Thursday October 1st, 2015

Charting a Path Toward a Treatment Breakthrough for AD by 2025
Stephen Salloway

Learning Objectives
At the end of this presentation, participants should be able to:

• become familiar with advances in molecular brain imaging providing biomarkers for early diagnosis and treatment outcomes in AD clinical trials
• learn about challenges in clinical trial design for early AD
• learn about disappointing and encouraging outcomes in AD trials and emerging awareness of the need for combination treatments

Arts and Cultural Innovations in Dementia Care
Pia Kontos

This presentation will provide an overview of the use of participative arts in dementia care. It will explore research-based drama as a novel approach to knowledge translation.

Learning Objectives
By the end of this presentation, participants should be able to:

• Explain the power of the arts to enrich the lives of persons living with dementia and their informal and formal care partners;
• Explain why researchers are turning to drama as a novel approach to making research accessible;
• Identify the ways in which research-based drama can catalyze cultural change in dementia care.

Cracked: A New Light on Dementia
Cracked Performers

Cracked: new light on dementia is an innovative research-based theatre production that casts a critical light on society’s one-dimensional view of dementia as an unmitigated tragedy. The play is intended to inspire alternative ways of seeing persons with dementia, instill the importance of maintaining strong relationships with them, and reinforce the imperative for good ethical care.

Cracked follows persons with dementia and their families on their unique journeys with dementia, from diagnosis through to their new lives in a long-term care home. The families grapple with what the diagnosis means, if and how the diagnosis changes their relationships and how they struggle to be with each other in the present where the persons with dementia call them to be. Filled with poignancy, honesty and humour, this play brings to the fore the richness of the social world of dementia and encourages audiences to see the humanity of persons who are living with dementia. Cracked is based on research conducted by Drs. Sherry Dupuis, Gail Mitchell, Pia Kontos, and Christine Jonas-Simpson, all of whom are health researchers who specialize in the areas of aging, dementia, and research-based drama. Developed collaboratively with Julia Gray, a playwright and director, a group of artists, persons living with dementia and their family members, Cracked is grounded in the idea that relationships must be front and centre when providing care for persons with dementia, memory in all of its forms must be valorized, self-expression must be nurtured, and the humanity of those who are living with dementia must be fully supported.

Friday October 2nd, 2015

The Prevalence of Dementia in Canada and its Impact on Canadians
Larry Chambers

Estimates of present and future dementia prevalence and monetary costs can increase awareness to inform service planning at all levels, including informing initiatives such as a national dementia plan for Canada. Reports on dementia prevalence and monetary costs must be: user friendly (e.g. single number not a range of numbers); robust so all sectors can use them with confidence; and, provide benchmarks against which progress can be assessed. These estimates also can increase public awareness about severity experienced by those living with dementia and their caregivers. Estimates should document costs of care, loss of income, and other demands of care.

Learning Objectives
At the end of this sessions, participants should be able to:

• Outline the strengths and limitations of the two main sources of dementia prevalence estimates – provincial administrative data bases and community epidemiologic surveys;
• Contrast the results when mild cognitive impairment is included as well as “possible/ probable dementia” in estimates of dementia;
• Present monetary costs of dementia analyses including: 1) point of view (e.g. government funded services versus societal), 2) scope (e.g. types and completeness of costs (e.g. direct, indirect, and intangible), 3) valuation (e.g. incremental direct cost estimation and valuing indirect costs of caregiving and multi-tasking).

AGE-WELL NCE Inc.
Bridgette Murphy, AGE-WELL Managing Director

This presentation will provide an overview of the AGE-WELL Network of Centres of Excellence, including its research themes, objectives and opportunities to participate.

Understanding the Needs of Older Adults with Dementia and their Careers
Arlene Astell, CCNA Investigator, AGE-WELL Investigator

This presentation will explore the needs and priorities of people living with dementia, their families and formal caregivers, with particular reference to how technology could address these.

