When someone experiences a stroke, brain cells are deprived of oxygen and other key nutrients, causing the cells to die and potentially resulting in permanent brain damage, paralysis, long-term disability and even death. The sooner someone gets treatment, the less damage may be done. This is why timely diagnosis and treatment play a critical role in stroke patient outcomes. Time is brain.

Sunnybrook is one of Ontario’s regional stroke centres and home for the North and East Greater Toronto Area Stroke Network. Our dedicated interprofessional stroke team care for patients across the spectrum of stroke recovery, including emergency and inpatient care, rehabilitation and prevention.

We spoke with Dr. Rick Swartz, Neurologist at Sunnybrook and medical director of the North and East Greater Toronto Area Stroke Network, to learn more about stroke and the importance of seeking help as soon as possible.

Recognizing stroke symptoms FAST

The Heart & Stroke Foundation introduced the acronym FAST as a way to remember the key signs of stroke.

• Face: Is the mouth or lower half drooping?
• Arms: Can you raise them both?
• Speech: Is it slurred or jumbled?
• Time to call 9-1-1.

If you or a loved one experience any FAST symptoms, it is important to call 9-1-1 immediately. Don’t try to sleep it off and don’t drive yourself. Calling 9-1-1 is the best way for an ambulance to take you where you need to go for urgent stroke care. The sooner you receive stroke care, the better chance of recovery.

What are the different types of stroke?

There are two types of stroke; ischemic (clot) and hemorrhagic (bleeding). Ischemic stroke is the most common type of stroke and occurs when there is an interference with blood flow to the brain, usually caused by a blood clot or narrowing blood vessels. Hemmorhagic stroke, commonly referred to as a brain bleed, occurs when an artery or vessel ruptures and bleeds into the surrounding brain. A common cause of brain bleeds could be long term high blood pressure or head trauma (traumatic brain injury).

What are some risk factors of stroke?

It is important to know that anyone can experience a stroke, regardless of age, sex or race. However, there are some factors, such as smoking, inactivity, unhealthy weight or diet and alcohol consumption, that can increase your risk of stroke. Many of these risk factors are modifiable, and making small lifestyle changes can help reduce your risk.

Individuals with other health conditions like high blood pressure and cholesterol, diabetes, atrial fibrillation and some forms of cancer are also at a higher risk. These conditions can result in the narrowing of arteries or the formation of clots/blockages, which could interfere with blood flow to the brain.

Your risk of stroke also increases as you age. Women are also at a higher risk, especially those who have experienced menopause or pre-eclampsia.

Stroke and stroke care is different for everyone, and the interprofessional stroke team at Sunnybrook is dedicated to making sure patients with stroke receive the timely and compassionate care they need.

More resources for stroke:

• To learn more about stroke, visit Toronto Stroke Networks.
• Visit our MyCare Stroke Care Pathway to learn more about what stroke care at Sunnybrook looks like.
• Sunnybrook is home to the North and East Greater Toronto Area Stroke Network, learn more about our Regional Secondary Stroke Prevention Clinic.

The post Time is brain: What you need to know about stroke appeared first on Your Health Matters.

This Migraine and Headache Awareness Month, we spoke with Dr. William Kingston, neurologist and director of the Sunnybrook Headache Clinic, to learn more about the symptoms and causes about “the big three” types of headaches and advice on when to seek help.

Tension headaches

A tension headache is the most common type of headache, in that everyone you know, including yourself, has experienced at some point. It is a mild to moderate, non-debilitating headache that usually doesn’t have any other symptoms, like nausea or sensitivity to light, associated with it. Tension headaches are typically a rare reason to go to the doctor.

Tension headaches and migraine are both what we call a primary headache disorder, which means there isn’t an underlying cause that can be seen on a laboratory test or scan.

Migraine

Migraine is the most common reason someone would seek medical attention for a headache. It is also the most common reason you may have a disability associated with a headache. The World Health Organization has recognized migraine as being the second most debilitating condition that exists in terms of years lived with the disability, because migraine can affect people their whole life.

Migraine affects about 12-15 per cent of the population and make up for approximately 10 per cent of primary care and emergency room visits. Despite this, it may take years for someone to receive a migraine diagnosis, with some people actually never receiving one.

