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Do you worry that you or someone you care about may have dementia? In this episode host Ian Gillespie talks with geriatrician Dr. Michael Borrie the Medical Director for the Aging Brain and Memory Clinic at St. Joseph’s Parkwood Institute about the signs and symptoms of dementia to watch for.
Welcome to the DocTalks Podcast, a conversation on what’s new and relevant in the world of Canadian medicine and hospital health care. Join us for each episode, as we interview physicians, patients and caregivers to dive deep into what it’s like to treat and live with some of today’s most common health challenges. Hosted by Ian Gillespie.
Note: The content of St. Joseph's DocTalks Podcasts is for informational purposes only. The material is not intended for and should not be used as a substitute for direct medical advice from a licensed health care practitioner.
DocTalks - Dementia
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[00:00:00] Ian Gillespie: Welcome to The DocTalks Podcast, a conversation on what's new and relevant in the world of Canadian medicine and hospital healthcare. I'm your host, Ian Gillespie, and I'm here to ask the questions and find the answers you need to know. We wanna help our listeners know how to prevent and detect illness and how to navigate our healthcare system.
Be sure to subscribe to the doc talks podcast is stay up to date on new episodes and follow us on Twitter @stjosephslondon or visit. sjhc.london.On.ca/podcast.
I'm Ian Gillespie and welcome to The DocTalks Podcast brought to you by St. Joseph's Healthcare London. Today's episode, we're talking about dementia and the signs you need to watch for in yourself and others. We're gonna be discussing a lot of aspects and facets of the disease. And to help me today, shed some expert light on this topic is Dr. Michael Borrie, the medical director for the Aging Brain and Memory Clinic at St. Joseph's Parkway Institute and professor in the Division of Geriatric Medicine at Western University. Dr. Borrie is a world renowned physician and scientist who spent much of his 30 year medical career treating and studying dementia with a focus on mild cognitive impairment and Alzheimer's disease.
Dr. Borrie, thank you for joining us. Welcome.
[00:01:40] Dr. Michael Borrie: Thank you very much, Ian.
[00:01:42] Ian Gillespie: Let me start. I'll just throw out a few little facts that we have that have been provided by the, uh, Alzheimer's society of Canada. More than 500,000 Canadians live with dementia. That number's expected to rise to more than 900,000 by 2030. 70 6,000 Canadians are diagnosed with dementia every year.
One in five Canadians, have experience caring for someone living with dementia. But I, I wanna start with just, um, kind of, I think a, a basic question or concern that I think that a lot of people might have, and that'll get us into discussion. And that is this, I mean, I'm 64, my father struggled with Alzheimer's disease before he died.
I sometimes forget names. I sometimes forget where I put things. Uh, I have trouble recalling sometimes a particular fact or a name of a movie or sports team or something like that. Should I be worried about dementia?
[00:02:39] Dr. Michael Borrie: I think, uh, what you've highlighted is one risk factor that you have identified, which is a family history.
You have a first degree relative who had dementia. Now, one would want to qualify that and understand better, at what age did your father develop symptoms? If it developed in his eighties or nineties, that would be different from someone developing symptoms in their fifties, sixties, or seventies. So that would be something I would want to clarify with a person.
I would want to look at other risk factors that a person would have, and, and there are many risk factors, but they actually are additive. So if a person had a history of concussions as a younger person through sports, or if they had what we call vascular risk factors, so high blood pressure, diabetes, elevated cholesterol, smoking, atrial fibrillation.
These are risk factors which contribute to the risk of stroke, which can be another contributing factor to the potential to develop dementia. So that would be looking at, at sort of broad range of risk factors. You raised the observation that you had, that sometimes you forget names and it was particularly for sports teams or a movie or where you might have been, and also forgetting where you may have put things. These are common that young people, middle aged people, older people experience.
[00:04:08] Ian Gillespie: So forgetting people's names after meeting them. That's that's just normal?
[00:04:12] Dr. Michael Borrie: Names is probably one of the most difficult thing for us to remember. And we can all relate to the occasion where we go to visit people that we aren't particularly familiar with.
