Ask the Expert: Can dementia pass onto the individual's children and grandchildren?

Yes, but it depends! It depends on what you mean by "dementia". As we have explained in previous blogs, most cases of dementia in people over the age of 65 are caused by Alzheimer's disease. There are 2 types of Alzheimer's disease; "sporadic" Alzheimer's disease and "familial" Alzheimer's disease. The vast majority of cases of Alzheimer's disease are the sporadic type, and having a "first degree relative" (e.g. parent or sibling) with the disease, increases your risk of developing the illness by 2-3 times compared to someone your age that doesn't have a relative with the illness. But "familial" Alzheimer's disease is even worse - if you have a parent with the illness, your risk of developing Alzheimer's disease is 50% . The good news here is that familial Alzheimer's disease is exceedingly rare - only 1-2 % of all cases of Alzheimer's disease. Unfortunately, the risks for other types of dementia, like vascular dementia (dementia due to strokes and cerebrovascular disease) and frontotemporal dementia are also elevated for many family members. While we cannot do anything about our genetics, we can all certainly attempt to lead "brain healthy" lifestyles to delay the onset and reduce the risk of developing dementia as we age.

Professor Nathan Herrmann 

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair in Geriatric Psychiatry

Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre

What It’s Like Having a Grandparent with Alzheimer’s

In all the TV shows I watched as a little girl, the kids would often visit their grandparents on the weekends. Whether it was an episode of Caillou or the Berenstain Bears, the children would always have a fun weekend with their grandparents, as they baked cookies together and looked through old photos. But for me, my weekends with my grandparents were nothing like the TV shows. What I didn’t understand at the time was that my grandfather was beginning to develop dementia.

Since his diagnosis of Alzheimer's disease, my grandpa's condition has only worsened. Sometimes, he leaves the house to go for a walk, but then forgets how to get home and cannot remember his own address. Fortunately, his neighbours help him and bring him home safely. After a few incidents of wandering, we knew that it was too dangerous for my grandpa to leave the house alone. So we installed a second lock on his door. Today, he can’t leave the house alone unless my grandmother unlocks the door.

But the hardest part of this journey is seeing my grandfather become frustrated with his failing memory. "I’m useless; I can’t remember anything" are his most common phrases nowadays. It's really heartbreaking to see him so discouraged.

Despite the burden of this illness on both my grandpa and myself, it is more important that I cherish the moments I spend with him, rather than focusing on his suffering. I'm grateful that he still remembers me and I choose to take each day as it comes, because I never know when it will be the last. I'm afraid of the day when he won’t remember me anymore – when I will no longer be his only granddaughter, but a stranger. The day when he loses his battle to dementia will be the most difficult day. So that's why I hold onto our memories, even if I have to explain to him what a selfie is every time. I’m blessed to hold his hand every step of the way, while this illness takes him away from me. Although his condition deteriorates, I love him unconditionally and hold in my heart the one thing that will never change – dementia will never take away my grandfather and our memories shared together. I will always remember them, as long as I can.

My story is only one in 1.1 million Canadians who are affected directly or indirectly by this disease. For those of you who have a loved one with dementia, know that you are not alone. Yes, it will be difficult, but know that the pain and suffering that comes with the illness is accompanied by the compassion and love we have for them.

Ask the Expert: In the future, will dementia start affecting individuals at younger ages?

No! In fact, in the future dementia will hopefully begin even later in life, if we manage to control obesity, diabetes, high blood pressure, and other vascular risk factors. 

Only a small number of cases of dementia begin in the 50s (and some even in the 40s), and many of these are either cases of "Familial Alzheimer's disease" or Frontotemporal dementias which are strongly genetic illnesses. The most common dementia is Alzheimer's disease which typically begins in the 60s, 70s and 80s. While genetic factors do influence the age of onset of this disease, vascular risk factors also play a role. By reducing the rates of smoking, treating high blood pressure, high cholesterol and diabetes, and reducing the rates of obesity, the onset of this illness could be delayed. Results from the famous Framingham Heart Study in the US have already begun to show the incidence of Alzheimer's disease appears to be declining, likely as a results of the benefits of these interventions. Along with exercise, mentally stimulating activities and a Mediterranean diet, it is possible we can even push the onset of the disease much later into life. Finally, if we can find a disease modifying agent that delays the onset of the illness by even 5 years, we will be able to cut the number of patients with dementia in half. 

