Canadian Consortium for
Neurodegeneration in Aging (CCNA)
Team 17

Our project aims to study the quality and type of information that is (or is not) exchanged between first- and second-line health services. Specifically, we are interested in examining the validity of subjective first-line assessments of sensory function (vision & hearing) in comparison to objective second-line assessments that are conducted with at sensory rehabilitation centres, specifically with older adults that are affected with a cognitive impairment. The goal is to identify which subjective first-line assessment items (e.g., self-reported functional impairments) most strongly correlate with objective second-line assessment items (e.g., visual acuity, pure-tone audiometry) in persons with a cognitive impairment versus those without measurable cognitive decline. We believe that the results will elucidate possible opportunities for improved assessment and identification of high-risk individuals, inform improved referral and information exchange between first-and second-line services, thereby improving continuation of care, and allow us to better understand the process of navigating the health system from the perspective of this specific clientele

For more information about this research project, please contact Dr. Walter Wittich (walter.wittich@umontreal.ca )

Individuals who develop vision and hearing loss in adulthood in addition to age-related cognitive changes often report a variety of challenges when navigating the healthcare system, such as feelings of being rushed during medical appointments, lack of rapport with physicians, as well as communication problems. Little is known about experiences of seniors with complex health issues when communicating with primary care doctors. The objective of this study is, therefore, to explore the facilitators and barriers encountered by seniors with sensory and cognitive loss when communicating with their primary care doctor. The results of this study will provide crucial information for medical and rehabilitation professionals who provide training and support to clients with complex impairments and their families, as well as for medical personnel so that they can better meet the needs of the diverse aging patients they serve.

For more information about this research project, please contact Dr. Walter Wittich (walter.wittich@umontreal.ca)

Older adults with cognitive impairment (CI) and those with sensory impairments (SI; i.e., vision and/or hearing loss) have poorer health outcomes than those without these impairments. The influence of CI in conjunction with SI on health service utilization and health outcomes is virtually unknown.

The key objectives are to: describe two cohorts of clients (home care and long-term care [LTC]) in terms of their level of health and physical functioning; examine the factors, within the home care cohort, that either increase the risk for cognitive decline over time or are protective against this outcome; and examine how various client characteristics, and caregiver traits, in the home care cohort, are predictive of future admission to LTC.

The project utilizes existing electronic health information collected with two standardized assessment instruments which are mandatory across Ontario. The data were obtained from the Canadian Institute for Health Information (CIHI) who stripped the data of all identifiers prior to sharing with the research team.

The home care sample includes data collected using the Resident Assessment Instrument for Home Care (RAI-HC). The RAI-HC was developed by interRAI (www.interrai.org) and includes about 300 items, including data on vision and hearing, as well as a series of health index scales that describe clients’ physical, cognitive and emotional status. Other items capture client-level health outcomes such as social isolation, functional abilities and communication difficulties. The RAI-HC data were linked by CIHI, at the client-level, to administrative data that captures the use of hospital services and admissions to LTC.

We will use similar data collected in all Ontario LTC facilities using the MDS 2.0 assessment form (which is very similar to the RAI-HC). All residents are assessed upon admission and quarterly thereafter. The MDS 2.0 also includes items on vision and hearing, as well as items that can be used to generate the various health index scales.

We would like to acknowledge The Alzheimer Society of Canada for their support of this project.

For more information about this research project, please contact Dr. Dawn Guthrie (dguthrie@wlu.ca)

