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Two new interventional studies have been brought to London, focused on improving quality of life for patients with Alzheimer’s disease and their caregivers. Both hope to improve upon standard approaches to treating agitation, a core symptom of Alzheimer’s.

Agitation is a significant source of stress for patients and caregivers. It is complex and difficult to treat. Often, families do not know about this particular symptom of Alzheimer’s and are not properly trained on how to manage care while dealing with agitation. 

“These studies are designed to have a direct impact on patients, families and care providers, to improve quality of life and function in those suffering from agitation due to Alzheimer’s,” says Dr. Amer Burhan, Associate Scientist at Lawson Health Research Institute (Lawson) and Geriatric Neuropsychiatrist, St. Joseph’s Health Care London (St. Joseph’s).

Parkwood Institute, a part of St. Joseph’s, is one of multiple sites participating in these studies across Canada and the United States.

One study aims to identify patients early in their diagnosis, while they are living at home or in the community, and apply a comprehensive psychosocial approach, with or without medication, to help with the management of agitation. “We hope to identify participants and have them participating in our program before they experience a crisis due to agitation,” explains Dr. Burhan.

Psychosocial intervention is a way of helping patients and caregivers understand the reasons for agitation. Agitation can develop due to a wide range of causes. For example, patients may just be bored and need help to find something meaningful to occupy their time, they could be upset about something in their current environment, or may be suffering from physical discomfort or pain.

Interventions can include communicating with patients in a manner that creates calm, scheduling meaningful activities, and maintaining routine and rhythm in life. The research team will connect with families early after diagnosis to give them the tools and support they need.

Initially, participants will be treated using structured psychosocial intervention to help reduce and manage their agitation. After three weeks, they will be reassessed and if significant agitation continues to persist, the patient will be randomly selected to receive either a placebo, or medication known as S-Citalopram to treat agitation while they continue to receive psychosocial care.

Sylvia Wilson is the wife of one of the study participants. By enrolling in this trial, she feels she has gained a much better understanding of her husband’s disease, and is grateful for the support that study participants receive.

“My husband typically does not like going to visit doctors, but Dr. Burhan and his team are great,” says Wilson. “They understand agitation, and other symptoms of the disease very well, and I notice a difference in his mood with the treatment he receives through the study.”

Participants are still able to receive care from their primary physician and care teams, with the study providing an added layer of support.

Another study is focused on Alzheimer’s patients who are admitted to hospital or living in long-term care. The aim is to standardize the approach to care for agitation related to Alzheimer’s. After baseline assessment, participants will be randomized to receive the current treatment as per usual, or an integrated care pathway derived from evidence-informed treatment guidelines. These include washing out medications that have not helped, adding individualized behavioral and environmental support, and if medications are needed, use a specific set of medications and dosages based on best evidence. 

“Better understanding agitation is a growing area of interest in geriatric research. The work being done locally is part of an international effort to create a paradigm shift in treating patients with Alzheimer’s disease and agitation,” explains Dr. Burhan.

Researchers are ready to offer these studies to patients and their families, hoping to make these treatment protocols an integral part of care for patients with agitation due to Alzheimer’s disease. Those interested in learning more about these studies can contact Dr. Burhan at @email or call 519-646-6100 x. 48170.

View the trial brochure

In the media: Study on 'agitation' in Alzheimer's patients seeks participants

A research team led by Lawson scientist Dr. Mamadou Diop has been awarded a Lawson Internal Research Fund to investigate whether a previously developed optical technique that can detect arthritis within one week of onset could also be used to provide early assessment of treatment response for rheumatoid arthritis (RA).

RA is a disease that causes chronic inflammation of the joints, which results in pain, reduced quality of life and loss of productivity. There is no cure for RA but a new category of drugs – biologic agents that can reduce pain and slow down or even halt disease progression – has revolutionized treatment.

However, these new drugs are expensive and only work in 30 per cent of patients, which means many RA sufferers are treated with no benefit for up to six months – the time it takes for current monitoring methods to reliably determine whether a treatment is working or not. “This is a direct consequence of the lack of sensitivity of current monitoring methods,” says Dr. Diop, who is also an assistant professor at Western University’s Schulich School of Medicine & Dentistry.

Since their recently developed optical technique has a high sensitivity to arthritis, Dr. Diop and his team believes it could also be used as a safe and convenient method of assessing treatment efficacy in RA patients. Additionally, there are striking similarities between RA and cancer, and it has been shown that optical techniques can predict cancer in as early as one day after therapy starts.

At St. Joseph’s Health Care London, they will test this theory in a rat model of RA and compare the results of the optical technique to histology and CT imaging, other established methods of determining whether a treatment is effective.

“If successful, this project will generate a safe, low-cost technique that can detect treatment response in RA within days of starting treatment. This would reduce the risk of further joint damage experienced by many patients for whom the drugs are ineffective,” says Dr. Diop. “We hope this will enable early redirection of patients with non-responding RA to alternative treatments, such as a combination of multiple drugs and more frequent monitoring.”

Dr. Diop adds, “The Lawson IRF grant will enable us to test the validity of our hypothesis and subsequently generate valuable preliminary results to support grant proposals for larger external funding.”

