Research initiative offers new hope
for progress against dementias

Lady Davis Institute is headquarters
for Canada-wide network

Hard as it may be to believe, it’s only been since the early 1980s that Alzheimer’s disease and related dementias have been recognized as something other than normal aspects of aging. These diseases were not considered priorities for medical treatment or public policy until relatively recently, when the number and proportion of seniors in society rose significantly, while the totals of those diagnosed with dementia skyrocketed.

In 2011, approximately 747,000 Canadians were living with Alzheimer’s or other dementias. The Canadian Institutes for Health Research (CIHR) has estimated that by 2031, about 1.4 million Canadians will have dementia, costing the economy nearly $300 billion per year.

Now that the impact and future implications of these illnesses have grown clearer, the CIHR, in collaboration with a network of public and private partners, has established a Canada-wide network of researchers—with headquarters in the Lady Davis Institute at the JGH—to tackle dementia and related diseases, such as Alzheimer’s.

“Despite the huge progress that has been made, the challenges are enormous,” adds Dr. Alain Beaudet, President of the CIHR. “As longevity has increased, the incidents of dementia have increased. Unfortunately, our understanding of the brain and how to prevent its dysfunction is still in its infancy.”

The brain is, without a doubt, the body’s most complex organ, as well as the most inaccessible and difficult to test. Although 170 molecules have been assessed as potential treatments for dementia, only four have gone to market—and they merely help to improve symptoms without halting the disease.

“Until recently,” Dr. Chertkow says, “research into dementia was in a position not unlike that of diabetes research in the 1700s. Back then, a doctor had no more accurate a means of measuring elevated blood sugar than touching a drop of a patient’s urine to his tongue to determine whether it tasted sweet.

“However, even though we have a long way to go, we believe we can make significant advances by bringing together the expertise that is now available. With sufficient funding and with people working synergistically, we will be able to find new molecules and new approaches to treatment. This will include medication, but it will also extend into prevention and lifestyle change. We hope the result will be transformative progress within five or ten years.”

The CCNA is conducting its research by pursuing three complementary themes, Dr. Chertkow explains:

• Prevention: exploring the impact of nutrition, exercise and other lifestyle factors, with the expectation that a person will develop dementia. “These are complex issues, requiring individuals to be followed for extended periods. But these lines of investigation could be among the most fruitful over the long term, if they yield evidence about the factors that underlie the cause of the disease.”

• Treatment: investigating various treatment options, ultimately including clinical trials for drugs. “This is a multi-faceted inquiry that addresses a range of questions, such as whether controlling blood pressure helps with disease progression. It may turn out that, as with HIV/AIDS, a cocktail of drugs will prove to have the best results, and we may discover that so-called ‘failed’ drugs are effective, if prescribed in combination.”

• Quality of life: determining how best to maximize the quality of life for people with dementia and their caregivers. “In the short term, this theme may yield the greatest impact. Our aim is to help people who now have dementia, and to improve the ability to cope that they and their caregivers now have. We are also looking at bigger social issues, like designing future homes that afford patients the optimal living environment.”

Why a consortium on a national scale? Because the CCNA can offer a structure and a funding platform that bring together numerous clinicians and researchers to solve the puzzle of how to prevent or treat dementias. By fostering collaborations, convening an annual meeting and holding webinars, the CCNA will provide those who are working on these diseases with opportunities to learn from one another and make their efforts more efficient.

“With an infrastructure, shared research platforms, national research teams and a cohesive research agenda, we hope to accelerate our progress and eventually to find a cure,” Dr. Chertkow says.

“Even more than they already do, Canadian researchers will play a prominent role on the world stage in the global fight against dementia. For those living with Alzheimer’s and other neurodegenerative diseases, the CCNA offers real hope.”

Assessment tool is global necessity

Dr. Howard Chertkow is best known as a member of the team—along with Dr. Ziad Nasreddine and Dr. Natalie Philips—that developed the Montreal Cognitive Assessment (MoCA) test, the gold standard for diagnosing early cognitive impairment.

Its great value is in helping doctors to determine whether an elderly patient’s weaker memory is just a result of aging or the first sign of cognitive impairment that may foreshadow the onset of Alzheimer’s disease. No quick and easy answer to that question was available until this diagnostic tool was developed in 2005 at the Lady Davis Institute.

Now it has even entered the world of pop culture. In the opening episode of season 3 of the hit Netflix drama House of Cards, a character who suffered a traumatic brain injury is given the MoCA to determine his status.

The tool is so widely accepted that the scientific paper in which it was introduced has been cited well over 1,000 times. This means it is referred to frequently in scholarly works around the world, because it is of such fundamental importance to the field.