When an elderly woman, believed to have dementia, was referred to Sunnybrook Health Sciences Centre, the multidisciplinary dementia clinic at the hospital decided to investigate further.
"The neurologist confirmed she had cognitive impairment and Parkinson's but suspected she might also have depression," explains Dr. Anthony
Levitt, chief of Sunnybrook's Hurvitz Brain Sciences Program. "While the psychiatrist on the team agreed she could have depression, the geriatric specialist was concerned that the patient's blood pressure medication may be contributing to her depression."
The team conferred and decided to treat the depression first."We treated her for depression, and remarkably all the other symptoms completely disappeared," says Dr. Levitt. "She's an actress and she went back to the stage, acting in musicals and other local productions. People thought she would never be able to do that again."
The Hurvitz Brain Sciences Program has a unique model of care that takes an integrated approach to diagnosis and treatment.
"The beauty of having a co-ordinated approach is that you get all this information at once, without having to wait months for a variety of consultations and a treatment plan," explains Dr. Levitt, adding that the impact of this goes beyond just the patient.
"This woman was in her mid-60s and her husband, who's in his mid- 70s, was finding it more and more difficult to manage her," he says.
"Recently, he had had surgery and if she had not been well enough, he would have needed extra help for himself as well as for her. But in the end she has been able to look after him. It has implications for the entire family."
Sunnybrook is revolutionizing the landscape of treating brain illness with its team approach to integrated care, bringing specialists together in a timely manner to look at each case holistically.
The vision is to embed research into care and take a collaborative approach to brain illnesses such as stroke, depression, anxiety and dementia.
Unique in Canada, this kind of integrated approach to brain illness is the future of health care and it's already happening at Sunnybrook. The next step is to bring everything under one roof.
On October 16, the Hurvitz Family Foundation made a $20-million donation as the first step in creating the Hurvitz Brain Sciences Centre, where a co-ordinated approach to the major brain illnesses of our time will help turn the hospital's research endeavours into viable treatments.
The burden of brain diseases resonates worldwide. At the G8 summit last December, world leaders pledged to tackle dementia head on. At the event, Dr. Margaret Chan, director-general of the World Health Organization (WHO), said there is no other illness with such a profound effect on lives: loss of function and independence, and the need for care.
"I can think of no other condition that places such a heavy burden on society, families, communities and economies," said Dr. Chan, "where innovation, including breakthrough discoveries, is so badly needed."
The goal is, by 2025, to find a significant treatment, if not a cure, in anticipation of the "silver tsunami" – the significant rise in the median age of the population.
Dr. Levitt believes that goal can be met. "Ninety per cent of what we have learned about the brain we have learned in the past 10 years. We are now urgently looking for diseasemodifying treatments for dementia."
According to the WHO, the burden of depression and anxiety (as well as stroke) as causes of disability are also rising globally.
"It's important to realize these conditions are all interrelated," says Dr. Levitt. "If you have depression, your risk of stroke and dementia is increased. If you have a stroke, your risk of dementia and depression is increased. [The three conditions] are a combination of vascular disease and inflammation in the brain."
He adds, "Neurology, neurosurgery and psychiatry are often geographically separate even within the same hospital, despite the fact that we are managing the same conditions.
A psychiatrist treats and manages depression and the neurologist manages stroke and dementia. We need to work together to fully understand the brain connections of these conditions and we need to be co-located, so patients have access to everyone they need, and experts can cross-pollinate to enhance each other's understanding."
Sunnybrook's experts are doing just that. According to Dr. Levitt, having psychiatrists, neurologists, neurosurgeons and other brain experts working closely together is the best way to hasten cures. In addition to situating psychiatry within medical science, the Hurvitz Brain Sciences Program conducts laboratory research right alongside clinical care, ensuring that the best and newest treatments are available quickly. It also uniquely cares for adolescents, adults and the elderly.
"By treating a range of ages, we are making discoveries that inform new treatments and patient care across different disorders and throughout the lifespan," explains Dr. Levitt.
"What we learn about brain changes in the elderly helps us to focus on what to explore in youth. What we learn from examining the biology of youth helps us to discover new treatments that could help the elderly," says Dr. Levitt.
That kind of interconnected learning – sharing knowledge among disciplines once seen as separate – and locating experts together puts Sunnybrook at the forefront of solving some of the most powerful and devastating illnesses of our time.
This is the first in a six-part series on the future of brain sciences. Look for the next one on Thursday, February 5. For more information, visit sunnybrook.ca/brain.
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.