Alzheimer Society of Canada

BackgroundAging is associated with a decline in specific cognitive abilities and increased variability of dynamic functional connectivity (v‐dFC; Jauny et al., 2022), across the whole brain (Yang et al., 2023) and in the default network (Douw et al., 2016; Madhyastha & Grabowski, 2014). We investigated the extent to which age‐related changes in v‐dFC would be mitigated by an intervention to enhance physical activity in older adults at risk for Alzheimer's disease (AD) and whether the changes in v‐dFC were related to cognitive improvements.Method50 participants from the PREVENT‐AD longitudinal cohort (Tremblay‐Mercier et al., 2021) with a family history of AD were assigned to the intervention (N = 21; Mage=69.8 years) or the active control group (N = 29; Mage=70.3 years) for a four‐week randomized controlled trial. Multi‐echo gradient‐echo EPI sequence was used to acquire resting‐state functional MRI data at baseline and post‐intervention. Using Schaefer's 200 parcellation across Yeo's 17 networks, the dFC matrices were constructed with the Multiplication of Temporal Derivatives method (Shine et al., 2015; 10 TR overlapping windows). Modularity, system segregation (Chan et al., 2014), within‐network and between‐network FC of the DefaultA/B/C and ControlA/B/C networks were calculated for each dFC matrix. V‐dFC was defined as the standard deviation of these measures. Group by time interactions effects on v‐dFC were estimated after controlling for age, education, sex, motion and APOE4 carriership status. Change scores in v‐dFC measures were correlated with changes in cognitive performance on digit span and digit symbol matching tasks.ResultThe intervention group showed decreased modularity and maintained system segregation within‐DefaultC, between DefaultC—ControlC v‐dFC, compared to the control group who showed increased v‐dFC (Figure 1) after the intervention period relative to baseline. The baseline to post‐intervention decrease in v‐dFC of modularity was related to concurrent improvement in digit symbol matching task performance (Figure 2).ConclusionAn intervention to enhance physical activity mitigated age‐related increases in v‐dFC network segregation and connectivity of the DefaultC subnetwork. DefaultC corresponds to the medial temporal lobe subsystem (Andrews‐Hanna et al., 2010), including the parahippocampal, retrosplenial and inferior parietal regions, which are highly vulnerable to AD pathology (Buckner et al., 2005).

BackgroundThere is limited research focused on lifestyle interventions for people living with dementia and recent systematic reviews primarily focus on the impact of exercise on cognition. However, functional abilities and quality of life (QoL) are the outcomes most consistently prioritized by people living with dementia, care partners, and healthcare professionals. We conducted a systematic review to understand the impact of two lifestyle interventions (physical activity, nutrition) on the functional abilities, quality of life, and nutritional status (nutrition interventions only) of people living with dementia living in the community. The results presented here focus on the effects of nutrition interventions.MethodSystematic literature searches for peer‐reviewed intervention studies were conducted in four databases (MEDLINE, EMBASE, Scopus, CINAHL). Articles were exported to Covidence, where duplicates were removed and two independent reviewers performed study selection, data extraction, and risk of bias assessments. A narrative synthesis was conducted.ResultSix studies met the inclusion criteria. Five studies compared nutrition interventions to usual care. Interventions included education/counselling on nutrition through various delivery modes; one study also included coaching to reduce care partner stress and encourage protein supplementation. Sample sizes (n = 12 – 946) and follow‐up periods varied substantially across studies (3 weeks – 12 months). Five studies assessed nutritional status, all of which used the Mini‐Nutritional Assessment. The two largest studies, a cluster‐randomized trial with 946 participants (intervention = 448; control=498) and a non‐randomized controlled trial with 225 participants (intervention = 151; control=74) found significantly better nutritional status in the intervention compared to control groups. Results showed no change for two studies and data collection was incomplete for one study. Other outcomes measures included: QoL (n = 2 studies), activities of daily living (ADL)/instrumental ADL (n = 3 studies), falls (n = 1 study), grip strength (n = 1 study), timed up and go test (n = 1 study), lower body strength (n = 1 study), and step test (n = 1 study).ConclusionExisting literature suggests that nutritional status can be improved through nutrition interventions, supporting a role for nutrition risk screening and intervention among people living with dementia. Additional large‐scale studies are needed to understand the impact of these interventions on nutritional status, QoL, and functional abilities while considering barriers to access.

