When she was in her late 60s, Diana Pritchard began noticing that her memory wasn’t what it used to be. She’d forget to show up to appointments and found that she had to rely increasingly on notes to help her remember things. Concerned about her memory changes, she spoke with her doctor and got a referral to St. Michael’s Memory Disorders Clinic, one of only a handful in Toronto.
Dr. Corinne Fischer, director of the clinic, met with Pritchard and, after a battery of cognitive tests and brain imaging, determined that she had mild cognitive impairment.
“We found a change in her brain function, but she wasn’t displaying any changes in everyday functioning, so at this point, we simply chose to monitor her every six months and recommended lifestyle changes, such as more physical exercise, social engagement and mental activity,” said Dr. Fischer. “We also gave her the option of enrolling in one of our research studies that are studying this specific population.”
St. Michael’s Memory Disorders Clinic sees about 100 new cases and 200 to 300 reassessments per year. What makes the clinic distinct is the incredibly diverse population it serves. The hospital’s densely populated downtown catchment area spans some of Toronto’s wealthiest and most disadvantaged neighbourhoods, include homeless and immigrant populations, and is home to people from dozens of different ethnic groups. The clinic’s patients range in age from 19 to 100, with the average age being 60.
Coupled with the fact it is closely linked with neuroscience and neurology as well as the newly formed Toronto Dementia Research Alliance, St. Michael’s is an ideal place to conduct dementia research. It’s allowed researchers to examine major themes in dementia, such as functional impairment, behavioural symptoms and cognitive reserve – the ability to preserve memory.
In 2011, Dr. Tom Schweizer, head of the St. Michael’s Hospital Neurosciences Research Program, published groundbreaking work that found Alzheimer’s patients enrolled at the clinic who spoke more than one language had twice as much brain damage as unilingual patients with the same level of clinical disease based on analysis of CT scans. This provided the first physical evidence that bilingualism delays the onset of Alzheimer’s disease.
As Pritchard was being actively followed at the clinic, she was able to start on cognitive enhancing medication at the earliest possible time when she started to display active symptoms of Alzheimer’s disease. Because Pritchard was diagnosed early – starting treatment as soon as possible gives patients the best chance at preserving their memory – she was able to be quite independent at home and continue her daily routine. Ten years after first coming to the memory clinic, Pritchard is only now contemplating moving to a long-term care home.
“Unfortunately, despite our best efforts and treatment, dementia progresses,” said Dr. Fischer.
St. Michael’s memory clinic, in addition to providing outpatient care, services seven long-term care homes in its catchment area, so when the time comes for patients such as Pritchard to move into a long-term care home, her continuum of care will not be disrupted. If she moves into one of the long-term care homes in the area, she will be seen by the same team who’s cared for her from the start. This includes an attending geriatric psychiatrist, a behavioural neurologist, nurse clinician, medical students, and residents and research assistants.
“The benefit of continuity of care is that we have a thorough understanding of the patient,” Dr. Fischer said. “We’ve also gotten to know and developed relationships with the caregiver and the family. It’s about really knowing the person and his or her situation.”
St. Michael’s recently became an official member of the Toronto Dementia Research Alliance, a group of all the University of Toronto-affiliated memory clinics.
“The hope is to provide access to innovative research for patients at all stages of dementia and improve their quality of life,” said Dr. Fischer.