CAMH - McMaster Collaborative Care Initiative For Mental Health Risk Factors In Dementia
Condition: Depression; Anxiety; Mild Cognitive Impairment
MeSH terms: Dementia; Depression; Depressive Disorder; Anxiety Disorders; Cognitive Dysfunction
Study type: Interventional

Summary: 
      Age remains the single most significant risk factor for developing dementia, particularly
      Alzheimer's dementia (AD). Given the rate at which Canada's population is aging, the quest to
      determine modifiable risk factors, whether by prevention, earlier detection, or an ability to
      slow the rate of decline, is a key priority in health care. Primary care is likely to play a
      pivotal role in this initiative. Collaborative mental health care between primary care
      providers and mental health clinicians has been demonstrated to be effective at the patient
      and system levels. Thus, the overall goal of this project is to assess impact and feasibility
      of implementing a collaborative care evidence-based Integrated Care Pathway (ICP) in
      addressing three potentially reversible risk factors at high risk for developing AD: anxiety,
      depression, or mild cognitive impairment (MCI).
    

Detailed description: 
      The investigators will enroll 150 participants overall (CAMH and McMaster). Seventy-five will
      be cases who will be enrolled into the ICP arm of the study and these will be patients born
      in the calendar year 1951, 1953 or 1955. The investigators will enroll an additional 75
      controls that were born in the calendar year 1950, 1952 or 1956.

      Patients of general practitioners being seen at primary healthcare clinics in the Greater
      Toronto Area and in Hamilton, who were born in the calendar year 1950, 1951, 1952, 1953,
      1955, or 1956 will be consented and screened for anxiety, depression, and Mild Cognitive
      Impairment (MCI).

      If patients born in 1951, 1953 and 1955 reach a threshold level of anxiety, depression, or
      MCI symptom burden and have a confirmed diagnosis, rather than receive treatment as usual,
      the participants will be enrolled into an Integrated Care Pathway (ICP), which offers
      evidence-informed treatment for the management of these syndromes in a routine, algorithmic
      fashion. All enrolled cases entered in the study will be provided with general interventions
      that address lifestyle and medical factors that both contribute to these syndromes and are
      thought to predispose patients to develop dementia. If the symptom burden is severe enough,
      based on standardized assessments, evidence-based psychopharmacology (a trial of sertraline
      and/or venlafaxine) will also be offered, with a standardized titration schedule.
      Collaboration will be built into the ICP - a psychiatrist will be present at the clinic and
      in contact with primary care providers to provide patient- and physician-level support,
      consultation, and episodes of care as necessary. Rates of anxiety, depression, and MCI
      diagnosis/detection, time to treatment initiation, and improvement in symptom burden will be
      assessed.

      If patients born in 1950, 1952 and 1956 reach a threshold level of anxiety, depression, or
      MCI symptom burden, these individuals will form our comparison group and will receive
      treatment as usual (TAU).
    

Intervention name(s): Sertraline; Venlafaxine; CBT/Psychological Therapy; Psychiatric Consultation; Lifestyle Intervention Resources
Intervention type(s): Drug; Drug; Other; Other; Other
Other intervention name(s): zoloft; effexor
Intervention MeSH terms: Sertraline; Venlafaxine Hydrochloride
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Collaborative Care; Depression; Anxiety; Mild Cognitive Impairment; Integrated Care Pathway