They may be associates or friends, or we may be at a gathering and they go around the group and introduce people. Often, it's just by first names, it's not even second names. If we actually had to try and remember people's second names, as well as their first names, that would be challenging. So names are something that
is any cognitively normal person has and different people have different ways of remembering names and that, so right there, if you're starting forgetting names or, or you forget someone's name, and then you say, well, am I starting to develop Alzheimer's disease? One needs to put it in the, the context, that names are difficult to remember. What becomes important is that if you're actually forgetting names of people that you actually know quite well, and if it is trying to find the names of something that you know particularly well remembering a movie or a sports team is something that happened in the past.
So you are linking this, not only the name, but the past event, but if you are looking at an object in front of you and you can't remember the name of it, Please pass me the salt and pepper, that takes it to another whole level, cuz this is now suggesting that a person may be having trouble with language and that's different from what you were describing.
[00:05:36] Ian Gillespie: Interesting. So in my situation, I may not need to worry as much as I thought, just based on my . Family history?
[00:05:43] Dr. Michael Borrie: So based on the information you provided me, we don't know the history around your, your father's progression of symptoms or anything like that. But a family history is important in the same way that a person would pay attention to a family history of cancer or stroke or heart disease, uh, or diabetes.
It would carry that same sort of increased risk.
[00:06:08] Ian Gillespie: Okay. And obviously there are various levels and degrees of memory loss. And I wondered if you could talk a little bit about that. I think you had said earlier before we started that one of the first ones. Uh, you refer to as age associated memory loss, is that correct?
Can you talk about that one?
[00:06:26] Dr. Michael Borrie: Age associated loss is a loss that occurs as one ages and this begins in the forties. So if you look at observational studies of people in cohorts, five year cohorts, and administer neuropsychological tests to them, as you go through each of those age cohorts, there is a decline that is measurable, using that technique. And one of the studies that did with was, was the white all studies. So this showed that if you go up in five year increments, there is a decline related to age. As one gets older, one's performance on those tests decline. It's not something that a person is complaining about. It's not something that is observed.
So we call it age consistent loss. So the next level, which has been defined in 2014 is called subjective cognitive decline. So a person has the subjective complaint that I am misplacing things more often than I used to. I am forgetting events. I'm forgetting discussions more often than I used to. I may repeat myself a little more often than I used to.
So those are observations that that person may be aware of. Only they often will be aware of it. The people around them, or partner, other family members may not be aware of that. And if you test that person on a common testing tool that we use in the clinical in family practice with primary care providers, the Montreal Cognitive Assessment, shortened to the mocha, that a person will perform within the normal range, 26 or better on that test. The next category is mild cognitive impairment. So these people again have the complaint of memory loss, and there'll be other examples, and these often will be observations made by other family members.
And it may be at a point now where the family members and people around them are more aware of it than the person themselves. In fact, the person themselves may be much less aware. They say I have had problems with my memory for six months, and the family says, well, actually, you know, it's been two or three years.
So, in these people, when you test them on the mocha, they will score below the normal range. They will have evidence of impairment on a test. However, the instrumental activities of daily living that they do, driving grocery, shopping, banking, yard work, housework, finances, managing those things that are learned behaviors. Those things are essentially intact. They're not impaired in any discernible way. Dementia, which would be the next category, not only do they have impairment on that tester on the mocha, that you'll find some impairment there, and that may relate to impairments in memory, impairments in language,
there may even be behaviors, uh, and during mild com impairment, there may be certain mild behaviors that are observed as, as well at that point. But with dementia, one or more of the instrumental activities of daily living are significantly impaired. Now the person themselves may not again have the awareness of that or insight that they are impaired, but certainly the family member saying this person used to be really good cook,
and now the meals don't taste the same, ingredients are being left out, they can't coordinate. A more complicated meal, the meals have become more simple in their construction and design of, of the meals.
[00:10:06] Ian Gillespie: Dr. Borrie, you mentioned the MOCHA test. Can you give us an idea of what are, what does that cover? What are the sort of, um, areas that you investigate there?