Older adults with significant cognitive loss due to Alzheimer’s disease (AD) and other neurodegenerative illnesses often have co-morbid loss in hearing and/or vision. There is now a strong scientific literature showing a relationship between sensory loss and cognitive performance and between sensory loss and incident dementia. Hearing loss is independently associated with incident dementia and cognitive decline in AD is more rapid in those patients with hearing loss. There are parallel issues regarding vision loss. There are a number of potential mechanisms for the relationship between sensory function and cognitive decline, including common biological substrates, the exhaustion of cognitive reserve, environmental de-afferentation, and/or increased social isolation due to communication difficulty. This line of research will focus on the relationship between sensory loss and cognitive impairment in a unique dataset of participants with neurodegeneration, namely the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND http://ccna-ccnv.ca/compass-nd-study/ ) Study of the Canadian Consortium on Neurodegeneration in Aging (CCNA http://ccna-ccnv.ca/). This will include 1650 patients with or at risk for dementia from across Canada, including persons with AD, frontotemporal dementia, vascular dementia, and persons who are at risk for developing dementia, namely, older adults with subjective cognitive impairment (SCI) and mild cognitive impairment (MCI).

A vast array of data are obtained on these participants: extensive medical histories; a broad range of cognitive functions; vision, hearing, and olfactory measures; social/developmental histories; measures of quality of life, social networks, and cognitive reserve; biomarkers, genetics, and 3T MRI measures of brain grey and white matter.

Through this program of research, we will:

• document the prevalence of hearing impairment and vision impairment, in healthy controls, SCI, MCI, and AD, in order to better meet their needs in clinic;
• determine the impact of sensory loss and/or cognitive loss on brain structure (grey matter in the sensory cortices, multimodal association areas, hippocampus, etc.) and connectivity (white matter);
• determine whether cognitive decline is greater in patients with sensory impairment compared to those with intact sensory abilities;
• determine whether more persons with MCI with sensory impairment develop AD, compared to those without sensory impairment; and,
• develop sensory-fair cognitive assessments to be used in clinics to more validly assess older adults with sensory and cognitive decline.

For more information about this research project, please contact Dr. Natalie Phillips (natalie.phillips@concordia.ca)

People with sensory (hearing and vision) loss have been shown to be at higher risk for developing cognitive decline and dementia in large, population based studies, even when taking into account confounding factors such as age. Many questions remain. For example, it is unclear if sensory losses contribute to the development of cognitive decline, or if hearing and vision loss are just symptoms of brain degeneration. If there is a causal link between sensory loss and cognitive decline, then treating sensory loss might be an important strategy for delaying cognitive declines since hearing and vision loss are common and often under-treated. There are theories as to why sensory loss might cause cognitive decline. One posits that sensory loss reduces social engagement and participation which in turn accelerates cognitive decline by reducing brain stimulation. Another question that remains unanswered is why the risk of cognitive decline varies so widely among people with sensory loss. That is, although the studies consistently show that on average, people with sensory loss are at higher risk, not everyone with sensory loss loses their cognitive functions faster than their peers with normal hearing or vision. What makes people susceptible, and what makes them resilient to cognitive degeneration? We aim to answer these questions using data from the Canadian Longitudinal Study on Aging (CLSA) which is a study of 50,000 ordinary Canadians from across the country. Participants in the study are age 45-85 at baseline and are followed for 20 years. Every 1-3 years, they provide p responses to questionnaires and participate in physical examinations where their hearing and vision are tested (along with other measures). A wide range of cognitive tests are administered, making the CLSA a valuable tool for cognitive research.

For more information about this research project, please contact Dr. Paul Mick paul.mick@interiorhealth.ca

Language and communication problems are part of the hallmark criteria for dementia. Caregivers, both family and non-family, have identified language and communication barriers as factors that contribute to the tremendous strain and stress of caring for persons with dementia. Breakdowns in communication between persons with dementia and their caregivers, particularly during every-day, socially-oriented conversations, are pernicious, increase in proportion with syndrome progression, contribute to lower health-related quality of life and are linked with multiple sources including language deterioration, cognitive problems, and vision and hearing impairments, among other factors.

Recent investigations have begun to examine the nature and types of communication problems in the conversations between persons with dementia and their caregivers, with a focus on identifying person-centered, evidence-informed communication enhancement strategies. To date, several studies revealed that family caregivers are not informed fully about useful, empirically derived strategies. The four-fold objectives of our study are (1) to gather representative samples of conversation between persons with dementia who exhibit hearing loss, vision loss, and dual sensory loss (e.g., hearing and vision losses) and their family caregivers, (2) to analyse the digitally audio recorded samples for instances of breakdowns in communication and effective elements of communication, (3) to identify communication strategies that optimize effective person-centered communication, and (4) to provide specific recommendations for effective communication strategies for informal caregivers of persons with dementia with hearing, vision and dual sensory losses.

