There is a lack of integration between mobility, falls, and cognitive research. The Gait and Brain Lab is paving a new way to approach the problem of falls and falls prevention in older adults with cognitive problems: to improve cognition in order to improve mobility.
‘Gait and Brain’ Cohort Study
This cohort study is aiming to include 400 participants with mild cognitive impairment (MCI) followed bi-annually for a total period of 3 years to determine how subtle changes in gait may predict progression to dementia and mobility disability. In addition, we seek to understand how vascular risk factors, structural change in brain cortex, inflammatory markers and vitamin D levels can influence trajectories in cognition, gait and mobility. Results from this ongoing study have been published: Association of dual-task gait with incident dementia in Mild Cognitive Impairment: Results from the Gait and Brain Study. JAMA Neurology 2017 May 15, 2017. doi:10.1001/jamaneurol.2017.0643 . This study is registered at www.ClinicalTrials.gov (NCT03020381)
The SYNERGIC TRIAL (SYNchronizing Exercises, Remedies in GaIt and Cognition, A Randomized Controlled Double Blind Trial) is uniquely designed to evaluate the effect of aerobic and progressive resistance training exercises, isolated or combined with cognitive training and vitamin D supplementation, in older adults with Mild Cognitive Impairment (MCI). This trial will be conducted by the Motor Exercise and Cognition Team which is part of the Canadian Consortium in Neurodegeneration and Aging (CCNA). This trial is registered at www.ClinicalTrials.gov (NCT02808676).
The Gait and Brain Lab is one of several sites nationally to participate in the observational COMPASS-ND Study, funded through CCNA. Participants with the following memory conditions will be recruited into COMPASS-ND: Subjective Cognitive Impairment (SCI), Mild Cognitive Impairment (MCI), Subcortical Ischemic Vascular MCI, Mild Alzheimer’s disease, Dementia of Mixed Etiology, Lewy Body disease, Parkinson’s dementia/MCI and Frontotemporal dementia. The COMPASS-ND study is designed to provide the data that will enable 14 out of 20 of CCNA’s research teams to address their hypotheses, including Team 12 (Mobility, Exercise and Cognition) led by Dr. Montero-Odasso. Participants partaking in the SYNERGIC Trial at any of the 5 national sites are invited to co-enroll in this observational study. www.ClinicalTrials.gov (NCT03402919)
Improving Mobility and Cognition in Older Adults: Establishment of an Interdisciplinary Clinical Research Program Using Non-Invasive Brain Stimulation (NIBS) Study
The NIBS research project is examining whether a method of non-invasive brain stimulation, called repeated Trans-cranial Magnetic Stimulation (rTMS), will improve walking ability and cognition in individuals with executive dysfunction. This study is conducted with co-investigator Dr. A. Burhan at Parkwood Institute, Mental Health. This trial is registered at www.ClinicalTrials.gov (NCT02740530).
Motor, Exercise and Cognition Team, as part of the National Canadian Consortium in Neurodegenerative Diseases and Ageing (CCNA)
Team 12: Mobility, Exercise, and Cognition (MEC) is led by Manuel Montero-Odasso and co-led by Louis Bherer, who each focus on the relationship between physical activity, motor performance and cognitive decline in aging and neurodegeneration. Motor and cognitive decline in aging often interact because of the common brain networks they share. Aging associated or diseases driven neuroanatomical changes in these networks have consequences for motor learning and control, memory, executive functions, gait and balance in older adults. More importantly, motor and cognitive decline are important risk factors for dementia, falls and fractures and future disability. The MEC Team is focused on the interaction and expression of cognitive and motor decline during the course of neurodegenerative diseases, which will then be translated into innovative exercise-based interventions.
Ontario Neurodegenerative Disease Research Initiative (ONDRI – OBI)
Dr. Manuel Montero-Odasso is co-leader, along with Dr. Bill McIlroy from Waterloo, for the Gait Platform for this OBI funded project. This project is aimed to amalgamate research collaborations across Ontario for common assessment in gait and cognition. Watch Dr. Montero-Odasso describe the gait and balance platform here, find ONDRI Study assessments here, and Dr. Michael Strong (Principal Investigator, Western University) speaking on the future of ONDRI Study here (June 2017). More details can be found at the ONDRI website here.
Cognitive enhancer medication to improve gait and reduce falls. A randomized Controlled Trial
This randomized double-blinded clinical trial is evaluating the effect of cognitive enhancers in people with MCI. The goal is to determine the effect of cognitive enhancers on fall risk in elderly people with MCI, with the hypothesis that cognitive enhancers will be improve in balance and gait due to improved cognition, specifically, attention and executive cognitive function. Specifically, cognitive enhancer medication improves gait performance in elderly patients with dementia by improving attention and executive function. J Am Geriatr Soc. 2009; 57(2): 359-360, BMC Neurol. 2009 Aug 12;9:42
Vitamin D supplementation to improve mobility and cognition
We are evaluating the effect of high doses of vitamin D on muscle function, gait, and balance in older people with frailty. This CIHR funded study examines the question if Vitamin D can have a therapeutic effect beyond supplementation doses. Preliminary result has been published J Gerontol A Biol Sci Med Sci. 2011 May;66(5):568-76.