The IRF is designed to provide Lawson scientists and students the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph's Health Care Foundation).

The most frequent cause of stroke is Atrial fibrillation (AF), a cardiac arrhythmia consisting of irregular heartbeats. These strokes are the most devastating ones. Recent observations in stroke patients suggest that stroke can also cause AF. This Post-Stroke Atrial Fibrillation (PSAF), in turn, can produce more strokes.

Victoria Thorburn, a Master’s student at Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry in the department of Anatomy and Cell Biology, has been awarded with a Lawson Internal Research Fund (IRF) Studentship to develop the first rodent model of PSAF. The goal of the study is to gain more understanding of the relationship between stroke and PSAF.

The cause of PSAF is currently unknown but it is believed that strokes occurring in the insular cortex, a brain region responsible for monitoring heart rhythm, may trigger PSAF. When this brain region is damaged by stroke, the heart is left without regulation, resulting in chaotic heart rhythms. Previous studies have not been able to confidently diagnose PSAF, since approximately one third of AF cases are silent or asymptomatic.

“Without continuous monitoring of heart rhythm prior to stroke, it is difficult to determine if PSAF is in fact a newly developed arrhythmia occurring after stroke or whether it was actually a silent form of AF that already existed before stroke,” Thorburn says.

Thorburn will experimentally induce stroke in the rat insular cortex to determine whether PSAF or other types of irregular heartbeats occur as a result. The project will be supervised by Dr. Luciano Sposato, Lawson scientist, physician at London Health Sciences Centre and associate professor in the Department of Clinical Neurological Sciences at Schulich, and Dr. Shawn Whitehead, assistant professor at Schulich. They will monitor heartbeat before and after insular stroke then assess potential biological factors or structural changes in the brain or heart that may be associated with PSAF. Animals that developed PSAF will be compared to those without the condition.

Since the proposed cause of PSAF, the involvement of insular cortex damage, differs greatly from the traditional cause of AF, which is often a structural abnormality in the heart, there could also be a difference in treatment. The hope is that the knowledge of PSAF formation gained from the first rodent model will lead to the development of prevention and therapeutic strategies, minimizing the number of stroke patients affected by PSAF and ultimately reducing the recurrence of stroke.

“I wanted to become involved with research that was currently relevant and had the translational potential to improve public health. With the current aging population, the number of individuals directly affected by stroke and AF will continue to rise,” says Thorburn. “Thanks to funding opportunities like Lawson’s IRF, students like myself are able to train alongside accomplished researchers and participate in research that uniquely integrates both basic science and clinical perspectives.”

The IRF is designed to provide Lawson scientists and students the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph's Health Care Foundation).

For patients with kidney stones, ureteral stents (hollow devices placed in the ureter – the tube between the kidney and bladder) can be used temporarily to relieve urinary obstruction. Despite the use of antibiotics, ureteral stents often become encrusted with minerals and coated with bacteria. This can lead to complications like infection and the need for replacement surgery. 

Published today in Cell Reports Medicine, researchers at Lawson Health Research Institute and Western University conducted a novel microbiome study to examine bacteria associated with ureteral stents. They found that nearly all the stents, whether visibly coated or not, had unique bacterial profiles that were most associated with a patient’s medical condition rather than antibiotic use. For patients with ureteral stents, they may benefit from a personalized approach to care and antibiotic treatment. 

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The study included 241 patients from St. Joseph’s Health Care London. The research team collected and analyzed patient urine samples and ureteral stents following surgical removal, as well as relevant patient information such as antibiotic use and history of infections.  

“We wanted to know which bacteria were present and whether the bacteria found in urine samples corresponded to the bacteria found on a patient’s stent,” explains Dr. Kait Al, Postdoctoral Fellow at Lawson and at Western’s Schulich School of Medicine & Dentistry. “We found that there was a bacterial community present on almost all stents, even if they were not visibly affected, and that it differed from the bacterial community found in a patient’s urine.”

These findings challenge long-held beliefs that the urinary tract is a sterile environment devoid of bacteria.

The study revealed that the bacteria present were determined by an individual patient’s medical condition. They differed significantly based on comorbidities like irritable bowel syndrome, obesity and hypertension. Antibiotic use within the past 30 days did not seem to have an effect on the types of bacteria detected on the stents. 

“While more research is needed, our study suggests that antibiotic use during the placement of these stents could one day be more conservative or targeted based on each patient’s condition,” says Dr. Jeremy Burton, Lawson Scientist and Associate Professor at Schulich Medicine & Dentistry.

The team also discovered that in patients needing multiple stents, the bacterial community remained stable over time, suggesting that infections on a patient’s previous stent could direct the course of treatment for their future device placements. 

“This is the largest study of its kind, investigating bacteria both in urine and adhered to ureteral stents,” states Dr. Hassan Razvi, Urologist at St. Joseph’s, Lawson Associate Scientist and Professor at Schulich Medicine & Dentistry. “We hope this will be the first step towards personalized care, ultimately leading to fewer stent-associated infections.” 

The study was made possible through the generous support of The W. Garfield Weston Foundation and St. Joseph’s Health Care Foundation.

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Dr. Kait Al, Postdoctoral Fellow at Lawson and Schulich Medicine & Dentistry