In estate litigation, we often hear about Alzheimer’s and how it can affect the daily lives of so many Canadians. Unfortunately, there is no treatment for Alzheimer’s at this time, other than medication that can be taken to (hopefully) slow its effects and prolong one’s quality of life.
Interestingly, Biogen Inc. has been working on what has been labelled a “controversial” new drug called “Aducanumab”. The controversy is, first of all, the rather bumpy ride this new drug has had with the U.S. Food and Drug Administration (FDA) and the regulatory approval that this treatment needs in order to be made available to consumers.
According to Biogen, if this drug receives regulatory approval, it will become the first treatment to slow decline in people with Alzheimer’s disease.
The problem is that to date, it is not clear as to whether there is “substantial” evidence of effectiveness which is what is required in order to gain the coveted regulatory approval that allows the drug on the market.
A recent update is not positive for Biogen as an independent advisory committee to the FDA found that the clinical data does not show the drug to be effective for the treatment of Alzheimer’s disease.
I am sure this is not the outcome desired by Biogen strictly from a financial perspective but it is certainly not a positive outcome for the many people affected by Alzheimer’s today.
Here is to hoping that if this treatment does not prove to be successful, that another one becomes available soon.
To learn more about recent updates on Biogen Inc. here is an article from November 10, 2020.
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America’s Top Forty show was hosted for decades by Casey Kasem and was one of the top radio shows in the world. Casey was born Kemal Amin Kasem in Detroit on April 27, 1932 to Lebanese immigrant parents who worked as grocers. He succeeded on radio and also did other work like voice roles in cartoons like “Shaggy” on Scooby-Doo. When he died on June 15, 2014 at age 82 his estate was reported to be valued at over $ 80 million USD.
After his death, three children from his first marriage were involved in what can only be described as a very sad dispute with his second wife that went on for over 5 years. The dispute was recently reported to have been settled in December 2019. This, in my view, is another example of what goes wrong when proper estate planning is not considered by parents/spouses/children. The ensuing consequences are often unfortunate and can be played out, in large part, in the courts. There is too much to the Casey Kasem story for this blog but, the story involves his dementia from Lewy Body Disease, one of the most common progressive dementia’s after Alzheimer’s. It involves his disappearance and a Los Angeles court declaring him a missing person on May 12, 2014. It involves his not being buried for six months after he died and then being buried in Oslo Norway for some reason on December 16, 2014. For more on this story I suggest the article by Amy Wallace entitled “The Long, Strange Purgatory of Casey Kasem”.
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These days, life expectancy is longer than ever. We have previously blogged (for instance, here and here) about some considerations and consequences of having a longer life expectancy. A recent article in The New Yorker considers aging, and in particular, anti-aging now that people are generally living longer. The online version can be found here: Can We Live Longer but Stay Younger?
One of the problems with living longer, as highlighted in the New Yorker article, is that we still must deal with the challenges and realities of aging. What we really want is not eternal life but rather, eternal youth.
The article discusses several efforts to address or counteract the types of issues that we face as we age. For instance, a geneticist at Harvard has successfully extended the life of yeast, and is moving on to human trials. A Harvard molecular biologist, George Church, has had success reprogramming embryonic stem cells to essentially turn an old cell into a young cell. Church’s work has been done so far on mice and dogs, but there are plans to commence human clinical trials within the next five years.
The goal of the work being done by Church is to live better, not necessarily longer: “The goal is youthful wellness rather than an extended long period of age-related decline.” The article discusses the nature of this age-related decline, through the illustration of a “sudden aging” suit that allows the wearer to experience the physical challenges of aging, including boots with foam padding to produce a loss of tactile feedback, and bands around the elbows, wrists, and knees to simulate stiffness. The point of the aging suit is to help create empathy and understanding about how difficult each and every task (an example was reaching up to a top shelf and picking up a mug) can be for older adults, both physically and mentally. So the question becomes, if we are living so much longer, but with age, every day and every task becomes much more difficult, what can we do to counteract that?
The work being done related to anti-aging and the creation of products to make older people’s lives easier is interesting and seems to be moving in new directions. For instance, the article mentions the difficulty of marketing certain products aimed at older people, because we do not like the idea of buying something that reminds us that we are old. So instead of selling a personal-emergency-response system to send an alert and seek assistance in the event of a fall, or some other physical emergency, in the form of a pendant worn around the neck, it is suggested that the most effective such device would be an iPhone or Apple Watch app.
Unfortunately, the issue of dementia is still a concern. There still does not appear to be a cure in sight for Alzheimer’s or other forms of dementia. The causes remain unclear. The effects, however, are evident. One of the individuals mentioned in the article was Professor Patrick Hof, who studies brains. On the physical effects of dementia on our actual brains, Professor Hof notes that “[y]ou can’t tell any difference, even under extreme magnification, between an aging non-demented brain and a younger human one…But, holding an Alzheimer’s brain in your hand, you can see the atrophy.” It appears that there is still a lot of work to be done in this area, in particular.
