In 2019, Canada launched its national dementia strategy, joining a list of countries around the world who are rising to the challenge issued in the World Health Organization’s Global action plan on the public health response to dementia (2017–2025). The numbers underscore the need: in Canada alone, more than 500,000 people are living with dementia – and that number is expected to approach one million in the next 10 years – placing enormous burden on the healthcare system, but more importantly, on the people and families who are affected by dementias, such as Alzheimer’s disease, the most common cause and type of dementia.
Donald MacIntosh emotionally recalls his mother’s experience with Alzheimer’s disease: “She was playing bridge with friends one night and couldn’t find her way home – that was how it began.” Donald describes the years that followed as being marked by loss – of memories, independence, and eventually, identity, as his mother’s Alzheimer’s disease progressed. “She couldn’t recognize herself in a picture that was taken two years earlier,” says MacIntosh. “She was a beautiful person who was intelligent and vibrant; it was heartbreaking to watch her go through that.” Fifteen years later, while still in his 60s, MacIntosh was confronted with his own diagnosis of Alzheimer’s disease.
At that time, MacIntosh was a successful attorney who had litigated high-profile cases in Canadian immigration and national security for more than 25 years. His above-average ability to recall facts and information had been instrumental in achieving this success. So when he began forgetting things, he knew something wasn’t right. “I have always believed in being proactive; due diligence has paid off in both my personal life and in law, so I wanted to know what was happening,” says MacIntosh. After scoring poorly on a clinical memory test, he was referred to the Toronto Memory Clinic for further evaluation.
Dr. Sharon Cohen, Neurologist and Director of the Toronto Memory Clinic, says it’s important to differentiate between other causes of memory loss and Alzheimer’s disease. “Alzheimer’s symptoms, predominantly memory issues, come on gradually and progress over time. When we see this, we first want to rule out other possible causes of memory loss, such as head injuries, stroke, B12 deficiency, alcoholism, thyroid deficiency…if those tests and scans are negative, we say, it’s probably Alzheimer’s disease. But to confirm the diagnosis, there is a second tier of testing,” explains Dr. Cohen, referring to tests that look for what science now understands to be the hallmarks of Alzheimer’s disease.
“The earliest change we see is amyloid accumulation and this indicates that brain cells are dying,” explains Dr. Cohen. “We have an enormous number of brain cells and we’re resilient, but when enough of the brain is injured, we begin to see the first signs of cognitive impairment.”
Research shows that it is the build-up of these proteins that is toxic to the brain, a process that can begin up to 20 years before the mild cognitive impairment, or MCI phase of the disease, when symptoms first appear.
“Since we can now identify amyloid accumulation in the brain early, we can intervene and try to forestall the disease’s progression. But many people dismiss or downplay their symptoms, often avoiding seeking medical advice, and in doing so, also missing the opportunity for early intervention strategies that can make a long-term difference.”
Dr. Cohen points to the misconceptions around dementia and aging as key reasons for the delay in diagnosis. “If you’re slowly losing your ability to remember, think and reason, there is a tendency, until things are really bad, to put it down to the aging process. But there’s very little cognitive decline that’s part of normal aging. So when people become more forgetful compared to their baseline, that is a sign that they should get assessed. It’s not a time when an individual, family member or physician should say, ‘Oh well, what do you expect for being in your 80s?’,” says Dr. Cohen.
Of course, there is a stigma associated with Alzheimer’s disease that can also deter people from seeking a diagnosis. “It’s a realistic fear,” says Dr. Cohen. “People wonder if there is any upside to knowing they are in the early stages of a terrible disease that will rob them of their autonomy and quality of life. Even family physicians often don’t feel equipped to do the appropriate tests, or comfortable disclosing a diagnosis of Alzheimer’s disease.” Dr. Cohen is hopeful that this will change. “It’s a serious brain disease that needs to be identified early because that’s when we can do something about it.”
Dr. Cohen is referring to the MCI phase, when memory issues first begin, before the actual onset of dementia. “In this stage, people are still contributing to society they’re still working, shopping and banking, yet they’re uncomfortable because they know something is changing. They’re relying more on their calendars; they are still able to cope, but they’re not quite themselves. That is the time we need people to be able to come forward and get a clear answer,” says Dr. Cohen. In addition to ensuring the disease itself is appropriately managed, Dr. Cohen points out that the diagnosis opens the door to support services that help improve quality of life for both the patient and the family, as well as interventions for coexisting conditions that can impact people with Alzheimer’s disease.
Five years after his diagnosis, MacIntosh is doing well and believes his outlook is partly to credit for where he is today. “You can’t become morose. You have to fight the disease with every ounce of strength,” says MacIntosh. According to Dr. Cohen, the fight should begin as early as possible. “The field is moving in the direction of brain protection and there are lifestyle strategies you can adopt right now, such as staying mentally and physically active, adopting a plant-based/Mediterranean approach to eating and getting enough sleep,” says Dr. Cohen, pointing out that heart health and brain health are connected. “And if you do have symptoms, or you have a family history and carry the APOE4 gene, which is a strong predictor of Alzheimer’s disease risk, see a doctor. Don’t wait for it to advance. Let’s keep healthy people healthy.”
For more information about Alzheimer’s disease visit www.alzheimer.ca
This story was created by Content Works, Healthing.ca’s commercial content division, on behalf of a Canadian research-based pharmaceutical company.