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Canadian researchers are the first to study how patterns in the way older adults walk could more accurately diagnose different types of dementia and identify Alzheimer’s disease. 

A new study by a Canadian research team, led by London researchers from Lawson Health Research Institute and Western University, evaluated the walking patterns and brain function of 500 participants currently enrolled in clinical trials. Their findings are published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.  

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“We have longstanding evidence showing that cognitive problems, such as poor memory and executive dysfunction, can be predictors of dementia. Now, we’re seeing that motor performance, specifically the way you walk, can help diagnose different types of neurodegenerative conditions,” says Dr. Manuel Montero-Odasso, Scientist at Lawson and Professor at Western’s Schulich School of Medicine & Dentistry.  

Dr. Montero-Odasso is world renowned for his research on the relationship between mobility and cognitive decline in aging. Leading the Mobility, Exercise and Cognition (MEC) team in London, he is pioneering novel diagnostic approaches and treatments to prevent and combat early dementia. Dr. Montero-Odasso is also co-lead of the Mobility, Exercise and Cognition Team at CCNA, a team composed of 22 researchers and 6 trainees. 

This study compared gait impairments across the cognitive spectrum, including people with Subjective Cognitive Impairment, Parkinson’s Disease, Mild Cognitive Impairment, Alzheimer’s disease, Lewy body dementia and Frontotemporal dementia, as well as cognitively healthy controls. The study used data from the COMPASS-ND Cohort and the Gait and Brain Study Cohort. 

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Gait assessment looks at the way in which we move our whole body from one point to another, helping to analyze mobility and the brain processes involved. 

Four independent gait patterns were identified: rhythm, pace, variability and postural control. Only high gait variability was associated with lower cognitive performance and it identified Alzheimer’s disease with 70 per cent accuracy. Gait variability means the stride-to-stride fluctuations in distance and timing that happen when we walk.  

“This is the first strong evidence showing that gait variability is an important marker for processes happening in areas of the brain that are linked to both cognitive impairment and motor control,” notes Dr. Frederico Perruccini-Faria, Research Assistant at Lawson and Postdoctoral Associate at Western’s Schulich School of Medicine & Dentistry, who is first author on the paper.

“We’ve shown that high gait variability as a marker of this cognitive-cortical dysfunction can reliably identify Alzheimer’s disease compared to other neurodegenerative disorders.”  

When cognitive-cortical dysfunction is happening, the person’s ability to perform multiple tasks at the same time is impacted, such as talking while walking or chopping vegetables while chatting with family.  

“Having gait variability as a motor marker for cognitive decline and different types of conditions could allow for gait assessment to be used as a clinical test, for example having patients use wearable technology,” says Dr. Richard Camicioli, Professor at the University of Alberta and co-senior author on the paper.  

The London team collaborated with researchers at the University of Toronto, University of Calgary and University of Alberta. They are part of the Canadian Consortium on Neurodegeneration of Aging (CCNA), a collaborative research program tackling the challenge of dementia and other neurodegenerative illnesses.

Dr. Montero-Odasso adds that this gait variability could be perceived as similar to an arrhythmia. Health care providers could potentially measure it in clinical settings, like how heart rhythm is assessed with electrocardiograms.  

This study was primarily funded by CCNA, supported by a grant from the Canadian Institutes of Health Research.  

 

In a new study from Lawson Health Research Institute (Lawson), scientists have discovered that a specific protein has the potential to be used to treat some patients with primary open-angle glaucoma.

Primary open-angle glaucoma is the most common type of glaucoma, which is a group of diseases that affect nearly 70 million people worldwide. Glaucoma is characterized by progressive damage to the optic nerve which ultimately leads to blindness. In this new study, led by Dr. Sunil Parapuram, researchers examined the role of a protein called “phosphatase and tensin homolog” (PTEN) in the trabecular meshwork. The trabecular meshwork is a porous tissue in the eye through which the clear fluid that fills the eye drains out.

