McLean Hospital 115 Mill Street Belmont, MA 02478
Brent P. Forester, MD, MSc, is the chief of the Division of Geriatric Psychiatry at McLean Hospital and medical director for Behavioral Health in the Center for Population Health Management at Partners HealthCare. Dr. Forester is an expert in geriatric psychiatry, specializing in the treatment of older adults with depression, bipolar disorder, and behavioral complications of Alzheimer’s disease and related dementias. He is a distinguished fellow of the American Psychiatric Association and has previously served on boards of the American Association for Geriatric Psychiatry and the Alzheimer’s Association of Massachusetts/New Hampshire.
Dr. Forester’s research focuses on using brain imaging techniques and careful clinical assessment to better understand the causes of depression and bipolar disorder in later life and to identify promising new targets for effective treatments. He also studies novel treatment approaches to manage common behavioral complications of dementia such as agitation and aggression.
Dr. Forester leads the Geriatric Psychiatry Research Program, founded in 2000, and the Geriatric Mood Disorders Research Program, founded in 2005. He is dedicated to pursuing a better understanding of the relationship between brain function and behavioral symptoms of Alzheimer’s and related dementias in older adults. He also researches the neurobiological causes and correlates of mood changes and disorders in later life, and the relationship between cognitive impairment and mood changes. Dr. Forester and his team are committed to helping develop and test novel treatments that will improve quality of life for older adults.
Behavioral symptoms of dementia (now known as major neurocognitive disorder) are an important target for research and treatment. Symptoms such as agitation and aggression are the most challenging obstacles to continued care in the home setting, and lead to caregiver stress and burnout. They are highly associated with excess morbidity, mortality, and long-term care placement. Dr. Forester and his team pioneered the use of ECT in treating behavioral symptoms in patients with major neurocognitive disorder. Their pilot studies suggest that ECT is an effective and safe treatment for agitation and aggression in dementia.
Dr. Forester’s pilot study on endocannabinoids to reduce agitation in patients with major neurocognitive disorder demonstrated safety and efficacy for dronabinol, a synthetic cannabinoid. Dr. Forester and his team are currently conducting an NIA funded, large, multisite, randomized controlled trial of dronabinol in the Cognitive Neuropsychiatry Program, an inpatient unit at McLean. They are also studying lithium to treat behavioral symptoms of major neurocognitive disorder in outpatients.
Dr. Forester and his staff explore promising avenues to earlier diagnosis and expanded treatment options for older adults with neurocognitive disorders. The IDEAS study investigated the use of a PET imaging scan to look for evidence of amyloid deposits—or deposits of an abnormal protein implicated in Alzheimer’s disease—in people who are experiencing mild memory problems. Dr. Forester’s group is currently participating in three clinical trials investigating potentially disease-modifying therapies for mild cognitive impairment or mild Alzheimer’s—the Biogen EMERGE trial, which studies a monoclonal antibody targeting amyloid plaques, the Biogen TANGO trial, which tests a monoclonal antibody targeting extracellular tau, and the Eli Lilly TRAILBLAZER trial, which studies a combination therapy of a monoclonal antibody targeting amyloid and a BACE inhibitor.
People in the early stages of neurocognitive disorders often experience depressive symptoms, and depressive episodes that emerge in later life may indicate a developing neurocognitive disorder. However, evidence also shows that younger adults with depression are at heightened risk for developing major neurocognitive disorder later in life. Treatments for major depression and bipolar disorder in older adults are poorly studied, but are urgently needed as both disorders are risk factors for cognitive impairment and suicide. Dr. Forester aims to better understand the neurobiological causes of mood changes in older adults, and focuses on translating these findings into effective, safe, and targeted treatments.
Dr. Forester’s team is investigating the relationship between mood changes in later life and neurocognitive disorders using imaging techniques and biomarkers in their study on mood changes in adults with mild cognitive impairment. Dr. Forester is also running a longitudinal study tracking neuropsychiatric changes that occur with aging in patients with mood disorders and in healthy controls. The team’s multidisciplinary approach incorporates clinical, neuropsychological, medical, genetic, and structural and functional imaging data, and has high potential for personalizing medicine to help older adults with depression or bipolar disorder.
Dr. Forester and his staff offer clinical trials of novel treatments for older adults with mood disorders. They are currently studying the safety and efficacy of a low frequency magnetic stimulation device to help treat older adults with bipolar disorder who are currently depressed. They were involved in a study assessing how a genetic test that provides clinicians with information on genetic markers of psychiatric medication metabolism in individual patients can help guide psychopharmacological treatment of depression.
Woodward MR, Harper DG, Stolyar A, Forester BP, Ellison JM. Dronabinol for the treatment of agitation and aggressive behavior in acutely hospitalized dementia patients with non-cognitive behavioral symptoms. American Journal of Geriatric Psychiatry 2014;22(4):415-9.
Forester BP, Harper DG, Georgakas J, Ravichandran C, Madurai N, Cohen B. Antidepressant effects of open label treatment with coenzyme Q10 in geriatric bipolar depression. Journal of Clinical Psychopharmacology 2015;35(3):338-40.
Acharya D, Harper DG, Achtyes ED, Seiner SJ, Mahdasian JA, Nykamp LJ, Adkison L, Van der Schuur White L, McClintock SM, Ujkaj M, Davidoff DA, Forester BP. Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia. International Journal of Geriatric Psychiatry. 2015;30(3):265-73.
Belmont campus - South Belknap, Room 322