[00:10:15] Dr. Michael Borrie: The Montreal Cognitive Assessment was based on a number of neuropsychological domains that wanted to be examined. And it wanted to be a screening test that could be administered in about 20 minutes. And it achieves that. And the domains that looks like as is the area of memory. So registration of words.
So you're given five words, which a person has to repeat a second time to make sure that they've actually heard the words and that's helpful for actually knowing when they do that. It also looks at language. So do they actually, are they able to say those words back correctly? So it does evaluate language at that time.
And then. At the end of the test, those five words, uh, explored further and the examiner will say, can you tell me what the five words were and a person with memory problems, won't be able to remember those five words. They won't be able to remember any of them. They're completely gone. There is a visual spatial executive domain.
So we asked them to draw a clock. So could you draw a clock face? You anticipate they're gonna draw a round clock. They don't always do that, but usually it's a round clock. They place the numbers inside the clock. So you ask them to put the numbers on the clock and put the time at 10 past 11. So you want them to put the short hand to the 11 and the long hand
to the two indicating 10 past. Often a person who's thinking more concretely will put the hands to the 10 and the 11. And that's clearly, uh, an impairment uh, in, in cognition, we will ask them to copy a chair or a cube. So this is exploring the area visual S spatial domain. And then there's a test, another test of executive function called the, the Modified Trail B or the Mini Trail B where you draw a line from a number to a letter to the next number, to the next letter in an ascending order. So it goes from one a to two, B to three C and that way for about five letters and numbers. And that's a, a brief test of executive function. That's important for things like driving and later, if a person's having difficulty with that and our driving, we will do a full trails B, which goes out to 13 numbers and letters and in particular pattern. We will ask other other items on the test. We'll look at attention. So we will, we'll give them a series of 25 letters and ask them to tap on the table every time they hear the letter A and this is, and there'll be eight different points where the letter a may be alone or together, or even three all at once, but they have to tap at their appropriate time.
[00:12:59] Ian Gillespie: And how do the mocha results help you with the diagnosis and treatment of patients with dementia?
[00:13:05] Dr. Michael Borrie: It would be the pattern in change on those different elements over time. The memory tests obviously are affected first, but if a person is presenting with a language disorder, which may be due to say Fronto, temporal dementia, they.
Have the elements on language in particular are impaired. Uh, whereas someone presenting with Louy body dementia may have visual spacial executive impairment. A person with vascular cognitive impairment may also have impairments on those executive function and visual spatial impairment may be impaired as well.
So it, it does help to some degree, differentiate between the different types of cognitive impairment measures at that point in time, a person's performance, but more importantly, over time, it allows you to see other changes and you can also see, are there improvements. So does a person improve in response to applying non-drug approaches, do the medications that you start, those colonaries inhibitors,
and, and when I do, they, um, uh, respond, uh, to those.
[00:14:11] Ian Gillespie: Well, that's excellent. This might sound silly, but I, I keep thinking about the clock test and I wonder if that might start losing its effectiveness because I've honestly encountered young people who constantly read the time from a digital
instrument and, and often are unfamiliar with an old analog hands on the clock.
[00:14:29] Dr. Michael Borrie: That that is true. But at this point for the dementia, we're not testing young people. So it it's, it's, it's less of a that's that's, but that may be something for another generation to deal with. Right. But I think there's still gonna be clocks in the town square and that sort of thing that are going to be, but you're absolutely right.
That there are digital clocks everywhere and, and the notion of clock is, is certainly over time may change and we may go to different things, but it's interesting to see how the, the performance on a clock test change.
[00:14:59] Ian Gillespie: You mentioned that there is a spectrum of dementia. How does a patient's location on that spectrum affect their diagnosis or treatment?
[00:15:08] Dr. Michael Borrie: It is important to be clear on that spectrum of cognitive decline. And earlier we said for this particular talk on the website, we would actually put that diagram with that spectrum of cognitive decline as an illustration. And we use it in the clinic when we're seeing people for the first time and it was subsequent visits saying where on the spectrum of cognitive decline.
