$2.87 million grant studying varying presentation of behavioral symptoms in dementia

The study will look at how the variability of different behaviors can affect quality of life.
Written by: Erica Techo
Media contact: Bob Shepard

R01grant4Carolyn Pickering, Ph.D., associate professor, School of NursingA five-year, $2.87 million R01 grant from the National Institute of Mental Health to the University of Alabama at Birmingham School of Nursing will study how environmental, personal and disease-related factors contribute to the presentation of behavioral symptoms in patients with Alzheimer’s disease.

Dementia patients can experience a wide variety of symptoms, and while memory loss is one of the most common, little is known about what causes the varying presentation of behavioral symptoms associated with Alzheimer’s disease and dementia.

“People with dementia experience other symptoms such as aggression, apathy, anxiety and others; but which symptoms they have and how intensely they’ll experience those symptoms vary quite significantly among patients,” said Carolyn Pickering, Ph.D., associate professor of nursing, whose program of research focuses on supporting high-quality care within family caregiving situations. “The variability of symptoms makes it really hard to plan, to leave the house or to complete basic tasks, and caregivers often say they want to know what causes the ‘bad days.’ Through this study, we’ll look at underlying causes to determine what factors into that variability.” 

The study will include 162 patient-caregiver partners, with equal representation of Caucasian and African American participants to make sure interventions and findings will work across populations. The caregivers will complete daily, virtual diary entries that track symptoms, activities and other environmental factors. Pickering has utilized these survey-like diaries in past studies and says feedback is typically positive, and that caregivers say the diaries offer a chance to reflect on their day. 

“Generally, we’ve gotten really good feedback from diary studies, and we typically get 90 percent of diaries back,” she said. “For caregivers, symptoms are their life, so this is a really important topic. The diaries also help with measurement accuracy because you get more real-time information and less recall bias.” 

By collecting diary entries, they can build an idea around what behaviors are a symptom of dementia versus which are a response to environmental factors, Pickering says. In addition to the survey data from diaries, the study will also involve collection of biological samples to analyze on a molecular level and seek out other explanations such as genetic predispositions. Once again, this information will allow them to determine which symptoms are environmental responses rather than symptoms of the disease process, which can inform treatment plans such as whether to use a pharmacologic or non-pharmacologic approach.

Previous clinical trials have developed treatments in model organisms such as mice; but those treatments are not effective in human subjects, says co-investigator Andrew Pickering, Ph.D., assistant professor in the Department of Neurology. Understanding what factors may cause milder or more severe symptoms is a first step toward addressing or lessening disease symptoms directly. 

R01grant5Andrew Pickering, PH.D., assistant professor, Department of Neurology“If we can understand why patients are experiencing dementia and symptoms differently, we can work to lessen disease symptoms, which may be more effective than the approaches we have,” he said.

Carolyn Pickering added that, while some pharmacologic treatments work to address aggression or anxiety, there is no FDA-approved drug explicitly focused on the management of dementia symptoms. Non-pharmacologic strategies to manage symptoms are the first-line approach, but unfortunately they do not always work.

“Findings from this study will inform a nursing, person-centered approach in which we can individualize care strategies based on the type or severity of a symptom a patient presents with. By taking an interdisciplinary approach with our biologic components, the findings will also inform novel drug development for symptom management,” Carolyn Pickering said. “We want to give caregivers as many tools as we can to help their loved ones.” 

The Pickerings joined UAB in 2019 and say its resources, as well as location and community reach, make it possible to reach a diverse population as well as a population that is heavily impacted by dementia, which hopefully will lead to better person-centered and pharmacological treatments for Alzheimer’s and dementia. Both are also investigators involved with the UAB Alzheimer’s Disease Center’s research

“One of the benefits is that UAB is a leading hospital that draws in patients from the four surrounding states,” Andrew Pickering said. “The South also has very high levels of dementia, which is partly to do with other health factors. At UAB, we’re able to encompass a larger pool of participants from a range of health conditions, socioeconomic status and geographic location, which we might not be able to reach at other academic health centers, to hopefully develop better interventions and treatments in the future.”