Migraines feel different for different people. A migraine could be a headache that lasts up to four hours, and severe enough that it interrupts your daily activities or causes sensitivity, nausea or a loss of appetite. Some people might experience these symptoms every day, others a handful a year. People who suffer from migraine might also develop an aura, which means they might experience visual symptoms like seeing spots. In the hours or days leading up to a migraine, people might experience prodrome, which are symptoms like neck pain, certain food cravings or increased urination.

One of the biggest misconceptions of migraine is that it is a result of a lack of self-care. Migraine is an inherit neurological disease that is influenced, but not caused by of poor self-care. Migraine is a condition that loves routine. Maintaining regular sleep patterns, adequate hydration and exercise has been shown to be really beneficial for people with migraine. It’s not going to be a cure, but it may improve your chances of managing migraine.

Cluster headaches

Cluster headaches are typically shorter, and happen multiple times, or in clusters, every day. These types of headaches occur usually exclusively on one side of the side of the head, behind the eye and around the temple. Cluster headaches are sometimes also referred to as alarm clock headaches, because they may appear at the same time of day or year, so people might be able to predict when a cycle of headaches might start.

Cluster headaches have been described as being the most painful condition known to human beings on a pain scale. This can also have significant implications on mental health, as the unmanageable pain interferes with daily living.

Those suffering from cluster headaches receive a diagnosis in an average of five years. Part of this is because cluster headaches have longer periods of reprieve, so by the time they receive care from a specialist, the headaches are gone until the cycle later repeats itself.

When should I seek help for headaches?

Headaches are an extremely common conditions and many times not a cause for concern, but there are a few “red flags” doctors look out for. If you are someone that has never experienced headaches, especially if you are over the age of 40, and have suddenly developed headaches, reach out to your family doctor or general practitioner.  You should also seek help if you experience brand new headaches that wake you from sleep.

Thunderclap headaches are another “red flag” that doctors warn about. These headaches are sudden, painful headaches that reach peak intensity in under a minute. If your headaches are accompanied by other symptoms like fever, nausea, blurred vision or weakness, then it’s time to seek medical attention.

More patient resources and awareness:

• Migraine Canada
• Migraine Awareness Month – Out of Office campaign

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There are many urban legends surrounding eye health, but are any of them actually true?

As we mark Vision Month this May, we asked Dr. Kenneth Eng, chief of the Department of Ophthalmology and Vision Sciences at Sunnybrook, to answer some “old wives’ tales” and common questions about eye health.

“Eating carrots will improve my eyesight”

While carrots contain beta-carotene, a substance closely related to vitamin A which is essential to the metabolic function of the retina, there is nothing magical in consuming carrots that would result in improved eyesight or a reduced need for glasses.

It’s important for people to try to maintain a healthy diet rich in many nutrients. This can be protective in terms of reducing the risk of certain conditions, like age-related macular degeneration, but it is unlikely that mega-doses are beneficial for otherwise healthy individuals.

“Don’t sit too close to screens”

There is no evidence that sitting very close to screens causes any permanent injury to your eyes. However, prolonged screen time can result in eye strain or discomfort and can result in more dry eye symptoms. In children, there is some evidence that increased screen time may lead to greater myopia, or nearsightedness, and that increasing outdoor activities may be protective.

It is good to keep in mind the 20-20-20 rule: take a 20 second break every 20 minutes to look at something at least 20 feet away.

“Reading in poor lighting will hurt my eyes”

Much like sitting close to a screen, reading in poor light will not result in harm to eyesight but can be a cause for symptoms of eye strain and can exacerbate dry eye symptoms. Especially in older adults needing reading glasses or bifocals, reading in dim light will makes it significantly more difficult to read efficiently given the reduced contrast of print. It’s always sensible to read in well-lit areas and/or adjust the brightness on a screen to optimize reading comfort.

“Wearing glasses make your eyes weaker”

It is important that, if you need corrective prescription glasses, that you wear them regularly. Eyes do not become more dependent when wearing glasses or contact lenses. On the contrary, there is evidence that for children with myopia, maintaining a clear image on the retina with their full prescription reduces the likelihood of as much progression of their nearsightedness. People with hyperopia, or farsightedness, can develop eye strain and headaches without their glasses.