BackgroundThe global workforce is aging 1, increasing the prevalence of Mild Cognitive Impairment (MCI) and Young‐Onset Dementia (YOD)2, and driving organizations to adopt more comprehensive approaches to inclusion3. These conditions pose unique challenges for employers balancing inclusivity with operational efficiency. Traditional accommodation approaches often prove inadequate, relying on outdated practices unsuited to the evolving needs of employees with cognitive impairments. This study examines the intersection of empathetic organizational practices, technology integration, and resilience‐building strategies to support workers with cognitive disabilities.MethodUsing a multi‐level comparative case study design, we conducted 97 semi‐structured interviews in two diverse Canadian organizations—one in the public sector and one in healthcare. Drawing on a socio‐technical systems framework and the Job Demands‐Resources (JD‐R) model, we explored how these organizations manage job demands and resources for employees with MCI and YOD. Interviews addressed workplace culture, accommodation practices, managerial support, and technology's role in creating inclusive environments.ResultEffective accommodations combined empathetic leadership, flexible management, and the strategic deployment of both digital and non‐digital technologies. Organizations enabling adaptive decision‐making and iterative feedback loops demonstrated greater resilience. However, technology alone was insufficient; a person‐centered, adaptive approach aligned with organizational workflows was vital to reduce strain and enhance job performance.ConclusionFindings underscore the need for empathetic, flexible workplaces where managerial and technological systems respond to employees’ evolving cognitive needs. A conceptual model of “strain and resilience cycles” highlights how organizational structures and technology must continuously adapt for sustained support. The results emphasize fostering an inclusive culture, reducing stigma, and leveraging technology in ways that enhance—rather than hinder—employees’ experiences. By integrating empathetic leadership, personalized accommodations, and adaptive feedback systems, organizations can improve both operational efficiency and the well‐being of employees with cognitive impairments.

Improving supports to enhance wellbeing of people living with dementia is a priority. Engaging people living with dementia, care partners, and other stakeholders in development of interventions increases the likelihood they will be relevant and impactful. We describe the participatory approach used to co-design the Dementia Lifestyle Intervention for Getting Healthy Together (DELIGHT) program, which aims to promote the health and wellbeing of people living with dementia and care partners. The DELIGHT project was guided by a team of researchers, people living with dementia, care partners, and an Alzheimer Society representative. The co-design team included additional people living with dementia, care partners, exercise professionals, dietitians, health care professionals, and community service providers (n = 29). The co-design was planned for in-person but was transitioned to six online, 1.5-h sessions due to COVID-19 related restrictions. We used breakout rooms for discussion, with people living with dementia in each breakout room. Co-design meetings focused on identifying target population and outcomes and developing program components and structure. Two or three guiding questions focused discussion in each meeting. The final co-design session focused on the overall structure of the DELIGHT program. Program resources were iteratively designed with the research team, co-design team, and other external stakeholders. The result of the co-design process was the DELIGHT program, an 8-week, twice weekly program designed to promote living well with dementia for people living with dementia and care partners. Each session includes 50-60 minutes of exercise and 20-30 minutes of facilitated, shared learning with an associated resource. A healthy snack may be offered. Shared learning focuses on healthy eating, sleeping well, mental well-being, social connection, and physical activity. Our vision is that the co-designed DELIGHT program will promote the health and wellbeing of people living with dementia and care partners, increasing the likelihood of living well with dementia.

BackgroundAdult day programs aim to facilitate aging in place by supporting the health and well-being of persons with dementia and providing respite to their caregivers. However, studies on the effects of day programs are inconclusive, and we especially lack insights into the context conditions and mechanisms of day programs that may produce different outcomes for different groups of persons with dementia and their caregivers. Our objective was to conduct a realist review, synthesizing research on day programs to develop program theories explaining how and why day programs do or do not produce positive or negative outcomes for different groups of persons with dementia, and caregivers.MethodsWe identified 14 literature reviews (including 329 references published between 1975 and 2021) on adult day programs. From this initial pool of studies, we will include those that focused on day program attendees with dementia or meaningful cognitive impairment, and/or their caregivers, and that report how day program contexts (C) and mechanisms (M) bring about outcomes (O) for attendees and caregivers. We will extract CMO statements (i.e., narratives that explain how and why day programs do or do not bring about certain outcomes for whom and under what circumstances). Using additional focused searches, citation mapping, citation tracking, and discussions with our researcher and expert team members, we will identify additional references. CMO statements will be synthesized, transformed into hypotheses, and linked and visualized to form program theories. Using focus groups and the James Lind Alliance Priority Setting Partnership method, we will discuss and prioritize our CMO statements and refine our program theories with 32 experts (older adults, caregivers, Alzheimer societies, caregiver organizations, day program staff and managers, and health system and policy decision makers). DiscussionBy identifying essential elements and processes of day programs and related knowledge gaps, this study will generate much-needed knowledge to leverage the full potential of day programs so they can provide appropriate care, preventing premature institutionalization, and unnecessary acute and primary care use. This will ultimately improve the quality of life of persons with dementia and their caregivers, alleviate caregiver burden, and reduce social costs. Systematic review registrationPROSPERO CRD42024504030

