Answer: This is always a difficult question for me to answer. For some patients with even mild dementia, changing locations can lead to an increase in disorientation and confusion. Caregivers have complained to me that at times, the person with dementia can even become incontinent because they cannot find the bathroom in their hotel room. Perhaps a bigger concern is whether an increase in confusion because of the unfamiliar location and environment will lead to agitation and anxiety. This is a particular problem for air travel, where the person is stuck in a noisy, crowded confusing environment where there is literally no escape for hours.

Unfortunately there are no clear predictors of who is likely to be able to tolerate travel and who will not. For instance, factors such as age, gender, type of dementia, and severity of cognitive impairment, are not particularly helpful, as the response is so individual. I typically inquire about how they have tolerated travel in the past, though given the progressive nature of the illness, even this is not totally reassuring. Sometimes it is worthwhile trying a “trial run” where the patient and the caregiver may stay overnight at friends or family nearby to judge what effect changing environments will have on the person.

I generally encourage families to travel in order to enrich the quality of life for the patient and their caregiver, and at times, travel will be unavoidable. In these instances, it is always useful to have a game plan which could include notifying the travel authorities, ensuring adequate health insurance, having help arranged to get you to the gate, and waiting for you when you arrive. You might speak to your doctor about the availability of medications to help with agitation in the event this is necessary, but there are risks associated with the use of these drugs and they should not be used for the first time if you have no idea how they affect the person with dementia (either positively or negatively).

Finally, given how different the environment will be, you will need to be especially careful about leaving the person with dementia unattended at any time during the trip.

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“Zika virus comes from the same family of viruses as Dengue fever and West Nile virus. It’s predominantly spread by the Aedes mosquito, although it is not circulating here in Canada so there’s no risk of contracting Zika by mosquito bite here,” says Dr. Andrew Simor, head, Department of Microbiology and Infectious Diseases consultant at Sunnybrook Health Sciences Centre.

There are, however, other ways the virus can be transmitted. And while most people who get Zika will never experience any symptoms, women who are pregnant or trying to get pregnant are at much greater risk. Here are three things you need to know about Zika virus:

1) Most people don’t even know they have it

Only about 20% of people who are infected with Zika actually experience any symptoms. The rest have no idea they were ever infected with it at all. “If you do have symptoms, it will feel like having a mild flu,” says Dr. Simor. Fever, rash, nausea, joint and muscle pain, headaches and redness of the eyes are all signs of a Zika infection. The only way to know for sure, though, is by getting a blood test.

“There have been instances of people developing Guillain-Barre syndrome several weeks after a Zika infection, but it is rare,” says Dr. Simor. The overwhelming majority of people will fully recover from Zika.

2) Zika can be transmitted through sexual contact

Mosquitos are transmitting the Zika virus in other parts of the world, but not in Canada. So how else can someone get the virus? “The Zika virus stays in the blood for no more than a week, but it may persist in men’s semen for much longer- at least 60 days,” says Dr. Simor. The virus can then be transmitted to the man’s sexual partners.

So, if a man has traveled to a Zika affected part of the world, is bitten by a Zika-carrying mosquito, and contracts the virus (and he often won’t have any symptoms, so he won’t know he had Zika), he may transmit it to his sexual partner for months afterward. It is recommended that men who travel to or live in an area with Zika virus transmission and their non-pregnant sex partners should either abstain from (or use condoms during) sex, in order to reduce the risk of Zika virus transmission.

3) Women who are pregnant, or trying to get pregnant, are at highest risk

For healthy adults, contracting Zika is not serious- most will never even experience symptoms. However, the risk is much greater for women who are pregnant or trying to get pregnant. “There is a confirmed link between a women contracting Zika virus during pregnancy and microcephaly, which means the baby’s brain does not fully form, leading to cognitive impairment,” says Dr. Simor. It’s still unknown how often this happens, or at what point in the pregnancy the risk is highest, but it is important that women who are pregnant or planning to become pregnant take precautions:

• Avoid travel to Zika affected areas
• If travel is unavoidable, take measures to avoid mosquito bites, such as using a mosquito repellant with DEET, using mosquito nets at night, and wearing long pants and long sleeved shirts
• Men from who have traveled from a Zika affected area should either avoid having sex, or use condoms during sex with their pregnant partners, for the duration of the pregnancy

As always, if you have any questions or concerns about Zika virus, discuss them with your doctor.

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