The Dementia Research And Prevention Plan
The dementia research and prevention plan demonstrates the Government of Canada’s commitment to act on dementia. This plan contributes to the knowledge needed to improve care and helps families caring for a loved one with dementia.
If you are a caregiver of someone with dementia, please visit seniors.gc.ca for information on how you can access local resources and take advantage of federal tax credits.
For more information on how the Government of Canada is addressing dementia, visit:
A Blood Test For Diagnosis
The second big breakthrough in 2020 was the development and release of a blood test to diagnose Alzheimers disease. The test measures a persons levels of amyloid beta. Abnormal levels of amyloid beta in someones blood will, with 90% certainty, indicate whether the person has amyloid beta in the brain in the form of amyloid plaques.
Previously, doctors could only gain this information through amyloid PET scans or by cerebrospinal fluid analysis, which are typically only available in large academic medical centers. Moreover, such tests are costly, and Medicare doesnt cover them. In contrast, a blood test is much more accessible to people.
The blood test was released for clinical use in November 2020. It received a Breakthrough Device designation by the FDA in October 2021. This is another potential game-changer, says Dr. Morris. If youre concerned that you might have Alzheimers disease dementia, now a blood test is available, and it will, I think, really advance the ability to make an accurate diagnosis.
The test is currently marketed for people with symptoms of dementia to provide support for an Alzheimers diagnosis. Dr. Morris said doctors can order the test. But because it has not received FDA approval, neither insurance nor Medicare will cover it. So the patient will have to pay an out-of-pocket fee. He is hopeful that, with time, the test will prove its value, leading third-party payers to cover the test.
Cognitive Retraining And Dementia
Cognitive interventions for dementia syndromes encompass a wide range of modalities, including cognitive training that targets one domain and increasing task difficulty as expertise develops, cognitive stimulation targeting multiple domains with emphasis on social interaction, and cognitive rehabilitation tailored at improving activities of daily living. These interventions aim at enhancing cognitive reserve, that is, the structural and dynamic capacities of brain circuits that compensate when one or more brain regions do not function adequately, thus increasing resilience against the neuropathological changes of dementia., Several long-term follow-up studies have looked at trajectories of cognitive impairment and the effect of cognitive stimulation, including the German Interdisciplinary Longitudinal Study on Adult Development and Aging Study, the Minority Aging Research Study, the Memory and Ageing Project, the Chicago Health and Ageing Project, and the Betula prospective cohort study. The PACE study was an RCT designed to study the effect of cognitive interventions on the progression of MCI. The intervention group received supervised education on cognitive retraining strategies. Over a period of 2 years, there was no significant effect on progression to dementia however, a limitation of the trial was the lack of active supervised task engagement for the participants of the intervention group beyond the 5-week intervention period.
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Principles Of Intervention In People With Dementia
In the 2017 Commission, we discussed that when concerns are raised by patients or family, an accurate diagnosis is helpful. Such a diagnosis provides a gateway to intervention and services where available, for planning for possible futures, and support for family, as well as to research. Unfortunately, these services are not always available. National plans for dementia support timely diagnosis and offer help to individuals and their families.
We did not address screening of those not presenting with concerns but rigorous systematic reviews by the US Task Force on Prevention have found an absence of evidence of benefit and harm.196 The first trial of population screening took place in the USA, screening 4005 primary care patients aged 65 years or older. No clear benefit or harm in terms of quality of life, mood, or increasing diagnostic rates was found.197 Other strategies might become more valuable in time such as sensitive awareness of risk factors, when routine records suggest an individual might be deteriorating cognitively.198
What Foods Are Bad For Dementia
The MIND diet specifically limits red meat, butter and margarine, cheese, pastries and sweets, and fried or fast food. You should have fewer than 4 servings a week of red meat, less than a tablespoon of butter a day, and less than a serving a week of each of the following: whole-fat cheese, fried food, and fast food.
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Interventions Once A Diagnosis Has Been Made
Medication
Cognitive training in people with dementia
A meta-analysis of 12 controlled trials of 389 people with mild dementia, completing 4 or more hours of group-based computerised cognitive training , found a small, statistically significant beneficial effect on overall cognition, driven by two trials of virtual reality or Video games , one with a low and one with a high risk of bias.55
A Cochrane review207 found 33 trials of cognitive training, only one of which overlapped with the study above, with around 2000 participants with mild-to-moderate dementia, most with a high or uncertain risk of bias.207 People completing cognitive training, compared with usual treatment or non-specific activities, had small-to-moderate effects on overall cognition and specific cognitive abilities such as verbal fluency and improvements lasted for a few months to 1 year. No direct evidence was observed to suggest that cognitive training was better than cognitive stimulation therapy.