Learning Objectives
At the end of this presentation, participants should be able to:

• Describe some of the main priorities of people living with dementia, their families and formal caregivers;
• Discuss the key challenges in trying to meet their needs;
• Describe the potential for technology to address these needs and priorities.

Examples of Technologies to Support Older Adults with Dementia
Alex Mihailidis, CCNA Investigator, AGE-WELL Investigator

This presentation will provide an overview of the cutting edge research and development that is being completed as part of the new AGE-WELL Network of Centres of Excellence. It will include examples of new technologies to support older adults with dementia from the fields of smart homes, robotics, and artificial intelligence.

Learning Objectives
At the end of this presentation, participants will be able to:

• Discuss the types of technologies that are being developed as part of AGE-WELL;
• Describe how advanced fields such as computer science, artificial intelligence, and robotics are being applied to support older adults with dementia;
• Understand how these new technologies can be used to support older adults with dementia and their caregivers.

Measuring the Impact of Technology on Older Adults with Dementia-Social and Ethical Issues
Jeff Jutai, AGE-WELL investigator

To help ensure the successful adoption and diffusion of technologies that support healthy living for older adults with dementia, it is important to measure the impact of these technologies. This presentation will review social and ethical issues that affect the quality of these measurements.

Learning Objectives
At the end of this presentation, participants should be able to:

• Describe the value of measuring the impact of technology on older adults with dementia;
• Discuss important social and ethical challenges in measuring technology impact;
• Critically appraise approaches to measuring the impact of technology on older adults with dementia.

Brain Volumes in Dementia
Simon Duchesne

This presentation will provide an overview of morphometry techniques from anatomical MRI. The usefulness of the metrics provided (e.g. specific brain substructure volumes) within the context of aid to diagnostic in dementias will be highlighted.

Learning Objectives
At the end of this workshop participants should be able to:

• Describe brain morphometry techniques that are now available in the clinical domain;
• Discuss the relative sensitivity and specificity of brain volumetry in the context of dementias;
• Discuss the potential applications for brain volumetry in aid to diagnostic and prognostic of dementias.

Mild Behavioural Impairment (MBI): A new syndrome linking later life neuropsychiatric symptoms and neurodegenerative disease
Zahinoor Ismail, CCNA Investigator

This presentation will review the impact of neuropsychiatric symptoms (NPS) on the trajectory of neurodegenerative disease from preclinical normal cognition states through to MCI and dementia. Research criteria for a new syndrome called Mild Behavioural Impairment will be discussed, which links NPS and the spectrum of neurodegnerative disease.

Learning Objectives
At the end of this presentation, participants should be able to:

• Discuss the importance of NPS on dementia outcomes;
• Review the impact of late onset NPS in older adults with normal cognition;
• Explore new criteria for Mild Behavioural Impairment.

It is Time to Change the Culture of Long-term Care
Sherry Dupuis, CCNA Investigator

This presentation will explore the need for culture change in dementia care specifically and long-term care more generally. It describes what culture change is, the challenges associated with culture change, processes and strategies for achieving culture change, and the possibilities of transformational change.

Learning Objectives
At the end of this presentation, participants should be able to:

• Describe what culture change is and is not;
• Understand the challenges of culture change in long-term care and what is needed to support it;
• Develop specific actions to support culture change in their own practice.

Debate - CSF Biomarkers and PET Amyloid Should be Used to Clarify a Diagnosis of Alzheimer’s Disease in Clinical Practice
Moderator: Howard Feldman

• Affirmative side: Dr. Stephen Salloway
• Opposing side: Dr. Kenneth Rockwood

This presentation will discuss the benefits and risks of using amyloid biomarkers in clinical practice.

Learning Objectives
At the end of this presentation, participants should be able to:

• Better understand the benefits and risks of using amyloid biomarkers in clinical practice;
• Become familiar with appropriate use criteria for amyloid PET in clinical practice.

