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TORONTO, July 25, 2016 — The prevalence of Alzheimer's disease and other dementias has increased more than 18 percent in Ontario, Canada, over the past eight years, according to new research reported today at the Alzheimer's Association International Conference 2016 (AAIC 2016) in Toronto. Although prevalence rates have remained higher among women (97.3 per 1,000 in 2012/13) than men (68.2 per 1,000), the increase over the study period was greater among men.
A wide range of Canadian research findings spanning clinical, epidemiological and care models were reported at AAIC 2016, demonstrating the breadth of the country's contributions to innovative research on Alzheimer's science and care. This is the first time Toronto has hosted this prestigious international conference, which is a catalyst for generating and dispensing new knowledge about dementia.
"The research findings coming out of AAIC 2016 underscore the need for, and value of, a holistic approach to Alzheimer's research," said Heather M. Snyder, PhD, Senior Director of Medical and Scientific Operations at the Alzheimer's Association.
Additional findings from Canadian researchers presented at AAIC 2016 include:
"The quality, diversity and breadth of research coming out of Canada is helping to build a broader understanding about Alzheimer's disease and dementia prevention, progression and management, and offers new insights, tools and approaches," said Larry Chambers, PhD, Scientific Advisor to the Alzheimer Society of Canada.
"The research findings coming out of AAIC 2016 underscore the need for, and value of, a holistic approach to Alzheimer's research," said Heather M. Snyder, PhD, Senior Director of Medical and Scientific Operations at the Alzheimer's Association. "Research into new treatments is vital, but we also need to establish a broader understanding of who is at risk for Alzheimer's, how it's burdening our health systems, and how to best provide care and support for all who have the disease and their families. The commitment to research by national governments must be increased to match the devastating impact it is having on individuals, families and national economies."
Data generated through the routine administration of health care programs, also known as health administrative data, are a valuable resource for monitoring incidence and prevalence trends in Alzheimer's and other dementias over time and helping to plan effectively for needed increases in health system capacity.
Canadian researchers from the Institute for Clinical Evaluative Sciences (ICES), the Ontario Brain Institute, the University of Toronto and the University of Waterloo aimed to assess trends in dementia prevalence, incidence and related costs over an eight year period in Ontario, Canada.
The researchers used population-based health administrative data to examine trends in yearly Alzheimer's and dementia prevalence, incidence and publicly funded health system costs from 2004/05 to 2012/13 in older adults by age group, sex and region in the province of Ontario. Annual health system costs included total attributable government healthcare spending associated with one year of health system use; not just costs ascribed to Alzheimer's and dementia care.
Researchers found that, over the time period of the study:
Median health system costs associated with one year of health system use were CDN$19,468 (range CDN$4,490 to CDN$47,726) for prevalent cases in 2012/13 and CDN$16,549 (range CDN$5,070 to CDN$47,899) for incident cases. Long-term care and hospital care accounted for the largest portion of total costs in both groups.
The prevalence of Alzheimer's disease and other dementias has increased in Ontario over the past eight years. Our cost analysis shows a dominance of costs from acute and long-term care sectors, showing the scale of the challenge for publicly financed health systems," said Susan Bronskill, PhD, from the Institute for Clinical Evaluative Sciences (ICES), Toronto. "Accurately and proactively monitoring incidence and prevalence - and health system use - of persons with Alzheimer's and other dementias is important to capacity planning for government agencies, local providers and national health systems."
Alzheimer's disease and Parkinson's disease are two illnesses closely correlated with aging and decrease in brain function. Despite the similarity of these two neurodegenerative disorders, the characteristic brain changes that identify them vary. Parkinson's is primarily associated with dopaminergic decreases in the key brain pathways, while Alzheimer's is primarily associated with abnormal protein folding and aggregation in the brain.
Many people live with elevated levels of Alzheimer's or Parkinson's pathology yet remain cognitively healthy or free from associated motor symptoms. Researchers from Douglas Mental Health University Institute in Montreal sought to better understand how this happens, and how that understanding might be used to improve treatment and prevention.
Researchers used brain imaging technology to map brain communication functions, including a novel technology that maps the different neuroanatomical structures most associated with memory function and motor circuits. They used network-based analysis strategies to determine areas of the brain related to "resilience" in those without cognitive decline yet with elevated pathological burdens.
Findings demonstrated several areas of the brain that appear to be intrinsically related to differences in Alzheimer's and Parkinson's, and also resilience against neurodegenerative disorders. These include preservation of the CA1 region, which is required for memory retrieval, as a resilience mechanism in Alzheimer's, and the enlargement of the striatum and cerebellum, a critical motor region of the brain, in individuals with lower dopamine levels as a potential resilience mechanism in Parkinson's.
