Osteoporosis is often referred to as the “silent thief”. The disease is caused by low bone mineral density (BMD) and can occur over a number of years without any symptoms. It is often diagnosed when the first fracture occurs and the disease is already fairly advanced and less treatable. At least one in three women and one in five men will break a bone due to osteoporosis in their lifetime.

Artificial intelligence screening tool, Rho, was developed by 16 Bit inc., a Toronto-based medical device company founded by Canadian radiologists Dr. Mark Cicero and Dr. Alexander Bilbily, radiologist and affiliate scientist at Sunnybrook Health Sciences Centre. The company’s mission is to create trusted AI-based medical software to improve the quality and accessibility of health care for all. Rho automatically screens patient x-ray scans for low BMD and alerts physicians of increased risk of osteoporosis which allows patients and physicians to work together to create preventative treatment plans.

We recently sat down with Dr. Bilbily to chat about how Rho is shaping the future of health care.

What inspired you to become an inventor and create Rho?

I enjoy my clinical work, but its impact scales linearly – I can only help one patient at a time. What excites me about software is it can scale exponentially, creating value even while I’m asleep, camping in the backcountry, or chasing after my toddler.

We created Rho because our health-care system urgently needs smarter, more sustainable solutions. With an aging population, rising costs, and limited resources, we have to find ways to improve care while reducing expenses. Rho identifies patients at high risk for osteoporosis using x-rays they’ve already had without extra imaging or added cost. This enables much earlier intervention which prevents devastating fractures for patients and reduces cost to the health-care system. We have successfully built and deployed the first tool of this kind which has already impacted the lives of over 300,000 Canadians.

What skills or traits have helped you the most in your journey as an inventor and entrepreneur?

Curiosity, the ability to learn quickly, and empathy have all been essential. As a physician, transitioning into entrepreneurship meant learning an entirely new language – product development, branding, market strategy and, regulatory affairs. My curiosity pushed me to dive in, and years of medical training helped me to quickly learn and adapt.

Empathy has been a key strength because it has helped me build a strong partnership with my co-founder, recruit a mission-driven team, and deeply understand the needs of our customers and patients.

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

Start with something you think the world needs – something you’re willing to spend 10 years of your life building. Healthtech is hard. It comes with all the usual start-up challenges, plus regulatory, clinical validation, and compliance hurdles that increase cost, risk, and time. If your motivation is just financial, it’s hard to weather the storm. But if you’re mission-driven, that purpose will sustain you and attract others who share your vision like key teammates, advisors, and early customers.

How has Sunnybrook and INOVAIT enabled you to make your technology a reality?

INOVAIT, [Canada’s image-guided therapy and AI network led by Sunnybrook], has been essential at every step of Rho’s journey. Through the Pilot Fund in 2022, they helped support our AI model development, early user testing, and Health Canada approval. That funding and visibility gave us a critical boost to land our first customers. More recently, the FOCUS Fund has supported our commercialization efforts which included helping us expand Rho’s capabilities, build evidence through publications, and grow into international markets.

Sunnybrook has also played a pivotal role – from running Rho’s first prospective clinical trial with CAN Health Network, to supporting bold new research in my lab. That includes exploring next-generation AI use cases in medicine – some of which are admittedly a bit out there, but might just shape the future.

The post Sunnybrook Inventors: Dr. Alexander Bilbily appeared first on Your Health Matters.

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.

“He spent over an hour with me, reviewing healthy lifestyle advice in detail to improve my heart health,” says Abdel. “His care, and advice, has changed my life.”

Abdel has lost approximately 40 pounds in four months by closely following Dr. Moustafa’s tips. The changes, for a self-professed foodie, initially came as a shock. No added sugars, no processed carbs. And the kicker: 30 seconds for each bite or mouthful.

“He patiently listened to my daily eating routine and explained to me the quality of the different types of food, as well as the appropriate healthy quantity and frequency of meals each day. He also detailed the benefits of chewing the food slowly,” explains Abdel.

Aiming for 30 chews per bite improves digestion, nutrient absorption, and most importantly helps you feel full, potentially leading to better weight management. Abdel is now maintaining a good calorie deficit with a sustainable balanced healthy diet and regular exercise.

“I haven’t felt this healthy in more than ten years,” he says. “I’m able to go for daily walks effortlessly, and I’m gaining muscle mass by regularly visiting the gym.”

The patient and doctor have also bonded over their shared experience of being from Egypt. “In Arabic culture, the physician is called “Ḥakīm” which means a wise person. For me, Dr. Moustafa is that person,” says Abdel.

Dr. Moustafa’s impact extends to the students he works with each year at Sunnybrook. He recently received a Peters-Boyd Academy Teaching Award: Foundation Faculty Teaching for Clinical Skills.

