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

Welcome Back from Professor Nathan Herrmann and Student Chair Selina Chow

Last year, a group of students from Havergal College established the Dementia Awareness Program in partnership with Professor Nathan Herrmann - Head of the Division of Geriatric Psychiatry at Sunnybrook Health Sciences Centre. The purpose of our program is to increase the community’s understanding and appreciation of dementia, reduce the stigma associated with mental illnesses, as well as provide the valuable opportunity for high school students to volunteer with, and enrich the lives of people with dementia. While visiting the residents in a dementia care home in Toronto, Canada weekly, we shared our experience and the knowledge we learned about dementia with the community on this blog. Our blog has been a key tool in raising awareness of dementia and de-stigmatizing this common illness. Since we began our blog last year, we received more than 2,000 visits from over 10 countries worldwide - including United States, Russia, Mexico, Germany, Hong Kong, Argentina, France, Australia, Poland, and more.

We are very excited to be gearing up for another year of the Dementia Awareness Program this year, by continuing our community partnership between Havergal College students and a local senior’s residence, while also continuing our blog here. In particular, this year’s blog series will feature current research developments in dementia, along with “Ask the Expert” posts. We want to open up our blog to include your questions about dementia through “Ask the Expert”, which will be answered by Professor Nathan Herrmann. Please feel free to take advantage of this opportunity to ask our world-renowned expert, whether it be about the pathogenesis of the illness or how to interact with a family member with dementia. Questions can be submitted through the comments section on this blog. We look forward to receiving your questions!

We hope this will be of interest to you and the community. Together, we can learn more about this important cause and work to de-stigmatize dementia.

You can also follow Dr. Herrmann’s “Memory Doctor” blog for dementia caregivers at: http://health.sunnybrook.ca/memory-doctor/

Professor Nathan Herrmann and Student Chair Selina Chow

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

Week 15: Concluding Remarks by Professor Nathan Herrmann and Student Chair Selina Chow

Professor Nathan Herrmann 

The goals of the Havergal Dementia Awareness Project included increasing the community's understanding and appreciation of the problem of dementia, reducing the stigma associated with dementia and allowing a small group of senior students the opportunity to volunteer with, and enrich the lives of people with dementia. 

While many members of the parent body are aware of the problems associated with dementia, and may even have older family members with the illness, there's no question that for many of the students, reading our blog and speaking to our student volunteers, may have been the first opportunity to learn about Alzheimer's disease and other dementias. Given the aging of our society, the number of dementia sufferers is increasing dramatically, and this will lead to a huge burden on many (or most) families, as well as society as a whole. It is therefore essential that all of us are able to appreciate the signs and symptoms of the illness, and be prepared to help people with dementia to ensure their lives are healthy, safe, and as fulfilling and comfortable as possible. We all have a role to play in ensuring these goals.  

By visiting and spending time with a group of seniors with dementia, our Havergal volunteers entertained, comforted and stimulated these individuals, improving their quality of life. They tackled the stigma attached to the diagnosis of dementia by recognizing that people with dementia are no different from you and me – they have good days and bad days; they have likes and dislikes. But we all recognize that everyone with dementia has a similar need to be respected and treated with compassion. The student body can work towards spreading the word about the importance of this illness and the need to improve our understanding about the causes and treatment of dementia. The parent body can help ensure that local, provincial and federal governments are preparing appropriately to help families manage these people so that we don't become overwhelmed. Finally, fundraising for dementia research and the Alzheimer's Society, is something we can all participate in. 

It has been an absolute pleasure for me to work with the school and a fantastic group of dedicated, compassionate students over the past year. I am convinced they have accomplished the goals they set for themselves and wish them congratulations and success in their futures! Finally, I would like to thank the residents and staff at Cedarhurst Dementia Care Home for allowing us into their lives.

Selina Chow (Student Chair), Clarissa Yu, Daniela Krcmar, Katherine Ross, Olivia Nadalini, 
Dr. Erika Friesen

When we first started this Dementia Awareness Project, we were excited to embark on a meaningful journey to learn more about dementia – an illness that we did not know much about. As a group, our first step was to understand the memory loss issues those seniors face, followed by how it affects their daily lives. Before our visits to the dementia care home, we were nervous about how to interact with the residents there. We worried about things that could go wrong, asking questions such as, would they reject our visits? Would they be hostile to us? How should we respond in such circumstances? 

Nevertheless, before our volunteer work began, Dr. Herrmann gave us an overview about dementia and how to interact with someone with dementia. We continued to explore this illness further through readings and writing the weekly blog posts, under the guidance of Dr. Herrmann. As with all new endeavors, we have experienced a steep learning curve. We tried our best to apply what we had learned from Dr. Herrmann and from writing our blog to our weekly interactions with the seniors. During our visits to the dementia care home, some residents were easily approachable, while others were totally unengaged or even expressed frustration. Some would remember us from the previous week, whereas others would have no recollection of our visit. At the end of each weekly visit, we debriefed as a group about the highlights and challenges of our interactions. Every week, Dr. Herrmann has tirelessly explained to us why the residents behaved the way they did, and gave us strategies on how to deal with similar situations. We have learned more than we could have ever imagined from Dr. Herrmann, and our ability to engage with people with dementia has significantly improved. After the first few sessions, we were able to successfully engage the residents in conversation, arts and crafts, and even have a winter holiday sing-along with them! It is amazing to see how much the residents have come to enjoy our visits – a big smile appears on their faces when we arrive, and they always ask when they will see us again at the end of our visit.  

