Cognitive Neurosciences Program

Program Lead: Dr. Eric Smith

The Cognitive Neurosciences Clinic provides expert medical consultation for patients with cognitive disorders, educates undergraduate and postgraduate learners, and conducts research on the causes, medical evaluation and treatment of cognitive disorders and dementia. 

Our multidisciplinary physician workforce is a unique aspect of our program, allowing us to provide comprehensive evaluations for complex neurological and psychiatric disorders as well as overlap syndromes. There are six neurologists (Philip Barber, Bijoy Menon, David Patry, Dawn Pearson and Eric Smith) and four psychiatrists (Robert Granger, Zahinoor Ismail, Aaron Mackie and Brienne McLane) who see patients at the two clinic sites at Foothills Medical Centre and the South Health Campus. 

Commonly diagnosed syndromes and disease include mild cognitive impairment, Alzheimer’s disease, vascular cognitive impairment, frontotemporal dementia, primary progressive aphasia, and Lewy body disease. When appropriate, we obtain detailed neuropsychological assessments, brain imaging including MRI or FDG-PET, and cerebrospinal fluid analysis.

Our clinical care is integrated with an internationally recognized research program focusing on vascular contributions to cognitive decline and dementia, and neurobehavioural complications of the early stages of neurodegeneration. Three clinic members have major investigator-initiated research programs in cognitive disorders (Eric Smith, Zahinoor Ismail, and Philip Barber), supported by external funding from the Canadian Institutes of Health Research, Brain Canada, and other agencies. We collaborate internally with researchers from the Departments of Clinical Neurosciences, Radiology, and Community Health Sciences. Externally, we have multiple collaborations with researchers at most of the major Canadian universities as well as international centers (e.g. Edinburgh, Munich, Boston).

Our research team is located at the Healthy Brain Aging Laboratories at the University of Calgary. Currently, the team includes a project manager, MRI physicist, two research nurses, three research assistants, one post-doctoral fellow, one PhD student, and four master’s students.

Dementia research at the University of Calgary is coordinated by the Dementia and Cognitive Disorders NeuroTeam of the Hotchkiss Brain Institute. The NeuroTeam is co-led by Dr. Eric Smith along with Dr. Lorraine Venturato from the Faculty of Nursing. Our program research activities are aligned with the NeuroTeam, with many within-team collaborations. 

Program members play critical roles in the Canadian Consortium on Neurodegeneration and Aging (CCNA). The CCNA is Canada’s national research strategy and is funded by the Canadian Institutes of Health Research. Within the CCNA there are 25 different teams organized into three themes. One of the major projects of the CCNA is a patient cohort study called COMPASS-ND, for which we began recruiting patients in 2017. 

Dr. Smith leads the Vascular Illness Team of the CCNA and directs the core lab for visual review of COMPASS-ND brain MRIs. Dr. Ismail is a member of the Neuropsychiatric Team and Dr. Barber is a member of the Vascular Illness Team. 

Clinical trials are an important component of our research program. Trials are needed because many of the causes of dementia are neurodegenerative diseases without disease-modifying treatments. We maintain an active program in pharmaceutical company-sponsored clinical trials, led by Dr. David Patry. In the last year, patients with Alzheimer’s disease and mild cognitive impairment participated in these trials.

Clinical Care Highlights

We continue to see increasing numbers of referrals, with 533 new referrals in the last year. A similar number of patients are seen in follow up.

In the past year our clinical innovations focused on helping our patients get better access to supportive care in the community and providing additional resources on living well with cognitive impairment and dementia. Nurse Karyn Fischer led an effort to identify community resources. She created a package of information on multiple services including home care, day programs, the Alzheimer Society FirstLink program and others, as well as information on what to expect when living with cognitive impairment or dementia.. We also uncovered significant gaps in information on services, most particularly on driving safety, which can be impaired by cognitive disorders. We created Alberta Health Services-approved pamphlets with information on how to self-evaluate driving safety, how to get assessed for safety, and how to cope when driving is unsafe including how to access alternative means of transportation.