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An Attorney for Personal Care and a Guardian of the Person is statutorily mandated under section 66(3) the Substitute Decisions Act, 1992 (the “SDA“) to make certain decisions in the incapable person’s best interests if the incapable person’s wishes and instructions are unknown or if it is impossible to act in accordance with those wishes and instructions.
A component of the best interests analysis, as set out in section 66(4), includes considering whether the guardian’s decision is likely to,
“i. improve the quality of the person’s life,
ii. prevent the quality of the person’s life from deteriorating, or
iii. reduce the extent to which, or the rate at which, the quality of the person’s life is likely to deteriorate.”
Given that improving the quality of a person’s life and preventing their quality of life from deteriorating are two sides of the same coin, there is exciting and heart-warming new technology which uses Google Street View to treat Alzheimer’s patients.
This new technology is a prototype called BikeAround. BikeAround is essentially a stationary bike that stimulates the experience of, literally, biking down memory lane for an Alzheimer’s patient. The patient is placed on a stationary bike which faces a projection of his/her familiar hometown streets from Google Street View. The experience is intended to prevent memory loss by bringing to mind locations that are associated with the patient’s memories. The simultaneous physical stimulation from the act of biking is also considered to be a crucial component of the benefits from this new technology.
Anne-Christine Hertz is the biomechanical engineer who developed BikeAround.
This video on Hertz’s research is not to be missed.
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Tomorrow marks the end of World Alzheimer’s Month, a campaign to raise awareness and challenge the stigma surrounding dementia.
MP Lisa Raitt marked the occasion this month by making a member’s statement in the House of Commons. In her statement, she noted the 564,000 cases of Alzheimer’s disease in Canada, and the 25,000 newly diagnosed cases each year: one of which was her husband Bruce Wood in 2016 at the age of 56. Raitt stated that the diagnoses presents significant challenges, but that “living with dementia can be okay”.
Alzheimer’s Disease International states that the stigmatization and misinformation that surrounds dementia remains a global problem, and that 2 out of 3 people globally believe that there is little or no understanding of dementia in their country.
Canada appears to be making progress in addressing some of the issues surrounding Alzheimer’s disease. In June, 2017, Bill C-233, the National Strategy for Alzheimer’s Disease and Other Dementias Act, received Royal Assent. The Act requires the federal Minister of Health to develop a comprehensive national strategy to address all aspects of Alzheimer’s disease and other forms of dementia. Within 6 months, the Minister of Health must convene a conference with her provincial counterparts and other stakeholders for the purpose of developing the national strategy. The Minister is to report to Parliament within two years of the proclamation of the Act.
As another resource, the Alzheimer Society Canada website is an excellent tool for raising awareness and a better understanding of the disease, with detailed information about dementia and Alzheimer’s disease, and living with the disease.
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If you have been to a wedding or to university within the last several decades, you know Spirit of the West’s anthem “Home for a Rest“. If ever there was a song guaranteed to get you up onto your feet and the party started, this is the song. I know I personally cannot think of my early days at university without it playing somewhere in the background. It is for this reason that I read with great sadness the Globe and Mail’s report that Spirit of the West will be performing their final ever show this coming weekend.
Spirit of the West’s lead singer, John Mann, who is only 53 years old, has previously been diagnosed with early-onset Alzheimer’s. While the band had previously advised that they hoped to keep performing for as long as possible, only two years after making the diagnosis public, the band has advised Mr. Mann’s status has declined such that the time is right to bring the show to an end. Mr. Mann’s story echoes that of country legend Glen Campbell, who recently publicly played out his own battle with Alzheimer’s, releasing the gut-wrenching “I’m Not Gonna Miss You” as his final song, detailing his battles with the disease.
While hearing stories like those of Mr. Mann and Mr. Campbell are never easy, they provide us with the important opportunity to remind ourselves that no one in this world is necessarily immune from issues affecting their capacity. While it can sometimes be difficult to talk about, stories like these remind us of the importance of executing documents such as a Power of Attorney for Property and Power of Attorney for Personal Care to ensure that you are properly looked after should you become incapacitated.
While we may no longer be able to hear Spirit of the West perform live in person, their music will no doubt live on for years to come. So without further ado, take me home: Spirit of the West – Home for a Rest (Music Video)
According to the News Release, the Finding Your Way program is a “multicultural safety campaign that helps people with dementia stay safe and active, while helping to prevent the risk of wandering and going missing.” It notes that the program’s training services will be enhanced this year to include both first-responders as well as supportive housing and retirement home staff.
The Finding Your Way program is specifically focused on addressing and preventing individuals with dementia from going missing and states that 60% of people with dementia related memory problems become lost at some point. Their website provides some resources, including checklists for What to do when a person with dementia goes missing and What to do when reuniting after a missing incident. They also provide some suggestions of ways to reduce the risks associated with dementia. The first suggestion is to stay safe at home, by considering the best living arrangements for someone with dementia and ensuring that individuals with dementia maintain their health. The second suggestion is to be a part of the community while reducing the risk of becoming lost by carrying identification at all times, ensuring that someone knows where the senior with dementia is going, and dressing appropriately for the weather. The third suggestion encourages getting around in the community by urging seniors with dementia to get to know their neighbours and professionals in the neighbourhood (i.e. pharmacists, grocers, bankers), as well as participating in social activities.
