Transcript: Dr Guy Proulx - Part 2 | Nov 26, 2003

(music plays)

A slate reads “The advice given in Mini-Med School is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.”

Against a blurry background of blue and pink pills, a video reel displays pictures of medical gear such as a needle, a scan of a human body and heart rate monitors.

The title of the show slides in: “Mini-Med School.”

Then, Guy Proulx stands on a stage in a university auditorium giving a lecture. He is in mid-fifties, clean-shaven with receding black hair. He’s wearing glasses, a black suit jacket and an open-necked light purple shirt.

Behind him, a computer screen is projected on a tall white wall.

Guy says LET'S LOOK AT
BEHAVIOUR WHEN SOMEBODY HAS
DEMENTIA, OKAY?
SO BIG, NICE TIP FOR YOU.
TO UNDERSTAND ABOUT DEMENTIA
BECAUSE DEMENTIA AFFECTS THE
ASSOCIATION AREA OF THE BRAIN,
THE THINKING, THE COGNITION,
MEMORY, THINK ABOUT THE FOUR
A's.
I'LL BE TEACHING ABOUT THE FOUR
A's AND E, OKAY.
BREAK DOWN IN LANGUAGE,
APHASIA.
BREAK DOWN IN MOTOR, COMPLEX
MOTOR A PURPOSEFUL MOVEMENT,
APRAXIA.
BREAK DOWN IN PERCEPTION,
AGNOSIA.
BREAK DOWN IN MEMORY, AMNESIA.
BREAK DOWN IN EXECUTIVE
FUNCTIONS OR PLANNING AND
COMPLEX UH...
[stammering ]
SEQUENCE OF BEHAVIOUR AND
EXECUTION OF BEHAVIOUR,
EXECUTIVE FUNCTIONS SO LET'S
LOOK AT THOSE AND REMEMBER THAT
THOSE COMPLEX BEHAVIOURS ARE
RELATED TO DAMAGE TO THE BRAIN
SO THEY'RE JUST NOT BEHAVIOURS
DISCONNECTED OR DISEMBODIED,
OKAY?
SO THE FIRST ONE IS APHASIA,
BREAK DOWN IN LANGUAGE.
SECOND IS APRAXIA, THE
INABILITY TO TRANSDUCE A VERBAL
COMMAND INTO ITS MOTOR
EXPRESSION.
SOUNDS SIMPLE TO YOU, EH?
IF I WOULD ASK YOU PEOPLE A
VERY SIMPLE QUESTION, RAISE
YOUR RIGHT HAND, RIGHT, WELL,
THAT'S EASY, RIGHT?
IS IT NOT EASY?
RAISE YOUR RIGHT HAND.
VERY GOOD.
OKAY, SO WE TAKE THIS FOR
GRANTED.

A caption appears on screen. It reads “Guy Proulx. Baycrest Centre for Geriatric Care.”

He continues IF YOU HAD ALZHEIMER'S DISEASE
WHICH QUITE A FEW MIGHT HERE,
UH... NOBODY RAISE THEIR -- NO,
YOU HAD TO TAKE SOUNDS AND
THOSE SOUNDS HAD TO BE GIVEN
INTO ENGLISH, HUH?

The caption changes to “Wisdom Versus Dementia: A Walk Through the Aging Brain Part 2...”

He continues SO YOU HAD TO TAKE THOSE
SOUNDS, TAKE -- RAISE YOUR
RIGHT HAND.
TAKE THOSE SOUNDS, MAKE THE
ASSOCIATIONS IN THE AUDITORY,
UH, AND VERBAL SECTIONS OF THE
BRAIN AND THEN TRANSMUTE THAT,
PUSH THAT OVER TO THE MOTOR
SYSTEM.
IT'S MUCH MORE COMPLICATED THAN
WE THINK AND THAT'S WHAT BREAKS
DOWN WITH DEMENTIA, ALZHEIMER'S
DISEASE.
SO YOU TELL A PATIENT, UH, UH,
FOR EXAMPLE, HERE I SAY TO HIM
SMILE FOR ME.
THERE'S AN INDIRECT, OKAY,
SMILE.
THE VOLUNTEER IS SMILE.

He runs a PowerPoint presentation.

He continues SO WHEN I ASKED HIM TO SMILE
THE WORDS HAD TO GO TO THE
CORTEX, THE AUDITORY CORTEX,
MAKE THE ASSOCIATION THERE, GO
DOWN TO THE MUSCLES OF THE
SMILE AND EXECUTE THAT BUT HE
WAS DAMAGED SO HE COULDN'T DO
THAT.

A slide shows the process of smiling.