You should always avoid wearing someone else’s glasses as an incorrect prescription can lead to eye strain and discomfort. If you are not comfortable with your glasses (old or new), you should see your eye care professional to ensure that they have the correct prescription.

“Eye exams can only tell me about my vision”

There are many ocular conditions like cataracts, glaucoma, and macular degeneration that are screened and diagnosed by regular eye exams, but many systemic conditions may appear during these exams too!

Even in patients without visual symptoms, common conditions such as diabetes, hypertension, and high cholesterol can be detected. Much more rare conditions such as metabolic and inflammatory diseases and even cancers can occasionally be detected and diagnosed in the course of a routine eye exam.

Eyes are a window not only to the soul but an important way for doctors to screen for other systemic conditions!

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We asked Dr. David Wasserstein, trauma and knee reconstruction specialist in the Schatzker Joint Preservation Initiative for Active Adults and the Holland Bone & Joint Program at Sunnybrook, for some tips on how to protect your joints so you can keep doing the activities you enjoy most.

What impact can high-intensity exercises like running have on your joint health?

From a medical-evidence perspective it is currently unclear whether high-intensity exercise increases the risk of joint breakdown.  In fact, there is evidence on both sides, suggesting there may even be a protective effect in addition to concern for early breakdown. This is typically relevant to load bearing joints like the hips, knees and ankles, and in persons who are performing high levels of impact exercise like running and jumping.

Acute injuries, like sprains, strains and fractures, are more common in sports due to contact or when someone is placed into an awkward or uncontrolled position like landing from a jump.

For high-volume impact activity athletes, we are also concerned for injury around the joint.  Most commonly they experience tendon injuries including overuse and inflammation.  They may even experience stress injury to bone that results in fractures.

What are your top tips for preventing pain and injury while living an active lifestyle?

People run into to trouble when they do too much of one thing.  So, even if you are training for something specific, like running a marathon, don’t forget to vary the exercise and training.  Maintaining strong cardiovascular health that is needed for this type of high-volume exercise can be achieved in several ways in addition to just running, things like cycling, swimming, or rowing, for example. Taking an approach of cardiovascular training that ‘rests’ the usually overloaded parts of the body can be helpful.

Resistance or strength training is critical for bone, joint and tendon health. It should be incorporated into any fitness routine. Sufficient rest and adequate nutrition are also key elements of maintaining optimal health and reducing the risks of injury.

The benefits of an active lifestyle cannot be understated from the perspective of musculoskeletal health but also for every organ system, including mental health. So definitely stay active!

What should people do if they’re experiencing joint pain while exercising or participating in other high-intensity activities?

First is to rest and then consult a physician or therapist. Although we live in a world of ‘access to information,’ that information exists largely unregulated in social media spaces. Those spaces can be a good place for information but they can also be a good place for misinformation. I would exercise caution and rely only on trusted sources!

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Vitreous hemorrhage is a leading cause of severe vision loss worldwide. This condition, commonly caused by diabetic retinopathy, occurs when diseased retinal blood vessels rupture, rapidly filling the eye with blood and rendering someone blind within minutes. The traditional treatment for this condition involves a period of watchful waiting to allow for natural resolution, which can take many months. Patients suffer while waiting, facing limitations in physical activity, reduced work productivity and the fear of impending surgery or permanent blindness. If the hemorrhage does not clear, surgery is the only alternative.

Dr. Gary Yau, ophthalmologist and affiliate scientist in Physical Sciences and the Hurvitz Brain Sciences Program at Sunnybrook, is developing a non-surgical, office-based solution that uses the power of sound to restore vision loss caused by vitreous hemorrhage. The technology applies focused ultrasound waves deep within the eye to fragment the hemorrhage and accelerate its clearance, all without the need for incisions.

Partnering with SRI, Dr. Yau founded Vitreosonic, to accelerate the technology and its potential to transform the current treatment paradigm, having a significant impact on how patients may recover from this blinding condition in the future.

Dr. Yau sits with the Vitreosonic technology, which applies focused ultrasound waves to the eye non-invasively.

How did your training as a physician help you as an inventor?

Medical training is, understandably, centred around learning the craft of clinical care. While it may not explicitly focus on invention or product development, health-care professionals are uniquely positioned to contribute to innovation. We work on the front lines, encountering real-world clinical challenges and observe firsthand where current solutions fall short. Our research background trains us to think critically about evidence and improvement, and as end-users of medical technologies, we bring valuable insight into what works in practice, not just in theory.