Professor Nathan Herrmann

Nathan Herrmann MD FRCPC
Professor, Faculty of Medicine, University of Toronto
Lewar Chair in Geriatric Psychiatry
Head, Division of Geriatric Psychiatry
Sunnybrook Health Sciences Centre

Research Update: The Relationships between Dementia and Nutrition

In 2014, researchers from the Global Observatory for Ageing and Dementia Care at King’s College London investigated the relationship between dementia and nutrition. The report, published by Alzheimer’s Disease International, touched on many links between nutrition and dementia, as summarized below.

First, a connection was found between nutrition, fetal development, and dementia, as the micronutrients and fats accumulated as a fetus can affect the development of the brain and nervous system. In turn, this may affect one’s risk of developing dementia in the future. 

In addition, researchers investigated the relationship between dementia and fats. While fats may be harmful for the brain if consumed in excess at mid-life, they can also act as an energy reserve to combat the neurodegenerative effects of dementia. However, further research is needed to explore the relationship between fats and cognitive function.

The report also explained that a Mediterranean diet may be key to preventing dementia. The Mediterranean diet, which consists of lots of vegetables, olive oil and fish, can reduce the risk of cardiovascular disease. As a result, this may potentially reduce the risk of dementia. There are many studies reporting a positive correlation between a Mediterranean diet and a lower risk of dementia; however, some studies have found no correlation at all.

Aside from nutrition and dementia prevention, there is also a link between malnutrition and patients with dementia. Weight loss is very commonly observed in dementia patients due to lower nutritional intake. It was found that dementia-related neurodegeneration may impact brain regions responsible for appetite control, thus contributing to the observed weight loss. The reason why malnutrition is a notable symptom of dementia is because in many cases, it proves to be fatal. This study suggests that eating habits of dementia patients can be improved through: caregiver education about the importance of nutrition, giving patients oral nutritional supplements, using feeding assistance tubes, and more.

For more information on this report, visit http://www.alzheimer.ca/sites/default/files/files/national/breaking-news/adi-nutrition-and-dementia.pdf

Ask the Expert: Are there any blood tests to screen for dementia?

Unfortunately, there are no blood tests to screen for dementia. In fact, there are no tests of any kind that can make the diagnosis of dementia, while a person is alive. The diagnosis is made by a medical doctor (MD) who takes a history, performs a physical exam, and does some cognitive testing, which includes things like assessing memory, concentration and language skills. Frequently, the physician will also order some routine blood tests to ensure there are no other medical conditions that could interfere with memory - like diabetes, thyroid problems or infections. The MD might also order a CT scan or MRI of the brain to look for evidence of strokes, or patterns of brain shrinkage that could help identify if a specific type of dementia is more likely than another. 


The search for a blood test which accurately identifies Alzheimer’s disease or other types of dementia is an active area of research, though no tests developed so far are sufficiently accurate.

Professor Nathan Herrmann 

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair in Geriatric Psychiatry

Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre

Research Update: New Ways to Treat Alzheimer’s by Opening the Blood-Brain Barrier

In May 2017, scientists at Sunnybrook Health Sciences Centre in Toronto, Canada made history as the first in the world to use focused ultrasound to temporarily break through the blood-brain barrier (BBB) in patients with Alzheimer’s disease.

The BBB is composed of high-density cells around the smallest blood vessels in the brain, known as the capillaries. While preventing toxic substances in the bloodstream from reaching the brain, this barrier, however, also prevents drug therapies from entering the brain to treat diseases. As Dr. Sandra Black – internationally renowned Brill Chair of Neurology at Sunnybrook Health Sciences Centre and University of Toronto – says, “There are many therapeutic drug treatments that do not work or cannot be properly tested in Alzheimer’s disease because they cannot pass the BBB.”

In November 2015, Sunnybrook researchers successfully opened the BBB for the first time, testing the ability to deliver chemotherapy directly into a patient’s brain tumour. Using MRI-guided focused ultrasound, this recent phase 1 trial in May 2017 was the first time the BBB was opened in patients with Alzheimer’s, although no drug treatments were given. If this trial is successful, researchers will consider conducting another trial to test introducing small amounts of drug therapies through the BBB. They may even target the part of the brain that is most affected by dementia – the hippocampus, which is responsible for creating new memories.

The ability to open up the BBB opens up new possibilities of treating brain disorders. “By opening up the BBB using low frequency ultrasound, we’ve taken a small but important step that opens up a whole new vista of possibilities. The hope is there may be a way to eventually open up multiple little windows, in a gentle way, in order to get large molecules like drugs and even stem cells into the brain,” says Dr. Sandra Black.

More information about Sunnybrook’s research on opening the BBB in dementia patients can be found here: https://sunnybrook.ca/media/item.asp?c=&i=1562&page=33939&f=alzheimers-focused-ultrasound-blood-brain-barrier