He continues THAT'S DAMAGE.
THEN WHEN I SHOWED HIM
SOMETHING VERY FUNNY IT WENT
INTO THE PRIMITIVE BRAIN, THE
EMOTIONAL BRAIN, NO DAMAGE
THERE, WENT RIGHT TO THE GUT TO
THE EMOTIONAL BRAIN AND BINGO,
THE PARALYSIS WAS GONE.
OKAY, ANOTHER CONFUSED PATIENT,
ANOTHER SMALL MIRACLE BECAUSE
WE UNDERSTAND THE COMPLEXITIES
OF THIS.
THIS IS BEAUTIFUL I THINK, HUH?
SO NOW... PERCEPTUAL PROBLEM.
LISTEN, LOOK AT THIS.

A slide under the title “Knowledge without awareness” appears on screen. It reads “Steps of the process of recognition still take place despite an inability to experience familiarity and formal recognition. Patients with severe amnesia can still learn complex skills.”

He continues THIS MEANS THAT PUTTING A NAME
ON SOMEBODY'S FACE IS JUST ONE
TINY, TINY PART TO RECOGNITION.
SO THE WAY WE MEASURE THAT,
RESEARCH UH, MEASURE THAT WAS
THAT THEY WOULD HOOK PEOPLE ON
ANOTHER PART OF THE NERVOUS
SYSTEM SO THE ONE WE'RE TALKING
ABOUT HERE IS THE CENTRAL
NERVOUS SYSTEM, THE BRAIN AND
THE SPINAL CORD AND BEYOND THAT
ALL THE NERVES GOING OUT IS
CALLED THE PERIPHERAL NERVOUS
SYSTEM AND IN THE GUTS, OKAY,
AND THEN THE ORGANS.
THAT'S CALLED... NERVOUS
SYSTEM.
YOU CAN MEASURE THAT WITH A
MACHINE CALLED -- THEY CALL IT,
IT'S CALLED GALVANIC SKIN
RESPONSE.
SOME PEOPLE CALL IT LIE
DETECTORS, THE WRONG WORD.
YOU GET 13 PEOPLE, THEY'RE
MOSTLY STRANGERS.
THREE OF WHICH ARE THE WIFE AND
THE DAUGHTERS AND THE PERSON
WITH ALZHEIMER'S WITH THIS TYPE
OF PROBLEM WOULD SAY HELLO TO
ALL THESE PEOPLE NOT
RECOGNIZING THE TWO DAUGHTERS
AND THE SPOUSE AND THAT'S VERY
DIFFICULT ON A FAMILY.
WE'VE BEEN MARRIED FOR 50
YEARS, HE DOESN'T RECOGNIZE ME.
IT'S VERY HARD.
OKAY, THEN YOU HOOK HIM ON THIS
MACHINE, LOW AND BEHOLD HE SAYS
HELLO TO EVERYBODY BUT ONLY THE
RESPONSE... TO THE LOVED ONES,
TO THE DAUGHTERS AND TO THE
WIFE SO YOU KNOW BEFORE YOU GO
AND VISIT SOMEBODY WHO HAS A
LOT OF DAMAGE, YOU SAY THEY
DON'T RECOGNIZE ME.
BE VERY CAREFUL BECAUSE
RECOGNITION IS A COMPLEX
PROCESS AND MANY, MANY ASPECTS
STAY TO THE LAST BREATH, OKAY,
TO THE LAST SECOND.
THE OTHER A, AMNESIA.
THE LAST A IS:
OKAY, SO THE LAST A, AMNESIA.
PATIENTS WITH SEVERE AMNESIA --
WHAT THEY FOUND, OKAY, IS THAT
ALTHOUGH YOU CAN'T REMEMBER,
YOU CAN'T REMEMBER, THAT'S HOW
BAD THEIR MEMORY CAN BE, YOU
CAN STILL LEARN SOME THINGS,
OKAY?
SO UH, SO UH, THIS IS A PATIENT
WE SAW AT BAYCREST.
IT WAS SO BAD THIS GUY WOULD
WALK AROUND WITH HIS DRAWER AND
IN THIS DRAWER HE HAD OH, I HAD
STROKE IN THE PART OF THE BRAIN
HELPS LAY DOWN NEW MEMORIES AND
DON'T WORRY ABOUT GOING BACK TO
WORK BECAUSE IT'S BEING TAKEN
CARE OF BY THE SOCIAL WORKER
AND MY WIFE AND SO ON AND SO
FORTH.
AND HE WOULD MEET WITH YOU AND
HE WOULD SAY HELLO, WHAT'S YOUR
NAME?
CAN I GO HOME?
CAN I GO BACK TO WORK?
NO, YOU HAD DAMAGE, YOU KNOW,
THANK YOU.
VERY NICE.
HE'D WALK OVER HERE.
HELLO, WHAT'S YOUR NAME?
WHY AM I HERE?
NOT EVEN A MINUTE HE'S STARTING
ALL OVER AGAIN.
YOU DO THIS THREE, 400 TIMES IN
HALF A DAY THOSE NURSES ARE
GOIN' LIKE REALLY NERVOUS.
HE GETS NERVOUS AND FIRST THING
YOU KNOW SOMETIMES YOU KNOW,
YOU HAVE TO MANAGE THIS THROUGH
MEDICATION BECAUSE IT'S VERY,
VERY, VERY, IT'S VERY COMPLEX
AND DIFFICULT.
I'VE CHECKED THE FILES AND I
SAW HE HAD A VERY ENGLISH NAME
AND I SAW IN THE FILES THAT HE
WENT TO A FRENCH SCHOOL IN
QUEBEC CITY.
MY BROTHER WAS THE SAME AGE,
WENT TO THAT SAME SCHOOL, HUH.
SO I MEET WITH HIM HE SAYS GOOD
MORNING, WHO ARE YOU?
CAN I GO HOME?
CAN I GO BACK TO WORK?
NO, YOU HAVE...
[speaking French]
YOU KNOW AND I'LL TELL YOU, HE
SAYS IN FRENCH HE SAYS WELL, I

