Managing the Behavioural Aspects of Dementia
Spotlight On: Dr. Amer Burhan
December 20, 2022
People who develop Alzheimer’s disease and other forms of dementia typically present with cognitive issues (e.g., memory loss, trouble finding words). Most people living with dementia will also experience behaviour changes throughout the course of their illness. Behaviour changes encompass a wide range of symptoms – from irritability and anxiety, to delusions and hallucinations.
Dr. Amer Burhan spends his time studying the behavioural aspects of dementia. During medical school, Dr. Burhan developed an interest in neuroscience. He completed a fellowship in neuroscience at the Montreal Neurological Institute, and residencies in psychiatry (University of Rochester) and geriatric neuropsychiatry (Western University). Over time, he began to focus on brain-based behavioural illnesses, and eventually, the area of behaviours in dementia. Dr. Burhan is now based at Ontario Shores Centre for Mental Health Sciences (Ontario Shores), where he is a Geriatric Psychiatrist, Physician-in-Chief, and Endowed Chair for Applied Mental Health Research. He also leads TDRA’s Neurotechnology Research Working Group (RWG), and works with the Caregiving and Long-Term Care RWGs.
Dr. Burhan’s research in dementia-associated behaviours began with an early brain-imaging study on emotional processing in mild cognitive impairment, then moved toward more clinical applications. He now focuses on monitoring, assessing, and managing behavioural aspects of dementia through a variety of studies. Overall, his research aims to identify signatures of different behaviours so they can be detected earlier, and managed more effectively.
To-date, available drug treatments are only modestly effective, and come with serious side effects like increased risk for stroke and death. There are also non-pharmacological interventions, which have shown promise when individualized to the person. For example, music therapy, physical activation, doll therapy, or aromatherapy. However, more comprehensive solutions are still needed for many dementia-associated behaviours. Toward this need, Dr. Burhan helped to develop quality standards to manage agitation and aggression in people living with dementia. This set of standards leads to an algorithm of care, which begins with an assessment of the person, implements individualized non-pharmacological interventions, and only when necessary uses drug treatments- with several safeguards to reduce risk of harm. These quality standards have been studied at Ontario Shores, and across other clinical sites in Ontario and beyond in collaboration with other leading centres like CAMH.
With TDRA’s Neurotechnology RWG, Dr. Burhan is leading cutting-edge research focused on profiling behavioural symptoms of dementia. This study involves multiple TDRA sites, and participants use wearable devices that track their movement and physiological changes, like change in heart rate with activity. Mathematical models are applied to all the data collected to identify individualized and consistent patterns. The aim is to identify an individual signature for emotional distress; this allows you to know when someone is at the beginning of an agitated episode, and to intervene before it gets to a crisis level. Dr. Burhan and his collaborators are also studying how this could be integrated into models of care for dementia.
TDRA’s Neurotechnology and Caregiving RWGs have also jointly secured a grant to adapt an existing program for caregivers/care partners of people living with dementia into the virtual reality (VR) space. Led by Dr. Burhan and Dr. Mary Chiu, and co-designed with caregivers/care partners, this VR skills-training program will help people to manage difficulties that may arise when caring for people living with dementia (e.g., agitation, wandering). Extending this program into the VR space improves its accessibility.
As part of TDRA, Dr. Burhan looks forward to bringing science and innovation as close as possible to people being treated at Ontario Shores and beyond. Along with its key partners (e.g., Ontario Tech University, University of Toronto Scarborough), Ontario Shores will help TDRA to extend its access and reach.