W6 Flashcards
what does CCNA stand for?
Canadian Consortium on Neurodegeneration in Aging
what is the aim of the CCNA?
national initiative aimed at tackling the growing onset of dementia and related illnesses and improving the lives of Canadians with illnesses and families and caregivers
who was the Minister of Health that launched the CCNA?
Rona Ambrose
what are the 3 themes for research?
- delaying onset
- prevention
- improve QOL
what was the general aim of CCNA?
combine expertise from across Canada and multiple disciplines
- broaden understanding of how NDD develop and the impact
- determine how to prevent, delay, modify progression and cope
what are the 4 objectives of CCNA?
- strengthen and synergize research
- become Canadian hub for leading and participating in international research
- reinforce international positioning, competitiveness and impact of Canadian research at global level
- improve QOL and quality of services
what are the 4 categories that are integrated?
- research
- synergy
- talent
- inclusion
what is the orientation to prevention?
primary
secondary
tertiary
what is primary prevention?
protect healthy individuals from developing NDD
- risk assessment
- education about PFs
- risk reduction
what is secondary prevention?
stop or delay the progress of NDD after risk classification or early diagnosis
- risk control and management
- monitor disease progress
what is tertiary prevention?
manage disease progress -> co-morbidities that may exacerbate rate of disease progression
what was phase1 of CCNA?
funding from multiple sources
what was participant flow in COMPASS-ND?
- recruitment into CCNA
- informed consent signed
- history, physical, cognitive eval
- questionnaires
- psychometric testing
- biosamples - blood, saliva, CSF
- sample processing
- sample shipping to biobank
- mri imaging acquistion
- mri it and databasing
- brain donation program and follow-up in clinic
what are the 6 goals of CCNA phase 2?
- understanding subgroups
- develop or test new treatment molecules
- develop prevention strategies
- allow earlier diagnosis
- innovate life improvements
- optimize health care delivery
what are the platforms associated with CCNA?
neuroimaging
can-thumbs up
Loris
COMPASS-ND
how many teams are there for CCNA?
19
what are the cross-cutting programs?
- knowledge translation and exchange
- training and capacity building
- women, sex, gender, dementia
- ethical, legal and social implications
- engagement of people with lived experience
- indigenous cog health
- social inclusion and stigma
what is the NDD diagnoses approach 1?
focus on “pure” cases of each (strict inclusion and exclusion criteria)
what is the narrow focus on approach 1?
craft diagnostic criteria to produce homogenous groups that represent a fraction of dementia population
what is the purity involved with approach 1?
exclude co-morbidities and mixed dementias
what was NDD diagnosis approach 2?
broader choice of inclusion and exclusion criteria
what is the inclusivity of approach 2?
broadly inclusive will produce heterogenous groups that will cover entire dementia population
what is the ecological representation of approach 2?
includes almost all co-morbidities and mixed
what is the rationale behind approach 2?
difficult to specify criteria and detect pure disease cases
what is the limitation to approach 2?
heterogeneity within diagnostic groups
what is NDD diagnosis approach 3?
moderate application of inclusion and exclusion criteria
what is the compromise with approach 3?
“rather broad” criteria: produce less homogenous groups that represent most of dementia pop
who is represented in approach 3?
co-morbidities and mixed dementias
are all mixed diseases included in approach 3?
no only most
who will be excluded from approach 3?
brain disease
major psychiatric disturbance
drug addiction
what model did Kaarin Ansety create?
CHELM
what does CHELM stand for?
cognitive health environment lifecourse model
what approach is close to CHELM?
CLASS
why is the CHELM approach similar to CLASS?
- core ideas in brain/cog aging and dementia
- importance of longitudinal approaches
- adding multi-modal RF to DPM
what is the overlap and relatedness between CHELM and CLASS?
differential changes, intra-individual, mechanisms, plasticity
cascades of risk (broader focus)
what are the 2 types of reserve capacity?
brain: passive, cognition affected after accumulation of pathology
cognitive: active, cognition continues despite brain pathology
what is the chain for the CHELM model?
biomarkers to RF -> controllable RF -> modifiable RF -> bio-clinical outcomes -> prism of neurocognitive resources -> cognitive or clinical outcomes
what is the Lancet Commission?
comprehensive review
- life course projection
how many modifiable RFs are there?
12
- education
- hearing loss
- hypertension
- obesity
- alcohol/tbi
- smoking
- depression
- physical inactivity
- social isolation
- diabetes
- air pollution
what are the 3 identified mechanisms of ND risk?
- reduction in brain/cognitive reserve/resilience
- increasing brain damage as a fxn of disease and insult
- spreading brain inflammation
what is the goal of the Lancet?
aim for reducing specific RF in order to modify risk mechanisms
what is Anstey’s “umbrella review”?
systematic review of world-wide evidence on RFs of dementia
what are the 3 conclusions from Anstey’s review?
- evidence base varies by NDD
- lack of “early” effect evidence
- much variability in geographical representation of evidence
what is the IRNDP?
international research network on dementia prevention
- how systematic and diverse studies of RA can contribute to understanding differential pathways toward or away from ADRD
who founded IRNDP?
Anstey
what is the purpose of the risk assessment?
allows for early detection of risk and for application to RCTs and RR protocol
what are the 6 health factors contributing to vascular risk for unhealthy brain aging and dementia?
stroke
obesity
smoking
high cholesterol
hypertension
diabetes
what are the 4 points from CULTURAL?
- need for cross-national and cultural investigations
- need for linking RFs with associated mechanisms
- need for harmonization
- exploring new research targetsw
what is the summary of CULTURAL?
scientific, ethical, and practical imperative to expand dementia risk and prevention research across nations, cultures, regions and under-represented populations
what are the 4 directions for the IRNDP research?
- expand diversity research
- expand attention to life course exposure variations
- expand evidence base
- expand long-term follow-up research
what are some social determinants of health affecting degree of or access to potential RF change?
- income and social status
- education and literacy
- employment and working conditions
- early childhood development
- physical environment and housing
- social supports
- access to health services
- biology and genetics
- gender
- culture
- race
- disability and ableism
what is the principle of SSDH?
person’s social and structural “context” affects RF, RR, possibilities for modifying risk or protection
what are SSDH?
non-medical, social, and economic factors that occur within everyday and working conditions of people and substantially influence the extent and direction of dementia risk
what are the challenges of SSDH?
modifiable RF and PF do not operate uniformly or universally, but only within the SSDH context of individuals
what is the implication of SSDH?
effectiveness of interventions to modify RFs and PFs depend on SSDH context
what are the communities of dementia and dementia risk?
- indigenous - growing # of older Ind and impacts of social determinants of health
- racialized - ethnic profile of older people is growing
- sex and gender
- chronological age - early onset poses a challenge
what is the Tom Kitwood quote?
when you’ve met one person with dementia, you’ve met one person with dementia
