UBCH CARD is an academic teaching and research clinic. Many members of our team, including health care providers, researchers, trainees and residents are part of the UBC Faculty of Medicine and other related disciplines.
The clinic provides assessment and diagnosis of Alzheimer Disease and Related Disorders for patients throughout BC, including care and support for the affected individual and his or her family by different team members including: geriatrics, neuropsychology, neurology, social work, geriatric psychiatry, genetic counselling, and neuropathology.
The clinic is also research intensive with a mandate to conduct research initiatives directed at understanding causes and treatments of Alzheimer disease and related disorders.
All patients will be seen by either a geriatrician (a doctor who specializes in conditions affecting older populations) or a neurologist (a doctor who specializes in conditions affecting the brain). The physician will complete a detailed history and physical examination. He or she may order additional investigations such as computed tomography (CT) head scan, magnetic resonance imaging (MRI), and/or laboratory (blood) tests.
The clinic physician will send a copy of his/her consult summary to the patient’s referring doctor and/or family doctor. Follow-up appointments will be determined after an initial assessment.
Dr. Haakon Nygaard came to Vancouver from Yale University, where he spent the past decade – first as a neurology resident, then PhD student, and finally a faculty member. He sees patients, conducts research and is the Director of CARD. His scientific interests include bridging the gap between drug development and discoveries in the laboratory and patient care. He is the lead investigator of a large multi-center trial (CONNECT) assessing a new drug for Alzheimer disease, originally developed to treat cancer patients. He was part of the team that discovered a key molecular pathway by which toxic proteins in the brain in patients with Alzheimer disease interact and destroy brain cells. An effort is now underway to develop drugs to modulate this important pathway, including the CONNECT trial. Dr. Nygaard is also the lead investigator on a project assessing the genetic factors involved in individuals living long into the 90s and 100s. Understanding the brain mechanisms of healthy aging can provide important insights into disease processes which preclude longevity, including Alzheimer disease.
Dr. Feldman is a Professor in the UBC Faculty of Medicine, Executive Associate Dean, Research and the former Director of CARD. In 2009, Dr. Feldman undertook a prominent position in a global drug development program at Bristol-Myers Squibb, where, as the therapeutic area Head, he led all the clinical neuroscience drug development. He returned to Vancouver in 2011 and resumed his leadership roles at both CARD and UBC. Dr. Feldman’s research focuses on aging, mild cognitive impairment and Alzheimer Disease. His interests include prevention of the disease and the advancement of novel clinical trial methodologies in dementia related research. His research has contributed to the discoveries of genetic mutations which cause FTD, FTD with motor neuron disease, as well as the development of important novel criteria for Alzheimer Disease.
Dr. Robin Hsiung is a staff neurologist at CARD and Associate Professor in the Division of Neurology, Department of Medicine, UBC. He has a special interest in the genetic and clinical epidemiology of Alzheimer Disease and related neurodegenerative dementias. He is also active in translational research on neurological health and aging. Dr. Hsiung’s research also explores biomarkers for Alzheimer Disease. Biomarkers are valuable to study because they are needed to confirm diagnosis and can be utilized to differentiate types of dementia and help clinicians identify cases in the earliest stages for rapid intervention and treatment.
Dr. Philip Lee is Clinical Associate Professor in the Division of Geriatric Medicine and an Associate Member of the Division of Neurology with UBC’s Department of Medicine. He is an internist who completed a fellowship in geriatric medicine. He also completed a behavioural neurology fellowship at the University of Toronto before returning to practice in Vancouver. Dr. Lee cares for patients at CARD and is a clinician educator.
Dr. Ian Mackenzie, a neuropathologist, has extensive expertise in using brain tissue banks in the care of patients with neurological disorders. His research program centres on neuropathology and the molecular genetics of neurodegenerative disease, particularly dementias. He leads the program on FTD that has resulted in the discovery of several gene mutations that cause this disease. Specifically, Drs. Mackenzie and Hsiung, along with collaborators from the Mayo Clinic and the University of California, San Francisco, are investigating a common genetic mutation underlying amyotrophic lateral sclerosis and a form of dementia helps to explain why many patients with those diseases get symptoms of the other. This finding was significant because the implications of finding the common genetic mutation to two diseases may lead to a treatment that could be used for both.
Dr. Dean Foti has been on staff at Vancouver General Hospital since 1996, with the title of Clinical Assistant Professor at the University of British Columbia. His practice is in Behavioural and General Neurology, with his main areas of interest dementia diagnosis and management. He provides education to family physicians and specialists in BC. Dr. Foti is an evaluating neurologist at the Clinic for Alzheimer Disease and Related Disorders, providing clinical care, teaching of Neurology residents and Behavioural Neurology fellows, and participating in clinical research and clinical trials in dementia.
Dr. Beattie, a specialist in Geriatric Medicine, attended at the UBCH CARD from its inception in late 1983 until retiring from practise in 2013. A primary interest was seeing patients and their families but she was also Medical Director for most of those years and she participated in a number of research projects about Alzheimer Disease and related dementias. These included the Canadian Study of Health and Aging, various clinical trials and the Canadian Alzheimer Disease quality of life project as well as other investigations. She is former President of the American Geriatrics Society and the Canadian Geriatrics Society and has served on the Board of the Alzheimer Society of Canada. She received the Queen Elizabeth II Diamond Jubilee Medal and was inducted into the Vancouver General Hospital Hall of Honour. She is President of the Pacific Alzheimer Research Foundation and sits on the Research Committee and Board of the Pacific Parkinson's Research Institute. In 2020 she received the Order of Canada.
