Toronto Estate Law Blog : Toronto Estate Lawyer : Hull & Hull Law Firm : Trust Mediation and Succession Planning : Serving Ontario, Ottawa, Mississauga, Hamilton

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A controversial article written by retired physician Ken Murray entitled "How Doctors Die" has people talking about advance directives - also known as Living Wills.

Advance directives are legal documents which express a person's wishes with respect to the kind of health care they want to receive in the event they become unable to make medical decisions for themsleves.  Legislation in Ontario requires that advance directives be considered when others make health care decisions on your behalf. 

Pursuant to section 21(2) of the Health Care Consent Act:

"A person who gives or refuses consent to a treatment on an incapable person's behalf shall do so inaccordance with the following principles:

1. If the person knows of a wish applicable to the circumstances that the incapable person expressed while capable and after attaining 16 years of age, the person shall give or refuse consent in accordance with the wish.

2. If the person does not know of a wish applicable to the circumstances that the incapable person expressed while capable and after attaining 16 years of age, or if it is impossible to comply with the wish, the person shall act in the incapable person's best interests."

A recent study found that about 67% of physicians prepare advance directives - while less than half of lay severly or termanilly-ill patients do.  Those who did prepare advance directives were three and a half times more likely to refuse certain types of medical intervention, including "rescue care" such as CPR. 

Ken Murray's article highlights the irony of a system where most physicians make the personal choice to refuse the very same procedures they perform on patients everyday.  In his article, he suggests that physicians are adverse to "futile care" because they know from experience that such procedures often merely prolong and exacerbate suffering, especially when performed on unhealthy elderly and/or chronically ill patients.

So, whether your instructions are to avoid so-called heroic measures, or to encourage the use of any means possible to elongate your life, advance directives are an excellent way to clarify your views with respect to your health care plan.  They also assist your substitute-decision maker in making difficult choices consistent with your wishes. 

Moira Visoiu - Click here for more information on Moira Visoiu. 

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A ‘controlled substance’ is any type of drug whose manufacture, possession or use is tightly regulated by a government because of the higher-than-average potential for abuse or addiction. In Canada, controlled substances fall under the parameters of the Controlled Drugs and Substances Act (S.C. 1996, c.19).  How is it, then, that hundreds of thousands of doses of OxyContin, morphine and other prescription narcotics are ‘robbed, pilfered or otherwise lost’ from the supply chain each year in this country?

On January 23, the National Post’s Tom Blackwell published some startling statistics about the not-so-slow leak of prescription narcotics from the supply chain. According to the Post’s research (based on Health Canada statistics), only 64% of the loss and theft of oxycodone (the active ingredient in OxyContin) is attributable to theft from, or robbery of pharmacies. Suppliers higher up the chain (e.g. manufacturers and importers) are also losing significant volumes of product, accounting for the other 36% of total loss. What scale of loss are we talking about here? If we just look at oxycodone, the combined black-market value of losses from pharmacies and ‘licensed dealers’ (producers, distributors, wholesalers) in 2010 was just over $18 million. That’s roughly a half million tablets.  Professor Benedikt Fischer, an addictions expert at Simon Fraser University summed it thusly: “This isn’t some trivial problem. We’re now looking at a problem that is a major source of disease and death. These drugs are killing a lot of people.”

The volume of drugs taken from wholesalers and distributors has also increased substantially in the past five years.  It is difficult to put a finger on any single cause.  Blackwell's article presented some prime suspects for consideration, including cutbacks in the number of controlled substance inspectors and the bare fact that a trend of increasing prescription rates for opioids translates into more opioids being in the proverbial pipeline.

It is critical that Health Canada gets to the root of the supply chain leaks.  Fischer's "these drugs are killing a lot of people" was no overstatement.  Indeed, as discussed in an earlier blog, accidental deaths in Ontario due to opioid use exceed deaths from HIV.  And from the Globe and Mail (January 6, 2012): the same number of people die from opioid-related deaths in Ontario each year as they do from motor vehicle accidents.  

