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Comment on Will I get Alzheimer’s if a parent has the disease? by Dr. Nathan Herrmann

Dr. Nathan Herrmann — Fri, 11 Jan 2019 15:13:00 +0000

Hi Kathleen. Without taking a detailed personal medical history and a careful family history which includes all family members with and without the disease, and the ages at which those affected developed symptoms, providing an accurate risk assessment is not possible. Even with this information risk profiling is still more art than science at this point, with the exception of the very rare forms of Familial Alzheimer’s Disease mentioned in my blog, which can be detected by genetic testing.  

My recommendation to those readers with concerns about their risk of developing dementia either with strong family histories, is to start a discussion with their family physician about all risk factors (including lifestyle and diet) and request a referral to a dementia specialist. A dementia specialist can determine whether genetic testing is indicated and/or might refer the person to a clinical geneticist, who would be able to provide the testing and appropriate counselling regarding genetic risks. 

Finally, I would remind the readers that at the moment, there is no cure or effective disease modifying therapy for Alzheimer’s Disease or the other forms of dementia, and therefore knowing one’s genetic risk may be unhelpful and even potentially emotionally harmful. At the present time, instead of focusing on your genetic risk which is unmodifiable, we should all be trying to improve our general medical health and lifestyle habits including exercise, diet and mentally stimulating activities which have shown the best evidence of reducing the risk of dementia.

Comment on Will I get Alzheimer’s if a parent has the disease? by Dr. Nathan Herrmann

Dr. Nathan Herrmann — Fri, 11 Jan 2019 15:13:00 +0000

Without taking a detailed personal medical history and a careful family history which includes all family members with and without the disease, and the ages at which those affected developed symptoms, providing an accurate risk assessment is not possible. Even with this information risk profiling is still more art than science at this point, with the exception of the very rare forms of Familial Alzheimer’s Disease mentioned in my blog, which can be detected by genetic testing.  

Comment on Will I get Alzheimer’s if a parent has the disease? by yidchick

yidchick — Mon, 07 Jan 2019 22:57:00 +0000

My mom had early onset Alzheimer’s and died at 60. My grandfather’s got dementia at 91. My great grandmother had Alzheimer’s in her 70s. Is this familial? My uncle is unaffected. I’m a mom of 5 kids and I’m very worried about getting Alzheimer’s or my kids getting it when they are older. Does Ohip cover genetic tests in this case?

Comment on Will I get Alzheimer’s if a parent has the disease? by Kathleen wilson

Kathleen wilson — Wed, 05 Dec 2018 15:43:00 +0000

Dear doctor,
Both of my grandmothers had/ has Alzheimer’s and ive recently had 2 aunts and an uncle diagnosed(father’s side). My maternal grandmother’s father also had Alzheimer’s. Im very concerned about my chances of developping the disease and was wondering if you could help clarify for me the chances of my getting it. Thanks for your time, kathleen.

Comment on Everything you need to know about dementia & legal issues by Dr. Nathan Herrmann

Dr. Nathan Herrmann — Fri, 16 Nov 2018 16:53:00 +0000

Hi. People with moderate dementia living on their own are my professional nightmare! The scenarios you describe are unfortunately not uncommon, and current medicolegal regulations in most western countries have made it increasingly difficult for families to intervene until danger is “imminent”. That is the price of ensuring personal liberties and limiting professional paternalism. I spend a lot of time empathizing with families in this situation, and telling them that sometimes, people need to get much worse cognitively or functionally before the family is able to intervene. As you note, it sometimes does require a crisis or an emergency room visit to finally enact an appropriate care plan.
Having said all that, caregivers should be aware that there are resources in many communities that might be helpful. Some communities have mobile crisis teams,and/or home visiting psychogeriatric services. In certain locales presenting before a Justice of the Peace, or utilizing the Public Guardian may allow intervention. Finally, in many communities, Community Relations Officers from the Police Department, can be very helpful.

