The loneliest goodbye

Agatha Christie’s fictional detective Hercule Poirot proudly relied on his “little grey cells” to solve puzzling murders. But in a growing number of real-life Canadians, those vital brain cells are compromised by Alzheimer’s disease, a degenerative brain disorder named for the physician who first described it early in the 20th century.

In Alzheimer’s disease, dense plaques containing a protein called beta amyloid block communication between some brain cells. Others become choked with filaments or “tangles” that include an abnormal form of another protein known as tau. As the brain cells die, the brain literally shrinks. Because different areas of the brain can be affected, symptoms may vary among individuals.

A steady decline
The disease is a form of dementia, a collection of symptoms indicating a dysfunctional brain. Dr. Howard Dombrower, a geriatrician and consulting physician of the memory clinic at Toronto’s renowned Baycrest Centre, is an Alzheimer disease specialist. He says the hallmark of the disorder is short-term memory loss, plus declining function in at least one other sphere – language, vual-spatial skills, planning or judgment, insight or concentration. Patients often don’t believe there is a problem. In fact, “Insight, realizing there is something wrong, is one of the first cognitive domains to go,” he says. But friends and family report a steady deterioration in the person’s cognitive abilities that gradually hampers occupational and social involvement, routine activities and eventually basic personal care. It may take one to 15 years to go through the early, middle and late stages.

The Canadian Study of Health and Aging Working Group estimates that Alzheimer’s disease represents 64 per cent of all dementias in Canada. Currently, 290,000 Canadians 65 and older have Alzheimer’s. Unless a cure is found, more than half a million will have the disease by 2031.

Diagnosis is based on clinical examination and the patient’s history. “What we’re looking for is the presence of a dementia syndrome,” Dombrower notes. “We do tests to rule out other causes such as a vitamin or mineral deficiency, or do a CAT scan to make sure there hasn’t been a severe stroke or brain tumour.” Drug interaction, infections and dehydration can also bring on dementia-like symptoms.

Early treatment is vital
“I feel very sad when I see someone in my office at the moderate to late stages,” Dombrower says. Intervention with medication is more effective in the early phase, and patients can participate in decisions about future care, financial matters and assigned power of attorney.

Aging is the biggest risk factor for developing Alzheimer’s disease, he observes. (The five to 10 per cent of known cases in people younger than 60 usually have an inherited form of the disease.) The Alzheimer Society states Alzheimer’s disease is not a normal part of aging even though one in 13 Canadians over 65 (one in three who are 85 or older) has the disease or a related dementia. Other contributing factors may include uncontrolled high blood pressure, high cholesterol, vascular disease (including coronary artery disease) and trauma to the head at a young age.

Maintain your brain
“I always like to tell my patients that they should exercise their minds,” Dombrower says. “If you’re developing short-term memory problems, that’s very important.” Participating in social activities is another way to delay onset or slow down the process of the disease, he adds. Studies in the Journal of the American Medical Association also indicate physical exercise lowers risk of cognitive impairment.

Treatment with certain drugs called cholinesterase inhibitors doesn’t cure the disease but slows and may actually improve or stabilize memory loss. Although deterioration usually resumes after a year on medication, Dombrower asserts patients who continue on the drug decline more slowly. A new and different class of drug, conditionally approved in Canada, may benefit those in moderate to late stages.

Hope lies in research
Although the idea has received a lot of media attention, research has yet to prove the worth of human stem cells in preventing or treating Alzheimer’s disease. Other studies include work on harnessing the immune system to combat the disorder, even though a vaccine that appeared to slow memory loss was withdrawn from testing when some people developed inflammation of the brain. The need for a cure is becoming more urgent as a large segment of the population moves ever closer to the age of Alzheimer’s onset.

More information:
Alzheimer Society: or 1-800-616-8816