Exercise and physical activity
Interventions And Care In Dementia
Not all dementia will be preventable and we present the latest evidence on intervention and care for dementia. To date the emphasis has been on specific subtypes of dementia, most notably on Alzheimer’s disease, which has been conceptualised over the years in a variety of changing diagnostic criteriaeg, DSM IV and DSM V.180, 181 Intense efforts have been put into biomarkers for early preclinical detection of the disease process before it becomes dementia. Biomarkers need to show reliability and validity, and for dementias they also need to be very closely and clearly related to clinical syndrome outcomes in the way that, for example, human papillomavirus is for cervical cancer, and hypertension has been for stroke.
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What Is A Professional Judgment Budget
Each year NIH submits a professional judgment budget that estimates the additional funding needed to advance NIH-supported research into the treatment and prevention of Alzheimers disease and related dementias. The report also summarizes progress and promising research opportunities. Only two other areas of biomedical research cancer and HIV/AIDS follow a similar process designed to accelerate research discovery. This approach is often referred to as a bypass budget because of its direct transmission to the President and then to Congress without modification through the traditional federal budget process.
Physical Inactivity Exercise And Fitness
Studies of physical activity are complex. Patterns of physical activity change with age, generation, and morbidity and are different across sex, social class, and cultures. The studies suggest a complicated relationship with the potential for both risk reduction and reverse causation.
Meta-analyses of longitudinal observational studies of 121 years duration showed exercise to be associated with reduced risk of dementia.2 A further overview of systematic reviews concluded that there is convincing evidence for physical activity protecting against clinically diagnosed Alzheimer’s disease.88
Since the 2017 Commission, the HUNT study of 28916 participants aged 3060 years has been published, reinforcing the previous literature in this area. At least weekly midlife moderate-to-vigorous physical activity was associated with reduced dementia risk over a 25-year period of follow-up but the confidence intervals were wide.89 In contrast the Whitehall Study reporting on the 28-year follow-up of 10308 people, found that more than 2·5 hours of self-reported moderate-to-vigorous physical activity per week, lowered dementia risk over 10, but not 28 years.33 Very long-term studies are unusual however, one 44-year study recruited 191 women purposively to be representative of the Swedish population and reported that 32% of the participants with low baseline peak fitness, 25% with medium, and 5% with high fitness developed dementia .90
Trials of exercise
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Supporting The Nhs To Deliver Benefits To Patients
A new treatment will have a large impact on the health system because of the sheer number of people living with dementia.
And the scale of the resources required in the NHS to deliver future treatments needs to be considered now.
The Dementia Medicines Taskforce would help ensure the NHS has the right clinical pathways and support for healthcare professionals to enable new medicines to be given as soon as they become available.
It would help fund those parts of the NHS that are already innovating and work with the NHS to implement this best practice more widely.
Physical Illness Delirium And Dementia
Dementia and delirium frequently occur together. In one hospital inpatients’ survey nearly 35% of those older than 80 years experienced delirium those with prior cognitive impairment had 15 times the risk of developing delirium than those without .282 People with delirium without known dementia are more likely to be diagnosed with dementia in the future than others, either because of pre-existing undiagnosed dementia or cognitive impairment, present in 20·7% and 37·8% respectively of one cohort, or because delirium has neurotoxic effects and so precipitates dementia.283 People with similar neuropathology show faster cognitive decline if they develop delirium than if they do not.284 Additionally, older people without dementia declined cognitively more than twice as fast after an emergency hospital admission for any cause, compared with those not admitted, suggesting any severe illness is associated with cognitive decline.285 Risk factors for delirium in dementia include sensory impairment, pain, polypharmacy, dehydration, intercurrent illnesses, such as urinary tract infections or faecal impaction, and an unfamiliar or changing environment.286 Delirium in older people should prompt consideration of underlying dementia.
A network meta-analysis of drugs for prevention and treatment of delirium did not include studies of people with dementia, thus we cannot use this to recommend drugs for people with dementia and delirium as this research might be inapplicable to them.291
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Failure To Demonstrate Efficacy Of Aducanumab
Researchers from Stanford University and the Mayo Clinic recently published a Perspective on the investigational drug aducanumab, which is under review by the Food and Drug Administration for the treatment of Alzheimers disease: The authors state, Aducanumab recently underwent two large phase III clinical trials that were stopped prematurely by the sponsor Biogen. One trial was trending positive while the other showed no benefits from aducanumab. Post hoc analyses led the sponsor to assert that there was a sufficient efficacy signal to justify a new drug application as a treatment for Alzheimers disease. The sponsor claimed that subsets of participants receiving sufficiently high doses of aducanumab demonstrated benefits in both trials. In contrast, we identified alternative accounts for the apparent drug benefits in post hoc subgroups that are unrelated to dose effects. Biomarker data were consistent with target engagement, but no evidence was presented to correlate biomarker changes to cognitive benefits. Our analysis supports the conduct of a third, phase III trial with high-dose aducanumab. Aducanumabs efficacy as a treatment for the cognitive dysfunction in Alzheimers disease cannot be proven by clinical trials with divergent outcomes.
