ADHD Med May Boost Attention, Reduce Apathy in Alzheimer's

Katharine Gammon

March 21, 2013

LOS ANGELES — Methylphenidate (MPH), a psychostimulant commonly used to treat attention-deficit/hyperactivity disorder (ADHD), can help improve attention and reduce apathy in patients with Alzheimer's disease (AD), new research shows.

"Apathy is one of the most prevalent neuropsychiatric symptoms in Alzheimer's disease, and it interferes with the daily activities of living," study author Krista Lanctot, PhD, senior scientist at the Sunnybrook Research Institute in Toronto, Canada, told Medscape News.

Dr. Lanctot explained that psychostimulants like MPH increase central dopamine concentrations and are known to play a role in modulating attention. The researchers hoped to find out whether the drug could help both apathy and attention — and how the 2 were linked.

The investigators enrolled 60 patients in a randomized, double-blind, placebo-controlled study to examine the safety and efficacy of MPH (10 mg PO twice daily) vs placebo for 6 weeks for the treatment of apathy (Neuropsychiatric Inventory [NPI] apathy subscale score ≥4) in AD patients.

They monitored apathy every 2 weeks. Patients were also assessed for overall change, global cognition, and neuropsychiatric symptoms.

Fifty-seven participants completed the study (34 women, mean age ±SD, 77 ±8 years). There were improvements in apathy in the drug-treated group as assessed using the Clinical Global Impression of Change (CGIC) scale (odds ratio [OR], MPH vs placebo, 3.7; 95% confidence interval [CI], 1.3 - 1.08), NPI apathy scale (estimated mean score improvement was 1.8 times greater for MPH; 95% CI, 0.3 - 3.4), and the apathy evaluation scale (AES) (estimated difference in change in AES favoring MPH = -2.5; 95% CI, -6.5 to 1.2).

For attention, there were improvements in apathy in the MPH group on the CGIC (OR, MPH vs placebo, 3.7; 95% CI, 1.3 - 1.08), the NPI apathy scale (estimated mean score improvement was 1.8 times greater for MPH; 95% CI, 0.3 - 3.4), and the AES (estimated difference in change in AES apathy favoring MPH = -2.5; 95% CI, -6.5 to 1.2).

Interestingly, there was no correlation between attention and apathy in the treated individual — each parameter improved independently. Dr. Lanctot noted that the reasons for this are not entirely clear.

Next Steps

David Sultzer, MD, professor of psychiatry and biobehavioral sciences at the University of California, Los Angeles, who was not involved in the study, told Medscape Medical News that the work was important and was carefully done.

"These results can help us understand how best to treat apathy and attention problems that occur in people with Alzheimer's disease."

Dr. Sultzer said that the next steps in examining MPH include validating the findings and identifying those patients who may benefit most from treatment or who have the fewest side effects.

"In addition, how such treatment may interact with usual antidementia treatments for Alzheimer's disease, other psychotropic meds treatments, and nonpharmacological behavioral interventions can be evaluated," he said.

"Finally, the brain mechanisms that drive treatment response can be studied in order to better understand what contributes to these symptoms and how they might be best treated or even prevented in the future."

Dr. Lanctot and Dr. Sultzer report no relevant financial relationships.

American Association for Geriatric Psychiatry (AAGP) 2013 Annual Meeting. Abstract NR 42. Presented March 15, 2013.