A pandemic crisis demands aggressive investment in comprehensive research: Current efforts to tackle dementia in Canada

NEWS & REPORTS

By Bruna Seixas Lima

“Whereas Alzheimer’s disease and other forms of dementia are progressive, degenerative diseases of the brain that result in impairment of thought processes and memory, as well as changes in abilities and behaviour;

And whereas the Government of Canada, in consultation with the ministers responsible for the delivery of health services in each province and territory should encourage the development of a national strategy for the care of people living with Alzheimer’s disease or other forms of dementia, as well as their families and caregivers.”

Bill C-233 – National Strategy for Alzheimer’s Disease and Other Dementias Act

[Assented on June 22nd, 2017]

Dementia is a condition in which cognitive decline is associated with gradual degeneration of brain cells (1). Dementia disturbs cognition and thus the ability to perform daily activities. Moreover, it causes changes to a person’s somatosensory skills, personality, and emotions (2). An estimated 1.1 million Canadians are affected by dementia directly or indirectly (2). The financial and emotional burden is placed not only on the person with dementia, but also on families, communities, and society, in the face of scarce available help (3).

The Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative launched in 2014 to address the need for more knowledge on dementia prevention, treatment, and quality of life (4). In November 2017, two meetings were held in Toronto: the Partners Forum and Science Day hosted by the CCNA, and the Canadian Conference on Dementia (CCD). In these meetings, a multi-sectoral group of researchers discussed a national strategy to address dementia.

The CCNA is an organization funded by the Government of Canada through the Canadian Institute of Health and Research (CIHR) and 14 partner organizations from the public and private sectors. The initiative received an investment of $31.5 million to be divided between 20 groups of scientists, whose research focuses on themes related to brain biology, rehabilitation, co-morbidities, quality of life, and caregiver support. This task force counts on the work of more than 350 clinicians and researchers who accelerate discoveries on age-related neurodegenerative conditions (4).

Researchers at CCNA are working to answer numerous multidisciplinary research questions. According to CCNA’s Director, Dr. Howard Chertkow there have been 172 drug development failures in research on Alzheimer’s disease (the most common type of dementia) (5,6). Unfortunately, the chance of success is too low and costs are high, so drug industries shy away from developing new drugs. Alzheimer’s disease (AD) is usually associated with the presence of amyloid plaques in the brain (a protein buildup around nerve cells); however, that does not always predict dementia (7). Yet, 76% of drugs are anti-amyloid approaches, reports Dr. Chertkow. In addition, AD is rarely the sole cause of health problems for a person with dementia. They may also experience vascular issues, high cholesterol, and mixed brain pathologies which are all common conditions in aging (8). These disorders interact with AD processes and increase the likelihood of dementia.

Additionally, the availability and quality of dementia care is varied across Canada. For patients living in rural areas and remote Indigenous communities, travel to find care may take hours. It is also more difficult for healthcare providers in these regions to access continuing education resources. Dr. Carole Estabrooks, whose research was presented at the CCNA meeting (9), says that the training provided to professionals assisting long-term care patients with dementia is varied and no regulated licenses are necessary. This leads to gaps and inequality of care: “Wealthier individuals get to die better than the regular Canadian citizen,” she said.

Dr. Kenneth Rockwood is a researcher working on the development of knowledge translation and exchange for the CCNA. According to Dr. Rockwood, CIHR took the lead for change with the formation of the CCNA, but he says this is not enough: “We are underfunded; our argument is strong, but our politics are weak. Scientists involved with dementia studies are passionate and will do the job they’re doing anyway, but we need more resources, and we need to push Ottawa for more support” (10). Indeed, according to CIHR, the economic cost of dementia in Canada in 2016 was $10.4 billion (11). The investment in dementia research in Canada is less than 10 per cent of the funding investment in the United States (2).

In February 2016, the National Strategy for Alzheimer’s Disease and Other Dementias Act (Bill C-233) was introduced in the House of Commons. This Bill proposed to bring together federal, provincial, and territorial representatives, healthcare professionals, researchers, and patients to develop a comprehensive national strategy to address issues related to dementia. In June 2017, Bill C-233 received royal assent, transforming the act into law. However, according to the Honorable Kelvin Ogilvie—who spoke at the CCNA meeting shortly before retiring as a senator—very slow movements have been made towards applying the regulations imposed by Bill C-233 in Canada. He urged that the public demand the government apply the recommendations from Bill C-233, and invest more in dementia research. When asked whether Canada could afford the demand he replied, “Canada can’t afford not to” (12).