Thwarting A Protein Reverses Brain Decline In Aged Mice
Impeding VCAM1, a protein that tethers circulating immune cells to blood vessel walls, enabled old mice to perform as well on memory and learning tests as young mice, a Stanford study found. Senior author Tony Wyss-Coray, professor of neurology and neurological sciences, co-director of the Stanford Alzheimers Disease Research Center, is quoted in this piece.
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When It’s Not Alzheimer’s: The Differential Diagnosis Of Frontotemporal Lobar Degeneration
The article is part of an ongoing series exploring the multiple differential diagnoses of Alzheimer’s disease. Frontotemporal lobar degeneration is estimated to cause up to 10% of dementia cases, and is often mistaken for Alzheimers. Dr. Sharon Sha, clinical assistant professor of neurology and neurological sciences, is interviewed about the differences.
But What Could A Dementia Medicines Taskforce Look Like
Chaired by a senior figure and reporting directly to government, it could bring together representatives from industry, the NHS, charity, and also researchers, with a single focus on fast-tracking the development and delivery of new medicines for diseases like Alzheimers.
Its scope would be to look across the whole research pathway, but it would focus in particular on how we expedite the set-up of new dementia medicine trials and quickly recruit participants.
Boosting the number of volunteers in clinical trials is important and the taskforce would aim to increase the number of volunteers taking part in larger, late-stage dementia trials to pre-pandemic levels.
One of the difficulties in dementia research has been getting the right volunteers for the right trial. Current medicine trials are focused on finding people in the early stages of disease like Alzheimers at the point when treatment will be best able to modify the disease. However, often people with dementia are not diagnosed until later in the progress of their disease and are, therefore, not eligible for involvement in a clinical trial. We want to change this, and the Dementia Medicines Taskforce would help roll out cutting-edge diagnostics in the NHS to provide more accurate, early diagnosis. It would also develop a dementia health and care data registry to ensure people with a diagnosis are matched to the right studies, appropriate to their type of dementia and stage of disease.
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Changes In Personality And Behavior
Dr. Guite: Paula, after that initial phase and the the memory loss, what else did you start to notice ?
Paula: Well, we noticed that she became quite isolated. She didnt leave the house, she did start to leave her peas on the cooker. And I think, you know, that was the point where we started to go, Eek, this is getting quite serious.
She still has some sort of instinctual habit, so shell still switch off the switches at the end of the day. Thats something that shes done forever. But pretty much everything else
She knows theres a fridge in her house, and she knows that there should be something on the shelves, and she will put stuff in the fridge. It could be a packet of crisps or it could be a cup. She has this sort of visual memory of the fridge, she sort of knows what its for, but she doesnt quite know how to use it.
But thats about it. She doesnt feed herself. If she wont drink water, she certainly couldnt take medicines. She does not wash . If we ask her to wash her face or something, shes quite canny, shell go in the bathroom, close the door, wont let you in, and then come out again.
She still believes that she cooks her own dinner, she still believes that she can do all the things that shes always done. I dont think its denial, necessarily. I think she just its happened, therefore, she must have done it.
Shes not very active, she pretty much sits on her chair everyday with the TV on and looks into space.
Healthy Lifestyle Increases Life Expectancy And Reduces Years Living With Alzheimers
Results of new research suggest that having a healthy lifestyle increases life-expectancy and is also linked to a reduction in the number of years someone may live with Alzheimers disease in the future. The medical publication the BMJ published the results of the US based study today . What did the scientists do?
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Key Points And Recommendations
We judge that sufficient new evidence supports adding three additional modifiable risk factors for dementia to our 2017 Commission model . We have been able to add updated evidence on the nine risk factors implicated in the 2017 Commission . Reduction of these risk factors might be protective for people with or without a genetic risk, although study findings have not been entirely consistent.175, 176, 177, 178 As we noted in the 2017 Commission, others have previously calculated an estimate of the risk associated with APO4 at 7% taking into account some other risk factors and this estimate highlights how relatively important potentially modifiable risk factors are in dementia.2, 179
For some risk factors, the pattern of risk and the individual’s other health, both physical and mental, might be especially important. Currently, the evidence suggests a Mediterranean or Scandinavian diet might have value in preventing cognitive decline in people with intact cognition, particularly as one component of a healthy lifestyle, although how long the exposure has to be or during which ages is unclear. We do not recommend taking additional vitamins, oils, or mixed dietary supplements as a means of preventing dementia as extensive testing in trials has not led to signals of beneficial effects.
Alzheimers Prevention And Preparedness Task Force
Sharon Sha, MD, clinical associate professor of neurology and neurological sciences, was appointed as a member of the Alzheimers Prevention and Preparedness Task Force for the State of California by Governor Gavin Newsom and Task Force Chair Maria Shriver. The purpose of task force is to present recommendations to the Governor on how local communities, private organizations, businesses, government and families can prevent and prepare for the rise in the number of cases of Alzheimers disease and all its consequences. The work and recommendations of the Task Force will be in parallel and incorporated in the Governors Master Plan for Aging.
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