Judith and Matthew are among the eight million people in Canada aged 65 and older. In recent months, both noticed subtle changes in how they moved and how well they remembered things - so each went to see their doctor.
What followed looked very different. Judith was referred to a physiotherapist, but her memory problems went largely unnoticed. Matthew was sent to a memory clinic, yet no one asked whether he had fallen recently or was having trouble walking.
Dr. Manuel Montero-Odasso
This type of fragmented care is exactly what Dr. Manuel Montero-Odasso has been working to change for decades. A geriatrician and clinician-scientist at Western and St. Joseph's Health Care London, his research shows that brain health and mobility are deeply connected throughout the aging process.
"As we get older, our mobility and cognition may decline, which can be worsened by mild cognitive impairment and dementia," said Montero-Odasso, inaugural holder of the Wolfe Research Professorship in Aging at Schulich School of Medicine & Dentistry. "But that doesn't have to be our destiny."
To improve the physical and brain health of older adults, Montero-Odasso advocates for a more holistic approach to care - one that addresses the full spectrum of aging challenges, from dementia to decline in mobility, from Alzheimer's to the risk of falls. His CIHR-funded research on these topics has been supported by the Canadian Consortium on Neurodegeneration in Aging (CCNA).
One of his projects led to a national consensus that recommended 10 mobility and cognitive tests to assess a range of functions - from walking speed to the ability to walk and talk at the same time. These recommendations have helped make the diagnosis of physical and cognitive impairments in older adults more consistent and standardized.
Under Montero-Odasso's leadership, the CCNA's Mobility, Exercise and Cognition team has looked at how physical and cognitive training together can improve health in older adults. Findings from two major studies, the SYNERGIC Trial and Synergic at Home Trial, showed that combining aerobic and resistance exercises (such as using bands and weights) with cognitive challenges is particularly effective. The team designed a personalized program that keeps the brain fit, from memory to executive function.
Joshua Titus, BA'16, MSc'22, with a study participant. Students and trainees are an integral part of the research team.
This combined approach not only slows cognitive decline but also improves mobility and brain health. Even more encouraging, the benefits lasted for up to a year. The team also found that not all physical activities are equal when it comes to protecting cognition.
"Walking is great for your cardiovascular health, but not enough to prevent or delay dementia. We need a mix of aerobic and resistance exercises combined with cognitive training," said Montero-Odasso.
Building on these findings, the Mobility, Exercises and Cognition team is developing clinical guidelines to help health professionals prescribe lifestyle-based activities such as physical and cognitive training to treat mild cognitive impairment, a condition that can lead to dementia.
Montero-Odasso's holistic approach to older adult care also focuses on preventing falls, a major issue affecting one-third of seniors worldwide. After identifying significant gaps in clinical practice around the globe, he and experts from 40 countries developed the World Fall Prevention Guidelines.
Endorsed by the Canadian Geriatrics Society and adopted in countries including Australia, Belgium, China, Malaysia and Norway, the guidelines are the first to incorporate the patient perspective and to consider key factors such as cognition, walking speed, balance and fear of falls. These guidelines provide practical tools, such as an algorithm that predicts the risk of falls and recommends targeted interventions.
Montero-Odasso says focusing on both brain and body should be a priority for all Canadians over 65.
"We don't stop moving and develop mobility disability because we age. We age because we stop moving," he said. "But it's never too late to make some lifestyle changes."
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