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New Alzheimer’s research aims to improve treatment and support for patients with agitation
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.
In the media: Study on 'agitation' in Alzheimer's patients seeks participants
Open Access Publications
The HULC Clinical Research Laboratory publishes a number of papers every year to share the important findings of our studies. The following are a list of open-access publications that anyone can access to read.
View open-access publications in the following categories:
Neck/Shoulder
- Appraisal of Clinical Practice Guideline: Management of Neck Pain
- The Contribution of Health and Psychological Factors in Patients with Chronic Neck Pain and Disability: A Cross-sectional Study
- Appraisal of: Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa)
- Design and implementation of the 2012 Canadian shoulder course for senior orthopedic residents
- Efficacy of workplace interventions for shoulder pain: A systematic review and meta-analysis
- A qualitative description of chronic neck pain has implications for outcome assessment and classification
- Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial
- Psychophysical and Patient Factors as Determinants of Pain, Function and Health Status in Shoulder Disorders
- Intra and Inter-Rater Reliability and Convergent Validity of FIT-HaNSA in Individuals with Grade П Whiplash Associated Disorder
- Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis
- Manual therapy with exercise for neck pain
- The effect of pressure pain sensitivity and patient factors on self-reported pain-disability in patients with chronic neck pain
- Validity of pain and motion indicators recorded on a movement diagram of shoulder lateral rotation
- The kinematics of upper extremity reaching: a reliability study on people with and without shoulder impingement syndrome
- What is a successful outcome following reverse total shoulder arthroplasty?
- Rotational strength, range of motion, and function in people with unaffected shoulders from various stages of life
- Validation of a new test that assesses functional performance of the upper extremity and neck (FIT-HaNSA) in patients with shoulder pathology
- Cross-sectional and longitudinal construct validity of two rotator cuff disease-specific outcome measures
- The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity
- Suppl 4: What is the Experience of Receiving Health Care for Neck Pain?
- A Description of the Methodology Used in an Overview of Reviews to Evaluate Evidence on the Treatment, Harms, Diagnosis/Classification, Prognosis and Outcomes Used in the Management of Neck Pain
- What Does ‘Recovery’Mean to People with Neck Pain? Results of a Descriptive Thematic Analysis
- Suppl 4: An Overview of Systematic Reviews on Prognostic Factors in Neck Pain: Results from the International Collaboration on Neck Pain (ICON) Project
- Suppl 4: An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders
- Suppl 4: Editorial: Management of Neck Pain
- Suppl 4: Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON Project
- Suppl 4: Knowledge Translation Tools are Emerging to Move Neck Pain Research into Practice
- Suppl 4: The Relationship Between Neck Pain and Physical Activity
- Suppl 4: Psychological Care, Patient Education, Orthotics, Ergonomics and Prevention Strategies for Neck Pain: An Systematic Overview Update as Part of the ICON Project
- Suppl 4: Use of Outcome Measures in Managing Neck Pain: An International Multidisciplinary Survey
- Suppl 4: Results of an International Survey of Practice Patterns for Establishing Prognosis in Neck Pain: The ICON Project
Elbow
- Patient reported pain and disability following a distal radius fracture: a prospective study
- Patient-rated tennis elbow evaluation questionnaire
- Radial nerve mobilization reduces lateral elbow pain and provides short-term relief in computer users
- Pain and disability reported in the year following a distal radius fracture: a cohort study
- The patient-rated elbow evaluation (PREE)
- A survey of practice patterns for rehabilitation post elbow fracture
Wrist/Hand
- The Patient Rated Wrist Evaluation (PRWE) was successfully translated into Tamil
- Provocative maneuvers demonstrate excellent accuracy in the “virtual” diagnosis of carpal tunnel syndrome among people with upper limb conditions—a short technical report
- Rasch Analysis of The Patient-Rated Wrist Evaluation Questionnaire
- The Impact of Sensory, Motor and Pain Impairments on Patient-Reported and Performance Based Function in Carpal Tunnel Syndrome
- Is casting for non-displaced simple scaphoid waist fracture effective? A CT based assessment of union
- Reliability and validity of electro-goniometric range of motion measurements in patients with hand and wrist limitations
- Evaluation of an Image-Based Tool to Examine the Effect of Fracture Alignment and Joint Congruency on Outcomes after Wrist Fracture
- A hand brace improve symptoms and function in carpal tunnel syndrome
Work/Nerve/Other
- Agreement and participants’ preferences comparing: self-rated falls risk questionnaire (FRQ) and activities-specific balance confidence (ABC) scale in community-dwelling older adults using the Bland–Altman method
- Psychometric Properties of The Zephyr Bioharness Device: A Systematic Review
- Clinimetrics: Upper Extremity Functional Index
- Appraisal of Clinical Practice Guideline: American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Management of Osteoarthritis of the Hip
- Education and Social Support as Key Factors in Osteoarthritis Management Programs: A Scoping Review
- The relationship between physical fitness and simulated firefighting task performance
- Pain-QuILT: A user-friendly tool for the self-report and tracking of pain
- Prevalence and distribution of musculoskeletal disorders in firefighters are influenced by age and length of service
- Development and validation of a new tool to measure the facilitators, barriers and preferences to exercise in people with osteoporosis
- Correction to: Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature
- Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies
- Measurement properties of painDETECT: Rasch analysis of responses from community-dwelling adults with neuropathic pain
- A therapist-focused knowledge translation intervention for improving patient adherence in musculoskeletal physiotherapy practice
- Appraisal of: Role of physical therapists in the management of individuals at risk for or diagnosed with venous thromboembolism: Evidence-based clinical practice guideline
- Evaluating the design and reporting of pragmatic trials in osteoarthritis research
- Assessing reading levels of health information: uses and limitations of flesch formula
- Corrigendum to “Risk Factors for Falls and Fragility Fractures in Community-Dwelling Seniors: A One-Year Prospective Study
- Órteses para o paciente com osteoartrite do polegar: o que os terapeutas ocupacionais no Brasil indicam?
- Muscle strength differences in healthy young adults with and without generalized joint hypermobility: a cross-sectional study
- Evaluating and optimizing pragmatic trial design in osteoarthritis research
- Reliability of three landmarking methods for dual inclinometry measurements of lumbar flexion and extension
- Beyond silence: protocol for a randomized parallel-group trial comparing two approaches to workplace mental health education for healthcare employees
- A modified evidence-based practice- knowledge, attitudes, behaviour and decisions/outcomes questionnaire is valid across multiple professions involved in pain management
- Scoping review of patient-centered care approaches in healthcare
- Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis
- Fall efficacy scale-international (FES-I)
- Too Fit To Fracture
- Knee osteoarthritis
- The reliability and validity of the computerized double inclinometer in measuring lumbar mobility
- Development and initial validation of the Satisfaction and Recovery Index (SRI) for measurement of recovery from musculoskeletal trauma
- Translation of Oswestry Disability Index into Tamil with Cross Cultural Adaptation and Evaluation of Reliability and Validity
- The work limitations questionnaire (WLQ-25)
- Ice-water (cold stress) immersion testing
- Development and validation of the patient-rated ulnar nerve evaluation
- Reliability and validity of the AGREE instrument used by physical therapists in assessment of clinical practice guidelines
- The quality of websites addressing fibromyalgia: an assessment of quality and readability using standardised tools
- The ten test for sensation
- Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review