Dr. Clark Funnell is a neurologist with subspecialty training in cognitive and behavioural disorders. He completed his neurology residency and clinical fellowship at UBC and is a clinical assistant professor in the division of neurology. His primary focus is the clinical evaluation and management of individuals with cognitive disorders.
NEUROPSYCHOLOGY AND PSYCHOMETRY
Some patients will be referred for a neuropsychological assessment. This assessment will be scheduled several months after the initial clinic visit and involves paper and pencil testing to evaluate different areas of cognition (i.e. memory, language, attention, visuospatial skills, etc.) as well as mood. This detailed testing may take 4-6 hours and is carried out by a psychometrist. Interviews with the patient and family are also included.
The neuropsychologist will interpret the results of this testing and provide feedback to the patient and/or their family within a few weeks.
Dr. Hayden is Clinical Assistant Professor at the University of British Columbia, Department of Medicine, Division of Neurology and holds Adjunct Faculty status at Simon Fraser University in the Department of Gerontology. She has been the Clinical Neuropsychologist in the Clinic for Alzheimer's Disease and Related Disorders since 1993. In this capacity, Dr. Hayden provides neuropsychological evaluation and consultation for diagnostic and case management purposes. In addition, she offers psychological treatment/support to patients and families, including children/teens of parents diagnosed with dementia. Dr. Hayden's research interests include: Neuropsychological Assessment Tools in Mild Cognitive Impairment and Dementia; Anxiety and Psychiatric Issues in Neurodegenerative Disorders; Cognitive Effects of Chemotherapy; Endocrinology and Cognition in Neurodegnerative Disorders; Neuropsychological and Psychiatric Issues in Traumatic Brain Injury; Cognition of Electrical Injuries.
Many patients will meet with a genetic counsellor during their first or second clinic visit. The genetic counsellor will take a detailed family history in order to identify memory or other health concerns that might be running in the family. The genetic counsellor can provide information about the genetics of memory disorders, recurrence risks for relatives, and genetic testing.
Genetic counselling is available to all Clinic patients (and their family members) upon request.
Emily Dwosh completed a Bachelor of Education degree from McGill University and worked briefly as a high school teacher in Montreal before completing her Master's degree in Genetic Counselling at the University of British Columbia. She has worked as a genetic counsellor at the UBC Hospital Clinic for Alzheimer Disease and Related Disorders (UBCH CARD) since 2001 and has provided information and support to hundreds of families from across BC who are affected by Alzheimer disease (AD) and other memory disorders. Emily has co-authored several peer-reviewed journal articles pertaining to familial AD and frontotemporal dementia (FTD) and continues to collaborate with her colleagues at the UBCH-CARD and the UBC Core for Neuroethics on a variety of ongoing research endeavours pertaining to these conditions. Emily continues to enjoy teaching medical and genetic counselling students as a Clinical Instructor with the UBC Department of Medical Genetics, and welcomes opportunities for community education in the fields of dementia and genetics.
As required, a social worker will complete a comprehensive assessment about your daily needs. Based on this assessment, the social worker will help you navigate the health care system by providing connections to community resources and supports specific to your situation. The clinic social worker is also available to help you develop additional strategies for managing a dementia diagnosis.
Social work appointments are scheduled for our patients (and their family members) by team member referral or patient/family request.
Amy Freeman received her Master of Social Work degree from the University of British Columbia in 1998. She has practiced in the health care field for over two decades. This practice has been rich and varied and includes working at Holy Family Hospital’s geriatric rehabilitation program for 10 years, as a home health case manager and as a social worker on geriatric psychiatry programs. She has also taught as a sessional instructor at UBC School of Social Work and served as a field instructor for social work students. In the research area, Amy has authored an article on the experiences of elderly women in hospital which was published in The Canadian Journal of Social Work. She has also participated in a research project which studied social isolation of seniors in care homes. The results of this study were published in a handbook which was distributed to care facilities throughout the province. Amy’s experiences have provided her with a broad understanding of the health care system and the challenges patients and their families face when requiring support, including the more complex challenges faced by families with a member with early onset dementia. Amy’s role in the clinic involves providing support to patients and families by helping them navigate available health care resources; assisting in transitions to care settings; consulting on home-based care management programs; and, advocating for increased resources and system change. In addition to her social work background Amy is a certified Canadian Fitness Education Services (CFES) Personal Trainer and Cross Fit (CF) Level 2 Trainer and has a special interest in the impact of diet and exercise on brain health.
CARD RESEARCH STAFF
Bryna Arsenault completed her Bachelor of Science in biology at the University of the Fraser Valley and her Master of Public Health at the University of Saskatchewan. Bryna joined the Clinic for Alzheimer Disease and Related Disorders in May 2016 as a research coordinator for the CARD study.
Penny Slack completed her BSc in Molecular Biology and Genetics at the University of Guelph and her MSc in Pathology and Laboratory Medicine at UBC. She joined this group in 2009, and is currently coordinating the phase I trial of a nutritional intervention of medium chain triglycerides in Alzheimer disease. Penny previously coordinated the Clinical Meaningfulness in Alzheimer Disease Treatment (CLIMAT) study as part of the BC Ministry of Health Alzheimer Drug Therapy Initiative, as well as a study looking at the processing of music in patients with Alzheimer disease. She rates on various clinical trials that the group is involved with and was the psychometrist on the Frontotemporal Dementia (FTD) study for several years.