New insights into treating behavioural symptoms of dementia

Dementia describes multiple symptoms that result from a number of diseases in the brain, which are not limited to memory and thinking problems. People with the condition can also experience behavioural and psychological symptoms such as agitation, sleeping problems, hallucinations and anxiety, which can all have a profound effect on their lives. Researchers at the Alzheimer’s Association International Conference 2018 have presented new research findings into the treatment of these complex symptoms.

Cannabinoid tested to help agitation in dementia

Researchers from Toronto, Canada, have presented their latest work assessing the effects of the drug nabilone in people with Alzheimer’s disease. Nabilone is chemically similar to the active component of cannabis and may be prescribed in the UK to treat nausea in people undergoing chemotherapy.

In the trial, 39 people with moderate-to-severe Alzheimer’s disease took nabilone capsules for six weeks and a dummy treatment for six weeks, with a one-week gap between the two phases. Participants experienced less agitation and a greater overall reduction in behavioural symptoms while taking nabilone, but more people experienced sedation when taking the medication compared to when they were receiving the placebo.

Dr Carol Routledge, Director of Research at Alzheimer’s Research UK, said:

“There is a common misconception that dementia is only about memory problems, but it can impact people’s live in a myriad of ways. Many people with Alzheimer’s disease experience distressing behavioural symptoms like agitation, but current drugs that are used to tackle these symptoms are not effective for everyone and can have dangerous side effects.

“In this trial, nabilone seemed to improve agitation in people with Alzheimer’s, although the medication also seemed to cause sedation. This was a very small study and we need to see larger studies into the safety and effectiveness of nabilone before we can say whether it could hold promise as a treatment for people living with dementia.

“While the availability of cannabinoid therapies has been in the news a lot recently, the drug explored in this study is already available through the NHS.”

Tailored lighting to help improve sleep cycle in people with Alzheimer’s disease

A team of US scientists have presented findings from a study of the use of tailored lighting for people with Alzheimer’s disease in a care home. Sleep problems are common in people with dementia and this study tested a lighting system designed to boost circadian rhythms – the biological clock that regulates our sleeping cycles.

A total of 37 people took part in the study, which used custom LED lights to deliver lighting designed to stimulate circadian rhythms. The researchers placed the lighting system in the spaces in which participants spent most of their waking hours. For four weeks the lighting system delivered a high circadian stimulus and for another four weeks a low stimulus with a four-week period in between the two testing phases.

The researchers measured sleep disturbances, mood and agitation in the participants before and after they received the lighting stimulus. They found that the high circadian stimulus was associated with benefits in all of these symptoms. After this initial testing period researchers continued to assess the effect of the high intensity circadian stimulus for a further six months.

Dr Carol Routledge, Director of Research at Alzheimer’s Research said:

“Getting a good night’s sleep is important for our brain and has many wider health impacts. Many people with dementia experience sleep problems and understanding how we could minimise these symptoms could lead to important benefits to many people’s lives.

“As researchers work to bring us closer to more effective drugs to improve the lives of people living with dementia in future, it is important that we also explore other approaches to tackle symptoms in the here and now. The positive findings in this work need to be developed further in a bigger, more powerful study to see if this type of lighting intervention is a viable approach for helping a large number of people with dementia.”

Evaluating Z-drugs for treating dementia

UK researchers have presented their latest work analysing existing studies to look at the impact of a class of drugs that are commonly used to treat sleep problems in older people. These Z-drugs (zolpidem, zopiclone and zaleplon) are similar to benzodiazepines and are sometimes used to manage behavioural symptoms experienced by people with dementia.

The scientists studied the data from thousands of people living with dementia who had been prescribed Z drugs, finding that the pills are linked with an increased risk of bone fractures. The researchers also found that a higher dose of z drugs was associated with an increased risk of hip fracture and death.

Dr Carol Routledge, Director of Research at Alzheimer’s Research said:

“Currently no drugs are able to slow or halt the progression of Alzheimer’s disease, but some medicines can help to help treat the day-to-day symptoms. Sleep problems can have a major impact on the lives of people living with dementia and while Z-drugs present a way to alleviate these problems, their benefits need to be carefully weighed against the risk of side-effects.

“This research highlights the need for these medicines to be carefully prescribed and doctors are best placed to assess the individual circumstances of their patients and make an informed judgement about the most appropriate course of treatment. Anyone with concerns about the medications they are being prescribed for dementia should speak to their GP.”