In Ontario, a lot of time, effort and money is being placed on understanding how to better recognize the early signs and mitigate the symptoms of dementia.
This part of the equation is a key to providing the best and most effective care possible to the 200,000 Ontarians living with Alzheimer’s disease and other forms of dementia as well as the projected 27,000 more Ontarians who will be diagnosed with the illness by 2016, say healthcare professionals.
“We need to find out new and innovative ways to understand (dementia) and develop new treatments that are more effective than what we have now,” said Dr. Tarek Rajji, chief of geriatric psychiatry at the Centre for Addiction and Mental Health (CAMH).
Rajji, a geriatric psychiatrist, also serves as the co-lead investigator of the innovative PACt-MD (Preventing Alzheimer’s dementia with Cognitive remediation plus tDCS in MCI and Depression) Study, which combines brain stimulation and cognitive remediation to determine whether the onset of Alzheimer’s disease can be prevented or even delayed. In May 2014, the PACt-MD Study was awarded the largest-ever grant ($10 million) for Alzheimer’s disease prevention research in Canada from the Brain Canada Foundation and the Chagnon Family.
Rajji told Metroland Media the goal of the study is to better understand how to prevent cognitive decline in patients who are high risk of developing dementia – essentially to prevent the progression of the illness when it is in the pre-dementia phase known as mild cognitive impairment.
There are three groups of participants in the study: those aged 65 and older with a history of clinical depression but no memory issues; those aged 65 and older with clinical depression and mild cognitive impairment; and those aged 60 and older with mild cognitive impairment and no history of depression. A total of 375 people from CAMH, Baycrest, St. Michael’s Hospital, Sunnybrook Health Sciences Centre and the University Health Network are taking part in this five-year study, which began recruiting in February.
Groups of participants attend a series of classes where they do memory exercises as well as painless electronic brain stimulation to improve neuroplasticity – the brain’s ability to change in response to intervention – so they can benefit better from the memory training.
Study participants, who will be evaluated annually on how their memory is doing, also do online memory exercises at home.
“By the time Alzheimer’s and dementia develop, it could be too late. We want to get an early handle on dementia and prevention is likely to have a big impact,” he said, adding the study also includes brain imaging, genetic testing, and other biomarkers to better understand the biology that connects depression to dementia and how to prevent it.
A FOCUS ON THE BRAIN
CAMH has a number of other dementia-related studies exploring the benefits of brain stimulation including magnetic stimulation. Researchers are trying to improve the function of the brain’s frontal lobe, which handles the executive functions of the brain such as planning, organizing and undertaking day-to-day tasks, Rajji explained.
In these studies, participants come in to CAMH, in Toronto, over a two-week period for testing and the outcome is then assessed.
Researchers at CAMH are also looking at the brain’s plasticity. To better understand this, they are also doing brain imaging as well as measuring of the electric activity of the brain to see how it functions.
“I think we’re doing some leading work in dementia (here at CAMH) and hopefully we’ll see some results,” Rajji said.
Another innovation in the field of researching and treating neurodegenerative disorders is a research-based initiative called the Ontario Neurodegenerative Disease Research Initiative (ONDRI).
This province-wide collaboration between more than 50 of the province’s lead neurodegenerative researchers and clinicians, four patient advocacy groups, the industrial sector, and more than 20 clinical, academic and research centres is studying how to improve the diagnosis and treatment of a number of diseases associated with dementia including Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis (also known as ALS and/or Lou Gherig’s disease), frontotemporal lobal degeneration and vascular cognitive impairment.
The collective effort is spearheaded by the not-for-profit, provincial government-funded Ontario Brain Institute. It’s a virtual research centre working to turn neuroscience research into innovation by strengthening connections between the province’s universities, hospitals and research institutes as well as its community of clinicians, industry, patients and advocacy groups.
Dr. Michael Strong, dean of the Schulich School of Medicine and Dentistry and professor at Western University in London, Ont., serves as the principal investigator for ONDRI.
“It’s a really unique initiative that brings together major hospitals and researchers across Ontario to look at dementia, specifically how it affects the frontal regions of the brain,” he said of the long-term observational study that is seeking common early indicators and risk factors of the five diseases.
“The goal is to identify the illness before symptoms present themselves. This is very unique. I don’t know of any other study like this in the world.”