Jennifer Hartman, guest blogger

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Nursing homes in Ontario select healthier patients over those who require more care, according to an expert in Ontario. This leads to backlogs in hospitals while patients with high needs wait for a nursing home that will accept them.

According to Healthzone, Dr. David Walker commented on the plight of an elderly woman who was threatened with a bill of $1,300 a day if she refused to vacate her bed at Toronto East General. The 84 year old patient suffered a stroke two months before and now requires a feeding tube to eat, but there are a limited number of nursing homes with the ability to care for her. 

“If she were walking around the floor of Toronto East General, looking forward to being able to go to a nursing home where she would be able to feed herself and play cards, she would be gone in a flash,” Walker said.

“The incentive at the moment is that you fill up your nursing homes with the healthiest people and our health system ends up burdened with all sorts of people with high needs,” he added.

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A recent study by the Alzheimer Society of Canada reportedly indicates some compelling information about Alzheimer’s diagnosis, including:

·                    it is estimated that 1.1 million Canadians will be affected by the brain disorder in the next 25 years;

·                    almost half of Canadians surveyed lived a year or more with their symptoms without seeing a doctor, and 16% of this group waited more than two years;

·                    among the most common early symptoms were frequent memory loss, disorientation of time and place and changes in personality, and more than half of the respondents indicated the reason for the delay was the belief that symptoms were part of “old age”; and almost a third of respondents cited their family member refusing to see a doctor as cause for delay; and

·                    delayed diagnosis results in a large treatment gap, and prevents people from getting valuable information about medications, support and better disease management.

The Alzheimer Society of Canada reportedly emphasizes the importance of getting the word out about investigating dementia, since awareness can help one get support, plan for the future and take advantage of the pharmacological and other ways to deal with the disease.

Have a good day,

Natalia R. Angelini - Click here for more information on Natalia Angelini. 

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Mele Kalikimaka is the thing to say
On a bright Hawaiian Christmas Day.
That's the island greeting that we send to you
from the land where palm trees sway.
- Mele Kalikimaka, as sung by Bing Crosby, or Don Ho, or Jimmy Buffett, or the tormenting little gremlin in my head at 3 a.m.  Take your pick.

It all started on November 1st, 2011.  I am referring, of course, to the launch of "Continuous Christmas music" on Star 102.5, your friendly station from across the puddle in Buffalo, New York.   I was in the car, surfing radio stations, when I made the grave error of landing on 102.5 FM.  With the kids in the backseat.  No putting the toothpaste back in the tube on that one.  Every day since then (when did Christmas morph into an 8-week affair, I ask you?) I am forced to listen to Madonna's DNA-unraveling attempt at "Santa Baby", the thankfully-only-occasional "Last Christmas" (WHAM.  Oh George - why didn't you answer any of my fan mail in high school?) and the radiator-rattling Mannheim Steamroller.  And then it happened, really, I'm not sure how, but it just did: Mele Kalikimaka was stuck in my head.  Didn't matter if I was working, vacuuming, driving, cooking... that piece of tropical treacle was doing laps in my head and there was no off-ramp in sight.   

James Kellaris, associate professor of marketing at the University of Cincinnati refers to this phenomena as 'getting bitten by an earworm'.  As detailed in an article in the December issue of Mental Floss magazine, "certain pieces of music may have properties that excite an abnormal reaction in the brain - a cognitive itch".  We rehearse the tune in our heads in order to scratch said itch, but the outcome is a form of perseveration hell - you have, in fact, exacerbated the itch so that the rehearsal becomes involuntary and you are trapped, like me, on a bright Hawaiian Christmas Day.  According to Kellaris, songs that are simple, repetitive or have some aspect of incongruity in them are most likely to get stuck.