For more information about this research project, please contact Drs. JB Orange (jborange@uwo.ca) & Marie Savundranayagam (msavund@uwo.ca)

In a preliminary study we showed that negative views of aging (stigma to age) was associated with self-perceptions and, in turn, behavioural measures of hearing and memory. These findings prompt the question as to whether or not declines in subjective and objective measures of sensory and cognitive functioning could be altered by interventions to address negative views of aging. The 2C subproject will consist of three main phases.

In Phase 1a, a battery of questionnaires to assess negative views of aging and self-perceptions of sensory and cognitive abilities will be administered online to 600 older adults who have volunteered for studies of aging at the University of Toronto. In Phase 1b, 400 of the participants who completed Phase 1a will be invited to the lab to complete behavioural measures of sensory (hearing and vision) and cognitive abilities.

The results of Phase 1 will be used to model the key components of negative views of aging and to develop a new measure of negative views of aging to be used in later phases of the CCNA subproject. Phase 1 will also be used to select participants for the intervention in Phase 2.

For more information about this research project, please contact Dr. Kathy Pichora-Fuller

In Phase 2, we will first pilot and then test the effectiveness an intervention based on the AgingPlus program, a program that has shown that reducing negative views of aging can improve the outcomes of older adults in a program to promote physical activity. The purpose of the intervention is to promote more positive views of aging in older adults who hold negative views of aging. By promoting more positive views, delays in help-seeking for sensory and/or cognitive problems should be reduced and better outcomes from sensory and cognitive interventions should be obtained. In Phase 2, our aim is to demonstrate that the intervention can change views of aging to be more positive in those who initially held negative views of aging and that readiness to seek help for sensory and/or cognitive problems is increased. Referrals to cognitive or sensory rehabilitation will be made for participants who are interested, including referral to the cognitive interventions conducted by the Baycrest CCNA researchers.

For more information about this research project, please contact Dr. Kathy Pichora-Fuller

In Phase 3, based on the results of Phase 2, we will extend the evaluation of the intervention to clinical samples of participants who will be receiving best current practice interventions for sensory and/or cognitive problems. The key group to be studied as part of this subproject will be older adults with some degree of cognitive problem (subjective cognitive impairment or mild cognitive impairment) and hearing or dual sensory (hearing and vision) loss. The approach will follow that used in Phase 2 with the lab-based sample of older adults. We hypothesize that out new intervention will change views of aging to be more positive and that outcomes from sensory and cognitive interventions will be improved for those who hold more positive views of aging.

For more information about this research project, please contact Dr. Kathy Pichora-Fuller (k.pichora.fuller@utoronto.ca)

Traditional approaches to characterizing individuals at various stages of cognitive decline (subjective cognitive complaints, mild cognitive impairment, dementia) typically focus on very specific aspects of cognitive, sensory, or motor performance in isolation of one another. However, an integrative approach that takes the interplay among these factors into consideration is likely to provide better insights into the real-world functioning of individuals and how they change over time. Using novel virtual reality (VR) simulation technologies allows us to systematically introduce different types of real world challenges (e.g. walking across a simulated traffic intersection or driving through a congested urban centre). By employing precise behavioural measurement tools such as motion capture technologies to measure kinematics and driving analysis software to measure driving behaviours, we are uniquely positioned to describe the resultant behaviours in very rigorous ways. By also carefully measuring individual sensory and cognitive functioning using traditional methods, we are also able to consider how these abilities (or limitations) are associated with performance on complex everyday tasks. This approach also has the potential of providing a more sensitive method of identifying those at risk during early stages of decline.

For more information about this research project, please contact Dr. Jennifer Campos (jennifer.campos@uhn.ca)