The post Heart healthy tips in action: Abdel’s story 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

The post What you need to know about “the big three” headaches appeared first on Your Health Matters.

“We’re here to support our Sunnybrook investigators in their leadership of clinical trials,” says Gail Klein, operations director for the CCTS. “We’re their right-hand people; providing internal supports and a full-service package to make things easier for them, while also acting as a partner to the partners – that is, other trial sites worldwide.”

Sunnybrook has a strong history of leading clinical trials locally, nationally, and globally. CCTS has expertise in the management and coordination of single-centre, multicentre, national and international clinical trials and research projects across any therapeutic area at Sunnybrook.

“This is an incredibly exciting time to be part of the clinical trials team at Sunnybrook,” says Dr. Paul Karanicolas, medical and scientific director for the CCTS. “Across our institution, there is a renewed and growing focus on innovation leading us to the forefront of inventing the future of healthcare. Our work is not only advancing medical science—it’s directly impacting patient lives in meaningful ways.”

Have a Sunnybrook-led clinical research project in mind (or in the works)?

Contact the CCTS at: ccts@sunnybrook.ca

The post Igniting Discovery: Where researchers go to get their research projects off the ground appeared first on Your Health Matters.

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!

The post Fact or myth? Understanding urban legends about eye health appeared first on Your Health Matters.

The roles they play

In Ontario, both SLPs and audiologists are regulated by the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO). According to CASLPO,

“SLPs are concerned with the identification, assessment, treatment, (re)habilitation and prevention of communication and/or swallowing disorders in children and adults.” They go on to explain that, “Audiologists are concerned with the prevention, identification, assessment, treatment, and (re)habilitation of auditory and balance difficulties in children and adults.”

Both professions manage a varied approach to their practice, including:

• Screening and assessment
• Dispensing of equipment
• Patient, staff, and family education
• Participation in rounds and discharge planning
• Individualized and group therapy
• Coordination of care with other staff

An interprofessional approach

Interprofessional collaboration is key to patient care at Sunnybrook. Audiologists and SLPs are vital to a variety of teams across multiple programs. At Sunnybrook’s Bayview Campus, audiologists work with otolaryngologists and hearing instrument specialists to operate a hearing aid clinic and Canada’s largest Adult Cochlear Implant Program. Speech language pathologists work in 8 of the 10 care programs at Sunnybrook, across all campuses. They provide care across acute care, transitional care, long-term care, palliative care and ambulatory care settings.

The intersection of communication

Both professions bring valuable expertise to the patient experience in different ways. What connects these roles is something that connects us all: communication! Audiologists and SLPs are dedicated to the improvement of communicative ability, both incoming and outgoing.

To that end, communicative disorders assistants (CDA) aim to support the cause by facilitating pathways for meaningful, effective communication. Jason Dallas is a CDA who works at our Veteran’s Centre and supports the audiology and SLP departments.

“Communication is a fundamental human right. I often hear how impairments in hearing or communicative ability can lead to feelings of frustration and isolation. I believe the work of Audiologists and SLPs is so important, and our residents and patients agree wholeheartedly!”

Communication strategies for everyday life

Whether you’re supporting someone with a communication disorder or seeking to enhance your own interactions, the following strategies will prove beneficial in supporting effective communication:

• Speak at a moderate pace and volume
  • Focus on speaking clearly
• Face your communication partner, and speak at eye level
  • In an environment where people are often masked, this can greatly enhance intelligibility
• Make sure important information has been heard correctly by asking the listener to repeat it back to you (e.g., appointment times; medication instructions)
• Reduce or eliminate background noise as much as possible
• To make sure that hearing aids are working:
  • Check that battery doors are fully closed OR
  • Make sure that rechargeable hearing aids are properly charged every night (cup the hearing aids in your hands and listen for feedback – feedback means sound is getting through)

At Sunnybrook, our commitment to communicative health is evident in the collaborative efforts of SLPs and audiologists. For more information, or if you think you require the services of an SLP or audiologist, visit:

• CASLPO (College of Audiologists and Speech-Language Pathologists of Ontario)
• SAC – OAC (Speech-Language and Audiology Canada)

The post Communication is care: The fundamental work of Sunnybrook’s audiologists and speech-language pathologists appeared first on Your Health Matters.

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!

The post How to protect your joints while living an active lifestyle appeared first on Your Health Matters.

How are balance and dizziness linked to hearing?

