Memory Disorders

Patient Population
Memory disorders in this patient population include Alzheimer's Disease and patients with dementia. The Toronto Western Hospital Memory Disorders Clinic evaluates approximately 450 patients annually (150 new consultations), nearly double the number seen in 1996. The majority of patients are managed on an ambulatory basis. The Clinic plays a crucial role in the coordination of patient management and social support, reducing the frequency of acute care hospital admission for this chronic care patient population. Annually, more than 300 patients require social work evaluation and support. Clinic Physicians provide consultation to the Psychogeriatric Dementia Rehabilitation Unit of Toronto Rehabilitation Institute, evaluating 900 patients per year.

Education
The growing public health problem posed by Alzheimer’s Disease, as well as increasing awareness and interest, necessitate an increasing role for the TWH Memory Disorders Clinic in the training of medical graduates enrolled in post-graduate programs, allied health professional trainees and the general public.

Each year, more than 50 residents and fellows in Psychiatry, Geriatrics, Internal Medicine and Neurology undertake core and elective rotations through the Clinic. International postgraduate trainees and fellows participate and the Clinic is also available for undergraduate ambulatory activities. Lay-members of the Alzheimer Association attend to learn about the dementias, and for guidance in the counseling and referral of patients/families for medical and social assistance.

Research
This program includes and internationally recognized team which is working to define the fundamental mechanisms causing AD, with the ultimate goal of using the information to develop effective therapies and cures.

The TWH Memory Disorders Clinic has been actively involved in several different types of research which has resulted in 29 lectures and more than 30 peer-reviewed publications in 1998. Major scientific discoveries include the mapping of a new Alzheimer’s Disease (AD) gene on chromosome 12.

Patients are recruited into clinical trials for new pharmacotherapies in dementia including a Phase IV trial of Galantamine (John R. Wherrett). A pre-clinical trial of a novel therapy for AD in a transgenic model of AD is being planned. It is anticipated that this will be followed by Phase I trials later in the year.

The Memory Disorders Clinic will participate in a multi-centre genetic epidemiology study including Duke University, UCLA, Vanderbilt University and Boston University.

Research applications have been submitted: 1) to test Vitamin E in Down Syndrome subjects at risk for Alzheimer's Disease; 2) to develop educational material for primary care physicians and care-givers; and 3) to develop measures of quality of life for Alzheimer's Disease patients.