Insights on Sleep, Apathy, and Alzheimer’s: An Interview with Dr. Krista Lanctôt

Figure 1: Dr. Krista Lanctôt in 2022 after being appointed to the inaugural Bernick Chair in Geriatric Psychopharmacology for her research on dementia (1).

by Julia Castel & Aurora Sportel, January 2025

Despite the common belief, memory loss, or even Alzheimer’s Disease (AD), is not a normal part of aging. This is what Dr Krista Lanctôt says when asked about the biggest misconception surrounding AD. In an interview with the McMaster Alzheimer’s Society, she explains how the distinct neuropathology of AD sets it apart from normal aging, with its symptoms far exceeding the extent of those seen with aging. 

 “I think that there is still a problem around recognition”, says Dr Lanctôt— director of the Neuropsychopharmacology Research Group at Sunnybrook Research Institute. Dr. Lanctôt, with over 300 publications, has focused her research on optimizing the treatment of neuropsychiatric symptoms associated with illnesses like AD. These symptoms include mood changes, cognitive changes, apathy, and sleep disorders. To achieve this goal, she uses methods such as neuroimaging, serum biomarkers, and pharmacotherapeutic trials, with results contributing to the understanding of how neurotransmitter, protein, lipid, and metabolite dysfunction are connected to neuropsychiatric symptoms. 

Dr. Lanctôt provides enlightenment on many relevant considerations regarding AD and its associated risk factors, “There are many disorders that increase the risk of Alzheimer’s Disease and they all share the basic premise that they can contribute to loss of brain cells (indirect), or interact with Alzheimer’s neuropathology (direct): plaques and tangles”. 

Plaques are clumps of beta-amyloid protein that build up in the spaces between nerves, while tangles are twisted fibres of tau protein that build up inside nerves. Together, these abnormal structures block communication between nerve cells, leading to cell death, and causing symptoms of AD such as dementia, memory failure, personality changes, and difficulty carrying out daily activities (2). 

Dr. Lanctôt’s research shows that sleep disturbances, including difficulty falling or staying asleep, may directly and indirectly increase the risk of developing Alzheimer’s, “There is evidence that amyloid clears overnight while sleeping, and chronic sleep problems are associated with a host of correlates like neuroinflammation and oxidative stress. Attention impairments may reflect an early sign”.

Symptoms of AD take a huge toll on the person with the disease, their family, and their caregivers. Researchers are currently working hard on emerging treatments and medications to minimize these symptoms, slow disease progression, and provide a better quality of life for all. Nevertheless, limited drugs are available to treat a highly common symptom of any kind of dementia: apathy. This symptom is associated with a decreased quality of life and motivation, and an increased cognitive decline (3). It is therefore relevant to enforce the “psychosocial interventions for apathy”, which “should always be put into place before medications are considered” according to Dr. Lanctôt. Such interventions include exercise and social interactions (4).

Dr. Lanctôt's lab has identified new treatments for agitation and apathy that are becoming established in conjunction with pre-existing psychosocial interventions. The pathway from a novel drug’s identification to its application in patient care is rather straightforward. What is lacking in this field is the “awareness and identification” of Alzheimer's Disease and its symptoms, as well as the ability to choose treatments best suited for an individual.   

As Canada’s elderly population continues to grow, so will the prevalence of dementia. Researchers predict that by 2030, nearly 1 million people in Canada will be living with AD (5). Groundbreaking research like Dr. Lanctôt’s thoroughly contributes to our understanding of AD and supports the development of treatments that can improve the lives of patients, as well as the lives of those around them.

References

1. Dr. Krista Lanctôt appointed to the inaugural Bernick Chair in Geriatric Psychopharmacology - Sunnybrook Hospital [Internet]. Sunnybrook.ca. 2024 [cited 2025 Jan 22]. Available from: https://sunnybrook.ca/media/item.asp?page=38&i=2407 

2. Alzheimer’s Disease and Dementia [Internet]. [cited 2025 Jan 10]. What is Alzheimer’s? Available from: https://alz.org/alzheimers-dementia/what-is-alzheimers

3. Azhar L, Kusumo RW, Marotta G, Lanctôt KL, Herrmann N. Pharmacological Management of Apathy in Dementia. CNS Drugs. 2022 Jan 10;36(2):143–65.

4. Rajkumar AP, Ballard C, Fossey J, Corbett A, Woods B, Orrell M, et al. Apathy and Its Response to Antipsychotic Review and Nonpharmacological Interventions in People With Dementia Living in Nursing Homes: WHELD, a Factorial Cluster Randomized Controlled Trial. Journal of the American Medical Directors Association. 2016 Aug;17(8):741–7.

5. Alzheimer Society. Dementia numbers in Canada [Internet]. Alzheimer Society of Canada. 2024. Available from: https://alzheimer.ca/en/about-dementia/what-dementia/dementia-numbers-canada