Scientific Synergy

Solving scientific problems related to dementia often takes teamwork and a collaborative approach. These two Canadian researchers are both part of the Canadian Consortium on Neurodegeneration in Aging, a national hub for dementia research

Dr. Howard Chertkow

CCNA/CAN-THUMBS UP

Because scientists still don’t know exactly what causes dementia or how to cure it, the field of dementia research has many moving pieces. Canadian universities and research hospitals are full of doctors and scientists studying varying theories concerning everything from genetics and brain chemistry on a molecular level to how diet and exercise can improve or delay symptoms. With so many different disciplines working on so many projects, it can be easy for individual labs to home in on their own specific areas of interest without connecting to the bigger picture of dementia prevention and care.

To address this, the Canadian Consortium on Neurodegeneration in Aging (CCNA) was established in 2014 to bring together country-spanning teams of scientists working in various areas of dementia research to collaborate and share information and resources. Currently, 19 national research teams are working in areas related to prevention, treatment and quality of life as they pertain to all forms of dementia. In 2019, the CIHR approved a second phase of funding for the CCNA, allowing it to take its framework to the next level.

“It’s the idea that individual scientists don’t really want to work alone. They want to collaborate with others interested in their topic,” says Dr. Howard Chertkow, senior scientist at Baycrest’s Rotman Research Institute in Toronto and the CCNA’s scientific director. “In Canada, we’re very collaborative. People like to work together, and they’re willing to share. Canada is small enough that you can go out and create a national dementia research community.”

This second phase has allowed the CCNA to move forward with a platform dubbed Canadian Aging and Neurodegeneration Prevention Therapy Study Using Multidimensional Interventions for Brain Support – Unified Platform (CAN-THUMBS UP). The title is a mouthful, but the acronym aligns with the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) and the American U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER), making the finger reference relevant to the global research community.

CAN-THUMBS UP brings together 60 scientists from within the CCNA who will take a multi-disciplinary look at dementia prevention. Through the platform, researchers will be able to evaluate different perspectives and combinations of approaches to dementia prevention, connecting strategies involving diet, exercise and sleep therapy as well as potential medications. The idea is that combining research and data will help researchers come up with real solutions to dementia prevention to offer to the Canadian public.

“This is really the decade where the research could deliver important game-changing innovations in dementia prevention. We know that if we could delay the onset of dementia by five years, we would reduce the number of people with dementia in Canada by about 50 per cent,” Chertkow says. “With the first five years of CCNA, we built our collaborative structure. Now we really want to go full speed to get some answers, some treatment and prevention strategies, and make those breakthroughs.”

Dr. Andrew Lim

Sleep and Dementia

Few things are as beneficial to our physical and mental well-being as a good night’s sleep. Most anyone who experiences disrupted sleep — be it due to sleep apnea, anxiety induced insomnia or busy shiftwork — knows that barriers to good sleep can lead to bad moods, confusion and a host of physical problems. It’s not surprising that sleep problems can play an even more significant role for people living with dementia.

For the last decade, Dr. Andrew Lim, an associate professor of neurology at the University of Toronto and a practising neurologist at Toronto’s Sunnybrook Health Sciences Centre, has been studying how fragmented sleep impacts cognitive decline and the development and progression of various forms of dementia. Over the years, Lim has authored several studies, and he is the lead of the Canadian Consortium on Neurodegeneration in Aging (CCNA’s) Sleep and Dementia team, along with the University of Montreal’s Julie Carrier. The CCNA is a national hub for collaborative research on dementia.

“It’s very clear that it goes both ways: fragmented sleep can be both a symptom of dementia, but it can also potentially be a contributor,” Lim says. “So much so that the latest Canadian Consensus [Conference on the Diagnosis and Treatment of Dementia] guidelines on the management of dementia recommend that doctors ask their patients with dementia about sleep symptoms and treat diseases like sleep apnea in patients that present dementia symptoms.”

Lim knows from his clinical practice that sleep issues can affect people with dementia. Behaviour like nighttime wandering can often be the deciding factor that causes families to place someone into long-term care. Studies have also shown there is a link between dementia and sleep apnea, which is often treatable.

Lim was an author on a 2013 study that followed the sleep patterns of over 700 older adults who were not diagnosed with dementia. The study concluded that those participants who suffered from sleep apnea or other sleep disruptions were more likely to develop Alzheimer’s disease and other forms of cognitive decline as they got older. But sleep issues don’t only affect older adults; Lim has also found that fragmented sleep can indicate that someone may develop dementia later in life.

This is not to say that poor sleep has a causal link to dementia —another neurological issue may be causing a patient’s fragmented sleep patterns as well as the dementia symptoms. To investigate further, Lim has been working with the CCNA to look deeper into the brain’s relationship between sleep and dementia. The next step will be studies, scheduled to start next year, that will introduce interventions for patients to see if treating sleep problems will decrease the likelihood of future cognitive impairment. Lim is also involved with studies that take a holistic approach to healthy sleep, diet and exercise, to see if a combination of healthy living pieces results in fewer or delayed instances of dementia.

“In the end we don’t think that poor sleep is necessarily the sole or solitary cause of dementia,” Lim says. “We think it’s probably one of many factors that contribute. You probably have other factors that predispose you to dementia, and sleep is just one of them. But all of this is more reason to say to yourself that it may not be such a great idea to get only five hours of sleep a night.” [ ]