Strong, a neurologist and leading ALS researcher who works as a scientist at the Robarts Research Institute, said he’s confident the ONDRI research will result in major breakthroughs in the field of neurodegenerative disorders.
“I think when we’re all said and done with this, we’re going to be able to answer some really important questions in terms of treating patients,” he said.
More than 600 participants will be monitored for up to three years in areas including gait and balance, eye measurements, neuropsychology and brain imaging, to name a few. This data will then be input into a comprehensive management system called Brain-CODE.
TRACKING EYE MOVEMENT
Dr. Doug Munoz, a neuroscientist at Queen’s University, has focused his career on understanding how the brain controls eye movement and how brain damage or abnormalities, including that caused by dementia, can affect it.
“What we have is a toolbox for how the brain works,” he said.
Munoz is one of the researchers contributing findings to ONDRI. In this instance, he’ll be exploring the connection between eye movement and dementia. To do so, he’ll be measuring where the eyes go to study memory loss using video-based eye tracking.
“This study will be helpful in early detection. It will help us detect dementia earlier than we can now,” said Munoz, who in his 20-plus year career has studied the correlation between eye movement and brain function for people of all ages.
PREVENTION, VASCULAR INJURY AND AMELOID PROTEIN
Toronto neurologist Dr. Sandra Black is one of the world’s lead researchers in Alzheimer’s disease and mild cognitive impairment.
She is the director of the Hurvitz Brain Sciences Research Program at Sunnybrook Research Institute, and is an advocate for prevention and early detection.
Before even discussing early detection, she emphasizes the importance of physical activity – especially in the teen years – proper sleep and healthy eating for brain health.
“Brain health starts young and these are things everyone can do,” she said.
In terms of her research, Black has worked on a number of interesting studies in recent years.
In one study, she looked at the cognitive effects of strokes and the often close links they have to Alzheimer’s disease.
Black, who is also a member of ONDRI and serves as the executive director of the Toronto Dementia Research Alliance, a multi-institutional collaborative network of memory programs at the University of Toronto, has also spent a great deal of time studying vascular injury and other related brain issues as well as the possible benefits of high blood pressure medications for dementia patients.
One of her main areas of research is the accumulation of ameloid protein in the brain for those with Alzheimer’s. She’s currently exploring new techniques to see the protein, which tends to accumulate in the brains of people with dementia.
“This is leading to some new and potentially exciting interventions,” Black said, noting treatment trials are currently underway.
Recently appointed an Officer of the Order of Canada, Black said she’s optimistic her research could be instrumental in helping prevent dementia from taking hold.
In the next few months, she’ll also be working on a trial vaccine aimed at halting ameloid deposits in the brain.
Black is also in the midst of clinical trials in which participants receive genetic testing to determine if they’re at greater risk of developing Alzheimer’s disease. This research could be especially effective for those who are at risk of developing early onset dementia.
Her research also involves brain imaging as well as better understanding the retina as it mirrors what’s going on in the brain.
KEY DEMENTIA RESEARCH FACILITIES
Other key dementia research facilities in Ontario include Baycrest Health Sciences’ world-renowned Rotman Research Institute, an international centre for the study of human brain function, specifically memory and the frontal lobe functions of the brain in normal aging and in the presence of diseases and conditions that affect the brain like stroke, traumatic brain injury, Alzheimer’s disease and other dementias.
In May, the $123.5-million Canadian Centre for Aging and Brain Health Innovations at Baycrest was announced. This centre, which is expected to be up and running by the end of the year, will focus on the causes of cognitive decline in seniors.
The John P. Robarts Research Institute in London, Ont., Canada’s only privately operated and directed medical research facility, is doing innovative research to understand cellular processes involved in dementia. It’s using targeted MRI techniques to provide earlier and more definitive diagnoses.
Toronto Western Hospital, which is part of the University Health Network, is another leader in the study of brain degeneration.
Its $174-million Krembil Discovery Tower is the new state-of-the-art research space for its scientists from the Krembil Neuroscience Centre, Donald K. Johnson Eye Centre and Buchan Arthritis Research Centre, as well as Altum Health and the Tanz Centre for Research in Neurodegenerative Diseases.
This nine-storey facility marks the start of an era in research for Toronto Western Hospital and the Toronto Western Research Institute. It brings together Canada’s largest concentration of neurologists, neurosurgeons, neuroradiologists and neuroscientists under one roof.