Responding to COVID-19 Pandemic

A Message From the TDRA Team

June 8, 2020

For the last few months, the world has been facing the new realities brought about by the COVID-19 pandemic, impacting nearly all aspects of life. People with dementia and their caregivers are particularly vulnerable at this time as access to both care and support services may be limited as a result of social distancing measures. We wanted to share some of the work we are doing to support people living with dementia and their families during this difficult time.

TDRA Site Clinicians and Researchers

The Toronto Dementia Research Alliance (TDRA) works together with the University of Toronto and five Toronto memory clinics located at Baycrest, Centre for Addiction and Mental Health (CAMH), Sunnybrook Health Sciences Centre, University Health Network, and St. Michael’s Hospital. Each of these organizations is helping to stop and prevent COVID-19 through care practices, including offering virtual care to patients living with cognitive and memory disorders like Alzheimer’s disease, and through innovative research. Here are some examples of early adoption of initiatives that are being put into place at our partner sites to continue care and research during this global pandemic.

Dr. Morris Freedman at Baycrest, together with Behaviour Supports Ontario (BSO), is leading work with 36 long-term care (LTC) homes across the Toronto Central Local Health Integration Network (LHIN) to provide support for individuals who have responsive behaviours such as agitation and aggression. Dr. Freedman and his team are providing virtual video and phone consultations, and follow-ups on LTC clients to help manage these behaviours and prevent emergency room visits. Consultations often also include family members, who offer insights into their loved one’s behaviours and ways to help.

In addition to this work, Dr. Freedman is seeing patients by video through his memory clinic practice at Baycrest. Using the Ontario Telemedicine Network, Dr. Freedman hosts virtual visits for new referrals and follow-ups for his patients with cognitive disorders, ensuring that their care continues during the COVID-19 pandemic. He is pioneering the use of virtual care tailored to the needs of people with dementia and has provided training to neurologists across Toronto on how to carry out cognitive screening tests by video, so more patients can benefit from this innovation in care.

Dr. Tarek Rajji and his team in the Adult Neurodevelopment and Geriatric Psychiatry Division at CAMH are providing outreach support to 21 LTC homes in mid- and west- Toronto. They provide older adult psychiatry and mental health nursing expertise, both virtually and in-person, to help LTC workers address mental health problems in older adults. They also plan to offer educational sessions, tools and technologies to help staff manage behavioural symptoms of dementia; technical support to assist staff in optimizing virtual care; and virtual coaching and mental health support sessions for frontline staff.

Based on their experience, Dr. Rajji along with Drs. Eric Brown, Sanjeev Kumar, Bruce Pollock and Benoit Mulsant recently published an article on the impacts of COVID-19 for older adults living with dementia, and ways to address these impacts. Their goal for this publication is to raise awareness about the needs and challenges of people living with dementia during the pandemic among researchers and clinicians alike.

In addition, CAMH researchers are planning to launch new research projects aimed at better understanding the impacts of the COVID-19 pandemic on older adults in the community and preventing COVID-19 infection among high-risk older adults.

Based on preliminary evidence that COVID-19 may invade the brain and also can cause stroke, TDRA members on investigative teams from Sunnybrook Research Institute and Rotman Research Institute have received funding from the Sunnybrook Foundation to perform Magnetic Resonance Imaging (MRI) using a protocol sensitive to subtle brain changes and stroke, as well as smell tests and sensitive neurocognitive assessments, to identify the effects of COVID-19 on the brain. Learn more about NeuroCovid19: brain imaging of survivors study.

The Canadian Consortium on Neurodegeneration in Aging (CCNA) led by Dr. Howard Chertkow, with nearly 325 researchers dedicated to finding a cure for dementia, has also been involved in a number of COVID-19-related initiatives. CCNA researchers have participated in several committees created to respond to different issues raised by the pandemic, including the effects on their current research and new research opportunities. In addition to these committees, the CCNA is also part of the COVID-19 and Dementia Task Force, which was convened by the Alzheimer Society of Canada to improve care for people living with dementia and reduce stigma and discrimination.

Although the pandemic has put a hold on in-person clinical assessments, such as MRIs, cognitive tests, and blood and saliva sample collection, some assessments using questionnaires can still be conducted over the phone. In line with safety practices, CCNA researchers are leading many COVID-19- and dementia-related research projects including:

Establishing guidelines for emergency room and intensive care unit communication and monitoring practices, including the use of telehealth (virtual) assessments and tests for patients
Researching ways to address both intensive care practices and ethical issues for people living with dementia who develop COVID-19
Studying the many impacts of COVID-19 on LTC homes, including one study that will compare the results of surveys done both before and after an outbreak
Assessing COVID-19 mortality rates in people living with dementia
Developing community guides for rural settings and Indigenous communities, which will be offered in many languages, as well as toolkits for caregivers/care partners and family members

All together, we are hopeful that these clinical and research-embedded-in-care projects will increase our knowledge about COVID-19 and the ways to prevent and treat it in the near future.

TDRA Coordinating Centre

During this time, TDRA’s Coordinating Centre Core team has continued to work virtually to ensure projects continue without delay wherever possible. The team is focused on:

Providing outreach and education about research to the public
Working with the Lived Experience Advisory Partners (LEAP) council to build trust in research
Increasing connections among Toronto neuroscience researchers
Supporting the management of dementia in primary care (i.e., family doctors)
Helping researchers across the city start their work more quickly
Supporting recruitment and engagement of participants in research

TDRA has also put together a list of resources for healthcare workers and for people living with dementia and their caregivers/care partners.