Fear not, my friend.  For every problem, there is a solution.  Kellaris states that the best cure for an earworm is to unleash an 'eraser tune'.  He theorizes that the eraser tune devours the earworm by 'combining the benefits of both distraction and replacement.'  Prudence dictates that the eraser tune of choice is itself not too sticky.

Whoomp...     ...there it is.

Jennifer Hartman, guest blogger

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The New York Times reported yesterday that 28-year old pre-eminent NHL enforcer Derek Boogaard did indeed have chronic traumatic encephalopathy (CTE) at the time of his accidental death in May of this year.  Boogaard is now the fourth of four former NHL players examined to show evidence of CTE. 

CTE is a form of progressive, degenerative damage to the brain caused by repetitive closed head injuries (i.e. ‘blows to the head’).  It is characterized by the buildup in the brain of an abnormal protein called tau which tends to form in clumps and disrupt brain function.  Part of Ann McKee's job is to solicit suitable brains for examination for the presence of CTE.  McKee is the co-director of the Boston University School of Medicine Center for the Study of Traumatic Encephalopathy, colloquially referred to as the Boston Brain Bank.  Within 24 hours of Boogaard's death, a phonecall had been placed from the Center to Joanne and Len Boogaard, requesting the brain of their son.  The Boogaard family readily agreed.  Sadly, in the span of time between the donation of the brain and the release of the results of the autopsy, NHL enforcers Rick Rypien and Wade Belak both lost their lives, reportedly due to suicide.  

While the presence of CTE in Boogaard is not unexpected, what did take researchers by surprise was the advanced degree of damage in someone so young.  “To see this amount? That’s a ‘wow’ moment,” McKee reportedly said when she viewed images of Boogaard’s brain tissue.  Had Boogaard lived, he likely would have developed middle-aged dementia as a result of the trauma to his brain. 

The last few years of Boogaard's life were tragic; blurred by post-concussion syndrome, a descent into alcohol abuse, a dependence on painkilling narcotics like Oxycontin and Percocet, self-neglect, repeated stints in rehab and ultimately, pervasive loneliness.   His legacy, however, will lie in the specter raised by the advanced CTE discovered in his young brain. As the Brain Bank's census of CTE-positive ex-NHL brains continues to grow, will the NHL change its tune about the link between hockey and CTE?  (According to NHL Commissioner Gary Bettman "it's way premature to be drawing any conclusions at this point.")  How will the NHL respond to this news?  How will it respond now to calls to rein in on-ice fighting? 

Let the debate continue.

Jennifer Hartman, guest blogger

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Dalton McGuinty has announced that, if re-elected, he intends to expand protected leave from work to employees to allow them to care for family members who cannot care for themselves due to serious injury or illness.

Currently, the Family Medical Leave plan allows employees to take up to eight weeks of unpaid leave to care for terminally ill family members. Under the expanded plan, employees would be entitled to the same eight week unpaid leave in order to care for ill or injured family members.

The plan is in addition to the eight weeks of protected leave afforded to employees with terminally ill family members.

Under the current plan, “family members” receives a broad definition: in addition to immediate family members, the definition includes foster children; siblings-in-law, uncles, aunts, nieces and nephews of the employee or the employee’s spouse; spouses of the employee’s grandchildren, uncles, aunts, nephews or nieces; and persons “who consider the employee to be like a family member”.

The employee must be “providing care” to the person. “Care” includes providing psychological or emotional support, or arranging care by a third party.

It is not clear whether the plan would allow employees protected leave to care for elderly or incapable family members. The press releases define the criteria for eligibility as “a serious injury or illness, including cancer or a stroke”.

At present, there is no corresponding Employment Insurance benefit during such leave (there is for leave for employees with terminally ill family members). The Ontario Government is calling on the federal government to extent Employment Insurance benefits to those taking advantage of the proposed expanded program.

Thanks for reading.

