Howard Chertkow: Researching dementia

Howard Chertkow (Baycrest photo)

With the goal of improving quality of life for Canada’s aging population, world-renowned scientists at Baycrest’s Rotman Research Institute in Toronto have created research programs focused specifically on memory and brain function. Over the last 30 years, Dr. Howard Chertkow, the chair in cognitive neurology and innovation and a senior scientist at the Rotman Research Institute, has diagnosed and treated patients with early stage Alzheimer’s disease and other forms of dementia, and led the team that created the internationally adopted screening tool for cognitive loss known as the Montreal Cognitive Assessment.

More than half a million Canadians are living with dementia and that number is expected to nearly double in the next 15 years, according to the Alzheimer’s Society of Canada. What can adults do to decrease their chances of developing Alzheimer’s disease?

The most proven effective ways to protect one from developing dementia are things that you do to prevent strokes and heart attacks. The short list is to avoid smoking, treat diabetes, treat high blood pressure, avoid obesity, treat high cholesterol and get 150 minutes of moderate exercise a week. In addition, there is good evidence that you should keep physically active, mentally and intellectually active, socially active and spiritually connected.

What are the earliest signs of Alzheimer’s disease and dementia?

In most cases, it is memory loss, which comes first. The earliest signs are subtle and mild and often simply ignored by people. The difficulty is that very mild memory loss can come with normal aging, and that means that for a while, the memory problems might just be a sign of normal aging and nothing to do with dementia. So I tell my patients that it’s normal to forget the name of someone you haven’t seen since last year’s Yom Kippur service. It’s not normal to forget the names of your grandchildren.

What are the risk factors and protective factors for dementia and Alzheimer’s disease?

The strongest risk factor is aging. Other risk factors are vascular, so if you have high blood pressure, diabetes, obesity, if you smoke, have high cholesterol, all of these risk factors for heart disease are risk factors for dementia.

The other risk factor is a positive family history: if dementia runs in your family, your risk of getting dementia doubles – from the regular eight per cent of the older population, which is the overall risk of dementia, up to 16 per cent. So even if you have a family member who’s affected, there is still a good chance that you will not develop dementia.

We know that people who are fit and exercise a lot are protected. People who have good dental hygiene and floss their teeth are protected. We know that people with higher education, higher incomes and challenging occupations are protected. We know that people without a family history and with certain genetic patterns, for example having the APO E3 gene rather than the APO E4 gene, are protected. We know that people who eat certain diets, such as a Mediterranean diet with very little sugar and little red meat and a lot of olive oil and fish and vegetables, these people are protected. And we know that people who have been on anti-inflammatory pills for arthritis or people who suffer from arthritis are protected. But all of these protective factors are relative, so even though education is protective, we still see university presidents who develop dementia.

How do you determine when your memory loss is normal and when it’s dementia?

If there are concerns, it is best to see your doctor. Because memory loss can be caused by sleeping pills, low B12, low thyroid, depression, high blood pressure or diabetes, or other brain processes such as silent strokes, brain tumours or a blockage in the brain, a full evaluation is warranted. Often, a brain scan such as a CT or MRI is arranged.


Can you identify the changing landscape in aging and brain health innovation?

There is a wide range of innovations, from special apps on iPhones, to smart houses, to machines that sit on your desk and remind you to take your pills. Likewise, the idea of driverless cars may lead to the ability for people with dementia to stay mobile longer than they can now. None of these technological innovations will actually change the disease, but it will increase our ability to improve people’s quality of life and help them cope with memory loss.

Explain how dental care is a factor in dementia prevention.

There is evidence that people who floss a few times a day and take good care of their teeth have less dementia than people who don’t floss and don’t brush so much and aren’t taking good care of their teeth. Why is that so? You have bacteria in your mouth. Recently, there is evidence that in some people with dementia, either the bacteria are getting into the brain or toxins are being released that get into the brain. There is clearly some sort of connection we haven’t quite figured out, maybe through inflammation or systemic inflammation.

What is the Canadian government doing to help the situation?

Last year, there was a bill passed in Parliament, Bill C-233, to establish a Canadian dementia strategy. The question is whether there will be any money attached to help find a cure. Alzheimer’s disease and dementia cost Canada $50 million a day and yet we spend far less than this every year on research for a cure. It’s really important for Canadians who are concerned about Alzheimer’s and dementia ask their candidates: “What are you doing to support finding a cure for Alzheimer’s disease in Canada?”


This interview has been edited and condensed for style and clarity.