Subcommittee on Neurological Disease Committee on Dec. 7th, 2010

[Patrick Brown, Conservative, Barrie, ON]

Aside from population growth.

[Dr. Jack Diamond]

It applies across the world, actually. There are two things. People are living longer, and this, I have to say, applies especially to men. At one time, twice as many women got Alzheimer's as men. The reason for that traditionally was that women lived longer than men. Well, men are catching up now, they're living longer, and while they're living longer, they are more lengthily exposed to the risk factors.

It was earlier said that we don't know what causes Alzheimer's, and in a sense that's true, but in a sense it isn't true. We do know what causes Alzheimer's. It's when the combined effects of the risk factors overwhelm the capacity of the brain to repair itself. It's as simple as that. What they do, of course, is very complicated. But it's all the risk factors, and of course the longer you live the longer you're exposed to those risk factors. Some are environmental; some are personal, like high blood pressure, high cholesterol, diabetes or obesity, chronic stress, chronic depression. These are all risk factors, and the longer you're exposed to them, of course, the more effective they're going to be.

The combination of the two, increased risk factors and increased duration of life, are actually adding to the numbers. Of course, the baby boomers right now have enormously boosted the numbers. But even without the baby boomers, we are still seeing an increase in diagnosed cases.

[Patrick Brown, Conservative, Barrie, ON]

A few years ago I was asked to present a government grant to a seniors' home in Barrie. It was at IOOF, and it was a grant to have all the seniors there take painting classes. It was a New Horizons grant, and it said that mental stimulation is a means of delaying the onset of Alzheimer's. I know the seniors there loved it.

Is that the type of thing we should be looking at? Should we be looking at more opportunities to work within seniors' homes in Canada?

[Dr. Jack Diamond]

You've lit upon actually the most important thing we have going right now.

If you don't want to get Alzheimer's, ladies and gentlemen, there are four things you should address immediately. One is regularly maintained exercise—just modest exercise, not a four-minute mile; an hour's gardening or an hour's housework is the same as an hour in the gym. Another is using your head by exercising your brain and involving yourself in activities. Another one is socialization, not isolating yourself but interacting. The final one is a healthy lifestyle, especially with diets and things like that. These have all been shown to significantly reduce the numbers, or advance, let's say, the time at which you get the condition, if you're going to get it, and they slow it down in people who already have it. No drug we have yet achieves that.

[The Chair, Conservative, Joy Smith]

Thank you very much, Mr. Brown.

Thank you, Dr. Diamond.

Ms. Hughes, I'm going to skip to you now because I want you to have an opportunity to ask some questions.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you.

You mentioned baby boomers. Certainly, I think we are going to be seeing an increase in the early onset of Alzheimer's because of the number of baby boomers who are coming up the ranks here. I think my sister was a prime example of that. My sister was very active and she did lots of reading. Sometimes we still shake our heads and ask, what's going on here?

I think there are a lot of people out there who may have it and don't know they have it. Dr. Lester and Mr. Mann certainly have indicated that, with respect to when it actually started, when the onset actually began.

And I think this would be part of the national strategy--how better to educate people to look for the signs, so that maybe some of the medication that is out there that would prevent or stop the progression.... I wonder if Dr. Lester and Dr. Diamond would like to comment on that.

[Dr. Robert Lester]

As I said earlier, I think that education of both the public and the primary care health providers would be extremely important in preventing or early detection of the disease and therefore early intervention. As I said, if you can intervene earlier, you can probably slow the progress. So I think the strategy around education is really a relatively inexpensive way of addressing some of the early problems that people with dementia have.

I will just give you an example with my own case. My son lives in Scottsdale, Arizona. Early on, he said to me, “There's something wrong with mom, because she can't find her way home when she goes out on the street.” I said, “All the houses here look the same. They're all brown adobe houses. What's the problem?” Given that I was living with her, I didn't see it, but my children who were not seeing her on a regular basis did see it.

I think this whole concept of education is extremely important, and it goes back to the whole issue of removing the stigma, which allows people to come forth.

I know, for example, that when my wife was diagnosed, friends of 60 years disappeared. They totally disappeared. Family disappeared. Colleagues disappeared. No one visits my wife except me and my daughter--virtually no one. I think if someone has cancer or someone has heart disease, that doesn't occur. People continue to participate. People just don't know what do when someone develops dementia. They don't know how to react. I think this whole concept of what it is, how you deal with it, how people identify it early, is really critical to the strategy, from my perspective.