Most patients in the clinic agree to have their clinical information recorded in our Prospective Memory Symptoms (PROMPT) registry, on of the Hotchkiss Brain Institute Brain and Mental Health Research Clinics, led by our research nurse Karyn Fisher. The registry now has data from more than 1,360 patients. We use these data identify patterns in referral diagnosis, quality of care, and risk factors for cognitive outcomes. Focus groups were convened last year to explore patient and care partner attitudes and experiences with the registry. The results were analyzed using mixed qualitative and quantitative methods. The dominant theme that emerged was “If it helps someone, then I want to do it”. These results have been presented at two scientific conferences and are now submitted for publication.

We have implemented the Mild Behavioural Impairment (MBI) Checklist into our clinic assessment battery. This questionnaire, developed and validated by Dr. Ismail, helps us to assess previously under-recognized behavioural symptoms of cognitive disorders even in their early stages. The important of these symptoms to care partners was investigated by Dr. Ismail and colleagues and published in International Psychogeriatrics (2018;2:233-244).

Focus on Education 

Medical students and residents participate in the Cognitive Neuroscience clinic at the Foothills and South Health Campuses as part of ambulatory and elective rotations. We run a practice examination station on cognitive disorders to help prepare our neurology residents for their final year qualifying examination by the Royal College. Dr. Cieslak was invited to lecture on cognitive neurology at the nationwide LAUNCH education program for neurology residents, reflecting our strong national reputation in education.

Education in research is another important aspect. We train graduate students, residents, and fellows in methods for researching cognitive disorders. Drs Smith, Ismail, and Barber combined to supervise a post-doctoral fellow, two PhD students, and six Master’s students in Neurosciences and Community Health Sciences at the University of Calgary. 

Dr. Ismail supervised a psychiatry resident to write a paper on mild behavioural impairment and its association with care partner care burden (International Psychogeriatrics 2018;2:233-244). Dr. Smith supervised a clinical fellow and PhD student to write a paper showing that patients with dementia have worse outcomes following hospitalization for stroke (Canadian Journal of Neurological Sciences 2018:1-5). Dr. Smith supervised a Master’s student to write a paper showing the microinfarcts are highly prevalent in patients with the small vessel disease cerebral amyloid angiopathy (Stroke 2018).

We educate other practicing clinicians through continuing medical education courses, lectures and presentations, and authoring reviews and book chapters. Dr. Smith authored the section on Vascular Dementia Diagnosis on the UpToDate website, the world’s leading online “textbook” for doctors.

Research Highlights

Dr. Eric Smith holds the Katthy Taylor Chair in Vascular Dementia from the University of Calgary and is funded by a CIHR Foundation Award.

Dr. Ismail was awarded a five year grant to a five-year CIHR project grant for the PARADIGM study (Pre-dementia at-risk states: a longitudinal study of cognition and neuroimaging biomarkers in Mild Behavioural Impairment (MBI).

Dr. Ismail is the site principal investigator of a U.S. National Institute on Aging sponsored clinical trial of escitalopram for treating agitation in Alzheimer’s disease, which began recruitment in 2018. Agitation is a common symptom in Alzheimer’s disease that causes much distress for patients and their care partners, and for which there are no effective treatments.

Dr. Ismail and colleagues discovered that behavioural symptoms are common and increase care partner burden even in patients considered only mildly impaired cognitively (International Psychogeriatrics 2018;2:233-244).

Dr. Smith and colleagues discovered that microinfarcts can be identified frequently on MRI in patients with cerebral amyloid angiopathy (Stroke 2018;49:1899-1905). This finding suggests that new strategies are needed to prevent them.

Dr. Smith and colleagues performed the first Canadian nationwide study on the prevalence of dementia in patients hospitalized with stroke. They found that more than 10 per cent of patients admitted with stroke have a history of dementia, and that they are at higher risk for poor outcomes.

Members

Neurology: Dr. Eric Smith (Director), Dr. Philip Barber, Dr. Alicja Cieslak, Dr. Bijoy Menon, Dr. David Patry, Dr. Dawn Pearson

Psychiatry: Dr. Robert Granger, Dr. Zahinoor Ismail, Dr. Aaron Mackie, Dr. Brienne McLane

Nursing: Karyn Fischer, Heather Jones, Patricia Mueller, Brenda Pomerance, Courtney Leitch

Neuropsychology: Dr. Catherine Burton, Dr. Kim Goddard

 

(Updated Dec. 2018)