It's an interesting exercise actually to ask the family member and the person where do they think they fall on the spectrum of cognitive decline? I'm thinking that they're, early, maybe having early dementia and the family member may be saying, well, maybe it's mild common payment, but the person themselves is thinking, well, I like the sound of age consistent loss.
And, uh, it's not really where, where they are. So sometimes you have to say, well, we will say, this is at least a mild, common impair, but in the back of your mind, having just met them for the first time, you really got that underlying suspicion that maybe it's really more than that. And you need to get more information, possibly from other family members who have got other observations that may be able to clarify that.
[00:16:14] Ian Gillespie: How important are family members or caregivers in the diagnosis of dementia and mild cognitive impairment.
[00:16:20] Dr. Michael Borrie: You, you do need those good observations from the family members. And one thing is about gathering the information from the family members. It needs to be done with them alone because they're not going to say to you in front of their family member, the cooking really has gone off and it's not as good as it used to be. They're not gonna say that in front of their family member or they're a terrible driver that really doesn't go over very well at all.
[00:16:46] Ian Gillespie: So are there, this is, there's probably not a simple answer, but then at what point should family members try to get a loved one seen by a geriatrician or someone other than a family physician?
[00:17:00] Dr. Michael Borrie: Well, I would back that up a bit and say, when should they bring it to the attention of the family physician? So if the family physician is attentive and attuned to that person, I would want them to bring that observation to the family physician when they start to observe those changes in that range, they may not see it in subject of cognitive decline that may in fact, be the insightful person with subjective cognitive decline, may themselves alone go to the family physician and say, I'm concerned. I'm working,
I'm forgetting passwords, I'm forgetting codes at work and I'm concerned. And I like to establish a baseline and do the mocha and the mocha will be done. And it'll be normal. The family who become aware when a person has that early changes, uh, that we see in mild cognitive impairment, where they are seeing the pattern of repeated
misplacement of items that they didn't use to misplace. So common things would be the glasses, keys, other items that they would usually take with them and repeating conversations. So repeating the same story, telling the same story or asking the same questions about arrangements or appointments that are upcoming, which have been conveyed to them.
And they say, now, can you tell me again when that appointment is, if they're repeating or repeatedly going to the calendar or using common one as sticky notes to reminders, and they're suddenly their, their office space is suddenly covered with sticky notes to remind them of, of, uh, now some people like myself,
always have used sticky notes. So I think that we, we have to see what the previous pattern, but it's the change in pattern is what you're looking at is, is, is that change. So they would go to the family physician or the primary care provider and they would do some sort of initial assessment. If you're seeing progression,
then I think that we'll be going back to the primary care provider and in our training of young family doctors, we're teaching them how to do all of these tools and to be insightful about this. So hopefully they will have the time and willingness to do those tests. And then if there's continued progression, then I think they may ask the primary care provider or that provider will take the initiative to make the referral to a specialist.
If they don't feel comfortable, making a diagnosis of mild impairment may be suspicious of that. But if they already have two or three mochas that have been done. That's very, very helpful for us, cuz what we are looking for is not a diagnosis based on a single mocha, cuz you can't make a diagnosis with a single mocha test, but it's the pattern of change.
[00:19:42] Ian Gillespie: And then once the diagnosis is made, once someone has been found to be on the spectrum, what options for treatment now exist?
[00:19:51] Dr. Michael Borrie: Well, it depends where on that spectrum of cognitive decline, they, they are. And when we talk about treatments, I, I would describe it as, uh, uh, maybe a broader term using management, because you are, you are not just looking, at because when we think of treatments, we're thinking of medications, for instance, but I think there's a lot of things that can be done.
We know there's a lot of things that can be done before that. And this is, uh, if you think of that spectrum of cognitive decline as a trajectory, and although, we describe it as, as a spectrum of decline. It is not a straight line trajectory as it progresses, it tends to accelerate. So some of the things that we want to do is to look at the non-drug approaches that might actually alter that trajectory.
