The CSHA objectives were divided into four categories.

1. Core objectives addressed the prevalence, incidence and risk factors for dementia, and the impact of dementia on family caregivers.

2. Secondary objectives covered other health topics (such as disability, frailty or healthy aging) that could readily be addressed in the context of the study.

3. In addition, participating investigators were encouraged to add supplementary “add-on” studies of personal interest to them, and for which they could obtain separate funding.

4. Finally, it was anticipated that the CSHA results would generate “spin-off” studies that could be undertaken by the same team members under separate funding arrangements.

The objectives for the 1991 CSHA-1 study were:

1. To estimate the prevalence of dementia among elderly Canadians;

2. To identify risk factors for Alzheimer’s disease and for vascular dementia;

3. To describe patterns of caring for patients with dementia in Canada and to assess the burden that caring places on the caregivers;

4. To establish a database for subsequent follow-up studies.

At CSHA-1 about a dozen add-on studies were undertaken, while the spin-off studies included the development of further diagnostic criteria for cognitive impairment, which influenced the subsequent development of CSHA-2, the second wave of the study.

CSHA-2 (1996)

The core objectives for CSHA-2 focused on the incidence and risk factors for dementia, but many secondary objectives were included, several building on work undertaken as add-on components of CSHA-1:

Cognition:

1. To estimate the incidence of dementia (all forms combined; Alzheimer’s disease, and vascular dementia);

2. To undertake cohort analyses of risk factors for Alzheimer’s disease and for vascular dementia;

3. To examine patterns of coexisting chronic disease in the demented and non-demented populations;

4. To describe the clinical course of dementia, including predictors of decline, institutional admission and mortality rates by sex, age and region.

5. To trace and classify the early stages of cognitive loss, identifying characteristics that distinguish those who progress to dementia, and describing patterns of normal cognitive aging.

Health, Disability and Frailty:

1. To determine what proportion of the elderly age “successfully”, to describe their characteristics and to identify predictors of successful aging;

2. To estimate the incidence and predictors of dependency in activities of daily living;

3. To review patterns and predictors of frailty; to identify the outcomes of frailty in terms of risk of subsequent illness, cognitive decline, institutional admission and mortality;

4. To examine the predictors of admission to institutional care.

Caregiving:

1. To quantify changes over time in the health of caregivers of people with dementia compared to caregivers of cognitively normal people;

2. To describe changes over time in the patterns of service utilization and support received by caregivers.

CSHA-3 (2001)

CSHA-3 completed our work on the early stages of cognitive decline and was intended to set the groundwork for intervention studies.

Cognition:

1. To estimate the prevalence and risk of progression from various categories of cognitive impairment or loss to dementia, based on the classification developed at CSHA-2;

2. To identify characteristics and / or test scores that prospectively distinguish those who develop dementia. From this, to develop algorithms to identify people at risk of decline;

3. To model the potential population impact of interventions for early cognitive impairment, covering impacts on longevity, costs to the health care system, and burden on caregivers.

Health, Disability and Frailty:

1. To describe the patterns of functional decline, frailty, institutional admission and mortality associated with various categories of cognitive change;

2. To estimate the 5-year outcomes of frailty, as defined at CSHA-2;

3. To provide outcome data on those who were apparently aging successfully at CSHA-1 and 2, and from this to refine our analysis of predictors of successful aging.

Caregiving:

1. To describe the needs for care of people with and without cognitive problems, to examine the care they receive in Canada, and to give a summary indication of the quality of life of their caregivers;

2. To compare patterns of community support service use for people with normal cognition, with early cognitive impairment, and with dementia;

3. To estimate the marginal cost of support and health services utilization for caregivers of persons with cognitive impairment.