What knowledge or skills do you need to become an inventor?

Perhaps the most essential skill I’ve observed in successful inventors is simply the ability to get things done.

Invention is about bringing an idea to life. It requires you to be both a dreamer and a doer.

As an inventor, you’re stepping into new territory, so you’ll inevitably hear phrases such as “this isn’t how things are usually done.” The ability to push forward despite those barriers is a necessity.

I certainly am early in this journey, and still have many walls to navigate, but this pursuit has been one of the highlights of my professional life. True invention doesn’t just advance care—it has the power to redefine it. I would encourage those that have a compelling idea to take this less travelled path, as its impact on patients can be profound.

What advice would you give to someone interested in launching a health-care company to commercialize their discoveries?

Absolutely go for it. Inventing and entrepreneurship aren’t the most common paths for health-care professionals, but they offer an incredible opportunity to make a lasting impact on patients’ lives.

I didn’t initially set out to start a company. It began with identifying a compelling clinical need, one that resonated deeply with me. Over time, it became clear that the only viable path to bring this solution to patients was through commercialization.

In that sense, forming a company wasn’t the goal, rather it was the necessary vehicle to move the solution forward.

Translating an idea into a real-world solution often requires knowledge beyond traditional medical training, such as intellectual property, regulatory strategy, and product development. For clinicians interested in innovation, being involved more upstream in the invention process not only broadens our perspective but also allows us to shape the direction and real-world impact of new solutions from the start.

As a health-care professional, your unique clinical insight is a major advantage that can help propel an idea forward.  Just as important, though, is knowing where your expertise ends and being resourceful in filling those gaps. It’s rare these days, especially in health care, to develop an impactful invention entirely on your own. I’ve been fortunate to collaborate at SRI with Dr. Kullervo Hynynen and an outstanding engineering team, Bohao Ning PhD and Christopher Hu MSc, whose expertise and partnership continue to be essential in moving this technology ever closer to the bedside.

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Expanding the treatment options for uterine fibroids

Uterine fibroids are a common but potentially debilitating gynecological condition.  Approximately 70% of women develop them before the age of 50. They are typically benign tumors that develop inside the wall of the uterus and can cause heavy menstrual bleeding, infertility and severe pain. Traditional treatment options include surgical treatments such as hysterectomy and myomectomy but these often require longer recovery times and can be quite invasive.

Dr. Elizabeth David, an interventional radiologist and affiliate scientist in the Odette Cancer Program, recently led a successful clinical trial, exploring the use of non-invasive MRI-guided focused ultrasound (FUS) for the ablation of uterine fibroids. Following the success of the trial, the device developed by Arrayus Technologies Inc., a Sunnybrook Research Institute spin-off company, received Health Canada Approval.

The Arrayus FUS system uses high-precision acoustic energy to precisely target and treat tissue deep within the body while protecting nearby tissue, without the need for incisions or general anesthesia. This research and technology are paving the way for Canadian health-care providers to offer a safe, non-invasive alternative to traditional surgical options thereby giving women with fibroids more treatment options and hopefully improving their quality of life.

Bridging gaps in stroke research and care

In the fall of 2024, a research team led by Dr. Amy Yu, neurologist and senior scientist in the Hurvitz Brain Sciences Program, was awarded $5M from the Heart & Stroke Foundation, Canadian Institutes of Health Research (CIHR) and Brain Canada Foundation for its work improving stroke care, treatment and recovery for women.

Every year, more than 30,000 women in Canada experience a stroke, and despite this prevalence, gaps in awareness, research, diagnosis, and care threaten women’s heart and brain health.

The pan-Canadian initiative, Stroke in Women: Growing Opportunities to Realize optimal Evaluation, Diagnosis, and outcomes, or StrokeGoRed, is the first formal research network in Canada dedicated to studying stroke in women. The interprofessional group aims to advance knowledge on how and why stroke affects women differently and provide mentorship to the next generation of stroke researchers and clinicians.

Personalized support for young patients with breast cancer

Sunnybrook is home to PYNK, the first program of its kind in Canada, designed to support Sunnybrook patients who are newly diagnosed with breast cancer at age 40 or younger.