MY FATHER WAS IN THE ARMY,
WENT TO VAL CARTIER NOT TOO FAR
FROM QUEBEC AND SEND ME TO THIS
FRENCH SCHOOL BECAUSE HE
THOUGHT THAT BILINGUALISM WOULD
PAY ONE DAY, RIGHT AND UH, HE
HAD A TYPE OF JOB THAT WAS VERY
USEFUL TO BILINGUAL SO ANYWAY
WE'RE TALKIN' FRENCH.
HE SAYS WHO ARE YOU?
WHY AM I HERE?
WHEN CAN I GO BACK TO WORK?
SO HE HAD NOT REGISTERED AT
ALL, OKAY?
THE NEXT DAY WE'RE DOING ROUNDS
AND GUESS WHAT?
WE'RE ABOUT FIVE OR SIX
DOCTORS, WE'RE DOING ROUNDS AND
WHAT HE SAYS, HE SAYS UH, TO ME
IN FRENCH, WHO ARE YOU?
[speaking French ]
WHY AM I HERE?
[speaking French ]
CAN I GO HOME?
I SAY TO HIM WHY DO YOU TALK
FRENCH TO ME AND NOT TO THEM?
HE HAD NO IDEA.
WE INSISTED BECAUSE IT WAS THE
FIRST TIME I SAW THAT.
WHY ARE YOU TALKIN' FRENCH TO
ME?
HE SAYS ARE WE GETTING
POLITICAL HERE?

[Laughter]

Guy continues YOU KNOW?
BECAUSE YOU LOOK STUPID.
I MEAN, HE WAS RUDE, HUH?
SO HE LOOKED CONFUSED.
I GOT HIM INTO MY OFFICE, OKAY,
HE COMES INTO MY OFFICE AND
SAYS WHO ARE YOU?
HELLO.
CAN I GO HOME?
CAN I GO BACK--
NO.
IT'S NOT EASY OKAY.
AND THEN I SAID I HAVE A TEST
FOR YOU SO THIS IS THE TYPE OF
TEST WHERE YOU DO ONCE, TWICE,
THREE TIMES YOU GET BETTER AND
BETTER AND BETTER AT IT.
HE DOES IT ONCE I TIME HIM,
OKAY AND HE DOES RIGHT IN THE
AVERAGE, DOES VERY WELL BECAUSE
THERE'S NO MOTOR PROBLEM WITH
THIS GUY.
I SAY WOULD YOU LIKE TO HAVE A
COFFEE?
HE SAYS YES.
WHAT DO YOU TAKE?
MILK AND SUGAR.
I GO BACK, I COME BACK HE SAYS
WHO ARE YOU?
WHY AM I HERE?
CAN I GO BACK HOME?
CAN I GO BACK TO WORK?
I SAID NO.
IF I WOULD'VE SAID HERE'S YOUR
COFFEE HE WOULD'VE JUST GOT
REALLY UPSET.
I NEVER ASKED -- HERE'S A
COFFEE, HE TAKES A COFFEE.
HOW'D YOU KNOW I TAKE MILK AND
SUGAR?
I GO... I DIDN'T LIE.
SO ANYWAY SO THAT TEST, I
COULDN'T SAY TO HIM LET'S DO IT
AGAIN.
WELL, YOU KNOW WHAT?
HE SAID WHO ARE YOU?
WHY AM I HERE?
CAN I GO BACK -- YOU KNOW, SO
HE HAD NO IDEA.
HE DOES IT A SECOND TIME HE
GETS BETTER AND BETTER.
HE COULDN'T REMEMBER -- HE
COULDN'T REMEMBER MY FACE,
VISUAL MEMORY.
HE COULDN'T REMEMBER MY NAME,
VERBAL MEMORY.
NONE OF THAT STUFF BUT YOU HAD
HIM DO A TASK SO YOU KNOW THIS
IS VERY, VERY GOOD KNOWLEDGE.
WE'RE GETTING TO UNDERSTAND HOW
ALL THIS WORKS IN THE BRAIN SO
BASICALLY WHEN PEOPLE SAY TO
YOU NOW THIS IS WHAT THE
UNIVERSITY OF TORONTO -- A LOT
OF RESEARCH HAS BEEN
DISCOVERED.
WHEN YOU SAY YOUR MEMORY IS BAD
YOU ASK WHICH ONE?
THERE ARE AT LEAST FIVE
DIFFERENT MEMORY SYSTEMS.
INDEPENDENT AND INTERACTIVE,
OKAY?
SO WE'LL GO THROUGH THEM
QUICKLY.