Paul E. Trudelle - Click here for more information on Paul Trudelle. 

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Spiders freak me out. I mean, they really...freak...me...out. I can handle the little ones; the ones with features so tiny, they are barely discernible. It’s the ones that have substantive girth, the ones with tricked out designs resembling alien heads on their backs  – those are the ones that cause me to fear for my personal safety. The logical part of my brain reminds me that I am 200 times larger than the average spider, and further, there are only 3 species of poisonous spiders in Ontario. In the battle mano a arachnid, I’m pretty sure I’d come out on top. So what’s with my visceral urge to flee? Why does emotion trump logic and hard data?

“What You Don’t Know Can Kill You”, an article in the July/August 2011 issue of Discover Magazine, speaks to the “perplexing tendency of humans to fear rare threats such as shark attacks while blithely ignoring far greater risks like unsafe sex and an unhealthy diet”. The author cites the recent example of Americans spending $200 to hoard $10 bottles of iodine pills after the Fukushima nuclear disaster in Japan. The U.S. EPA estimated the radiation reaching the west coast of the United States to be about 1/100,000th the dose one would receive on a round-trip international flight.  And yet over the course of a few weeks, Americans wiped out pharmacy supplies of the drug.  Why are we so inept at gauging real risk?  According to the article, the core of the issue lies in conflicting inputs: logic vs. instinct. The instinct part of the equation appears to have roots in evolution, which results in a healthy fear of sharks, bobcats and the like. The article states that deep inside the amygdala (the brain's emotional core), "our hardwired gut reactions developed in a world full of hungry beasts and warring clans, where they served important functions".  No matter that each year, falling coconuts kill ten times as many people as sharks do.  Move over logic, emotion is driving this car now.

              * Photo courtesy of Jennifer Hartman and one heckuva digital zoom function

Jennifer Hartman, guest blogger

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No more lineups at your local ServiceOntario kiosk.  No more downloading forms (only to have them wait patiently by the front door for the mail strike to end, but I digress).  At long last, residents of Ontario can now register online as an organ and tissue donor on a new website: BeADonor.ca.

In August 2010, I blogged about the tedious and onerous process of organ donor registration in the province that existed at that time.  Adding to the confusion is the widely held belief that carrying a signed organ donor card is tantamount to formal registration.  It isn't, and therein lies the glitch; a signed donor card is not recorded in the Ministry of Health and Long-Term Care's database, is often out of date, and is then subject to conflicting family wishes. 

There is no cost to register.  Online registration is easy, convenient, and secure.  1,500 people in Ontario are waiting for an organ donation right now.  Ontario's Health Minister, the Honourable Deb Matthews, issued a challenge on Tuesday when she expressed her hope that 1,500 new people will register by the end of the week.  If registering to be an organ/tissue donor has been on your 'to do' list for a while, take a few minutes and cross this one off. 

BeADonor.ca.

Jennifer Hartman, guest blogger

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On Thursday February 17, 2011, in the idyllic-sounding community of Sunny Isles Beach, Florida, former Chicago Bears safety Dave Duerson shot himself in the chest. He left behind a suicide note that read: “Please, see that my brain is given to the NFL’s brain bank.”

Duerson was 50 years old at the time of his death.

According to Ann McKee, the co-director of the Boston University School of Medicine Center for the Study of Traumatic Encephalopathy, the results of tests on Duerson’s brain revealed “classic pathology of CTE and no evidence of any other disease. He had severe involvement of areas that control judgment, inhibition, impulse control, mood and memory.” In spite of these cognitive deficiencies, it is not a grand leap to infer that Duerson had a great depth of insight into his condition or the arc his disease would follow in the future.