The Alzheimer Society of Ontario’s website provides some “Dementia numbers in Canada” stating that in 2011, 14.9 per cent of Canadians 65 and older were living with Alzheimer’s disease and other dementias, with the figure expecting to increase. It also notes that one in five Canadians aged 45 and older provides some form of care to seniors living with long-term health problems. In 2011, family caregivers spent over 444 million unpaid hours looking after someone with cognitive impairment, including dementia. It is clear that dementia affects a great deal of people in Canada and in Ontario.
The Minister Responsible for Seniors Affairs stated in the News Release that “[o]ur communities have an important role to play in helping keep people with dementia safe, and this funding will help the Alzheimer Society of Ontario to deliver these resources to even more Ontarians.”
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An exciting recent Canadian study has found a genetic variation that delays the onset of Alzheimer’s by as much as four years.
The study, undertaken by Judes Poirier and his team at the Douglas Mental Health University Institute and McGill University in Montreal, found a variant of a cholesterol-regulating gene which can delay the onset of Alzheimer’s. Previous studies have found a link between cholesterol and Alzheimer’s. This study found a variant to the normal gene, and found that those with the variant, about 25% of the population, develop Alzheimer’s about four or five years later than those without it. According to the press release, “Over the past two decades, research efforts around the globe have focused on identifying genetic and environmental factors responsible for causing or accelerating the progression of the common form of Alzheimer’s disease. However, little was known about possible protective genetic factors that can delay or even prevent the disease onset in humans.”
The next step would be to build on this research by developing a drug which would mimic the effect of the genetic variation for non-carriers. In particular, scientists are looking to develop a brain-specific cholesterol-regulating statin.
According to the report, the Alzheimer Society of Canada is interested in the research.
There is currently no preventive treatment for Alzheimer’s.
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As an avid sports fan, I enjoy watching the physical nature of most sports. Recently, our media has reported on the severity of head injuries, which are caused by “head shots”, and the need to implement rules in professional sports to prevent catastrophic head injuries from happening.
Alan Schwarz, an author for the New York Times, recently wrote an article about a loophole in the California workers compensation system that allows retired professional athletes to file a claim for injuries sustained decades before, particularly retired N.F.L. players.
Schwarz states, “Most states require workers’ compensation claims to be filed within one to five years of the injury; California’s statute of limitations does not begin until the employer formally advises the injured worker of his or her right to workers’ compensation.” Also, California’s workers compensation statutes “require a professional athlete to have played only one game of his or her career within state borders to file a full claim for cumulative injuries.” The logical policy reason behind this legislation is to protect outside workers who temporarily pass through the state, like truckers or flight attendants.
As you can imagine, this loophole has opened the flood gates for retired athletes to file their workers compensation claim. In fact Schwarz states that “about 700 former N.F.L. players are pursuing cases in California, according to state records, with most of them in line to receive routine lump-sum settlements of about $100,000 to $200,000.”
What makes Schwarz’s article interesting is the claim filed by Ralph Wenzel. Wenzel has filed a claim arguing that his dementia at 67 years of age is related to his career as an N.F.L. lineman between the years of 1966 to 1973. The theory of Wenzel’s case is that “hitting your head over and over on the football field causes certain conditions.” In fact, researchers at “at the University of North Carolina have recently linked pro football careers and concussions with heightened rates of depression, mental decline and Alzheimer’s disease.”
As we continue to see a rise in those who are diagnosed with dementia and Alzheimer’s, I think it will be interesting to see how the sporting industry reacts to this disease, particularly, the rules each professional league implements to eliminate “head shots.”
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Rick Bickhram-Click here for more information on Rick Bickhram
We repeatedly hear about the grim details behind Alzheimer’s disease. In a previous blog titled “The Grim Toll of Alzheimer’s”, I touched on a reported study called The Rising Tide: The Impact of Dementia in Canadian Society. This study has cited that as our population continues to age, the number of people suffering from Alzheimer’s disease is expected to double to 1.25 million within 30 years. Again, another grim statistic.
Today, I blog on another Alzheimer’s study, which fortunately does not have such grim details. In a recent article, Lesley Ciarula Taylor states that specialists in Rochester, Minnesota have discovered “a cheap and easy memory test can predict who will develop Alzheimer’s disease with almost perfect accuracy.” The Free and Cued Selective Reminding Test is used to distinguish normal aging memory loss from a degenerative brain disease.
Taylor states, “the cost is very low, much lower than an MRI. The hope is to be able to identify the disease as quickly as possible.”
There is no cure for Alzheimer’s. Diagnosing the likelihood of being vulnerable may not necessarily lead to a cure, but at least specialists in this area can now ask new questions that potentially could lead to different angles on handling this disease.
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Rick Bickhram-Click here for more information on Rick Bickhram