By: Allison Currie
The Nova Scotia Health Innovation Hub is a space where primary care providers, researchers, healthcare innovators and government can collaborate to quickly tackle some of the biggest challenges in the provincial healthcare system. Partnerships are at the heart of everything we do, and one such partner, as a member of our research and innovation community, is Dr. Kenneth Rockwood.
Dr. Rockwood is a clinician scientist who has led several studies on dementia and cognitive impairment, that underscore dementia as a preventable disease. Governments across the country continue to use Dr. Rockwood’s work in their policy creation, ultimately improving dementia care for patients and care providers.
In honour of January being Alzheimer's Awareness Month, we sat down with Dr. Rockwood to ask him a few questions about his experience working in dementia research and care, and what inspires him to do this work.
How has dementia traditionally been treated, and how have you seen that change over your career?
The biggest change I have seen during my career is that it is being treated.
We now have drugs that increase the “memory chemical” acetylcholine, and they have been available since the mid-90's.
Unfortunately, it looks like that is going to be the highlight of my career, at least therapeutically. These drugs, called cholinesterase inhibitors, have been effective in increasing the level of acetylcholine, and can offer great benefit. Still, I believe they remain underrated, often used in no more than half of people seeking treatment.
Another big change is a growing understanding of what happens in the brains of people with what we often call Alzheimer's Disease (but a better term for most people with it, would be “late life dementia”). That growing understanding is where new hope for a broader view of treatment arises.
It's also important right now to realize there is more to treatment than just increasing the memory chemical, acetylcholine. For instance, the amount of serotonin in the brain declines in those with Alzheimer's Disease, making many physicians more willing to use drugs that also increase the amount of serotonin as treatment.
These changes are nowhere near what we need, but I would never go back to the days when we had nothing to offer other than emotional support.
What do you wish more people knew about the treatment of patients with dementia?
I wish more people knew that treating people with Alzheimer's Disease is muti-factorial.
We must pay attention to people’s diet. Even though the evidence for dietary modifications is small, other interventions can build on this basis.
We must be vigorous in getting patients to exercise (including advocating for more places to exercise) and in design of buildings and public spaces that encourage exercise. This includes small bursts of exercise such as climbing stairs. In many buildings the design layouts are confusing, directions are poor, stairs can’t be found, and the only nutrition choices are highly processed foods.
We also need to promote the notion of social engagement. That includes obvious spaces for people to meet in sunlight.
Just like bad things can happen when several small, bad things add up, we can also have good things happen when several small, good things add up.
In my practice I tend to offer an optimistic approach. It’s difficult enough to tell someone they have dementia; I don’t want to upset them further. My approach is to be realistic, but to describe what success looks like. While it's not a guarantee, we can see a good response to treatment in someone empowered to improve their diet, exercise more, engage with others and let themselves be happier, rather than when they lived in a state of worry about what might happen (which is a common way that people come to clinic).
Why is research (and participation in research) so important?
Research, and participation in research, is important because it is the best hope we have of making care better.
For example, the cholinesterase inhibitors (the drugs that increase the level of the memory chemical, acetylcholine) taught us a lot about how the front part of the brain works. Our patients and families began to describe how widespread the impact of a drug that we initially felt was useful only for memory. We have seen evidence that it also improves initiative, improves judgement, improves organization and improves insight in a lot of patients. We learned this by carefully studying how people who live with late-life dementia responded to the drugs that we have available.
What symptoms were made better?
Which ones were harder to treat?
What patterns did we see, and how might that indicate the way in which the brain chemistry was working before and after treatment?
This is the type of research that will continue to improve people's experience with treatment.
What does your ideal patient journey look like for Canadians living with dementia?
The ideal patient journey that I’ve seen is when we have someone who comes to us with important symptoms, we’re able to make a diagnosis at the very start of the dementia being clinically apparent, and they show an early response to treatment. There’s an idea that some people who respond well to treatment, do so early, so positive results can be seen within a few weeks.
It’s important that we pay attention to the improvement that people see and don’t try to downplay it, but instead learn from it. People who respond well to one treatment are likely to respond well to other treatments too. We need to have the courage to try different combinations of drugs, slowly, while paying attention to what our patients tell us so we can determine whether we are on the right track.
We need to couple all of that with good social engagement, a good diet, good sleep hygiene and exercise. Combined, these are things that can allow many people to live successfully with dementia for many years.
What inspires you to do the work you do each day?
I am inspired to do the work I do each day by the patients in my clinic who are a continued source of inspiration, admiration and amazement to me. I have seen people respond exceedingly well to the direst circumstances. I have seen people who have worried more about what the impact will be on others than what the impact will be on themselves.
I find dementia care, despite the tragedies, to still be very optimistic. It’s the job I like the most.
Please note that, while dementia is a general term, Alzheimer's Disease is a specific brain disease. For more information about Alzheimer’s Awareness Month, visit the Alzheimer Society of Canada.
Clinical studies help translate research into potentially life-changing therapies that can help you, your friends and your loved ones, but research can’t happen without you. Sign up for Nova Studies Connect today: novastudiesconnect.ca