Doctors are seeing a rise in breast cancer rates among young women in their 20s, 30s and 40s, and while women under 40 make up a small amount of all breast cancer patients, they have unique physical, psychological and social care needs. Young patients with breast cancer are more likely to experience fertility concerns, social isolation, financial and career-related distress, and difficulties caring for young children, among other hardships as a result from their cancer diagnosis and treatment.

The PYNK program provides patients and their families with a continuum of support from the time of referral through treatment and follow-up. PYNK educates patients about their breast cancer diagnosis and the impact of treatment, empowering them to make informed decisions about their care. PYNK also helps patients navigate a complex medical system involving multiple specialists, such as plastic surgeons and oncofertility experts.

PYNK offers professional and peer psychosocial support, as well as resources on nutrition, exercise, and hair preservation options like cold capping and wigs. Patients also have access to specialized support for their children, including age-appropriate books about a parent’s cancer experience, childcare resources, and a child life specialist who can provide in-home therapy sessions.

The PYNK program bridges gaps that young women may face during their cancer journey, and can help those recovering get back to a “new normal” life, including returning to work or dealing with long-term effects of treatment.

Championing endometriosis diagnosis and care

Endometriosis, affecting approximately 10 percent of patients with a uterus, occurs when tissue similar to the lining of the uterus grows outside of the uterus, which often results in pain or infertility. On average, patients wait 9-10 years to be diagnosed with the condition, delaying appropriate care and impacting their quality of life.

Dr. Jamie Kroft, an obstetrician gynaecologist in the DAN Women & Babies Program specializes in minimally invasive surgery, and cares for patients who have lived with endometriosis for years without a proper diagnosis, which can end up impacting other major organs, like the kidneys, GI tract or lungs.

Dr. Kroft is working closely with other specialists in the GTA to form a central intake clinic for patients with endometriosis. Her advocacy is helping women in the GTA gain access to first consult sooner, advancing earlier diagnosis, treatment and pain management of their endometriosis and ultimately improving quality of life.

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This year we asked women in science at Sunnybrook what advice they would give to their younger self or girls aspiring to pursue a career in STEM.

Dr. Sophie-Marie Aicher

Dr. Aicher is a postdoctoral fellow in the Mubareka Lab at Sunnybrook Research Institute.

“Never stop being curious and celebrate even the tiniest wins along the way!”

Claudia Wong, RN

Claudia is a professional leader of nursing and manger at Sunnybrook.

“A career in science requires plenty of creativity. As a young person I was worried pursuing a career as a nurse would mean that I lose touch with the side of me that loves humanities, the arts and being creative. My career has proved me wrong – so much of nursing and other STEM careers require us to think creatively!”

Dr. Amy Yu

Dr. Amy Yu is a neurologist and senior scientist in the Hurvitz Brain Sciences Program at Sunnybrook.

“Go for it!! Be curious. Ask questions. Challenge yourself and others. Forge your own path.”

Dr. Yu is proud of her daughters (pictured above on the left), who are discovering their own paths.

Kristen Cimolai

Kristen is a research technician at Sunnybrook Research Institute.

“Don’t be afraid to make mistakes, because making mistakes is how you learn! Especially when you surround yourself with people who are willing to support you and assist you in your journey. I have learned the most after asking for help and being vulnerable around people who are eager to teach.”

Vicky Boateng, RN

Vicky is a project manager, critical care and nursing certificate programs at Sunnybrook.

“Be curious and try new things. You will never know what you like and don’t like until you have given it a try.”

Dr. Shannon Dunn

Dr. Dunn is a scientist in the Biological Sciences and Hurvitz Brain Sciences Research Program at Sunnybrook Research Institute.

“Sometimes it just takes one mentor to push you in the right direction. My ski coach knew I was interested in science, encouraged me to apply for a summer studentship and introduced me to a professor doing research in exercise science. This led to more summer placements, a Master’s, PhD and the rest is history!”

“To bridge the gaps you might face throughout your academic or professional career, you need to have a supervisor or academic mentor who can inspire you to reach the next level and to help facilitate a project that ‘has legs’ and can result in great outcomes.”

Dr. Marina Wasilewski

Dr. Wasilewski is a scientist in the Evaluative Clinical Sciences and St. John’s Rehab Research Program at Sunnybrook Research Institute.

