January is Alzheimer’s Awareness Month, a time to raise awareness to help fight stigma and better support those living with the disease. There are currently more than 650,000 Canadians living with dementia and within the next 10 years, that number is expected to reach almost one million.
Alzheimer’s disease is a brain disorder that affects memory and behaviour and interferes with everyday life. As the disease progresses, individuals experience more cognitive difficulties, and can lose their ability to read, walk or recognize loved ones. Some risk factors include age, genetics and sex, however anyone can get it in their lifetime. People with dementia have different experiences, but the effects of the disease are felt by many – patients, family members and friends alike.
While there is currently no cure for Alzheimer’s disease, efforts are being made worldwide to manage the disease. At Sunnybrook, scientists are driving the innovation and treatment of brain health and creating hope for the future.
Improving diagnosis and treatment
Much of the international criteria we have now for Alzheimer’s disease and other dementias is thanks in part to contributions from The Sunnybrook Dementia Study, a 25-year observational study measuring and monitoring changes in patients with dementias, vascular disease and other neurodegenerative diseases. Led by Dr. Sandra Black, cognitive neurologist and senior scientist at Sunnybrook, this study began in 1995 and is applying advanced MRI, genetic testing and cognitive and functional assessments at yearly intervals to measure and monitor changes in patients with neurodegenerative diseases.
The study has been a success thanks to its multidisciplinary team and importantly, the more than 1600 patient participants explains Dr. Black. “We learn from our patients, engage them in a partnership — it’s research embedded in care.”
Some of these patients may go on to participate in one of the many Alzheimer’s clinical trials at Sunnybrook. There are currently participants in several pharmaceutical studies that are working toward potentially modifying the disease by testing antibody therapies that can remove amyloid plaques in the brain. One example is the AHEAD study, which is exploring whether an investigational treatment can slow or stop the earliest brain changes due to Alzheimer’s disease. Researchers can detect changes in the brain of those with Alzheimer’s disease up to 20 years before symptoms begin. The goal of the AHEAD study is to prevent the development of memory loss and other symptoms, before the plaques cause too much damage to the brain.
While not yet approved in Canada, researchers and clinicians are also excited about new blood tests, available through research trials, that are being used for screening those at higher risk of developing Alzheimer’s disease. In addition to this screening process, amyloid PET scans are done using Sunnybrook’s Cyclotron facility, Health Canada’s only approved tracer for detecting amyloid deposits in the brain.
“Thanks to rapidly advancing precision medicine technologies, Alzheimer’s disease may soon become a preventable and treatable condition,” says Dr. Black. “This is a very exciting time in research, given the increasing prevalence of Alzheimer’s disease in Canada’s aging population.”
Addressing changing dementia demographics
In the past 20 years, Canada’s population has changed, but much of our scientific understanding of dementia risk factors is based on populations of European descent. As the population profile of dementia patients is projected to change, more research is needed to address the unique needs and experiences of diverse communities. The Canadian Multi-Ethnic Research on Aging (CAMERA) study aims to understand the risk factors of Alzheimer’s disease in diverse ethnic groups in Canada.
The study, led by Dr. Jenny Rabin, scientist in the Hurvitz Brain Sciences Research Program at Sunnybrook Research Institute, is following 300 participants, free from significant cognitive impairment, across three different ethnic groups: individuals from European, South Asian and Chinese descent. The study will allow researchers to study the earliest changes associated with Alzheimer’s disease and other cognitive disorders. CAMERA is the first study in Canada that brings together brain imaging and cognitive measures to investigate risk factors for dementia in a multi-ethnic cohort.
“This knowledge will ultimately allow us to develop more effective dementia prevention and intervention strategies for Canada’s diverse communities,” says Dr. Rabin.
Changing the course of the disease
The biggest risk factor for Alzheimer’s disease is age. Most individuals diagnosed with dementia are over the age of 65, however about one per cent of people with Alzheimer’s will have the genetic form known formally as autosomal dominant Alzheimer’s disease (ADAD). Also referred to as early-onset familial Alzheimer’s disease, the condition is genetically inherited or passed down through families. Individuals will begin to experience cognitive decline as early as their 30s. In Canada, there are more than 25,000 people under the age of 65 living with dementia.
“In the prime of your life, you’ll begin to experience memory loss, then develop changes in behaviour, such as trouble controlling emotions. You may lose your inhibitions. Eventually, you will lose the ability to communicate,” says Dr. Mario Masellis, neurologist and associate scientist at Sunnybrook.
In Alzheimer’s diagnosis and treatment, time is of the essence – the Dominantly Inherited Alzheimer Network Trials Unit (DIAN-TU) drug trial, is working toward slowing down, even potentially stopping, dementia symptoms in those predisposed to the Alzheimer’s gene. Dr. Masellis is leading the trial at Sunnybrook, one of the few Canadian sites taking part in the global study. The trial is testing two drugs that aim to lower the levels of the substance that causes amyloid plaques in the brain, which play a central role in Alzheimer’s disease.
Because early-onset dementia makes up a small number of dementia cases, there are fewer support systems for those patients, who may begin to experience cognitive decline while they’re still raising a family or growing their career. Research from the DIAN-TU trial can lead to the development of early intervention and prevention therapies to help people with early-onset Alzheimer’s disease.
The Garry Hurvitz Brain Sciences Centre
Sunnybrook’s new Garry Hurvitz Brain Sciences Centre, currently under construction, is a collaborative, state-of-the-art facility that will bring together clinical and research spaces to continue to advance Alzheimer’s diagnosis and care.
There may not be a cure yet, but the future of Alzheimer’s treatment is promising, thanks to the work of dedicated scientists and healthcare professionals at Sunnybrook and around the world.
