BBDC Member Profile

Walter Swardfager, PhD

January 2024
By Krista Lamb

Understanding the connection between type 2 diabetes and dementia may be a critical step in developing better treatments for both conditions. That is why Dr. Walter Swardfager and his team study the brain to find those connections.

Swardfager is an Associate Professor in the Department of Pharmacology & Toxicology at the Temerty Faculty of Medicine, and a Scientist at Sunnybrook Research Institute, at the University of Toronto. He is also Canada Research Chair in the Clinical Pharmacology of Cognitive Neurovascular Disorders. His research focuses on the contributions of metabolic disease to cognitive decline and dementia. His lab uses genomics, neuroimaging, serum biomarkers, and neuropsychological assessments, as well as public health records to better understand why diabetes, microvascular changes, and dementia often develop together, and how they can be slowed down.

“Type 2 diabetes is a major risk factor for dementia and it’s also a major driver of small vessel disease throughout the body. Diabetes became fascinating to me for that reason, and that’s where I’ve focused my career—on how to improve brain function for people with type 2 diabetes to mitigate the risks of dementia and the hazards of worsening diabetes control,” he says.

Being close to people living with diabetes has also shaped his work. Swardfager’s mother lives with type 2 diabetes, as did his grandmother.  He’s seen the way each person must find their own formula to manage their blood sugar and maintain a healthy life that they enjoy. “I saw the drugs not being that great for them. I saw the doctors being concerned about one thing, while my family were concerned about something else. So, I wondered how we can look at this condition in the context of a whole person, including how they think and feel.”

“Whereas I think of type 1 diabetes as a pancreatic problem that can affect the brain, I think of type 2 diabetes as a neuroendocrine problem that often involves the brain even before metabolic symptoms start,” he says.

Since his team started their type 2 diabetes studies at Sunnybrook and the neighbouring Toronto Rehabilitation Institute, their work has focused on the biological, social and psychological determinants of health for people with type 2 diabetes or prediabetes, many of which are dementia risk factors. Swardfager launched the Sunnybrook Type 2 Diabetes Study, an observational, longitudinal study that offers participants cognitive tests mood assessments, brain imaging, physiological assessments, and blood tests, followed by longer-term follow-up by linking their data to public health records. This will allow the team to uncover biological processes related to cognitive function in their cohort, and to identify novel predictors of dementia, complications and comorbidities, and the need for more complex diabetes care in the longer term. The team hopes that their studies will guide trials of new treatments to protect the brain and body from microvascular disease.

“We’re also looking at the pharmacoepidemiology of dementia in type 2 diabetes using provincial public health records. We compare the risk of dementia over time between people in Ontario who were prescribed one diabetes medication verses another,” Swardfager says. “We’ve seen that the SGLT2 inhibitors, for example, were associated with a 20 percent lower risk of dementia over three years. So, it does seem like the newer medications may be protecting the brain in ways the older ones are not. It will be very exciting to see over the coming years how this changing medication landscape affects long-term health outcomes in this population.”

Alongside his research, Swardfager is passionate about supporting the next generation of scientists to enter the field. His lab provides a place for about 20 young scholars to conduct their research. As the first person in his family to pursue a university degree, he knows that having mentors both within and outside of your close connections can be life changing.

Over the last two years, his lab began hosting a webinar for high school students across Ontario who are interested in learning more about working in science. “We’re trying to show young people from all backgrounds what clinical neuroscience research in diabetes really looks like. It might help them say, ‘that’s something I want to do’,” he says. “Showing them my career path, and having a panel discussion with my students, who can talk about how they got here and what they’ve learned – the things that worked and the things that didn’t – I think can be very valuable.”