So if you think of a trajectory and you want to make it a shallower trajectory, a longer slope of decline, then there are non-drug approaches that we would want to start with first. There are no drugs at this point that we could be introducing early on through subjective cognitive decline, mild cognitive impairment.
And there are six non-drug approaches we look at, particularly. Those would be encouraging people to engage with regular activity, a common one that people will agree to is walking. It's what most people do, but it has to be fairly brisk walking. It's effortful, intent, walking with intent. Uh, it could be swimming.
It could be activities at home, uh, who could be walking indoors during the winter, the various venues where you can actually walk indoors safely without the risk of falls. Then attention to diet. So there are various diets that are advocated, uh, Mediterranean diet is one that people commonly talk about.
And there's quite a body of evidence suggesting that people who follow a Mediterranean style diet are less likely to progress to dementia. And, uh, this is something that you want to initiate early. Uh, a person's got severe dementia, this is too late. It needs to be done earlier on if it's gonna make any difference to alter that trajectory.
So a Mediterranean style diet, which is, the components of that would be fish and nuts and leafy greens, high colored fruits, uh, vegetables, uh, whole grains, uh, small amounts of dairy, maybe pulses and legumes and, uh, some chicken or Turkey, but avoiding, uh, saturated meats like pork and, and beef.
Occasionally having those as, as a treat, if one has a wish for that. The socialization and, uh, mental stimulation. And this is something that the pandemic has highlighted for us. Uh, the impact has been huge on people who are cognitively intact, but even more evident to people who had any form of cognitive impairment being socially isolated and not getting the mental stimulation.
And we certainly saw the decline in people who had previously been attending the day programs that the Alzheimer's society and, uh, in London are the McCormick Home, but in other cities, there'll be other agencies VO N offering day programs. But these do programs where people can get really three things. One is mental stimulation, socialization, restorative sleep.
People with mild cognitive impairment, early Alzheimer's disease can get those things. Those things are very important. And the day program also gives the caregiver some respite. So that's an additional benefit of, of those things. The fifth, uh, would be restorative sleep. And the last thing we talk about is avoiding medications or alcohol or other compounds, which might affect cognition.
[00:23:29] Ian Gillespie: You touched on diet and exercise. Are there any other prevention techniques that work. I mean, we often hear, oh, do word games, you know, crosswords, uh, mental activities, things like that, playing an instrument. Do any of those, uh, strategies help delay or prevent dementia?
[00:23:49] Dr. Michael Borrie: When we, we have to be cautious about talking about preventing dementia.
Cause uh, we know that the likelihood of cognitive I impairment is associated with getting older. It's not caused by age, but if a person plans on getting old, they need to protect their brain for as long as they possibly can. And I think what you're trying to do is reduce the risk is, would be how we would characterize this re re reduce the risk of cognitive payment and
alter that trajectory of decline that one might see. So we certainly encourage mental stimulation and from different types of mental stimulation. So some people say, well, I do the crossword every day and I do suduko and these are good things to be doing. They're mentally stimulating, engaging, but you, if you want to get new neurons engaged and talking to each other in new and interesting ways, you gotta do new and interesting things.
If you're trying to build on the potential for the neuroplasticity within the brain to actually establish, uh, new connections that is tremendous potential within the brain for nerve cells to be connected to each other. They have up to 2000 connections with another nerve cell, which is incredible to think about.
So if you can build some of those connections and, and potentially build in some of that resilience, our hope is that that would alter that trajectory. I think the mental stimulating activity should be things that people enjoy doing. It shouldn't be frustrating cuz the frustration and pushing yourself to do something you can't do would not be worthwhile.
So if one was to say, take on jigsaw puzzles as a new and interesting activity, because that looks at spatial orientation and color and shapes and sizes and things like that, make sure it's something that you're going to be able to achieve. So one would build up to that in the same way with exercise.
It's something that you, if you've never had a regular pattern of exercise, lets establish a pattern that's doable and sustainable, whatever you're gonna be doing needs to be sustainable and doing with exercise, a plan, which gradually increases it in an incremental way so that it, is got something that, a habit that you're going to be able to continue.