In some primary open-angle glaucoma patients, the structure of the trabecular meshwork is damaged by fibrosis. Fibrosis is a thickening or scarring of tissue which is caused by an excess amount of matrix molecules such as collagen. Fibrosis of the trabecular meshwork prevents the fluid in the eye from draining out normally, which leads to increased pressure in the eye and damage to the optic nerve.

Dr. Parapuram’s team found that the inactivation of the protein PTEN can cause too many matrix molecules to be deposited in the trabecular meshwork, leading to fibrosis. On the other hand, when PTEN activity was increased, it reduced the amount of matrix molecules being deposited in the trabecular meshwork. These results indicate that drugs that can activate PTEN have high potential to be used as a treatment for open-angle glaucoma.

“There’s an immediate need for a new generation of therapeutic drugs for more effective treatment of glaucoma,” says Dr. Parapuram, a Lawson scientist at St. Joseph’s Health Care London and an assistant professor in the Departments of Ophthalmology and Pathology at the Schulich School of Medicine & Dentistry, Western University. “While further research is needed, drugs that activate PTEN could be the answer.”

Dr. Parapuram’s team will continue to study the function of PTEN in the trabecular meshwork in more detail and test the role of drugs that activate the protein as a potential treatment for primary open angle glaucoma.

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Dr. Michael Motolko (left), Chair/Chief, Department of Ophthalmology, and Dr. Sunil Parapuram (right).

“This study highlights the expansion of our department’s research activities into basic science application and its findings are relevant to many other fibrotic diseases,” says Dr. Michael Motolko, Chair/Chief, Department of Ophthalmology, Schulich School of Medicine & Dentistry,Western University, London Health Sciences Centre and St. Joseph’s Health Care London.

The study, “TGF-β induces phosphorylation of phosphatase and tensin homolog: implications for fibrosis of the trabecular meshwork tissue in glaucoma,” is published in Nature’s Scientific Reports.

Dr. Cheryl Forchuk is the recipient of the 2020 Innovation Award for her work to prevent discharges from hospital to homelessness. Throughout her career, Dr. Forchuk has been investigating potential best practice approaches to prevent homelessness in our community for a wide range of people, including those with severe mental illness, veterans, families, and youth. 

Her recent project, ‘Preventing Hospital Discharge into Homelessness: No Fixed Address Version 2 (NFAv2)’ streamlines housing and income services by bringing them into the hospital, and integrating them into a coordinated system of care.  

Research shows that when someone is housed, their use of medical and social services decreases. Safe and adequate housing is required for individuals to recover from illness. 

 Version one of this program was a great success, providing direct access to a housing advocate and Ontario Works from inpatient hospital psychiatric units in London. The No Fixed Address v2 program provides individual inpatients, at risk of becoming homeless, with housing and financial assistance while in hospital. A collaborative approach which includes the local Canadian Mental Health Association, the Salvation Army Rent Stability Bank, Ontario Works, and the City of London brings community supports to the hospital. This enables patients to recover from their illness and reduces the number who may return to the hospital. Dr. Forchuk’s use of in-depth, individual, quantitative interviews, and qualitative focus groups, allows stakeholders to voice their experiences with the program as well as capture traditional outcomes. 

“This innovative program has been so successful in London’s hospitals that the City of London has integrated the NFAv2 service within its municipal housing support programs,” explains Dr. Arlene MacDougall, Lawson Scientist and Dr. Forchuk’s nominator. “It also has the potential to be integrated across the province as the best practice in reducing homelessness in communities. Her efforts have been recognized by multiple funding agencies, and it will soon be the model for the rest of the nation to follow. Dr. Forchuk’s commitment to improve the lives and of those in our community makes her truly deserving of this award.” 

“The No Fixed Address research project is the first evaluation anywhere of a strategy that aims to reduce the number of hospital patients being discharged into homelessness,” says Dr. Forchuk. “I’m really proud of our collective efforts. We have been able to help a lot of people, and have also learned a lot throughout the course of this study.”