Toronto, ON (July 27, 2026) – A new cross-provincial clinical trial led by researchers at the Centre for Addiction and Mental Health (CAMH), published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, has found that a new Integrated Care Pathway (ICP), a structured, algorithm-based approach developed at CAMH for treating agitation in people with dementia, can reduce medication overuse without sacrificing effectiveness.
Agitation, which refers to restless, anxious, or aggressive behaviours, affects over 80 per cent of patients with dementia. It is extremely challenging for the affected individuals, their families, and caregivers, and can be difficult to manage, often leading to emergency room visits, hospitalizations, and long-term care home placement. Treatment often involves multiple psychotropic medications including antipsychotics, which are associated with an increased risk of serious adverse events. Research also shows that over 95 per cent of dementia patients take four or more medications simultaneously. Such polypharmacy may be linked to falls, delirium, rapid cognitive decline, and death—making it a serious patient safety issue.
The ICP, which has been designated a leading practice by Health Standards Organization, aims to address this issue. It prioritizes personalized non-pharmacological interventions first, such as music therapy, social interaction, or other purposeful activities, followed by the careful and sequential introduction of evidence-based medications only when necessary, as determined by standardized assessments and pre-determined decision points.
"We designed the ICP because the existing guidelines alone are not sufficient to change practice—what was missing was a structured process that clinicians could actually implement at the bedside,” explains Dr. Sanjeev Kumar, Scientist and Medical Head of Geriatric Clinical Research within the Adult Neurodevelopmental and Geriatric Psychiatry Division at CAMH.
Key Findings Highlight Effectiveness
In the 12-week, double-blind randomized controlled Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) trial, researchers studied patients across 12 inpatient psychiatric units and long-term care homes affiliated with academic hospitals. The findings showed:
- Equivalent clinical outcomes: Patients receiving the ICP-based care experienced improvements in agitation comparable to those receiving usual care.
- Reduced medication use: Patients in the ICP group used significantly fewer psychiatric medications during the critical early weeks of treatment.
- Lower polypharmacy risk: Over 12 weeks, the number of psychiatric medications increased modestly in the ICP group compared to a sharper rise in the usual care group.
“The polypharmacy finding is especially clinically meaningful as it demonstrates it’s possible to take patients off unnecessary medications without worsening agitation in dementia. This study gives us the foundation to expand the ICP into community-based settings, such as long-term care homes, where the need—and the opportunity—is far greater,” says Dr. Kumar.
“It is vital for front-line staff, which include personal support workers, nurses, and physicians, to have a standardized, evidence-based team approach for assessing and treating challenging behavioural symptoms such as agitation to improve patients’ quality of life and care. The ICP is exactly that—an effective, integrative pathway that stresses non-pharmacological approaches and reduced medication use whenever possible,” says Dr. Peter Derkach, Medical Director of West Park Long-Term Care Centre, one of the facilities involved in the trial.
Implications for Care
With more than 772,000 Canadians currently living with dementia—a number projected to reach 1.7 million by 2050—the need for safer, evidence-based approaches to care is urgent. The trial findings support the use of a standardized measurement-based approach for treatment of agitation and suggest that the ICP could serve as a new standard for managing agitation, from very start of treatment, by reducing unnecessary medication use and promoting more personalized, non-drug interventions.
“This comprehensive study offers comforting news and hope for families of people living with dementia. It shows that a thoughtful, consistent care approach can ease agitation while using fewer medications, thereby reducing the risk of side effects and supporting safer and compassionate care. For families, this brings reassurance that their loved one is receiving care tailored to their needs, ultimately offering comfort and peace of mind,” says Linda Krisman, family partner contributing lived experience to the study, about the real-world impact of the findings.
Looking Ahead
The team is expanding the use of the ICP in broader healthcare settings, including community hospitals and non-academic long-term care homes, where variation in care practices is greater. Future studies will also explore longer-term outcomes, such as caregiver burden, quality of life, and fall risk. In addition, the team is developing a technology-enabled version of the pathway (Tech-ICP) that will integrate technology-based decision-support tools, wearable sensors for monitoring behaviours, and technology based non-medication interventions such as virtual reality to further refine assessment, monitoring, and treatment of behavioural symptoms such as agitation with the ultimate goal of developing precision-based and personalized care for dementia.
The StaN trial was supported by the Brain Canada Foundation through the Canada Brain Research Fund, with financial support from Health Canada and the Centre for Addiction and Mental Health, and additional support from the Centre for Aging and Brain Health Innovation. TECH-ICP is generously supported by The Slaight Family Foundation, and Ontario Health Models of Care Innovation Fund.
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About the Centre for Addiction and Mental Health (CAMH)
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit camh.ca or follow @CAMHnews on Bluesky and LinkedIn.
Media contact:
CAMH Communications
media@camh.ca