[00:26:05] Ian Gillespie: Early on,
i, we mentioned that stat that I think it was one in five Canadians have had experience caring for a loved one who has some form of dementia. And you're talking about, there's a huge spectrum at play here, but is there some advice, just generally you can give to people who is living with a spouse or a, a relative or a family member that is on that spectrum of dementia?
[00:26:27] Dr. Michael Borrie: Well, I mean, the advice is going to be different depending on where, on that spectrum of cognitive decline, a person is. So if it's really early on, it would be taking the observations of change in cognitive abilities, making observations of change in language and documenting it and saying, this is the frequency with which this is occurring.
So if something's occurring once a month, initially, people will dismiss that and saying, well, maybe it's just because I'm getting older and they dismiss it. And it's important not to do that, but document it. But if it originally was once a month and now they're having some word finding difficulties and now it's occurring weekly or daily or several times a day, that characterizes a progression.
Likewise, the misplacing items or repeating already answered questions, repeating stories within a telephone conversation. This characterizes the change. And so that will give some qualitative and somewhat objective information to a primary care provider or a specialist that things are either progressing or that they are stabilizing or staying much the same.
And so that would be early on. Later on the observations will be different because it's going to be around instrumental activities of daily living to be able to perform those, and once you get into mild, moderate, severe dementia, you're going to see changes in a person's ability to provide self care activities of daily living as well.
Along with that will be the spectrum of safety. So there's 10 areas of safety that we look at that one would want to start to be concerned of. So if a person is driving, having observations around their driving, making a point of going with them in the car to know what is their usual pattern of driving.
Now, some people exemplary drivers. And, uh, unfortunately in London we have, uh, drivers who are not exemplary as well. And sometimes you would actually think they have dementia. We don't actually know cuz we can't test them when they're in front of us or behind us, but this is true in any setting. So people have different patterns of driving and different abilities with driving.
But what you wanted to see is, has their pattern of driving changed and has it become, are they more easily distractable? Are they doing things that they didn't use to do? Are they actually things that would be potentially dangerous. So making those types of observations. Are there other areas, uh, the risk of fire, particularly around a use of cooking, uh, going outside and wandering away with inadequate clothing. Wandering away and getting lost
would be another type of thing. Falls would be a concern. So a persons starting to have problems, gate changes, uh, where they may be at risk of falling. And they're, they're doing risky things. And potential for head injury would be a concern. People we've talked about dementia, but often they have other illnesses as well.
They may be on other medications, but they may have various musculoskeletal conditions, which may in addition to cognitive impairment, make them unsafe when walking and their judgment may become impaired. So instead of using the cane or the walker that they should be using to reduce the risk of falls, they will say, well, I think I can do this without these devices.
And they will be at risk of falling. There is the risk of things like abuse, financial abuse is one that can occur early on and this can occur, uh, at the point when they have subjective cognitive client or even mild common impairment. And so, uh, people signing up, uh, for a new contract to have their furnace or their air conditioner changed or, or some other modification of the house, which can be quite expensive,
and then they find that the company has put a lean on the house, and this is a problem. So these are things where they are unaware, but there's certainly scams either on, uh, the telephone or through the computer can be a concern.
[00:30:42] Ian Gillespie: I know from experience that being a caregiver to someone with dementia can be very, very difficult.
What advice do you have for caregivers out there?
[00:30:49] Dr. Michael Borrie: The caregiving is never evenly distributed between the family members. There may be five children. They may have different capacities or inclination to be involved with the caregiving role. They may be less involved with that person. Their relationship may be estranged possibly, and they may,
even though they've had an estranged relationship, may now be in the position of having to provide caregiving to a family, to a parent, for instance, but it's not evenly distributed. And it's, I important for the person who's the primary caregiver to make, be able to communicate with other family members to at least get some assistance with the caregiving. Cuz it does
have a toll on that person's mental and physical health and contribute to caregiver burnout. Uh, we monitor that using a instrument called the Zarot Caregiver Burden Survey or questionnaire. It's a self report and we follow that over time. And we see if that's increasing that often, maybe a reason that the family member is now willing to receive early on in the illness, a referral
to the Alzheimer's society or referral for a day program, for instance, to get additional support because they recognize that their care of a burden is increasing
[00:32:09] Ian Gillespie: With that, let, can I maybe get you to look into the future a little bit? Are there any sort of new, new research or treatments, uh, on the horizon that make you feel optimistic about dementia?
