Subcommittee on Neurological Disease committee  It's a bit of mystery why there's so much discrepancy in drug approval processes among the different provinces. There was hope that the central review would be a positive thing to speed things up, but actually it turned out to be the opposite. There will also be an ethical dimension to the whole process of diagnosing Alzheimer's before dementia.

Subcommittee on Neurological Disease committee  I really hope you'll stay away from the D word--

Subcommittee on Neurological Disease committee  --because Alzheimer's disease is a spectrum, from mild forgetfulness to more than that but not dementia yet. It's Alzheimer's disease. My argument for broadening it to the brain at large is that the pathology of Alzheimer's is actually a combination of things. There is some Parkinson's in there, and Lewy body, and some small stroke components, and amyloid and other changes in the brain cells.

Subcommittee on Neurological Disease committee  Maybe I can try to answer that with what's already known. There were studies done about personality disorders and stress exposure in life as a factor leading to or increasing the risk of Alzheimer's disease. There's no convincing data to that effect. Perhaps it's fair to say that if you are predisposed to a disease because of your genetic makeup, you will have the symptoms at an earlier stage if you had head injuries, if you were drinking alcohol too much, if you had hypothyroidism.

Subcommittee on Neurological Disease committee  The good news is that in Canada, close to 20 years ago, we started to work together--GPs, specialists of different types, and the Alzheimer Society of Canada, representing patients and caregivers--on one set of guidelines. And we've updated those guidelines periodically. So that's national.

Subcommittee on Neurological Disease committee  That's quite easy, because for Alzheimer's disease right now, there are only two kinds of medicine. One kind, which we've had for 10 years, increases the brain levels of a transmitter called acetylcholine. It was approved in Quebec and Ontario within a year or two, but there was a lag time for the Maritimes by about five years and a lag time for B.C. by about seven years.

Subcommittee on Neurological Disease committee  I can add something on the clinical side, if I may. There's been some pioneering work done by one of our McGill psychiatrists showing that some beta blockers, used at strategic times after PTSD is manifested, will suppress some of the long-lasting effects. So there is a start to pharmacological manipulation using old drugs to perhaps modify the longer-term impact.

Subcommittee on Neurological Disease committee  You're right on the mark: family history is probably the key factor. There may be some blood test to support your family history as a risk. There was a discovery made in Canada about a gene that malfunctions in 15% of the population. It's a variation of a gene that allows your brain to carry cholesterol efficiently in and out, and to build connections as you grow up as a child and maintain those connections as you age.

Subcommittee on Neurological Disease committee  It's part of a number of vascular risk factors, which include high blood pressure, especially at your age—40 to 60. In mid-life, high blood pressure is a known risk factor for dementia in general and Alzheimer in particular. That's preventive with technologies already available.

Subcommittee on Neurological Disease committee  Yes. I think that we have reached a certain plateau currently with regard to molecules that can attenuate symptoms at the dementia stage. However, we may be luckier with new models or new molecules. Also, as the lady was saying, we may develop an original approach that may derive from observation in the context of another disease, which could apply to many other cerebral pathologies.

Subcommittee on Neurological Disease committee  Most of the Alzheimer's patients are already retired and about 75 years of age, so they would have to pay income tax to get some money back with the tax credit. Perhaps the new generation of baby boomers, as they move into the ages when many of them unfortunately will have dementia, will have enough income to take advantage of such a program.

Subcommittee on Neurological Disease committee  Actually, the starting point has changed. We no longer wait for dementia to say that someone has Alzheimer's disease. The new biomarkers include spinal fluid examination--we need a spinal fluid lab in Canada, so add it to the wish list, please--and PET imaging, which is imaging of the brain with different tracers.

Subcommittee on Neurological Disease committee  I will begin answering, and my colleague may have something to add. For Alzheimer's disease, symptomatic treatments in use currently are administered for six months to two years on the average, and clinical trials to demonstrate their effectiveness last six months. In that case the approval and trial period under the current Patent Act is appropriate.

Subcommittee on Neurological Disease committee  Thank you, Madam. Members of the Subcommittee on Neurological Disease of the Standing Committee on Health, I am going to speak to you today as a clinician-scientist. My recommendations will pertain both to research and the needs of patients and their families. I have provided you with a copy of my document.