120| Apathy and Agitation in Neurodegenerative Diseases – A Conversation With Dr. Krista Lanctôt

This episode is a conversation with Dr. Krista Lanctôt about neuropsychiatric symptoms (NPS) in older adults with neurodegenerative diseases, with a focus on apathy and agitation. The discussion covers definitions, diagnostic criteria, epidemiology, methods of assessment, relation to degenerative neuropathology, and various treatment approaches.

A pdf of the transcript for this episode is available here.

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About Krista

Dr. Krista L. Lanctôt has a PhD in Clinical Pharmacology from the University of Toronto, with additional training in pharmacoepidemiology.  She is currently a Senior Scientist in Geriatric Psychiatry and in the Hurvitz Brain Sciences Program at Sunnybrook Research Institute, Research Co-Director in the Department of Psychiatry at Sunnybrook Health Sciences Centre and the Head of Neuropsychopharmacology Research.  In 2022, she was awarded the Bernick Chair is Geriatric Psychopharmacology. She is also a Professor of Psychiatry and Pharmacology/Toxicology, and Vice Chair of Basic and Clinical Sciences in the Department of Psychiatry at the University of Toronto, Toronto, Ontario, Canada.

Dr. Lanctôt is an active researcher with over 375 published papers, and Editor of the 2021 book “Apathy: Clinical and Neuroscientific Perspectives from Neurology and Psychiatry”.  Her group’s research has focused on optimizing the pharmacotherapy of cognition and neuropsychiatric symptoms associated with dementia and in predementia states.  She currently holds grants as a PI from the Alzheimer’s Drug Discovery Foundation, Alzheimer’s Association US, Weston Brain Institute and Canadian Institutes of Health Research.  She is a full member of the School of Graduate Studies in the Faculty of Medicine, University of Toronto, previous winner of the Faculty of Medicine Graduate Education Award, and has trained more than 40 graduate students.

Select Resources

Mild Behavioral Impairment Checklist (MBI-C)

References

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Chau, S. A., Chung, J., Herrmann, N., Eizenman, M., & Lanctôt, K. L. (2016). Apathy and attentional biases in Alzheimer’s disease. Journal of Alzheimer’s Disease, 51(3), 837-846.

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Herrmann, N., Ruthirakuhan, M., Gallagher, D., Verhoeff, N. P. L., Kiss, A., Black, S. E., & Lanctôt, K. L. (2019). Randomized placebo-controlled trial of nabilone for agitation in Alzheimer’s disease. The American Journal of Geriatric Psychiatry, 27(11), 1161-1173.

Herrmann, N., Wang, H. J., Song, B. X., Bawa, K. K., & Lanctôt, K. L. (2022). Risks and benefits of current and novel drugs to treat agitation in Alzheimer’s disease. Expert Opinion on Drug Safety, 21(10), 1289-1301.

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Lanctôt, K. L., Amatniek, J., Ancoli-Israel, S., Arnold, S. E., Ballard, C., Cohen-Mansfield, J., … & Boot, B. (2017). Neuropsychiatric signs and symptoms of Alzheimer’s disease: New treatment paradigms. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 3(3), 440-449.

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Miller, D. S., Robert, P., Ereshefsky, L., Adler, L., Bateman, D., Cummings, J., … & Lanctôt, K. L. (2021). Diagnostic criteria for apathy in neurocognitive disorders. Alzheimer’s & Dementia, 17(12), 1892-1904.

Mintzer, J., Lanctôt, K. L., Scherer, R. W., Rosenberg, P. B., Herrmann, N., Van Dyck, C. H., … & ADMET 2 Research Group. (2021). Effect of methylphenidate on apathy in patients with Alzheimer disease: the ADMET 2 randomized clinical trial. JAMA neurology, 78(11), 1324-1332.

Mohammad, D., Ellis, C., Rau, A., Rosenberg, P. B., Mintzer, J., Ruthirakuhan, M., … & Lanctôt, K. L. (2018). Psychometric properties of apathy scales in dementia: a systematic review. Journal of Alzheimer’s Disease, 66(3), 1065-1082.

Mortby, M. E., Adler, L., Agüera-Ortiz, L., Bateman, D. R., Brodaty, H., Cantillon, M., … & Theleritis, C. (2022). Apathy as a treatment target in Alzheimer’s disease: implications for clinical trials. The American Journal of Geriatric Psychiatry, 30(2), 119-147.

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Robert, P., Lanctôt, K. L., Agüera-Ortiz, L., Aalten, P., Bremond, F., Defrancesco, M., … & Manera, V. (2018). Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group. European Psychiatry, 54, 71-76.

Ruthirakuhan, M. T., Herrmann, N., Abraham, E. H., Chan, S., & Lanctot, K. L. (2018). Pharmacological interventions for apathy in Alzheimer’s disease. Cochrane Database of Systematic Reviews, (5).

Ruthirakuhan, M., Herrmann, N., Andreazza, A. C., Verhoeff, N. P. L., Gallagher, D., Black, S. E., … & Lanctôt, K. L. (2020). Agitation, oxidative stress, and cytokines in Alzheimer disease: biomarker analyses from a clinical trial with nabilone for agitation. Journal of Geriatric Psychiatry and Neurology, 33(4), 175-184.

Ruthirakuhan, M. T., Herrmann, N., Gallagher, D., Andreazza, A. C., Kiss, A., Verhoeff, N. P. L., … & Lanctôt, K. L. (2019). Investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe Alzheimer’s disease: Study protocol for a cross-over randomized controlled trial. Contemporary clinical trials communications, 15, 100385.

Ruthirakuhan, M., Herrmann, N., Vieira, D., Gallagher, D., & Lanctôt, K. L. (2019). The roles of apathy and depression in predicting Alzheimer disease: a longitudinal analysis in older adults with mild cognitive impairment. The American Journal of Geriatric Psychiatry, 27(8), 873-882.

Ruthirakuhan, M., Lanctôt, K. L., Di Scipio, M., Ahmed, M., & Herrmann, N. (2018). Biomarkers of agitation and aggression in Alzheimer’s disease: a systematic review. Alzheimer’s & Dementia, 14(10), 1344-1376.

Scherer, R. W., Drye, L., Mintzer, J., Lanctôt, K., Rosenberg, P., Herrmann, N., … & van Dyck, C. H. (2018). The Apathy in Dementia Methylphenidate Trial 2 (ADMET 2): study protocol for a randomized controlled trial. Trials, 19(1), 1-15.

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