“Being curious and tenacious will get you far. People may try to convince you that you ‘talk too much’ or ‘ask too many questions,” but keep talking and questioning! Relentlessly seek out educational opportunities and activities that celebrate and expand these qualities—they are your superpower in STEM!”

Kirishanthy Kathirkamathamby

Kris is a research safety & compliance manager and biological safety officer at Sunnybrook Research Institute.

“Follow your curiosity and let it guide you in a way that feels natural to you. Your journey is uniquely yours, and success has no single definition– define it for yourself. Embrace your strengths, use them to fuel your passion, and know that your contributions matter. Keep pushing boundaries your own way, and you will shape the future of the scientific world.”

Dr. Diane Nam

Dr. Nam is an orthopaedic surgeon and associate scientist in the Holland Bone and Joint Program at Sunnybrook.

“When I was young, people told me to choose a career in something I was good at. I wasn’t sure I’d be good in science and I chose something else. I finally caved and did a science degree and I haven’t looked back. Science is a wonderous thing. The knowledge you gain from studying science opens your mind to what is possible beyond what you can imagine. If I could go back to my younger self, I’d say just go for it!”

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The human brain is an extraordinarily complex organ responsible for our thoughts, memory, breathing and so much more. Its intricate networks, made up of billions of neurons working together, make our actions possible. Neurodegenerative diseases like Alzheimer’s and Parkinson’s disease can impact the patterns of these cells’ activity, and being able to map these networks and the cellular activity within them can inform potential treatments for these conditions.

Scientists have recently developed powerful microscopy systems and molecular techniques that create three-dimensional images of cells to study brain function and activity in detail. However, these images are exceptionally large and complex (with trillions of pixels), making it very difficult to detect changes in network activity patterns.

To address current gaps, a group of researchers in the Hurvitz Brain Sciences Research Program, in collaboration with teams in the United States and Europe, developed the AI-based Cartography of Ensembles (ACE) pipeline, a software that identifies patterns of brain cell activity in large volumes of brain data. A study describing the ACE pipeline architecture and its application in complex neuroscience problems was recently published in Nature Methods. ACE was designed using cutting-edge deep learning algorithms and trained on more than 30,000 3D images curated from microscopy images.

“ACE is capable of analyzing a wide variety of microscopy images, meaning researchers can use the pipeline to gain new insights into how specific populations of cells in different regions of the brain respond to disease,” says Ahmadreza Attarpour, the first author of the study and PhD candidate at SRI and the University of Toronto. “ACE goes beyond traditional methods relying on brain maps that divide the brain into pre-defined regions based on their coarse structural differences.”

Our novel pipeline acts as a detective, pointing out cell activity and patterns that would be otherwise difficult for even highly trained professionals to identify.”

The tool has the potential to accelerate discoveries in neuroscience because of its ability to help researchers accurately identify patterns of activity in specific cell groups and networks within every region of the brain. Researchers can monitor these patterns to better understand how neurological diseases affect brain activity and how treatments may normalize these activity patterns.

“Using ACE, scientists can evaluate the effects of experimental drugs on a particular population of cells across the brain or identify novel targets for neuromodulation therapies,” adds Dr. Maged Goubran, scientist in the Hurvitz Brain Sciences Research Program and Physical Sciences Platform and co-senior investigator of the study.

“ACE provides a powerful tool for mapping brain function and circuitry, paving the way for breakthroughs in neuroscience research and, ultimately, improved patient outcomes,” explained Dr. Bojana Stefanovic, senior scientist and director of the Physical Sciences Platform at SRI and co-senior investigator of the study.

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With no cure for the disease, scientists around the world are conducting research that is leading to breakthroughs in the diagnosis, progression and prevention of Alzheimer’s. Dr. Julie Ottoy, scientist in the Hurvitz Brain Sciences Program, is one of the many researchers at Sunnybrook Research Institute, studying the pathophysiology of Alzheimer’s and what impacts it has on patient outcomes.

Dr. Ottoy’s interest in researching the causes and progression of Alzheimer’s disease started from her personal experiences. Like many Canadians, she has seen firsthand how the disease can impact the lives of family members and friends. Her experiences with her own loved ones and conversations with individuals with lived experience have played a pivotal part in shaping her work.

They remind me time and again that the research we do is about people, their families and their futures.

