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Dr. Morris Freedman Dr. Morris Freedman, Baycrest’s Head of Neurology and Rotman Research Institute scientist

Catching dementia earlier to improve treatment

The key to treating and preventing dementia could lie in diagnosing early cognitive decline sooner.

Improving memory assessments

With this goal in mind, Baycrest scientists, in collaboration with the Toronto Dementia Research Alliance (TDRA), are developing a more sensitive and comprehensive diagnostic test, the Toronto Cognitive Assessment (TorCA).

“The current gold standard to diagnose someone with mild cognitive impairment involves a full neuropsychology workup, which can take from three to five hours, and not all individuals have easy access to this resource,” says Dr. Morris Freedman, Baycrest’s Head of Neurology and Rotman Research Institute scientist, and the Baycrest lead for TorCA’s development, along with colleagues from the TDRA. “Our assessment facilitates better understanding of cognitive performance and can be used in any clinical setting, such as a memory clinic or a doctor’s office. It can also be administered by any trained healthcare professional.”

The TorCA gathers extensive details about a person’s condition through a series of cognitive exams and is administered in about 40 minutes. Currently, the TorCA has been validated to detect mild cognitive impairment linked to memory loss; individuals with this condition have a higher risk of developing dementia.

“The TorCA has the potential to save both time and physical resources by identifying patients who may not require neuropsychological assessments to diagnose early cognitive decline linked to dementia,” says Dr. Freedman, who is an expert on clock drawing to assess a person’s cognitive abilities.

Accelerating dementia research

The TorCA has also been programmed to be administered on an iPad, which helps speed up patient evaluation and will assist in the creation of a patient’s electronic health record. The TorCA on the iPad is being rolled out across memory clinics in Toronto as part of the TDRA’s database, developed by the Rotman Research Institute’s Dr. Stephen Strother and other Canadian researchers, and will facilitate sharing research data across institutions to accelerate dementia research by identifying and recruiting consenting subjects who match criteria for different studies. Baycrest was the pilot site for implementing TorCA on the iPad.

"The only way we will make rapid progress in understanding and treating diseases in something as complex as the brain is to enhance national and international collaborations and pool resources and data,” says Dr. Strother, senior scientist at Baycrest’s Rotman Research Institute and leader in combining big data analysis with brain study. “Creating the appropriate infrastructure is the first step towards accelerating scientific discovery.”

This work was supported by Brain Canada, TDRA Partner Institutions, the University of Toronto, the Edwards Family Foundation, the Ontario Brain Institute, the Canadian Institutes of Health Research, the Saul A. Silverman Family Foundation, Morris Kerzner Memorial Fund, Brill Chair in Neurology, Dalhousie Medical Research Foundation, Irene MacDonald Sobey Endowed Chair in Curative Approaches to Alzheimer’s Disease and the George, Margaret and Gary Hunt Family Chair in Geriatric Medicine.

Treating dementia earlier

Having a larger pool of candidates for research studies will help RRI researchers, like Dr. Nicole Anderson, find solutions faster. Dr. Anderson’s research is focused on developing cognitive training and lifestyle interventions, such as the ENGAGE and LEAD studies, to help prevent or slow cognitive decline.

Lifestyle interventions, such as exercise, could reduce a person’s dementia risk. For example, there is evidence that exercise can improve a person’s memory and thinking skills and even reverse some of the damage done to the brain during aging or from brain disorders.

“In the absence of treatment, we need to think of ways to protect our brain health earlier and build up this protective factor, known as cognitive reserve, as a potential way to prevent Alzheimer’s disease,” says Dr. Anderson, RRI senior scientist and Director of The Ben & Hilda Katz Inter-Professional Research Program in Geriatric and Dementia Care.

The key to treating and preventing dementia could lie in diagnosing early cognitive decline and intervening sooner. Through the TorCA and the database being created, researchers would have easier and quicker access to participants for studies that could further inform our current treatment practices.

As part of Baycrest’s next chapter, the team will continue validating the test for other neurological conditions and work together to fulfill a promise to realize our vision - a world where every older adult enjoys a life of purpose, inspiration and fulfillment.

How you can help write our next chapter

With additional funding, researchers could speed up TorCA’s validation, translate the assessment to additional languages and move towards global adoption. 

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