the most common cause of dementia.

 

How common is agitation in Alzheimer’s disease? How does it affect people?

Agitation and aggression are common symptoms of dementia, with 35 to 50 per cent of people living with the condition affected. There are few treatments available to deal with these symptoms and those that do exist are not very effective, can only be used for a maximum of 12 weeks, and have several side effects.

These symptoms can often result in people living with dementia moving into care homes. The impact on the person living with the condition and their carers and loved ones can be devastating.

Ted, from Blackburn, was diagnosed with Alzheimer’s disease at the age of 76 but his family began to notice more aggressive and agitated behaviour a few years earlier.

His son Simon said: “One of the first signs that something was wrong with dad was that he would get increasingly aggressive at home. We would be walking on eggshells constantly as the simplest thing, even just talking to him, would set him off.

“The worst period of agitation was around three years after his diagnosis. Dad would be constantly awake in the night, tearing curtains down and pulling everything out of the wardrobes.

“Then he would constantly be looking for my mum, even though she was in the same room. He would walk around for hours shouting her name, wandering in the night, switching lights on and off, looking for her.

“No matter what we did or said, it was impossible to calm him. He often would only stop once he had exhausted himself.

“It pushed me and my mum to the edge mentally. Looking back, I don’t know how we coped. It was a lot of stress. Everything revolved around managing the next meltdown.”

Ted’s family managed to continue to look after him at home, but Simon admitted there were occasions when the family felt they could not cope much longer.

“I feel Dad’s agitation primarily came down to his frustration and fear and no matter what we did to try and ease it or reduce his fear he couldn’t understand. There’s a number of times where we were very close to admitting we couldn’t manage.

“The agitation created so much distress, agitation and upset for him personally. I think a treatment to reduce agitation would enable people to look after their loved ones at home longer. It would have massively reduced the stress for both Mum caring for him and Dad himself.”

What is Alzheimer’s Research UK doing to help people with agitation symptoms in Alzheimer’s disease?

To help address the huge unmet need for treatments that people like Ted and his family desperately need, Alzheimer’s Research UK and the Medicines Discovery Catapult made the case to the pharmaceutical industry. We did this by producing a blueprint for a potential medicine, known as a Target Product Profile (TPP), outlining the criteria that a new drug needs to meet to effectively treat a condition.

We also published an economic analysis to show that there is a potential market for such a treatment – a vital consideration for pharmaceutical companies thinking of investing in new research.

This highlighted that in the absence of any new treatments, the cost of agitation stands at £57,800 per person, with 90% of those costs coming from social care.

To promote this analysis, we jointly hosted a webinar with the Medicines Discovery Catapult’s psychiatry consortium, attended by representatives from the pharmaceutical industry, the NHS, charities and non-profit organisations, and academics.

 

Among them was researcher Chris Albertyn who is working on a clinical trial exploring the use of a cannabinoid-based medicine, Sativex®. The Sativex for the Treatment of AgitatioN in Dementia trial (STAND) involves treating agitation in nursing home residents that have Alzheimer’s disease. It also uses wearable technology to track motor function and sleep activity.

The STAND trial is funded by Alzheimer’s Research UK so it is thanks to your donations and support that this work is possible.

Chris, who is based at King’s College London, believes the TPP could improve the chances of a treatment for agitation in Alzheimer’s disease becoming a reality.

He said: “The TPP and economic model will make it easier for clinical academics, developers, SMEs and larger companies to plan their drug development and investment strategies,

“The core mission of developing a new treatment for these symptoms of dementia is to improve quality of life and care for those living with the condition. If this work encourages more research in this area, that will vastly improve the chances of realising this mission.

Chris added: “Drugs that are developed on the basis of a TPP are more likely to become available for the people who need them because they demonstrate a more targeted and efficient approach.”

“The STAND trial that Alzheimer’s Research UK is funding is a phase II randomised clinical trial that already meets the key criteria of this TPP.

“Sativex® has a more favourable side effect profile in older adults, is easily administered via oral spray, and is suitable for people who have difficulty swallowing. The trial is measuring neuropsychiatric symptoms such as agitation, depression, hallucinations and poor sleep, as well as quality of life and the challenges faced by carers.

“As it is based in care homes, it is targeting a population with a typically higher prevalence and severity of agitation symptoms, and so a treatment in this space would make a big difference.”

Alzheimer’s Research UK is dedicated to challenging the way people think about dementia and bringing together the people and organisations who can speed up progress.

And we hope that by highlighting the human and economic impact of agitation in Alzheimer’s disease and putting this under the spotlight, we’ll inspire more investment and progress in this area.

 

 

 

About the author

Marc Beyeler

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