Dr. Ottoy’s research is working to answer some of the most fundamental questions surrounding Alzheimer’s. Who is most likely to develop Alzheimer’s? In what cases does the disease progress faster? Can we detect changes in the brain before symptoms appear?

Her work specifically focuses on better understanding mixed dementia. This is when Alzheimer’s disease occurs alongside vascular brain damage, which occurs when the blood vessels in our brain are affected and the blood flow to the brain is disrupted. Although mixed dementia is common, it’s not fully understood, making diagnosis and treatment challenging.

Using advanced neuroimaging techniques, like PET and MRI scans, blood-based biological markers, computational biology and AI-based analysis tools, Dr. Ottoy’s research focuses on two overarching themes:

• Mechanisms: To better understand how changes in our blood vessels and immune system contribute to brain changes seen in Alzheimer’s and mixed dementia.
• Biomarkers: To investigate novel biological markers that can aid researchers and clinicians in predicting the progression of these disorders in their early stages.

Her research looks for signs of vascular damage on brain scans, patterns of inflammation and the presence of toxic proteins that form into amyloid plaques and tau tangles. By combining this information, researchers can group patients into more specific subgroups based on the biological changes driving their disease, in turn driving more targeted intervention.

Photo illustration. Kevin Van Paassen/Sunnybrook Health Sciences Centre.

“Alzheimer’s is a very heterogeneous disease, meaning there is a number of different contributing factors and causes for the disease,” explains Dr. Ottoy. “By identifying different subgroups of patients using biomarkers, we are a step closer to creating more tailored treatments that match the individual needs of each patient more closely.”

Another area of her research investigates how well different brain regions connect with one another. The abnormal buildup of tau, one of the toxic proteins in Alzheimer’s disease, leads to cognitive decline in Alzheimer’s disease. Some studies suggest the way brain regions connect with each other is a key mechanism for the spreading of tau. Dr. Ottoy’s work studies these highly-connected regions and tau epicentres, to predict where the tau will build up next.

By studying the interface between the vascular system, immune cells and the spread of Alzheimer’s-specific toxic proteins throughout the brain, scientists can identify novel treatment targets, determine the best time and approach for disease intervention and develop new biomarkers that can inform future clinical trials and potential treatments. Understanding immuno-vascular contributions to dementia is important because both vascular and immune factors are modifiable.

With the advent of disease-modifying treatments, we are closer than ever in meaningfully slowing the progression of Alzheimer’s disease.

Today’s research lays the groundwork for larger-scale initiatives, including multi-site collaborations, like Toronto’s first 7-Tesla MRI, housed at Sunnybrook and part of the Toronto Neuro-Immunology/Imaging Consortium (TONIIC), a multi-site collaborative research initiative focused on neuroimmunology and neuroimaging for diseases such as Alzheimer’s. These research efforts will deepen understanding of disease mechanisms and aid in identifying new biomarkers and therapies.

“My hope is that these advancements will drive the development of combination treatment strategies that reach the clinic and accelerate progress toward precision medicine for neurodegenerative diseases.”

Dr. Ottoy’s research in immune-vascular contributions to dementia is funded by the Alzheimer’s Association and BrightFocus.

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What is norovirus?

Norovirus is a highly contagious stomach illness that causes vomiting, diarrhea and stomach pains, that usually resolve in 12-72 hours. Sometimes referred to as the “winter vomiting disease,” norovirus is common in the cold winter months, when people are spending more time inside, in closer contact with each other.

How does norovirus spread? 

The virus is spread through infected fecal matter that gets ingested into the mouth. The virus can survive on surfaces like door handles, sinks or tables which people can unknowingly touch.

The virus can also spread through food and drink. Individuals may contract the virus after sharing food or drinks or eating food prepared by someone infected with norovirus.

Some raw shellfish like oysters or shrimp, can become contaminated with norovirus through the water, which can later be ingested if not properly cooked.

How can I protect myself from norovirus?

Frequently washing your hands with soap and water after going to the bathroom, before eating or preparing food or taking medications is the most effective way to prevent norovirus.

You should also frequently wipe down shared surfaces like handles, sinks, tables and cooking surfaces.

Be mindful of sharing food with others, or settings like potlucks, where food can easily become contaminated with norovirus.

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