Parallel Session I

Challenging common assumptions in dementia care and decision making
Paige Moorhouse, CCNA Investigator

This session will use cases to illustrate common assumptions among clinicians in regards to how to approach care planning and decision making. The presentation will illustrate the limitations of advance care planning; question how we approach determining capacity for decision making and make the case for contextualizing treatment decisions within the patients circle of care and symptoms.

Learning Objectives

• To consider the risks and limitations of population-based approaches to advance care planning in dementia and the ethical constructs that underlie them
• To understand factors beyond dementia that should influence clinicians’ assessment of capacity for decision making and how clinicians might recognize and address these factors
• To consider the role for clinician recommendations in the management of dementia symptoms and common comorbidities in dementia

Swallowing and Eating Issues in Advanced Dementia
Lisa Sokoloff

This presentation will provide an overview of swallowing, nutritional and eating issues in advanced dementia including evidence and ethical considerations.

Learning Objectives
At the end of this presentation, participants should be able to:

• Describe key factors to consider when assisting clients who have advanced dementia and swallowing/eating issues;
• Describe the evidence around enteral feeding in advanced dementia;
• Discuss alternatives to enteral feeding in advanced dementia.

Facts, Feelings and Fears: Supporting Families through Dementia and End of Life
Mary Schulz

This presentation will provide health care providers with an opportunity to reflect on the many complex and often contradictory issues and concerns facing families as dementia progresses and to learn about resources and strategies that can support them through the emotional and practical demands of preparing for end of life.

Learning Objectives
At the end of this presentation, participants should be able to:

• Have a better understanding of the common feelings and mis- information that families have regarding death from dementia;
• Provide information that can be helpful to families;
• Understand what resources are available to support them in their work with families in end of life dementia care.

Parallel II

The Spectrum of Frontotemporal Lobar Degenerations
Robert Laforce Jr., CCNA Investigator

This presentation will provide an overview of the main clinical syndromes found in the FTLD spectrum including the behavioral variant of frontotemporal dementia, primary progressive aphasias, corticobasal syndrome and progressive supranuclear palsy.

Learning Objectives
At the end of this presentation, participants should be able to:

• Recognize the key symptoms and underlying pathophysiology of each syndrome;
• Discuss the differential diagnosis of the main conditions found in the FTLD spectrum;
• Plan appropriate additional investigations in cases of atypical syndromes.

Young Onset Dementia
Mario Masellis, CCNA Investigator

Young onset dementias encompass a broad spectrum of different neurodegenerative conditions that result in cognitive impairment as a central feature. They affect individuals below the age of 65 and have devastating consequences on quality of life for both the patient and their family. This lecture will review the diagnostic approach to young onset dementias using the combination of clinical, cognitive and neuroimaging features to help narrow down on the broad differential diagnosis. It will then provide guidance as to both general and specialized laboratory investigations to order to achieve a specific diagnosis. Important diagnoses and related investigations that should not be missed will also be covered.

Learning objectives for above:

• Approach to differential diagnosis of young onset dementias using clinical, cognitive and neuroimaging investigations;
• Important diagnostic considerations and related investigations not to miss in the work up;
• Specialized testing including genetic and neurometabolic laboratory investigations.

Pin1:
A Small Enzyme with Big Implications for Alzheimer’s Disease and other Tauopathies
Jane Driver

This presentation will explore the biology of Pin, a unique enzyme that can “twist” pathogenic tau back into shape, returning it to a functional form. Antibodies that specifically target the pathologic form of tau show promise as targeted therapy for Alzheimer’s disease and chronic traumatic encephalopathy.

Learning Objectives
At the end of the presentation the participant should be able to:

• Review the unique role of Pin1 as a promoter of healthy aging;
• Explain how Pin1 dysregulation leads to pathogenic tau species;
• Identify new antibody technology that specifically targets pathogenic tau.