CTE (chronic traumatic encephalopathy) is a form of progressive, degenerative damage to the brain caused by repetitive closed head injuries (i.e. ‘blows to the head’). It is characterized by the buildup in the brain of an abnormal protein called tau which tends to form in clumps and disrupt brain function. CTE first came to public light after it was identified in the brain tissue of former Philadelphia Eagles player Andre Waters after his suicide in 2006.  The CSTE Brain Bank was established in 2008 for the sole purpose of collecting and studying post-mortem brains, because there is no medical test that can detect CTE in a living person.  The Brain Bank ultimately hopes to answer some of the critical questions about CTE.  How many concussions does it take to cause CTE? Is CTE time-dependent? -  is it the number of years of repeated blows that will determine who gets CTE and who doesn't?  In 2009, McKee published a study indicating that of the 51 confirmed cases of CTE at the time, 90% of the cases occurred in athletes.  If you have 10 minutes to spare today, watch this TIME video called "This is Your Brain on Football" in which McKee is featured.

Last Friday, 28 year old New York Rangers enforcer Derek Boogaard was found dead in his Minneapolis apartment. While details regarding the specific circumstances surrounding his death have been few, it spoke volumes that within 24 hours, Boogaard’s family had stepped forward to donate his brain to the Boston University School of Medicine.  

Jennifer Hartman, guest blogger

* image courtesy of Microsoft

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Blog subscribers are already familiar with the story of my daughter, my “Pirate Princess”, who was diagnosed last summer with a severe form of amblyopia; so severe in fact, that her brain was only exchanging messages with one of her eyes. Since her diagnosis, she has become a patient in the Ophthalmology Clinic at McMaster Children’s Hospital in Hamilton.

The McMaster Children’s Hospital (“Mac Kids”) Fundraising Council has launched a $1.3 million campaign to create the province’s largest centre of excellence for specialized pediatric eye care. I am proud to be Co-Chairing the Campaign for Pediatric Ophthalmology because of the extraordinary and utterly inspiring care my daughter receives at Mac Kids and because it will help save the sight and lives of countless children.

There are 8,000 visits to the existing eye clinic each year, although it was built decades ago for adult patients, and is equipped with aging and inadequate infrastructure. The benefits of a brand new, cutting edge Ophthalmology Unit specifically designed for treating children will be truly transformational.

As Co-Chair of this Campaign, I wish to express my sincerest thanks to Hull & Hull LLP. In yet another demonstration of their community-mindedness and generosity, the firm is among the first to step forward to support the McMaster Children’s Hospital Campaign for Pediatric Ophthalmology. In doing so, Hull & Hull LLP has seized the opportunity to ensure that children in the region have access to the best care by investing in McMaster Children’s Hospital. Hats off to you for your leadership, Hull & Hull LLP!

For more information about the Campaign for Pediatric Ophthalmology, or for information about how you can support Mac Kids, please contact Jennifer Laughton, VP Development, McMaster Children’s Hospital by email (jlaughton@HHSC.CA) or by phone at 905-521-2100 ext. 75977.

Jennifer Hartman
Guest Blogger
Member, McMaster Children’s Hospital Fundraising Council
Mac Kid Mom
 

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It was April 2000 and then-mayor of New York Rudy Giuliani was at his desk when he got the call. The voice on the other end of the phone was that of his urologist, who was about to deliver the results of Giuliani’s recent biopsy for prostate cancer: “The tests came back and they were positive”. Giuliani said thank you and hung up the phone with relief, believing that 'positive' had been used in the literal sense. In his mind, ‘positive’ meant ‘good news’. In fact, a positive test, in medical terms, indicates the presence of the parameter for which the test has been run. Giuliani had prostate cancer.

Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions". A 2006 study by the U.S. Department of Education found that 36 percent of adults are only able to understand hospital discharge instructions written at, or below, the fifth-grade level. Canadians don’t fare much better. In 2007, the Canadian Council on Learning (CCL) reported that only 40 percent of Canadians had the necessary skills to understand and act upon health information. Both the U.S. and Canadian studies revealed that poor health literacy disproportionately affects the poor, the unemployed, and recent immigrants. Statistics amongst seniors are particularly shocking; 88 percent have less than adequate health literacy skills.  Even geography plays a role, as illustrated graphically in this interactive map produced by CCL as part of their report.