The inner ear may be small, but it’s complex! It’s home to the vestibular system and the auditory system. The vestibular system has motion sensors that help us stay balanced and perceive movement, while the auditory system has hearing sensors that allow us to perceive sound. Both of these systems share nerve and blood supply pathways, so they are very interconnected. This means that many people affected by conditions of the inner ear can experience both hearing and balance symptoms, like hearing loss, dizziness, imbalance and tinnitus.

Is it often overlooked that balance and dizziness can be tied to hearing?

Absolutely. Patients often ask why we are testing their hearing when they come for balance testing. Generally, hearing health is overlooked as many people don’t get a hearing test until they have experienced several years of hearing difficulty or are persuaded by a family member or significant other to get checked.

Hearing impairment can also contribute to reduced environmental awareness and localization which can affect balance and movement. For example, hearing someone walking up from behind you or calling your name from your right or left. Also, hearing the acoustics in a room improves your understanding of your surroundings. Overall, hearing impairment can increase confusion about your surroundings and is linked to an increased risk of falls.

Which conditions can affect the health of the inner ear?

There are many, but here are some of the most common:

• Benign paroxysmal positional vertigo (BPPV): inner ear crystals dislodge and their movement causes vertigo/dizziness symptoms
• Meniere’s disease: fluid builds up in the inner ear structure often affecting both hearing and balance systems
• Vestibular neuritis: inflammation happens in the balance system nerve
• Labyrinthitis: inflammation of the inner ear affects both balance and hearing systems
• Superior semicircular canal dehiscence: a hole or thinning of the bone surrounding the inner ear
• Vestibular schwannoma: a tumor on the balance system nerve

How can balance and dizziness affect everyday life?

Dizziness and balance symptoms can range from mild to severe. Mild symptoms may mean you avoid specific activities, like bending over. Severe symptoms can result in a detrimental loss of abilities across all activities of daily living, including walking, bathing, lying down, getting up, using stairs, exercising, driving, concentrating, reading and working. In addition to the physical challenges, this can also place a huge burden on your mental health.

Dizziness is also a major risk for falls. In fact, adults with some form of inner-ear dysfunction are up to 12 times more likely to have a serious fall (Balance & Dizziness Canada). That’s why people experiencing dizziness or falling should absolutely be referred for testing.

What kind of testing and treatment is offered at Sunnybrook?

We have a team of audiologists that assess you and determine which parts of the ears are impaired. These assessment results are important for your physician to determinea diagnosis, treatment plan, or need for further testing.

A number of hearing tests are used to measure hearing sensitivity to a variety of sounds for each ear, and also check how well the ear drum is functioning. You need a referral from a family doctor for this type of testing.

Our team also offers many different types of balance tests. Most of these tests use goggles with built in eye-tracking cameras. Our tests compare eye and head movements during visual tasks. Some tests also stimulate the motion sensors of the ear with water or air to measure and compare the results from each ear. An ear, nose and throat (ENT) physician or neurologist referral is needed for the full diagnostic balance assessment.

In addition, we have added a new balance screening program to our available services. Audiologists screen patients for the most common dizziness and balance issues and provide them with education to help them manage their symptoms. To access this service, you need a referral from a family doctor.

If you’re interested in doing a quick hearing test at home, use this online tool. It only takes five minutes to complete, and is brought to you from Sunnybrook’s audiology services department and Shoebox.

The post How dizziness and balance are linked to hearing appeared first on Your Health Matters.

Big sister Debbie has always been there for Cindy; this time, as they scurry through hospital corridors, a little late for their first appointment of the day.

Together, the siblings navigate traffic, banter over the long drive from Brantford, and keep on top of appointments. Debbie is a little on edge, given the circumstances. She takes her support role seriously, as she – more than most, due to her career in nursing – understands its importance to patients; her sister, in this case. Cindy, as a result, comes across as laid back and has an energetic spring in her step.

Despite having left early as they always do, the heavy fog and wet morning meant road conditions were heavier than usual. But nothing was going to get in their way…

Cindy is part of a clinical trial, or research study, that is testing an investigative drug therapy for the prevention of Alzheimer’s disease. It is one of many dementia research trials from the Brain Lab in the Dr. Sandra Black Centre for Brain Resilience and Recovery at Sunnybrook Health Sciences Centre.

A volunteer participant for the study, Cindy is required to come in to hospital for regular visits – twice a month in her case, for now. This trip marked a year of visits; expected to continue another four years, for the duration of the five-year study.

Why would someone like Cindy – who shows no symptoms of Alzheimer’s disease – need or want to take that time to participate in such a research study?

