Q1. How do you use the results from SPECT scans to assist in treatment?

 

A1. SPECT scan is a type of test that looks at general patterns of blood flow as a way to try to reflect activity and function. A brain SPECT scan is a tool that may help with diagnosis, but it is not a specific treatment. But, by being more confident about a diagnosis, it may help a clinician choose the right treatment recommendations for a person. A SPECT scan may not always show an abnormality and sometimes abnormal results can be challenging to understand, which is why not every clinician uses this type of test.

Dr. Philip Lee

 

 

Q2. What does diminished perfusion in the frontal region bilaterally and symmetrically into the parietal lobe show? Would these results ever get better, or go back to normal?

 

A2. It is difficult to interpret SPECT scans in isolation, as it is a functional measure. This could represent a neurodegenerative disease and thus would not get better, but could also be an effect from another condition projecting to these areas, such as damage from a brain injury, stroke or even a mood disorder such as depression, in which case it could recover.

Dr. Dean Foti

 

Q3. How would you suggest treating early onset frontotemporal dementia or Alzheimer’s Dementia?

 

A3.Thank you for your very important questions. We always advise looking at supports and non-drug strategies for the patient and family. Medication treatments vary depending on the symptoms which a person is experiencing. The details of each person's clinic history is very important in helping to determine the correct medication recommendations. So, specific advice about medication treatment needs to be discussed with a clinician who knows the person's case well.

Dr. Philip Lee

 

 

Q4. Are there other outside, non traditional hypothesis about the cause of dementia?

 

A4.There are many theories of Alzheimer disease causes, including chronic infections or inflammation. It is important to note that there are many contributing factors to the development of dementia, including about 15 gene variants, head injury, vascular risk factors, depression, chronic pain, etc.

Dr. Dean Foti

 

Q5. What is happening in the brain when someone is seriously compromised with ADL’s on one day and a day later highly functional comparatively?

 

A5. Thank you for an excellent question. The precise mechanism of this well recognized phenomenon does remain uncertain. Imprecisely, in individuals where "cognitive reserve" has declined due to neurodegenerative disease, relatively minor stresses (poor sleep, anxiety, etc.) may cross a 'threshold' whereby function is significantly compromised. In some individuals, when such changes are very common/pronounced, a specific causes of cognitive impairment (lewy body disease) would be questioned. In many people, a trigger for the reduced function is not easily identified.

Dr. Clark Funnell

 

Q6. Are you seeing an increase of Alzheimer’s dementia symptoms in correlation with long Covid?

 

A6. It would be too early to tell, as the effects of this may take years to show up. In general, people who have another thing that impacts their thinking skills, such as head injury, stroke, or in this case COVID, may reduce the cognitive reserve of someone and the effect of AD changes in the brain (the amyloid and tau) may show up more. There is no evidence presently that COVID actually triggers AD changes in the brain.

Dr. Dean Foti

 

Q7. Do you know of any research studies that discuss dementia induced from delirium?

 

A7.Many elderly experience UTI’s causing delirium, and no one seems to understand why this happens, or if some people will be able to return to their cognitive baseline prior to the delirium. There are many studies that describe associations between delirium and the subsequent development of dementia. The exact relationship is not fully understood. It may be the case that delirium is a marker of brain vulnerability, i.e. a marker of very early neurodegeneration (delirium occurring at an otherwise presymptomatic phase of a neurodegenerative disease, with symptoms unmasked by the stress/inflammatory response caused by infection).

Dr. Clark Funnell

 

Q8. 73% of Caregivers are women according to presenter Sherri Hayden. Is this because the majority of those with AD are men (ie husbands) or is there another explanation.

 

A8. Thanks for a very interesting question. The discrepancy would NOT be explained by a higher prevalence of AD in men (in fact, AD risk is higher in women). This likely does reflect sociological factors (i.e. women continuing to be more likely to be in a caregiver role) as well as demographics with women having a longer life expectancy.

Dr. Clark Funnell

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Q9. Why isn’t there better treatment offered by the medical community to test, monitor, and treat women’s hormones when the levels affect so many health issues especially cognitive issues?

 

A9. An excellent question. This is a very complex subject and I certainly cannot provide a comprehensive answer. Broadly, while the medical community has identified associations between hormone status and many health issues, in general, we do not yet have an understanding about how to interpret hormone testing at an individual level and what interventions/modification of hormones may be helpful for that individual. The hope of course is that with increased understanding, there will be targeted management suggestions at the individual level.

Dr. Clark Funnell

 

Q10. Can all people with Hydrocephalus be shunted if required. If not, what are the consequences & implications. For example, will the brain swell.

 

A10. It really depends on their ability to undergo and recover from surgery, like any surgery. If the patient truly has NPH their symptoms will likely continue to progress.

Dr. Alexandre Henri-Bhargava

 

Q11. Dr. Funnell, If you or one of the physicians can please provide more info around SSRIs and dementia risk at some point.

 

A11.There are several studies which have shown an association between taking SSRIs and subsequent development of dementia, however, this is NOT consistent across all studies. For example, a recent study which was prospective (i.e. enrolled patients who had no cognitive impairment and subsequently followed these patients for an average of 10 years) and published in 2022 did NOT find an association of development of dementia with antidepressant use (https://alz-journals.onlinelibrary.wiley.com/doi/abs/10.1002/alz.064077). That being said, if the association is in fact a true finding, whether it is causal or is the result of confounding is uncertain. It may be the case that symptoms of anxiety or depression are early symptoms of what ultimately progresses into a neurodegenerative disorder. If this hypothesis is correct, SSRIs could be treating very early symptoms rather than actually increasing risk in any causal way.

Dr. Clark Funnell

 

 

Q12.Need research on how to best deliver physiotherapy to dementia patients who incurred injuries who are older.  They seem to write of people with advanced dementia as they say they are unable to remember exercises they need to do, instead of finding ways to partner with care partners or create simply programs that health authority careaides could incorporate into care plan.  They forget the downstream effects of not providing physiotherapy... lost mobility can impact physical health on family caregivers costing the health care system more money as family caregivers need treatment.  Also loss of mobility leads to some of these individuals becoming a two person assist costing health authorities more as they have to send two careaides to home to assist in caring for the dementia patient who has incurred an injury.  just because a patients brain health is declining does not mean they are incapable of improving their physical mobility.

 

A12. As a physiothrepist myself I would be happy to connect via email to chat further. I have worked in long term care and understand the complexity of this issue. My email is sallyanne.stelling@ubc.ca

Sally-Ann Stelling