Project Overview

Apathy (reduced goal-directed behaviour) is common in persons with dementia and associated with lower quality of life, increased dependence and faster decline. The brain chemical dopamine is disrupted in apathy in persons with dementia. Methylphenidate, an oral medication, increases dopamine and repetitive transcranial magnetic stimulation (rTMS), a method of non-invasive brain stimulation, relies on dopamine. Both improve apathy modestly in persons with dementia, such as Alzheimer’s disease.

We will assess whether methylphenidate combined with a type of rTMS (intermittent theta burst stimulation [iTBS]) can effectively treat apathy in persons with Alzheimer’s disease compared to iTBS alone. The combined treatment may increase dopamine in brain areas specific to apathy, while avoiding higher doses of either treatment, as higher doses increase side effects.

In this 10-week study, we will assess the effectiveness of iTBS in persons with Alzheimer’s disease who have been clinically prescribed methylphenidate (combined treatment), and those receiving no medication for apathy(comparison group). We will enroll 12 persons with Alzheimer’s disease in this study and they will all receive iTBS for 2 weeks (5 sessions/week). We will assess change in apathy symptoms at the end of the 2-week treatment and 8 weeks after completing treatment.

This research will be the first administration of iTBS for apathy in persons with Alzheimer’s disease. The study will help to determine if the combination of methylphenidate and iTBS or iTBS alone should be pursued as a treatment for apathy in persons with Alzheimer’s disease. If our results are positive, it will provide the information needed for a larger, confirmatory trial that can change practice.

Many persons with Alzheimer’s disease have apathy even after non drug interventions like stimulating environments. Our goal is to provide a novel treatment for those people. A safe and effective treatment for apathy can be expected to improve the health and quality of life for people living with dementia and alleviate care partner distress and burden, improving the overall care of persons with Alzheimer’s disease.

Principal Investigator

Krista Lanctot , Sunnybrook Health Sciences Centre

Team Members

Amer Burhan, London Health Sciences Centre

Partners and Donors

Alzheimer Society of Canada