Krista Lanctot, PhD

“When a patient is agitated, you definitely hear about it. The caregiver is going to give you a phone call.”

When patients with Alzheimer disease experience symptoms of agitation, the clinicians that are treating them are essentially guaranteed to receive a phone call about it, at the minimum.

According to Krista Lanctôt, PhD, it is a real problem in the care of these patients, and in recent years, it has become the focus of a multitude of treatments coming through the pipeline. As such, she issued a reminder to her fellow clinicians that when agitation episodes arise, ensuring the proper steps are taken to manage these patients is essential.

She advised ruling out any possible underlying medical conditions that could be causing it, including pain, as well as starting with any non-pharmacologic interventions. Reaching straight for the meds will not always provide the patient with the best outcome, despite the ease of their administration.

At the Alzheimer’s Drug Discovery Foundation’s 19th Annual Meeting in Jersey City, New Jersey, the psychiatry and pharmacology professor at the University of Toronto and senior scientist at Sunnybrook Research Institute sat with 

 to talk about managing agitation in patients with Alzheimer.

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Lanctôt advised ruling out any possible underlying medical conditions that could be causing it, including pain, as well as starting with any non-pharmacologic interventions.

Krista Lanctot, PhD: Managing Patients with Agitation

“Instead of first looking at a whole mixture of a whole bunch of molecules, we [need] to understand the system better.”

Research into the possible use of cannabinoids for myriad conditions in the neurology space has blossomed recently. One trial, conducted by Krista Lanctôt, PhD, and colleagues, explored the use of nabilone for symptoms of agitation Alzheimer disease, was very successful.

To discuss this pathway and its potential for Alzheimer, the psychiatry and pharmacology professor at the University of Toronto, and senior scientist at Sunnybrook Research Institute sat with 

 at the Alzheimer’s Drug Discovery Foundation’s 19th Annual Meeting in Jersey City, New Jersey.

Lanctôt spoke about how the increasing availability and popularity of medicinal marijuana in Canada, as well as the United States, will result in a parallel increase in research surrounding it. For quite some time, she noted, the medicines for agitation have been plagued by safety and efficacy issues, making these new developments very exciting.

Additionally, the newly published International Psychogeriatric Association criteria for agitation have been more or less accepted by the FDA, helping to better define the symptom. This, she said, could also aid improvements in its treatment.

The psychiatry and pharmacology professor at the University of Toronto and senior scientist at Sunnybrook Research Institute spoke about the use of cannabinoids to treat agitation in Alzheimer.

Krista Lanctot, PhD: Addressing Alzheimer Disease Agitation

“These results should not encourage you to use medical marijuana or recreational marijuana to try and treat these symptoms in Alzheimer disease.”

Krista Lanctôt, PhD, psychiatry and pharmacology professor at the University of Toronto, Sunnybrook Health Sciences Centre researcher spoke to 

at the 2018 Alzheimer’s Association International Conference in Chicago, Illinois, to discuss treating agitation in Alzheimer disease.

At the conference, Lanctôt presented preliminary results of a placebo-controlled, double-blind, cross-over trial that assessed the efficacy and safety of nabilone, a synthetic cannabinoid, for the treatment of agitation in moderate-to-severe Alzheimer disease. The 14-week trial compared 6 weeks of nabilone 1 mg—2 mg to 6 weeks of placebo, with a 1-week washout between phases.

The primary outcome was agitation, measured by the Cohen Mansfield Agitation Inventory; secondary outcomes included safety, overall neuropsychiatric symptoms (NPI total), cognition (sMMSE) and global impression (Clinician’s Global Impression of Change (CGIC). In addition, researchers assessed subjects’ pain (Pain Assessment in Advanced Dementia Scale (PAINAD)) and nutritional status (Mini-Nutritional Assessment-Short Form (MNA-SF)).

The results showed significant differences in NPI-agitation/aggression (

Lanctôt stresses that while the preliminary results are positive and showed that nabilone significantly improved agitation, neuropsychiatric symptoms, cognition and nutrition in subjects, clinicians should not use medical marijuana or recreational marijuana to try and treat these symptoms. A large confirmatory phase III trial is needed to verify the evidence regarding the safety and efficacy of nabilone in this patient population.

Nabilone significantly improved agitation, neuropsychiatric symptoms, cognition and nutrition in patients with moderate-to-severe Alzheimer disease.

Krista Lanctot, PhD: Treating Agitation in Alzheimer Disease

“What we found when we gave this medication was that we did have a statistically significant decrease in agitation.”

According to data Krista Lanctôt, PhD, psychiatry and pharmacology professor at the University of Toronto, presented at the 2018 Alzheimer’s Association International Conference, in Chicago, Illinois, nabilone, a synthetic cannabinoid, significantly improved agitation, cognition, neuropsychiatric symptoms and nutrition in those with moderate to severe Alzheimer disease.

The Sunnybrook Health Sciences Centre researcher sat down with 

to discuss the results of a randomized, double-blind, cross-over clinical trial, funded by Alzheimer's Drug Discovery Foundation and Alzheimer Society of Canada, that investigated the potential benefits of nabilone for adults with moderate to severe Alzheimer’s dementia with clinically significant agitation.

Lanctôt and colleagues investigated the potential benefits of nabilone over a 14-week period where participants received nabilone for 6 weeks, followed by 6 weeks of placebo, with 1 week between each treatment period.

In addition to measuring agitation, researchers studied overall behavioral symptoms, memory, physical changes and safety, concluding that nabilone offered clinically and statistically significant improvements in agitation when compared with placebo, as measured by the Cohen-Mansfield Agitation Inventory (

= .003), and significantly improved overall behavioral symptoms, versus placebo, as measured by the Neuropsychiatric Inventory (

Lanctôt stressed that the occurrence of sedation be closely monitored, as 45% of participants on nabilone experienced sedation compared to 16% that received placebo.

While there are still questions regarding the cognitive effects nabilone has on patients, overall, there was a slight improvement in the Mini-Mental Status Examination score in a subgroup population with more severe dementia.

The benefits of nabilone also went beyond the patient, as caregiver distress showed a significant reduction. For this patient population, a larger trial is needed to provide confirmatory evidence regarding and safety of nabilone. Being as this is a proof-of-concept trial, this trial is more so a signal, rather than leading to changes in clinical practice guidelines.

The psychiatry and pharmacology professor spoke about the results from the first clinical trial that showed that a cannabinoid can decrease agitation in Alzheimer disease. 

Krista Lanctot, PhD

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