[00:32:21] Dr. Michael Borrie: Well, the answer to that is yes. And you had earlier spoken about treatments and I talked about non-drug approaches to management. So there are existing treatments for people. So if they on that spectrum of cognitive decline have reached that phase between mild cognitive impairment and dementia, they may be willing to consider a treatment, uh, which can have some response on the symptoms of the underlying cause of dementia.
Uh, we've talked about dementia. We haven't talked about the different causes of dementia. So Alzheimer's is the most common form of dementia, vascular dementia due to small strokes. Louy body dementia is another form of dementia in Fronto temporal dementia. So all of those dementias. May respond to the group of drugs called the colon SRAs inhibitors, Donepezil, Rivastigmine, galantamine other generic names of those medications, but they can be tried.
It's not applicable in Fronto temporal dementia, but the others, uh, will respond, uh, to some degree in a modest way. And so this does give a little bit of encouragement to family members, at least for delaying the progression of the symptoms or moderating those symptoms that a little. Particularly loss of initiative, apathy, uh, may improve a little bit in a modest wave and I liken it to sort of taking people back six months to a year.
And that's where they may find the improvement. They may say, well, they're more like they more like they were six months or a year ago, but then it, they will continue to decline because the underlying disease process is not affected.
[00:34:02] Ian Gillespie: Dr. Borrie, what's the most exciting dementia research right now?
[00:34:05] Dr. Michael Borrie: I think the thing that is exciting and interesting in the field is the development of, or the testing of new treatments, which have the potential to be disease modifying that can actually alter the underlying pathology of the disease.
And most of these treatments that we are looking at are directed at Alzheimer's disease as a particular and most common pathology that we see in people who have progressive dementia. And these are treatments that try to remove amyloid to alter the tar protein abnormality that is occurring in the brain that Alzheimer originally described when he described plaques and tangles.
These plaques and tangles were due to the plaques due to amyloid accumulation within the brain. The tau protein abnormality in the nerve cells. The tau Tanes that we know now, he didn't know that at the time, but there are treatments being directed to that. Most of these treatments are intravenous, uh, treatments, intravenous antibody given once every four weeks, according to a protocol, I think the other area of, so these are new treatments,
there are some oral treatments that are being developed as well.
[00:35:19] Ian Gillespie: What's the role of imaging in dementia research?
[00:35:22] Dr. Michael Borrie: There are new ways to image the brain using pet imaging so we can actually see what Alzheimer originally saw, uh, at autopsy we can now see in life, uh, using. positron emission tomography scans or so-called pet scans.
Now these are not clinically available, a family physician and a specialist can't order these as part of the clinical workup, but they are part of clinical trials. Uh, people can get additional information from these scans. There are new blood tests that are been developed as part of those clinical trials.
Detecting minute quantities of abnormal amyloid and tau protein in the blood to be able to make the diagnosis of, uh, Alzheimer's disease. So that potentially is something in the future that is very promising that we will be able to have a more precise diagnosis. So not just relying it on clinical information and history from the family members and physical examination.
So those are, uh, new developments.
[00:36:25] Ian Gillespie: Well, Dr. Borrie, I wanna sincerely thank you for sharing your time and expertise. You've provided a lot of insight on this topic and, uh, it's been a pleasure, sir. Thank you very much.
[00:36:34] Dr. Michael Borrie: You're most welcome. Thank you for your interest.
[00:36:43] Ian Gillespie: That's it for this episode of The DocTalks Podcast. Thanks for joining us, and join us next time when we'll continue our conversation on what's new and relevant in the world of Canadian medicine and hospital healthcare. Be sure to subscribe and follow us on Facebook and Twitter at @stjosephslondon, or visit sjhc.london.on.ca/podcast.
Until then stay healthy.