Ritalin could treat apathy in Alzheimer’s patients, study finds

Lowell Jenkins describes what it’s like to have Alzheimer’s disease.

“Alzheimer’s takes away life, not all life, but it just does. It can’t be like what you’d like it to be,” Jenkins said. “Hell, it’s like hell.”

His voice trails off as he searches for words. It happens often. His wife, Julie Foley, gently reminds him of what he was beginning to speak about.

“For me, it has been excruciating to live with circumstances that you watch your cherished partner gradually lose more and more capacity,” Foley said. “At the same time we’ve been blessed with the capacity to make adjustments one at a time and we’ve found ways of continuing to do the things that are very important to us.”

Not all Alzheimer’s patients can continue to do the things they value, despite still having the cognitive ability. Apathy is one very common symptom of Alzheimer’s disease. Various studies suggest 70 to 90 per cent of individuals will experience apathy at some point.

While it may sound harmless enough, Dr. Nathan Herrmann, head of the division of geriatric psychiatry at Sunnybrook Health Sciences Centre, knows that isn’t the case.

“Apathy is a syndrome that involves lack of interest or motivation and these are the kind of people that are willing to sit in a chair all day and do absolutely nothing and be perfectly content,” Dr. Herrmann said.

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“This is extremely disturbing to caregivers who need to get them motivated, to get them dressed, to get them to eat, to get them to do anything and it can often be confused with depression.”

But, a new study led by Dr. Krista Lanctôt, a senior scientist at Sunnybrook Research Institute, discovered a treatment that might offer hope for some Alzheimer’s patients and their loved ones.

“What we did is we gave a drug called methylphenidate, that you may have heard of as Ritalin, that’s actually given to children who have Attention Deficit Hyperactivity Disorder,” Dr. Lanctôt said.

While the drug is the same, it has different effects in Alzheimer’s patients than it does in people with ADHD.

“We do think that it increases attention in people with Alzheimer’s disease as well as improving apathy,” Dr.  Lanctôt said. “But even though attention is a big problem in people who have Alzheimer’s disease, they don’t have the same underlying brain that someone with ADHD does.”

Researchers say the drug impacts the brain chemical dopamine to stimulate the reward and attention centres in the brain. The study involved 60 patients.

“We looked at apathy at the end of six weeks and we were very happy to see that the people who received the drug had improved scores in apathy compared to the placebo group. In this particular study 21 per cent of people on the medication had moderate to markedly improved apathy, whereas only 3 per cent of people in the placebo group had an improvement in apathy,” Dr. Lanctôt said.

“They may start doing some of their hobbies again that they’re still able to do, when the caregiver says ‘Do you want to go to a movie?’ they’ll come to a movie with the caregiver, they’ll go out and visit family again.”

Although this is an advancement in terms of Alzheimer’s treatment, it is by no means a cure.

“It’s not going to delay progression of Alzheimer’s disease,” Dr. Lanctôt said. “It is a symptomatic treatment that we hope can improve quality of life while people have Alzheimer’s disease. But it’s not a cure.”

Researchers say more rigorous study is needed to determine whether it is safe in the long-term, but Dr. Herrmann thinks it could still be prescribed by some doctors.

“It certainly is a medication that’s readily available because it’s a drug that’s been on the market for decades,” Dr. Herrmann said. “So we might see more of it being used once physicians are familiar with the results of our study.”

As an off-label use of the drug, it can be prescribed doctors at their discretion. If it is prescribed, it would be covered by the healthcare system.