Making a difference - mental health in neurodegeneration

 

People with dementia and other diseases that destroy the brain and nervous system (neurodegeneration) for example, Parkinson’s, or motor neurone disease, are vulnerable to mental health disorders like depression, psychosis and anxiety.

These conditions can cause patients more distress and disability than symptoms like memory loss or movement difficulties.

Drugs to treat psychosis in neurodegenerative conditions are available, but often cause unpleasant and dangerous side-effects.

UCLH-BRC research has identified why patients with neurodegeneration are at risk of mental health disorders, enabling Mental Health researchers to create new drugs and psychological treatments that will improve their care. They have also used their findings to create algorithms which identify if patients are prone to the side-effects of anti-psychosis drugs, so doctors can prescribe and monitor these medicines more safely.

Their search for better treatments for hallucinations and delusions in people with neurodegenerative disorders identified a drug used to treat nausea called ondansetron which could in theory control hallucinations in Parkinson’s disease. The BRC TOP HAT trial is testing ondansetron in a large group of patients. If the results are positive this could become a new NHS treatment.

The effects and side-effects of drugs which can treat hallucinations and delusions in dementia are produced by the way they are absorbed by the body and pass into the brain1. Data from the team’s studies of these drugs have allowed them to identify which factors produce these beneficial effects and unwanted side-effects2, and to write new guidance on how to prescribe specific drugs to treat psychosis and aggression in people with Alzheimer’s safely and effectively.

However, drugs are not the best approach for many mental health problems, and UCL-UCLH have also created new psychological therapies for people with neurodegeneration and their families. This includes START, the first programme of therapy and coping strategies to prevent burn-out and depression in dementia carers. Six years on, carers who received the START therapy were five times less likely to have clinically significant depression than non-START carers. Care costs were nearly three times lower among families in the START group3, with fewer dependents moving into care homes. START is now delivered in a third of the UK’s memory clinics, and is recommended by official NHS treatment guidelines.

1. Reeves S et al. Brain. 2017; 2. Reeves S et al. Br J Psychiatry. 2021; 3. Livingston G et al. Health Technol Assess. 2014.