As we finish our volunteer work at the dementia care home for this year, we will miss the residents dearly and look forward to visiting them again soon. We want to thank the staff at Cedarhurst Dementia Care Home, who have supported us weekly and helped us organize all the activities we did with the residents. We also want to thank the residents and their families for allowing us to come into their lives, and trusting us with the stories and memories they hold closest to their hearts.  

While we are far from being experts in dementia, we feel comfortable and confident in dealing with seniors with dementia. We are proud to be ambassadors of this important illness to our school community. We are happy to know that we have raised awareness about dementia among our friends and family, as many of our peers have approached us at school to ask us more about dementia, share with us how they are affected by dementia, and what our work means to them. Of course, this is just the beginning and more can be done to raise awareness of and de-stigmatize dementia. 

We are very grateful to Dr. Herrmann for his unfailing support and encouragement, having mentored and guided us throughout our entire journey this year. Dr. Herrmann has been an excellent role model for us, and we truly appreciate the time he devotes to helping us despite his very busy schedule. We are very honoured to have Dr. Herrmann – an internationally renowned expert – as our mentor. Thank you, Dr. Herrmann.

Finally, we thank our readers for following our 15-week series of our Dementia Awareness Program this year. We sincerely hope that through our blog, you have been able to deepen your understanding of dementia and learn more about what the Havergal College students are doing for this important cause.  

For additional information on dementia, you can also follow Dr. Herrmann’s “Memory Doctor” blog for dementia caregivers at: http://health.sunnybrook.ca/memory-doctor/

Professor Nathan Herrmann and Selina Chow (Student Chair)

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

Week 14: Future Prospects in Dementia Research

Written by Dr. Nathan Herrmann, MD FRCPC

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

As mentioned in a previous posting, at the moment, there are only 4 drugs approved in Canada for the treatment of the symptoms of Alzheimer’s disease. These 4 drugs provide modest benefits at best, and do not change the inevitable progression of the illness. While there has been decades of intense research, Alzheimer’s disease still cannot be prevented, its inevitable progression cannot be appreciably slowed or halted, and even its symptoms cannot be dramatically improved. Research continues however, with scientists generally targeting the 3 major pathological components of the illness which are amyloid, tau, and inflammation.

One of the more disappointing failures in the last several years has been the antibody treatments, including the recent results with solanezumab. This did not slow memory and cognitive decline in a large, lengthy study of people with mild Alzheimer’s disease. This type of treatment, aimed at removing amyloid, has also failed in many other studies with similar agents. There are still a couple of other similar antibody therapies and drugs aimed at reducing amyloid that are going into trials this coming year. These include trials of individuals who do not have Alzheimer’s disease diagnosed, but are at high risk for developing the disease based on family history and/or genetic profile.

Another disappointment this past year was the failure of a drug aimed at tau. Given that the majority of treatments that have been researched to date have focused on amyloid, this much newer focus is potentially exciting, and several antibody treatments for tau are in early development. Finally, a number of drug treatments which effect insulin and blood sugar are being examined given an intriguing relationship between insulin, blood sugar and the development of Alzheimer’s Disease.

Dietary supplements have also received attention recently. Medium chain fatty acids or triglycerides have been studied and are currently being examined in several trials. Coconut oil is an excellent source of these fatty acids, and while likely completely safe, its use cannot be widely recommended at present given the lack of definitive research.

Non-drug therapies are also being studied intensively. Unfortunately, while researchers have been studying treatments like exercise and cognitively stimulating activities like computer games, these interventions have not yet demonstrated that they can effectively prevent or delay the onset of Alzheimer’s disease or other dementias. Direct brain stimulation using electricity, magnetism, and even special lights, is being studied as well.

We are involved in a particularly exciting study aimed at preventing Alzheimer’s disease. This study of over 300 people who are at high risk for developing Alzheimer’s disease will follow people for up to 5 years or longer. We have chosen 2 groups of older individuals who are at high risk of developing dementia – those with mild cognitive impairment (but no dementia), and those who have experienced a clinical depression in the past. These individuals attend an 8 week, daily classroom course of “cognitive remediation” with specialized computer games, as well as receive a safe neurostimulation treatment called transcranial direct current stimulation. While we are about halfway through the study, we are continuing to actively recruit subjects for the trial. If you, or someone you know are interested in this study, please call us at 416-583-1350. Perhaps together we will find a cure for this terrible illness!