Solutions that bridge the gap between the medical community and the patient abound: the use of computer software to flag jargon and suggest alternatives (e.g. replace ‘hyperlipidemia’ with ‘high cholesterol’), the use of videos or handouts with lots of illustrations, the creation of opportunities for ‘teach-back’ that allow the doctor to confirm that his/her instructions were fully understood, and enhanced follow-up care after discharge to home from hospital.

Why are governments interested in health literacy? Susan Pisano, Vice President of Communications for America’s Health Insurance Plans sums it thusly: “Health literacy affects every single thing we do. The implications are mind-boggling.” Poor health literacy leads to higher rates of hospital readmission, unnecessary complications, and even death. Solid health literacy, in short, contributes to good health.

Jennifer Hartman, guest blogger 

* photo courtesy of iStockphoto

 

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I thought I would end the week by tying a few events from the past week together. Of course, Monday was St. Valentine’s Day (I hope you didn’t forget), and on Tuesday, I blogged on the odds of dying from certain causes.

A story reported on by KTLA in California seems to tie these two diverse topics together.

According to the story, an 18 year old Welsh woman shared a first kiss with her boyfriend. Moments later, she collapsed and died. Although the exact cause of her death is not known, it is believed that she suffered from a hidden heart rhythm disease brought on by Sudden Arrhythmia Death Syndrome (“SADS”). 

According to the SADS Foundation, each month in the United States, between 250 and 600 young people die suddenly and unexpectedly due to cardiac arrhythmias. As many as 12 in every 5,000 young people may have one of the conditions that can cause sudden cardiac death. Most sudden cardiac deaths are due to hereditary conditions. Most cardiac arrhythmias and structural defects that may cause sudden death are identifiable and treatable.

As with most conditions such as this, education goes a long way towards saving lives. Please visit the Canadian SADS Foundation for details of the warning signs, and other information. 

Do it for someone you love.

Have a great Family Day weekend.

Paul E. Trudelle - Click here for more information on Paul Trudelle.

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The frontal lobe of the brain is a true workhorse; it is responsible for reasoning, planning, sequencing, modulation of emotions, and conversion of thoughts into speech. The temporal lobes (one right, one left) are no multitasking slouches either. They serve to process auditory sensation and perception, are integral to language comprehension, and also play a role in the formation and retrieval of long-term memories. 

In frontotemporal dementia (also referred to as Frontal Lobe Dementia), the frontal and/or temporal lobes degenerate, resulting in dramatic personality and behavioural changes. These changes can include lack of insight, impaired judgment, lack of empathy, loss of inhibitions, inappropriateness, a general decline in social graces, impulsivity, withdrawal, ease of distraction, and perseveration of actions. In the later stages of FTD, symptoms include loss of language (‘aphasia’) and loss of muscle movement (‘akinesia’).

Onset of frontotemporal dementia (FTD) can occur at any time during adult life, however most individuals are typically between 50 and 60 years of age. There is currently no known cure for FTD, nor is there a means of slowing its progression. The average length of disease is about 8 years.

FTD accounts for approximately 2-5% of all dementias. Risk factors for the development of FTD are currently unknown, however there is a form which is passed genetically from one generation to the next, although it is extremely rare.

Jennifer Hartman, guest blogger
* image courtesy of Fotolia

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Worse than watching Sidney Crosby’s head hit  on New Year's Day, was watching Crosby’s attempt to right himself after the blow and skate off the ice. Dr. Wennberg, a University of Toronto concussion expert and NHLPA consultant, summed it thusly: “To see it was painfully obvious. The telling sign was when he tried to get up. Mr. Crosby’s right foot slipped behind him as he got back on his feet, and his mouth guard slipped out of his mouth – subtle signs that that the hit from Washington Capitals winger David Steckel jarred Mr. Crosby’s brain.” Diagnosis: Concussion.