Parallel III

The ABC of BPSD – From Assessment to Care Plan
Louise Carrier

This presentation will offer an overview of the assessment and management of behaviour and psychological symptoms of dementia with a focus on the pros and cons of using antipsychotic medication.

Learning Objectives
At the end of the presentation, the participant should be able to:

• Describe a conceptual model of BPSD;
• Develop an investigation and treatment algorithm;
• Discuss the appropriateness of using antipsychotics.

Parallel IV

Advancements in Molecular Imaging: FDG-PET and Amyloid PET
Robert Laforce Jr., CCNA Investigator

This presentation will provide an overview of recent developments in molecular imaging (FDG-PET and amyloid PET), its role in research but most importantly its clinical applications in the evaluation of a dementia syndrome.

Learning Objectives
At the end of the presentation the participant should be able to:

• Understand the basic principles of molecular imaging;
• Discuss how molecular imaging has helped understand dementia syndromes;
• Describe the role of FDG-PET and amyloid PET in clinical practice today.

The Genetics of AD and FTD
Mario Masellis, CCNA Investigator

Alzheimer’s disease and frontotemporal dementia are complex neurodegenerative disorders both clinically and from the genetics perspective. The majority of cases of AD are sporadic in nature with very few cases being due to the familial inheritance of autosomal dominant mutations in the Presenilin 1 and 2 genes, as well as the Amyloid Precursor Protein. In contrast, up to 40% of FTD cases are associated with a strong family history with the most common genetic causes being mutations in MAPT, GRN and hexanucleotide repeat expansions in C9ORF72. This lecture will review the complex genetic factors that increase the risk of AD and FTD, as well as the most commonly associated mutations that produce familial forms of the respective dementia syndrome. An approach to mutation testing based on clinical features will be outlined in detail and ethical implications of genetic testing will also be discussed.

Learning objectives for above:

• Review the familial mutations and genetic risk factors that respectively cause or are associated with increased risk of AD and FTD;
• Clinical features associated with different mutations;
• Ethical issues that should be considered in genetic testing.

Saturday October 3rd, 2015

Canada and the Global Challenge of Dementia
Yves Joanette

This presentation will provide information and allowed discussion on understanding the current global challenge related to the major increase of world’s prevalence of dementia by 2050. It will also allow to share the different global actions including the Global Action Against Dementia, the World Dementia Council and the roles played by WHO, OECD and other stakeholders. These actions will be presented with the impact they had, and are having, on international opportunities to work collaboratively. Finally, this presentation will share the goals and objectives of the Canadian responses to the different element of the global Call for Action in order to face the Canadian and global challenge of dementia.

Learning Objectives
At the end of this presentation, participants should be able to:

• Understand the current global challenge, awareness and reaction to the major increase of world’s prevalence of dementia by 2050;
• Take note of the different global actions including the Global Action Against Dementia, the World Dementia Council and the roles played by WHO, OECD and other stakeholders;
• Discuss the impact that this global response had and is having on international opportunities to work collaboratively and to learn from each other;
• Understand and discuss the nature, goals and objectives of the Canadian responses to the different element of the global Call for Action in order to face dementia.

Canadian Consortium on Neurodegeneration in Aging
Howard Chertkow, CCNA Investigator

The Canadian Consortium on Neurodegeneration in Aging (CCNA), the largest dementia initiative ever mounted in Canada, was created last September with a $31.5 million investment over five years from the Canadian government through the Canadian Institutes of Health Research (CIHR) and a group of 13 partners from the public and private sectors, including the Alzheimer Society of Canada, Sanofi, and other NGO’s and government agencies. “This large consortium will accelerate innovative and collaborative research to make a difference in the quality of life and the quality of services for Canadians affected by these diseases,” asserted federal Minister of Health Rona Ambrose at the CCNA launch. Dr. Chertkow, the CCNA Scientific Director, will outline the ambitious plan and research strategy of CCNA.