Despite the detrimental impact of apathy on the cognition, functional abilities, and quality of life of older people, it is often under-rated and under-managed. This integrative review provides a comprehensive overview of the barriers as well as potential facilitators to optimal care for older adults with apathy. A systematic search for relevant literature using Whittemore and Knafl’s framework was conducted to identify factors that inhibit or facilitate optimal detection and intervention for apathy in older people with and without dementia. Four key barriers were identified including lack of standardized definition of apathy, lack of awareness, overlap with other disorders, and methodological limitations of clinical trials. Key facilitators included involvement of the dyad (persons with apathy and their families/formal caregivers), education, training and experience, and adoption of new and innovative method of screening and intervention. To provide optimal care for older people with apathy, there is need to adopt a multifaceted approach, including the development of precise definition of apathy, consideration of person-centered approach, caregiver training, and best practice guidelines for management of apathy. Future research and practice into effective interventions for management of apathy in older adults, and enhanced education and training for healthcare professionals, are needed to ensure quality of care for older adults with apathy.

The Alzheimer Society of Ontario's Minds in Motion (MiM) program improves physical function and well-being of people living with dementia (PLWD) and their care partners (CP) (Regan et al., 2019). With the COVID-19 pandemic, there was an urgent need to transition to a virtual MiM that was similarly safe and effective. The purpose of this mixed methods study is to describe the standardized, virtual MiM and evaluate its acceptability, and impact on quality of life, and physical and cognitive activity of participants. Survey of ad hoc virtual MiM practices and a literature review informed the design of the standardized MiM program: 8 weeks of weekly 90-minute sessions that included 45-minutes of physical activity and 45-minutes of cognitive stimulation in each session. Participants completed a standardized, virtual MiM at one of 6 participating Alzheimer Societies in Ontario, as well as assessments of quality of life, physical and cognitive activity, and program satisfaction pre- and post-program. In all, 111 PLWD and 90 CP participated in the evaluation (average age of 74.6±9.4 years, 61.2% had a college/university degree or greater, 80.6% were married, 48.6% of PLWD and 75.6% of CP were women). No adverse events occurred. MiM participants rated the program highly (average score of 4.5/5). PLWD reported improved quality of life post-MiM (p = <0.01). Altogether, participants reported increased physical activity levels (p = <0.01) and cognitive activity levels (p = <0.01). The virtual MiM program is acceptable, safe, and effective at improving quality of life, cognitive and physical activity levels for PLWD, and cognitive and physical activity levels among CP.

Abstract With the rapidly increasing size of the dementia population, it is important to enhance our understanding of the similarities and differences that are found across the people living with condition. This work takes a closer look at the many faces of dementia in Canada by highlighting the diversity that is found within the national population projections for dementia. To conduct these forecasts, a simulation model was developed using demographic characteristics and risk factors for dementia to estimate the numbers of people living with dementia in Canada from 2020-2050. From the results of the Landmark Study, we will highlight findings related to sex, Indigenous Peoples, ethnic origins, and young-onset dementia. In 2020, 61.3% of dementia diagnoses were in females and this sex ratio is projected to stay constant over the three decades. For Indigenous Peoples of Canada, dementia numbers are estimated to increase by 273% (2020: 10,800; 2050: 40,300). People of Asian origin will increase from 8% of people living with dementia in 2020 to 24% by 2050. The changes are driven both by future immigration, and by people who have already immigrated to Canada in the past few decades. The Landmark Study also projects that there could be over 40,000 people under the age of 65 living with dementia in Canada by 2050.These findings illustrate the changing landscape of people living with dementia in Canada. These demographic characteristics, as well as other distinctions across population groups, profoundly affect the way in which dementia is experienced and their care needs.

Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards (www.dementiawellness.ca). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.

With increasing numbers of persons living with dementia and their higher rates of hospitalizations, it is necessary to ensure they receive appropriate and effective acute care; yet, acute care environments are often harmful for persons with dementia. There is a lack of dementia education for acute health care providers in Canada. Scotland presently delivers a dementia education program for health care providers, known as the Scottish National Dementia Champions Programme. The objective of this Policy and Practice Note is to present the collaborative work of Scottish experts and Canadian stakeholders to adapt the Dementia Champions Programme for use in Canada. This work to date includes: (a) an environmental scan of Canadian dementia education for acute health care providers; (b) key informant interviews; and, (c) findings from a two-day planning meeting. The results of this collaborative work can and are being used to inform the next steps to develop and pilot a Canadian dementia education program.