The word concussion is derived from the latin concutere (“to shake violently”). By definition, a concussion is a traumatic closed-head brain injury caused by a blow to the head and resulting in a temporary loss of normal brain function. The old school of thought was that concussions were considered ‘minor head injuries’ because the effects were seemingly temporary, and indeed, most individuals who suffer from a mild concussion will have no long-term effects. There is increasing evidence, however, that some people who sustain a concussion, and an even larger proportion of those who sustain multiple concussions, will endure long-term consequences. In 2009, the NFL finally conceded that “It’s quite obvious from the medical research that’s been done that concussions can lead to long-term problems.” In fact, a study commissioned by the NFL found that former NFL players were being diagnosed with Alzheimer’s Disease at a rate 19 times greater than the background rate for their non-NFL peers (see last year’s blog by Rick Bickhram on dementia and the NFL).   Long-term neurological effects, which can be permanent, may include memory loss, poor concentration, impaired reasoning, seizures, and depression.  Still not convinced?  The February 2011 issue of National Geographic  includes a graphic photograph of brain deterioration due to repeated hits to the head.

For additional information on concussions, and to access resources on concussion prevention, please visit www.thinkfirst.ca , a national injury prevention charity founded by brain surgeon Dr. Charles H. Tator.

Jennifer Hartman, guest blogger

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Medical research has shown that regular physical exercise is effective in delaying the onset of dementia and Alzheimer’s disease.  Other studies have shown that people who continue to exercise not only their bodies but their minds may function better. Doing crosswords, playing board games and participating in leisure activities like dancing and playing musical instruments may reduce the risk of dementia.   

Getting one’s legal affairs in order can help prevent both crisis in the event of physical and mental incapacity and the unwelcome intervention of strangers in personal decision-making. By preparing Power of Attorney documents relating to both personal care and property, a person can express his wishes and advance care directives to loved ones. If people are open about the purpose and content of these kinds of documents, important discussions among family members may result that help clarify everyone’s expectations, abilities and needs. We have blogged several times on Powers of Attorney in a broad range of contexts. 

Taking simple, inexpensive steps to look after your body, your mind and your rights promises some protection for you and for your family in the event that dementia touches one of you.    

For more information on dementia or Alzheimer’s disease and the protection of the vulnerable people suffering from these illnesses, you could contact the Alzheimer’s Society of Canada,  the Advocacy Center for the Elderly and The Office of Public Guardian and Trustee. The Office of the Public Guardian and Trustee (OPGT) - Ministry of the Attorney General. Finally, there are several blogs and podcasts on our website that offer useful insights into many of the legal and social aspects of these illnesses.

Julia Evans - Click here for more information on Julia Evans

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Within hours of the unconscionable shooting of Democratic Congresswoman Gabrielle Giffords, the discussion turned to Giffords’ prognosis. The phrase ‘cautiously optimistic’ smattered the evening newscasts. In Giffords’ favour is a wealth of research indicating that undamaged areas of the brain can compensate for damage to brain areas that control language, movement, and even memory and attention.

The brain’s plasticity, also known as ‘neuroplasticity’, refers to the brain’s malleability, or ability to adapt in response to new experiences. The concept of neuroplasticity is relatively new; just a few decades ago, scientists believed that the brain was hardwired, and thus ‘fixed’. The times they are a-changing, and indeed, on February 26, 2010, ‘plasticity’ was knighted Word of The Day by the New York Times.