"Our analysis has the potential to significantly impact the design of novel therapeutic interventions intended to delay disease onset, and could potentially suggest new targets for the prevention of Alzheimer's and Parkinson's," said Mallar Chakravarty, PhD, Douglas Mental Health University Institute. "This work could also provide a robust set of markers to enable the identification of disease trajectory and disease risk for healthy individuals."
Almost 1.4 million people identified themselves as members of at least one of Canada's Aboriginal groups in the 2011 census, and this population is aging significantly. With prevalence rates rising steadily, Alzheimer's disease and other dementias are becoming a considerable concern for Indigenous populations in Canada.
A group of researchers from Sudbury, Ontario, looked at the framework of "cultural safety" to deliver health services, and specifically dementia care, more effectively in Indigenous communities. Cultural safety is met through actions that recognize and respect the unique cultural identity of a population and appropriately meet their needs and expectations.
Culturally safe approaches to care need to incorporate healthcare provider training on the colonial history of First Nations; Indigenous explanatory models of dementia; appropriate approaches to the encounter with a healthcare provider, care and prevention; and improving access to appropriate care and support.
The research team formed partnerships with several diverse Indigenous communities in Ontario and collected and analyzed a broad spectrum of foundational data concerning dementia and caregiving. From 2011-2014, 168 people were interviewed in six regions of Ontario, including those living with dementia, informal caregivers, Indigenous Knowledge Keepers, seniors and healthcare providers in indigenous communities. These data were examined to elicit specific care and service needs and culturally-grounded approaches to care.
The researchers discovered that labeling symptoms of Alzheimer's and other dementias as disease is relatively new in Indigenous communities. They found cultural beliefs concerning the lifecycle and relationships that have implications for how Indigenous peoples understand and respond to dementia. These beliefs vary among different communities for many reasons, including differing historical and contemporary experiences with governmental bodies.
"As a result of our study, key areas within the healthcare experience have been identified that can be addressed to improve culturally safe care for Indigenous peoples with dementia in Canada," said Kristen Jacklin, PhD, from Northern Ontario School of Medicine. "The new partnerships have facilitated knowledge translation to better prepare frontline care providers to provide culturally safe dementia care."
"As the burden of dementia within Indigenous communities grows, we hope the strategies resulting from the study will have direct relevance for policy formation and service design in Canada, and even in other countries, where providing healthcare to Indigenous populations is a focus," Jacklin added.
Physical and social activity is associated with improved physical function, cognition and quality of life among older adults, including those with dementia. Originally developed in British Columbia, the Alzheimer Society of Ontario launched in 2014 its version of the Minds in Motion® (MIM) program, a physical activity and therapeutic recreation program for older adults with dementia and their caregivers.
The study sought to evaluate the change in physical function, physical activity, perceived self-efficacy (the amount of confidence a person has in their ability to achieve a task), and mood after participation in MIM. The program was delivered once per week for eight weeks to up to 22 participants at 13 Alzheimer Societies across Ontario. Each session consisted of 50 minutes of exercise (cardiovascular, strength, balance, coordination, and flexibility training), a short break and 50 minutes of therapeutic recreation (including social activities meant to invoke memory retrieval, imagination, word formation, and group socialization). Assessments were completed prior to and after the eight week program. Physical function was assessed with the Seniors' Fitness Test. Other outcomes were evaluated using questionnaires.
403 MIM participants completed the follow-up assessment. The average age of participants was 74 with 57% being female. Key findings include:
"Overall, our evaluation suggests that Minds in Motion is a promising program for the physical and social health of people with dementia and their care partners," said Kayla Regan, MSc, from the University of Waterloo. "Participants reported that they did more physical activity after the program than before, reporting more frequent, more intense, and longer bouts of physical activity. Ninety-six percent (96%) of participants indicated that they enjoy the program and 80 percent have returned to the program again. Additionally, 53 percent of participants report that they have developed new relationships through MIM."
"Because there was a small but significant decline in mood among participants, we recommend further study to better understand whether this change is a result of the program or unrelated changes over time," Regan added.
The Alzheimer's Association International Conference (AAIC) is the world's largest gathering of researchers from around the world focused on Alzheimer's and other dementias. As a part of the Alzheimer's Association's research program, AAIC serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community.
AAIC 2016 home page: www.alz.org/aaic/
AAIC 2016 newsroom: www.alz.org/aaic/press.asp
About the Alzheimer's Association®
The Alzheimer's Association is the leading voluntary health organization in Alzheimer's care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. Visit alz.org or call 800.272.3900.