The silver lining is that scientists are working tirelessly and there are promising studies being developed every day. In rehabilitation science, investigations have focused on the benefits of rehabilitative therapies which may delay functional and cognitive decline in persons with dementia. Lauren Bechard (PhD student at the University of Waterloo and a CCNA trainee) presented a poster at the CCNA on how to increase routine physical exercise for older adults to prevent and manage AD (13). Similarly, Monica Lavoie (PhD student at Université Laval) presented a poster at the CCD demonstrating the benefits of speech-language therapy in patients suffering from primary progressive aphasia (a type of dementia that primarily affects language skills) (14). More investment in rehabilitation science research could lead to the development of new methods of therapy to prevent or delay the progression of dementia, as well as the development of clinical trials to test their efficacy.

In 2015, Prime Minister Justin Trudeau and his administration renamed Industry Canada to Innovation, Science, and Economic Development Canada (15), and appointed a Minister of Science to emphasize their interests in science and innovation (16). In 2017, the government’s advisory panel submitted a report recommending a boost in the funding levels of basic research, generating a social media trend branded #SupportTheReport. Over the past few years, the government has stated their interest in research, but it is now 2018 and high time that these interests were translated into greater investments. Currently, over 600,000 Canadians diagnosed with dementia need our help (1), and so do future generations. There is no time to waste.

 References

  1. Miller NE, Cohen GD. Clinical aspects of Alzheimer’s disease and senile dementia. Raven Pr; 1981.
  2. Briefing developed by the Canadian Consortium on Neurodegeneration and Aging – March, 2017.
  3. Dunkin JJ, Anderson-Hanley C. Dementia caregiver burden: A review of the literature and guidelines for assessment and intervention. Neurology. 1998 Jul 1; 51(1 Suppl 1):S53-60.
  4. CCNA-CCNV. Canadian Consortium on Neurodegeneration in (2017). [online] Available at: http://ccna-ccnv.ca/en/ [Accessed 11 Dec. 2017].
  5. Chertkow H. Alzheimer Disease Drug Discovery – Past, Present, and Future. 9th Canadian Conference on Dementia – CCD [oral presentation]. Toronto, November 1st, 2017.
  6. Wong SL, Gilmour H, Ramage-Morin PL. Alzheimer’s disease and other dementias in Canada. Health Rep 2016;27:11–16.
  7. http://www.alzforum.org. Biomarkers Predict Alzheimer’s, But Shoe Does Not Always Fit [online] Available at: http://www.alzforum.org/news/conference-coverage/biomarkers-predict-alzheimers-shoe-does-not-always-fit (2013) [Accessed 11 Dec. 2017].
  8. org.au. Your Brain Matters – Evidence. [online] Available at: https://yourbrainmatters.org.au/your-brain-matters/evidence. [Accessed 11 Dec. 2017].
  9. Estabrooks C. Implementing Dementia Research: Success Stories from TREC. [oral presentation] CCNA Partners Forum and Science Day. Toronto, November 1st, 2017.
  10. Rockwood K. Securing Dedicated CCNA Research Funding in the National Dementia Strategy [oral presentation] CCNA Partners Forum and Science Day. Toronto, November 1st, 2017.
  11. World Dementia Council rallies global action in the fight against dementia [online]. 2017 (accessed on 2017-11-19). Cihr-irsc.gc.ca. Available from http://www.cihr-irsc.gc.ca/e/50175.html
  12. Ogilvie KK. Dementia in Canada: A National Strategy for Dementia-friendly Communities. [oral presentation] CCNA Partners Forum and Science Day. Toronto, November 1st, 2017.
  13. LE, Beaton DE, McGilton, KS, Tartaglia MC, Black, SE. Physical activity participation in Mild Cognitive Impairment and Alzheimer’s disease. Poster presented at the 9th Canadian Conference on Dementia. Toronto, November 3rd, 2017.
  14. Lavoie M, Macoir J, Bier N. Relearning functional vocabulary in primary progressive aphasia: Can new technologies be an ally? Poster presented at the 9th Canadian Conference on Dementia. Toronto, November 3rd, 2017.
  15. Pco-bcp.gc.ca. (2017). Machinery of Government Changes – Privy Council Office. [online] Available at: http://www.pco-bcp.gc.ca/index.asp?lang=eng&page=docs&doc=mog-ag-eng.htm [Accessed 11 Dec. 2017].
  16. Huffington Post Canada. (2017). The Minister Of Science In Canada Is Real, And The Community Is Over The Moon. [online] Available at: http://www.huffingtonpost.ca/2015/11/06/minister-of-science-canada_n_8492242.html [Accessed 11 Dec. 2017].