Neuroplasticity has applications in a number of facets of neurological inquiry.  For example, plasticity is relevant to stroke recovery and rehabilitation. Plasticity is also the cornerstone of studies that suggest that healthy aging (stimulating social interactions, regular exercise, and a healthy diet) can one day defend against Alzheimer’s Disease. The success of a cochlear implant is dependent on some degree of neural plasticity. When a child suffering from intractable seizures undergoes a hemispherectomy to remove half or a portion of half of the damaged side of their brain that is contributing to the seizure activity, plasticity allows the remaining brain to take over some of the functions of the lost hemisphere.

If your interest is piqued, here are some on-point links:

•  January 3, 2011 Newsweek article: Can You Build a Better Brain?
•  Oliver Sacks’ latest book: The Mind’s Eye (released October 26, 2010)
•  September 30, 2010 episode of CBC’s The Current: an interview with neuroplasticity pioneer Norman Doidge, M.D.
•  November 28, 2008 episode of CBC’s The Nature of Things: The Brain That Changes Itself
•  January 19, 2007 issue of TIME magazine: How the Brain Rewires Itself

Jennifer Hartman, guest blogger
 

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In the grey zone between benign forgetfulness associated with normal, healthy aging and the memory loss associated with Alzheimer’s Disease (AD), lies an intermediary condition known as mild cognitive impairment, or MCI. A person with MCI will experience greater memory problems than would be expected for his or her age and education, but would not suffer from the pronounced personality changes or cognitive problems (e.g. in the domains of learning, reasoning, decision-making) that characterize Alzheimer’s Disease, and would have ‘no significant daily functional disability’. According to Baycrest, individuals diagnosed with MCI have a 50% risk of developing AD within 5 years.

Since the introduction of the term MCI, two key questions have arisen:
i) How should MCI be diagnosed?
ii) Can we predict which individuals with MCI will go on to develop AD?

Clinical Diagnosis
The mechanisms by which MCI is diagnosed vary widely. Some physicians use the same diagnostic tests as those for diagnosing dementia; i.e. history-taking, physical examination, brief cognitive testing and possibly lab tests to rule out other reversible causes of memory loss. These tests are sometimes supplemented with imaging tools such as PET scans, CT scans and the MRI. In terms of cognitive screening tools, the Mini-Mental Status Examination has been shown to have low sensitivity to detect MCI while in contrast, the Montreal Cognitive Assessment has high sensitivity to detect MCI.

Risk of Progression
Research has demonstrated that there are measurable changes in people suffering from Alzheimer’s Disease many years before symptoms appear. Recent strides have been made in testing for these early changes, which include loss of brain volume and a reduction of a protein called amyloid in the cerebrospinal fluid.

It is estimated that 8% of Canadians over the age of 65 have dementia.

Jennifer Hartman, guest blogger

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The brain requires a constant flow of oxygen to function normally. In fact, the brain consumes about a fifth of the body’s total oxygen supply. When this flow is disrupted, brain cells begin to die, and one of two conditions results: i) hypoxic brain injury (due to a partial lack of oxygen supply to the brain); or ii) anoxic brain injury (due to a complete lack of oxygen supply to the brain). The two conditions are sufficiently related that the medical community uses the acronym HAI, which stands for hypoxic-anoxic brain injury.

Causes of HAI

The disease processes and injuries that can cause HAI vary widely, and include:
• stroke
• cardiac arrhythmia
• cardiac arrest
• suicide attempt
• near-drowning
• near-suffocation
• electrocution
• severe bronchial asthma attack
• carbon monoxide poisoning; and
• barbiturate poisoning.

Symptoms of HAI

Assuming one recovers from the initial loss of consciousness or coma, he or she may exhibit any of a number of symptoms. These cognitive symptoms may include:
• short-term memory loss
• a decline in executive functions (judgement, reasoning, information synthesis, attention, concentration)
• confusion
• depression
• hallucinations
• delusions
• personality changes; and
• language difficulties.

Prognosis

Chances for recovery from HAI are dependent upon length of unconsciousness, extent and location of brain damage, age of the victim, and initial recovery in the first month post-injury.

Jennifer Hartman, guest blogger