Canada is hosting the world's biggest dementia conference for the first time in a decade. What's changed since then?

Globe and Mail

a day ago

This week, researchers from around the globe are descending upon downtown Toronto to attend the Alzheimer's Association International Conference, the world's biggest and most influential meeting for dementia research.
The gathering is a chance for the international dementia community to discuss the latest research in the field; it's also where significant breakthroughs are often unveiled. At a related event on Saturday, the Canadian Institutes of Health Research (CIHR) – Canada's health research funding agency – announced $44.8-million in new funding for dementia and aging-related research initiatives, including the creation of 16 teams that will study everything from Alzheimer's biomarkers to dementia in Indigenous populations.
To set the stage for this year's conference, The Globe and Mail checked in with Jane Rylett, a professor at Western University and scientific director at the CIHR Institute of Aging, which hosted Saturday's event.
The last time this global conference was held in Canada was in 2016, nearly a decade ago. How has the dementia research landscape changed since then?
This is a really important inflection point. There is a new class of drugs, the antibody therapy, that came into the market within the last three or four years; they probably will be approved in Canada in the coming years.
But while there's huge hope around it . . . right now, there's a lot of debate around if they're really beneficial. For certain people, they don't work at all; other people have negative side effects by creating inflammation in the brain. And the benefit-to-risk ratio is not great. So I think at this year's conference, it's going to be really important to hear about new findings with that.
Something that's really gained momentum over the last few years is stepping back from the pharmacological approach to treatment and saying, 'What else can we do that will reduce the risk of developing dementia?'
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The other thing that's changed is there's always been an 'amyloid hypothesis' of Alzheimer's disease, based on these toxic peptides that get made in the brain and clearly have a role in brain health and development of dementia. But during these nine years, there's been a much greater move towards understanding the role of those and recognizing that while they're still important, they're not the whole story. Now there's more openness to looking at other hypotheses about how brain health can be impacted during the life course and can lead to dementia.
How should people feel about this present moment? Thinking back to 2012, the United States' health department set an ambitious goal to prevent and effectively treat Alzheimer's disease by 2025. But here we are today and that goal is far from met.
When people or groups make those kinds of statements, it doesn't necessarily mesh with the complication of the thing. And then what happens is people see [the missed deadline] and think, well, it didn't happen. That's always the danger of doing something like that.
The brain is a complex thing, it really is. The problem with something like Alzheimer's disease is it's so multi-faceted and it's a spectrum. There's so many areas of the brain that are impacted and the clinical presentation can look similar for people but what's happening in their brain, and where the degeneration is initiated, can be quite different.
There's no one pill that you're going to have that's going to be able to change the course or alleviate the symptoms.
So was it realistic to say in 2012 that this could be cured by 2025? Probably not. But it stimulated a lot of activity. We understand much more about the underlying pathology and the pathogenesis of the disease. And stepping back was an important thing, saying what can we do that is not a pharmaceutical or a pill? What are the life, behavioural and other things that we can do?
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There's been a lot of focus on the funding cuts in the U.S. that are under way right now, including to the National Institutes of Health (NIH). How has that affected things? is it looming over the conference this year?
Yes. A number of Canadian researchers also have been funded by NIH, either in their own right or as subcontracts on larger studies within the U.S., and for the most part, that has been ended, which is very problematic. So we have a number of very good Canadian researchers in all fields that have lost substantial funding, and we don't have the resources in Canada to replace that.
One of the big question marks is the impact it's going to have on the number of Americans that are going to be able to attend the conference. And I don't know the answer to that yet.
Let's talk about Canadian researchers. What role are they playing within the broader effort?
Canadian researchers are leaders internationally in these fields of study. There's really significant work being done by Canadians in the biomarkers area, so the diagnostic area.
We have a lot of expertise around how to develop and promote new methods for supporting caregivers and persons with dementia.
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We've got outstanding Indigenous cognitive health researchers that are developing new culturally safe and appropriate diagnostic and caregiving methods.
And we do have some very good work going on around pathogenesis, looking at changes in the brain during aging and how that may lead to loss of cognition. That's important because you really need to understand where those earliest changes come from. Those are the targets where you need to develop drugs and therapies.
This interview has been edited and condensed.