Learning Objectives
At the end of this presentation, participants should be able to:

• Understand the plan for Canadian research in dementia involving the 20 CCNA teams;
• Understand the strengths of Canadian research, the new opportunities, and the challenges of mounting such a large enterprise in Canada.

Understanding the Link Between Alzheimer's Disease and Cancer
Jane Driver

This presentation will provide an overview of the intriguing epidemiologic, genetic and biological connections between cancer and neurodegenerative diseases. Untangling this complex relationship has thus far revealed interesting pathophysiological and therapeutic insights and an opportunity to think “outside the box” about neurodegeneration.

Learning Objectives
At the end of the presentation the participant should be able to:

• Review the evidence for an unusual epidemiologic association between AD and many cancers;
• Explain the possible biological underpinnings of this association;
• Explore the implications for new approaches to treatment for both diseases.

Managing Swallowing and Eating Issues in Dementia
Lisa Sokoloff

This workshop will use varied educational techniques to engage participants in learning how to manage swallowing and eating issues in clients with dementia. Common issues will be identified and management strategies will be shared.

Learning Objectives
At the end of this workshop participants should be able to:

• Describe common swallowing, nutrition and eating issues that arise in clients with dementia;
• Describe various strategies to assist clients and SDMs in making decisions around management of swallowing, nutrition and eating;
• Discuss enteral feeding, “risk feeding” and “quality of life feeding” for clients with dementia.

Workshop 1

Providing Palliative Care to Frail Older Adults: Meeting Complex Needs
Laurie Mallery, Paige Moorhouse

In order to deliver effective end of life care when frailty is present, the paradigms of traditional palliative care need modification to address important differences between younger and older individuals. In contrast to younger cancer patients, who typically have predominant single-system disease, the majority of frail older adults die with complex interacting chronic medical illnesses and symptoms. When multiple health issues culminate in frailty, standard models of palliative may need to be modified. This presentation will review the challenges that frailty poses to optimal end-of-life care and address ways to provide effective palliative care to the frail elderly.

Learning Objectives:
At the end of this presentation, you should know:

• How palliative care differs for those with frailty compared to those with cancer;
• The challenges to optimal end of life care in frailty;
• How to address the gap in care for people who are not actively dying, but are at high risk of poor health outcomes;
• The elements that are needed to successfully deliver palliative care to those who are frail.

Workshop 2

Les Aphasies Primaires Progressives
Workshop given in French
Robert Laforce Jr., CCNA Investigator

Cette présentation fournira un survol clinique et pathophysiologique des principales aphasies primaires progressives incluant la variante sémantique, logopénique et la variante non-fluide.

Learning Objectives
À la fin de cette session, les participants seront en mesure de:

• Reconnaître les principaux types d’aphasies primaires progressives;
• Évaluer adéquatement les aspects clés du langage et de la parole;
• Planifier les investigations nécessaires afin d’éclaircir les présentations atypiques.

Workshop 3

Assessing Dementia in Immigrant Populations
Frank Knoefel, CCNA Investigator

This presentation will help the participant develop an approach to assessing cognitive impairment in immigrants whose languages the physician does not speak.

Learning Objectives
À la fin de cette session, les participants seront en mesure de:

• Identify specific elements of the clinical history that will help identify cognitive changes;
• Describe the Rowland Universal Dementia Assessment Scale (RUDAS);
• Develop skills at using the RUDAS and elements of the clinical history to improve diagnostic clarity for immigrant patients.

Workshop 5

The Art of Listening – The First Step in Detecting an Aphasia
David Tang-Wai, CCNA Investigator

This presentation will provide an approach to listen to a patient and detect their errors in language and will enable the examiner to determine if a formal language evaluation is required.

Learning Objectives
At the end of this presentation, participants should be able to:

• Provide an approach to listen to a patient and detect their errors in language;
• Enable the examiner to determine if a formal language evaluation is required.

