Our Work on Frailty and Deficit Accumulation
Geriatric Medicine Research is a small but internationally acclaimed team. We are best known for our work on frailty. That program spans the gamut from frailty measurement to interventions on frailty. This mostly occurs in humans, but through our links with the laboratory of Professor Susan Howlett at Dalhousie University, extends into animal models.
Our work on measurement has led to several tools. We are best known for having discovered the deficit accumulation model of frailty. It says that small, age related problems add up to give rise to frailty. As it turns out, the way that deficits accumulate can tell us a lot about aging and disease, especially the diseases of old age.
Related to the studies of how health deficits accumulate in a frailty index is a body of work on how social deficits combine in a social vulnerability index. This exciting work helps to explain why not everyone with the same degree of frailty has the same risk of poor health outcomes. Social vulnerability increases risk in those most at risk - whereas the absences of social vulnerability diminishes risk, especially in those least at risk.
The two lines of inquiry come together in a third set of inquiries, in a collaborative project with Professor Andrew Rutenberg, called the physics of frailty. That work considers how it is that damage which goes unremoved or unrepaired and which arises from a great number of sources comes together as health and social deficits that act in characteristic ways.
The fact that these problems are so characteristics gives us some understanding of how frailty can be lessened or even prevented. For example, physical activity--and especially exercise--offers one extremely promising route into this. So too does good nutrition.
Our Work on Cognition and Aging
The second major research program is on cognition and aging. The GMR team does work on factors that combine to increase the risk of cognitive impairment and dementia. We have a well-established program in the epidemiology of dementia. Likewise our group does work on many aspects of the treatment of dementia. It turns out to be surprisingly tricky to know whether dementia treatment works and in this we have developed and tested individualized approaches to understanding treatment success.
In collaboration with Dr. Xiaowei Song, Clinical Neuroimaging Senior Scientist with Fraser Health and Adjunct Professor in Computing Science at Simon Fraser University, we have developed a method for understanding how dementia changes brain structure. The many intriguing results that this work reveals includes the characteristic ways in which brain deficits accumulate and impact on cognitive function.
Since 2011, these lines of inquiry have all come together to help us understand the risks for and nature of cognitive impairment that occurs in late life. A current example is our 2019 paper in The Lancet Neurology which shows that frailty is an important risk for Alzheimer’s disease.
Through our collaboration with Professor Sultan Darvesh, who holds the Irene MacDonald Sobey Chair in Curative Approaches to Alzheimer's Disease, we aim to help bring new insights to dementia treatment and diagnosis.
We also particiapte in the Canadian Consortium on Neurodegneration in Aging, investigating how multi-morbidity modifies the risk of demeniita and patterns of disease expression.