When I first heard about this study, I knew right away I wanted to be a part of it. My mother had dementia, Alzheimer’s disease (AD). Seeing mom deteriorate mentally, it was difficult. She would have been in her late sixties, when she started manifesting confusion. She deteriorated; it was tough to see her go downhill. I wanted to learn what my risk was, to see if I could get more information, and what I could do about it”

Cindy Greatex,
clinical trial research participant,
68 years old 

Dementia is a term for several diseases that affect memory, thinking, and the ability to perform daily activities, with Alzheimer’s being the most common, contributing to about 60 to 70 per cent of dementia cases.

According to the World Health Organization, the illness gets worse over time and mainly affects older people. Having a family history of Alzheimer’s disease – in particular, if a biological parent or sibling has the disease – increases the risk of developing it.

As a part of the study, Cindy had the option to have her genes tested; she didn’t hesitate. The results showed that she has the strongest genetic risk factor for AD – which means she has a 15 times higher risk of developing the brain disorder than the average person.

As a medical doctor, Sunnybrook cognitive neurologist and brain scientist Dr. Sandra Black knows too well the devastating effects that diseases of the brain can have on patients, their quality and length of life, and their impact to families and loved ones.

Recognized internationally for her contributions to the diagnosis and treatment of vascular dementia, Alzheimer’s disease and stroke, Dr. Black has been compassionately providing care to patients and their families for most of her career, while working to advance research into what we know about the brain. This includes leading 88 clinical trials and training 110 trainees – new generations of clinicians and brain scientists, who have gone on to be leaders in cognition, stroke and dementia across the country.

While there are drug therapies available to help treat some of the symptoms of AD or other dementias (once those symptoms have already developed), there are limited medical options to address prevention, before the disease takes hold.

Yet Dr. Black has never been more optimistic.

Never before did we have the option or possibility of altering the pathway in which dementia develops. Now we’re actually looking at the pathology itself that leads to brain cell damage and cognitive decline. This is an emerging field and we’ve learned the sweet spot in preventing or slowing down Alzheimer’s disease is well before symptoms start.

Sandra Black,
Scientific Director, Dr. Sandra Black Centre for Brain Resilience and Recovery,
Sunnybrook Research Institute (SRI) and
Officer of the Order of Canada

She explains how the focus of therapies in their clinical trial research now is to intervene before the toxic processes behind the disease begin to form – a minimum of 10 to 15 years before symptoms kick in and “have a life of their own”, spreading in the brain.

“If we can do that, then you’re going to avoid it (dementia developing). It’s like stroke prevention: you get worked up, and put on prevention therapies, so you don’t have a stroke.”

The comparison should not go unnoticed, considering that she and her colleagues at Sunnybrook’s stroke clinic were one of the first to provide stroke prevention therapies in Canada in the 1990’s.

For the time being, volunteering to participate in a clinical trial is often the best option for patients like Cindy to access therapies that are not yet available “clinically”; in this case, a drug therapy in an effort to prevent or offset the very start of the disease process.

Receiving the drug, however, is not a guarantee as clinical trials are often randomized and blinded, which means volunteer participants are either selected for the drug therapy itself, or a “placebo” instead – the latter usually is just a saline solution – so Cindy and the research team don’t know which group she falls in.

“There has to be this placebo comparison in order for the study to be controlled, in order to validly test for any effects and differences – good or bad – of a drug being studied,” explains Halil Akbulut, clinical research coordinator in the Hurvitz Brain Sciences Program at Sunnybrook.

Without people like Cindy and her study support partner, we wouldn’t make any progress at all. They’re contributing to our understanding.

Cindy will continue to be closely monitored and tested for the duration of the study. Her sister Debbie is her “study partner”. In addition to providing a supportive role to Cindy, Debbie is part of her “team”, sharing any cognitive, physical or emotional changes she observes while outside the hospital setting. Changes to cognition can include thinking processes such as attention, learning and memory, language, remembering, reasoning, and problem solving.

If Cindy’s cognition or overall health declines, she will be pulled from the study. If it’s found that she was on the placebo, she will be offered the drug therapy as part of the agreement as a participant of the study. If she was on the drug arm of the study, she will continue to be offered it, for as long as she and her care team decide to use it.

I’m learning so much through this study, I’m learning how to eat better, how to sleep better, interacting more with people; so it’s giving me a lot of tools that I can put into place now while I’m going through the study, and I know it will make a difference in my life, to a better quality of life.

When asked if she had any advice to offer others who may be considering a clinical trial, Cindy added:

“If there are clinical studies available, sign up. It helps to find out as well genetically whether you have a predisposition – a higher probability of getting the disease – so there’s so many good points about being part of a study. I encourage people to find out if anything is happening in your community – I’m commuting myself – it’s worth the while to do that.”

The post Igniting Discovery: Can we stop dementia in its tracks, before it starts? appeared first on Your Health Matters.