“Researchers and clinicians must embrace the complexity of dementia to gain a clearer understanding of the whole person and the risks they are confronted with. This approach will have a direct impact on the quality of life and quality of care received by people living with dementia.” Dr. Melissa Andrew
Dr. Melissa Andrew’s research philosophy and clinical practice aligns with a growing conversation about the need to develop holistic treatments for dementia, and at the early stages of the disease. Treatments that take into account not just each individual’s physical condition, but also their environment and life circumstances.
In considering “non-traditional” risk factors for dementia – and considering them together rather than one at a time – Andrew and her team believe researchers will come closer to understanding how dementia arises, and how to best identify and treat it in the clinic.
This marks a clear departure from convention, which sees researchers seeking out “pure” cases of dementia that are isolated from other factors that occur with aging. People in trials and studies tend to be selected for “not having other things wrong,” Andrew explains. Contrast this with patients who appear in the clinic, who tend to be “older, more women than men, socially vulnerable, and have functional difficulties and many overall health problems.”
Granted, selectiveness makes sense from a practical standpoint – in that it gives researchers increased clarity on the effects of what is being tested in a study or trial. But it, regrettably, excludes the “true face of dementia” by leaving older, frailer people with multiple medical conditions, out.
This disconnect between clinical trials and practice has undermined progress in research that would have a direct impact on the quality of life and quality of care received by people with dementia. Researchers and clinicians must, therefore, embrace the complexity of dementia to gain a clearer understanding of the whole person and the risks they are confronted with.
Dr. Andrew’s research takes place within the Canadian Consortium on Neurodegeneration in Aging (CCNA). The CCNA functions as a research accelerator within and across teams throughout Canada in an effort to understand the real-life presentation of dementia. Specifically, the goal of COMPASS-ND – the CCNA’s signature study – is to study dementia in all its forms, including cases where there are multiple pathologies involved, such as Alzheimer’s disease and cerebrovascular disease, referred to as “mixed” dementia. This broad approach is being taken in order to investigate what these dementias have in common, as well as what differentiates them. Doing so will help in diagnosing, understanding, and working to prevent the onset of dementia in all its forms.
For their part, Andrew and her team recently discovered that when frailty worsens, it can lead to declines in cognitive function and vice versa. Understanding, assessing, and treating the vast majority of people with dementia, therefore, requires taking account of a broader range of factors that occur with aging, rather than looking at dementia in isolation.
Specifically, Andrew recommends measuring overall health status using tools such as the Comprehensive Geriatric Assessment and the Clinical Frailty Scale. These tools can help quantify the many problems that can come with old age, while – at the same time – demonstrate their impact on cognition.
In other words, what happens “below the neck” matters a lot for what happens “above the neck.” And, because frailty and cognitive decline are intertwined in this way, strategies to address one have the potential to benefit both.
Next, the team will assess how cognitive impairment, frailty, and social context (social vulnerability, education, and employment status), impact quality of life, and whether these impacts differ for women and men.