Nov 8, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Lost Canadians are Canadian Citizens who were stripped of their citizenship by arcane provisions of the 1947 Canadian Citizenship Act. There were several ways to lose your citizenship. One way to was if you had Canadian parents but you were born outside of Canada. Thats me! I was lucky, and my parents registered me properly when they got back. Unfortunately many parents didnt do the right paperwork. These Lost Canadians didnt realize they didnt have citizenship until they tried to get a passport or a pension as an adult. The next time I could have lost my citizenship was when I was 24. Apparently, if I was living outside of Canada on my 24th birthday, I would have automatically lost my citizenship because I was born outside of Canada. A new law amending the Citizenship Act came into effect on April 17, 2009. This new law gives Canadian citizenship back to nearly 1 million Lost Canadians.

But, then there are my kids. Because I was born outside of Canada, if I had my kids outside of Canada, they would not be granted Canadian citizenship. Even though I have lived in Canada since I was 6 months old, I am a Canadian Citizen and have lived here continuously for 30 plus years, I could have been prevented from passing Citizenship onto my kids. I dont think the Lost Canadians saga is over yet.

Dementia causes another type of lost Canadian. It is estimated that 500,000 Canadians have Alzheimer's disease or related dementia. About 71,000 of them are under the age of 65. Women make up almost 75% of the group. As the baby boomers age, we expect the number of people in Canada with Alzheimers disease to double to over 1 million Canadians lost with Alzheimers over the next 25 years.

Alzheimers disease is the most common form of dementia. Dementia is a condition with symptoms like loss of memory, poor judgment and reasoning, changing moods and change in ability to talk and communicate. Alzheimers disease was discovered by Dr. Alois Alzheimer in the early 1900s. He found plaques and tangles in the brains of some dementia patients after they died. These are still the hallmarks of the disease doctors look for when confirming Alzheimers disease after the death of the patient.

In Alzheimer's disease, brain cells die. This results in of loss of memory and cognitive functioning. One key brain chemical, acetylcholine, appears to be in short supply in Alzheimers disease. Many drugs used to treat Alzheimer's disease are aimed at increasing the amount of acetylcholine in the brain.

Cholinesterase is an enzyme that breaks down acetylcholine. Drugs that inhibit this enzyme will leave more acetylcholine in the brain. The first cholinesterase inhibitor to gain wide scale use in Canada was donepezil or Aricept. We now also have rivastigmine or Exelon and galantamine or Reminyl. All three of these are cholinesterase inhibitors and they are indicated for mild to moderate Alzheimers disease.

Memantine or Ebixa is a little different. It is called an NMDA receptor antagonist. It works on a different brain chemical called glutamate. It is approved for use in moderate to severe Alzheimers and can be used with Aricept.

Here is the bad news. None of these medications is a cure. None of these medications will stop the disease from progressing. The best any of these medications can do is help manage symptoms and help maintain a persons functioning for as long as possible. I see a lot of false hope in the pharmacy that these medications will fix a loved one with Alzheimers. They wont. And these medications are expensive and not always covered by Manitoba Health.

The future for Alzheimers may be brighter, though. The researchers are learning more about how to prevent the dementia. One thing from the research I found interesting is that preventing concussions and head injuries in the young may help those people to avoid dementia when they are older. And there is research happening today that we hope will produce treatments in 5 to 10 years that may be able to slow and stop the progression of Alzheimers disease.

Over the next decade hopefully we can close the loop-holes in our immigration laws and cure Alzheimers disease and then have no more Lost Canadians.

For more information see: Alzheimers Society of Canada www.alzheimers.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.


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