Workshop 6

Beyond Medication….Managing Behaviour and Psychological Symptoms of Dementia in the Community
Louise Carrier, Christine Thibault, Nicole Diotte
Capacity of 30

This workshop is set up as a role play. Sandra brings her mother, who suffers from mild-moderate dementia, to her physician’s office seeking help with her agitation.

Learning Objectives
At the end of this workshop, the participant should be able to:

• Appreciate the challenge of managing BPSD in the community;
• Facilitate communication and collaboration with community partners;
• Develop and implement non-pharmacological interventions.

Workshop 7

Consent & Capacity: Evaluation of the Person's Decision Making Ability
Andrea Stewart

A person with a neurocognitive disorder or other mental illness may still be able to independently make financial, medical, or living situation decisions. For many people with neurocognitive disorder, their decision-making ability is impaired. In this presentation, we will review when and how to evaluate a person's capacity to make medical care decisions, and reflect on the ethical principles that inform this practice.

Learning Objectives
At the end of this presentation, participants should be able to:

• Identify situations including illness type, decision type, and timing that would merit the formal evaluation of a person's decision-making capacity;
• Evaluate decision-making capacity for medical care in a person with a neurocognitive disorder;
• Prior to, during, and after such an evaluation, identify and reflect on the ethical issues involved in capacity assessment.

Workshop 8

Measuring Brain Volumes with MRI in Dementia
Simon Duchesne, CCNA Investigator

This presentation will provide an overview of morphometry techniques from anatomical MRI. The usefulness of the metrics provided (e.g. specific brain substructure volumes) within the context of aid to diagnostic in dementias will be highlighted.

Learning Objectives
At the end of this workshop participants should be able to:

• Describe brain morphometry techniques that are now available in the clinical domain;
• Discuss the relative sensitivity and specificity of brain volumetry in the context of dementias;
• Discuss the potential applications for brain volumetry in aid to diagnostic and prognostic of dementias.

Workshop 9

The New NIH Criteria for Alzheimer’s Disease and MCI: Incorporating Biomarkers into Diagnosis
Howard Chertkow, CCNA Investigator

A new set of criteria have been published based on the work of NIH committees. We will review the basis and organization of these criteria.

Learning Objectives
At the end of this presentation, participants should be able to:

• Become familiar with different categories of biomarkers, and their current status in supporting the “Pathophysiology of Alzhiemer Disease” for clinical and research purposes.

Workshop 10

Comparison of Multiple New Criteria for Alzheimer’s Disease: How Not to Get Lost in Translation
Sandra Black, CCNA Investigator
Ben Lam

Rapid progress in Alzheimer’s biomarkers and the push for diagnosis at ever earlier stages of disease has in recent years has spurred consensus groups to update previous criteria for dementia and Alzheimer’s Disease. The resulting criteria are not equivalent and may hinder as much as aid the busy clinician or clinical trialist. In this workshop, we plan to lead a lively interactive journey through a sometimes confusing taxonomic landscape.

Learning Objectives
At the end of this workshop participants should be able to:

• Identify the “Alzheimer’s syndrome” and how it is shaping the modern conception of Alzheimer’s disease;
• To concisely review five major consensus criteria, with attention on overlap and areas of significant discordance;
• To invite discussion on how these divergent criteria might best be applied to the clinical and research setting.

Workshop 11

Driving and Dementia - What Every Practicing Clinician Should Know Practicing
Frank Molnar, CCNA Investigator

This workshop will cover the basics of assessment of fitness-to-drive in persons with dementia, approaches to communicating concerns and addressing risk and will then explore solutions to challenging situations faced by attendees.

Learning Objectives
At the end of this presentation, participants should be able to:

• Describe reasonable and sound approaches to assessing fitness-to-drive in persons with dementia;
• Discuss concerns regarding fitness-to-drive with their patients;
• Develop approaches to thorny / challenging clinical scenarios.