[Dr. Jack Diamond]

I can just add to that.

Remember I told you about the hallmarks of Alzheimer's disease, the plaques and the tangles. They begin decades before the dementia. People who are 30 and 40 who are doomed to get Alzheimer's already are developing these changes in the brain. Right now there is a strategy going on in most countries, including Canada—which is just being pulled together by Dr. Serge Gauthier—to investigate the proposals that have been made for early diagnosis. Ridiculous as it sounds, this includes pre-symptomatic diagnosis. We actually have the tools, if we wanted to use them, that could detect the signs of impending Alzheimer's before you actually have conditions that Dr. Lester was just referring to. But they are not necessarily going to be approved.

They are potentially expensive. One of them, the spinal tap, is invasive and potentially dangerous. If we could do all of those things without any discomfort, then we could actually pick up people, and they could start to address the possibility that they're going to get Alzheimer's even before they have any symptoms at all.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

With the increase in Alzheimer's and the fact that I think just every home doesn't have the capacity or the ability to really provide the services needed and the stimulation needed for these people, it's becoming more of a warehousing issue. Especially with the baby boomers and the early onset, the programs are just not in place. I don't think this is a responsibility province to province. I think as a whole, when you're looking at early onset, we have to look at programming on the national level, to say this is what we need to do to assist them in being able to stay productive while they're in long-term care facilities or while they're being cared for by a caregiver—and I was one of those caregivers, by the way.

I'm just wondering, as to the strategy and the role of the federal government, what would you like us to hear a little bit more today that may have been missed or that hasn't been emphasized enough?

[Shannon MacDonald]

There are key tables that these issues could be raised at, so that the levels of government could be working together to start to address some of these things that perhaps are delivered by a province or a territory but that we want to be universally available across the country. So I would strongly encourage the Government of Canada to take a leadership role and take these issues to FPT tables, particularly around health.

Every provincial and territorial government across the country wants to keep its citizens productive. They recognize the economic benefits of keeping people at home for as long as possible. There isn't a track to run on right now, and some leadership around bringing the issues forward at the policy table, where real conversations can happen about solutions, I believe would be one of the single most important things that could come out of this work.

[Dr. Jack Diamond]

This applies not only to Alzheimer's disease. There are other diseases. We know of one gene that makes you susceptible to Alzheimer's. It's a simple test, but you couldn't just go to a hospital and get it. Your doctor might be able to get if for you if he thought there were reasons why he would like to be sure that you are or are not on the way to getting Alzheimer's. It's called the ApoE4 test. This is a question that really hasn't been discussed as openly as it should.

I believe in the States, if you go into a hospital, they routinely test for this gene—but they don't tell the patient, it's buried in the records—because it might help the clinician make a diagnosis subsequently.

[The Chair, Conservative, Joy Smith]

Just be very brief, please, Ms. Benczkowski, and then we're going to stop.

[Deborah Benczkowski]

I'll say just two things. Recently, in meetings I've had in Ottawa with members of Parliament, the Alzheimer Society has received two messages, one being that any issues around the creation of a strategy will not be looked on very favourably, that the push for having strategies is really not something the government will support. That is one message I heard.

The second message I heard is that any kind of work at the federal-provincial-territorial table should really come up through the provincial ministers, not from the federal minister.

So I would suggest that that's a real opportunity for this subcommittee to come forward with a clear recommendation.

I agree with what Shannon said in terms of the federal government having a real role in taking leadership on developing a brain strategy and addressing these issues.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

I want to thank the panel for coming today and giving us your very insightful information.

This committee, I believe, is a very unique committee. People are very committed. You understand that at the committee everybody has their wish list. If you wanted to pay astronomical tax dollars, we could put everything into health care. But the strategy around neurological disorders is something this committee wanted brought to the forefront, to do what we could to address it. It is, I think as never before, an emerging health issue that's really never been addressed the way we need it to be.

But I have to tell you quite honestly that if you brought people in talking about cancer—talking about anything else—they would come with the same zeal and the same demands, and probably the same picture. What makes this different is that this is something, in our view, that we've never really had in front of a committee. And I give credit to all my colleagues who have taken up the torch and really want to get this examined, as we all do.

I think all of us have had someone in our lives or someone who has touched our lives.... This is not foreign to us because we are members of Parliament, as Ms. Hughes has so eloquently attested to. So the understanding about caregiving and about this research is of paramount importance for us to hear and to put forward.

Thank you so much for joining us today.

I will adjourn now until our next meeting.