Comment on Everything you need to know about dementia & legal issues by Liz

Liz — Thu, 15 Nov 2018 22:11:00 +0000

Hi Dr. Herrmann,
I work in private retirement communities. What I often find is that those with more moderate stages of dementia that develop behaviours while living in their own home are very difficult for the family to manage. For example, residents refuse to take medication, refuse to use a walker, refuse to bathe, send home care help away, stop eating, devlop infections etc. No one can “force” these individuals to do these activities. Families often watch their parent decline not knowing how to help. What are families to do when doctors are unwilling to declare an elderly person incapability of making there own medical decisions? Even if they are declared incompetent, can they really force someone to bathe or take medications. Do they have to wait for an emergency room visit before they can act? These seniors are often at medical and financial risk due to ‘stubbornness’. They experience personality changes and start lashing out at their family who is only trying to help.

Comment on Will I get Alzheimer’s if a parent has the disease? by Dr. Nathan Herrmann

Dr. Nathan Herrmann — Tue, 28 Aug 2018 12:07:00 +0000

Hi,
It is only recently that researchers have recognized that the eyes may be the windows into the brain of patients with dementia including Alzheimer’s disease. There are some small preliminary studies that have shown a number of measures of eye structure, including the thickness of retina, easily measured by a method called Optical Coherence Tomography (OCT) scanning, is not only associated with dementia severity, but may predict who will develop dementia. As I always emphasize, these studies are very small, preliminary and require replication in larger, longer studies in order to truly understand how accurate they are and to determine whether these tests belong in daily clinical practice.
Having a first degree relative with Alzheimer’s Disease, such as a parent, in and of itself, probably doubles the risk of developing the illness, especially when the disease starts before the age of 65.
There are a number of studies running in Canada and the US that are aimed at patients at high risk for developing Alzheimer’s Disease, including OCT studies. I generally recommend starting with the Alzheimer’s Society of Canada (http://alzheimer.ca/en/Home/Research) which lists many of the studies currently running in Canada, hopefully in a community close to you.

Comment on Will I get Alzheimer’s if a parent has the disease? by AW

AW — Mon, 27 Aug 2018 20:42:00 +0000

Dear Dr. Herrmann,
My father was diagnosed with alzheimer’s at the age of 58 however we noticed changes in his behaviour a few years before that age. At the age of 58 he also encountered a retinal detachment. Recent studies are showing some correlation between retinal thinning and dementia/alzheimer’s disease. I am turning 31 in September and last year was advised by an optometrist I have retinal thinning. Are my chances of developing early on set AD now higher since my father is diagnosed with this and I appear to have retinal thinning?
If so, what are my next steps? Are there studies I can participate in to further investigate retinal thinning and decline in cognitive functions?
Thank you

Comment on Everything you need to know about dementia & legal issues by Dr. Nathan Herrmann

Dr. Nathan Herrmann — Fri, 24 Aug 2018 14:28:00 +0000

Hi. The answer depends on the province/country in which your dad resides, as all these issues differ from province to province, and country to country.
In general, as POA for property, it should be your responsibility to protect your Dad’s estate, based on his previously expressed wishes. If, in your opinion, your father is making inappropriate financial decisions based on the impairment from his dementia, it would be best to speak with his MD and then a lawyer about how best to proceed from a medicolegal perspective. While he may need to be declared incapable to manage his affairs, the process differs based on the exact wording of the POA document, and the local legislation. Best of luck!

Comment on Everything you need to know about dementia & legal issues by D Mercer

D Mercer — Thu, 23 Aug 2018 18:48:00 +0000

Hi Dr. Hermann. I am a Canadian resident with an elderly father with vascular dementia and 2 previous strokes, in residential care (nursing care). My question is medico-legal regarding declaring incompetency of handling his own affairs as he is starting to request thousands of dollars on hand, purchasing a car he would be unable to drive (no license, would not be qualified), etc. I am the only active caregiver and do hold all of the usual medico-legal paperwork that my father put in order a few years ago so I could manage his affairs. My question is, with his new requests which are not in his best interests, is it adviseable or necessary to get him legally declared incompetent?