A slide reads “Episodic memory: Explicit recollection of incidents that occurred at a particular time and place in one’s personal past. Semantic memory: General knowledge of facts and concepts that is no linked to any particular time and place.”

He continues UH, SO THE EPISODIC MEMORY,
OKAY?
WHAT THE HELL DOES THAT MEAN?
OKAY, THAT MEANS THAT OTTAWA IS
THE CAPITAL OF CANADA.
RIGHT?
THAT'S A FACT.
I WENT SKATING IN OTTAWA LAST
YEAR, FEBRUARY 14th ON THE
CANAL WITH MY KIDS AND WE HAD

WE ATE BEAVER TAILS, RIGHT?
THAT IS AN EPISODE IN MY LIFE.
A VERY SPECIFIC TIME AND PLACE
THAT OCCURRED TO ME PERSONALLY.
OKAY, THIS REALLY GOES -- YOU
KIND OF LOSE SOME OF THIS WITH
NORMAL AGING AND SEVERELY OKAY,
WITH DEMENTIA BUT THIS HERE
REMAINS, OKAY?

The slide changes to “Procedural memory: For the acquisition of skills and habits. Knowing ‘how’ rather than knowing ‘that’. Acquired gradually over time through repetitive practice. Working memory: Concerned with short-term retention, operating over seconds. Holds information on-line for basic cognitive activities.”

He continues YOU KNOW YOU DON'T GO TO
UNIVERSITY ON HOW TO SKATE,
HUH?
YOU CAN GET A PHD ON HOW TO
SKATE IN SAUDI ARABIA, OKAY,
WHATEVER.
AND YOU SAY YOU'RE GOING TO
CANADA, I'M GONNA LEARN HOW TO
SKATE.
I'M GONNA SEE VIDEOS OF GUY
LEFLEUR.
I'M GONNA GET A PHD ON HOW TO
SKATE, RIGHT, BUT YOU DON'T PUT
THEM ON.
YOU COME TO MONTREAL AND WHAT
HAPPENS, HUH?
YOU FALL ON THE DERRIERE.
YOU HAVE TO DO THAT.
YOU DON'T GO TO UNIVERSITY HOW
TO GOLF OR HOW TO...
[ stammering ]
WHATEVER.

[ Laughter ]

Guy continues TO RIDE A
BICYCLE, RIGHT?
WORKING MEMORY, OKAY THAT'S
REALLY THE SHORT-TERM MEMORY.
SO IF I -- YOU KNOW, IF YOU
WANNA DO A PHONE NUMBER AND
HOLD IT IN YOUR MIND WHILE
YOU'RE DOING IT THAT'S WORKING
MEMORY.
IF I WOULD GIVE YOU THE WORDS
TO REMEMBER NO, I WILL GIVE YOU
THOSE WORDS I DON'T KNOW,
TABLE, TAIL.
[speaking French ]
I WANT YOU TO GIVE THEM BACK TO
ME BUT IN ALPHABETICAL ORDER.
NOW THAT'S WORKING MEMORY.
YOU HAVE TO THINK IT OUT.
TABLE.
[speaking French ]
NO.
[speaking French ]
TABLE.
YEAH.
[speaking French ]
TABLE, TAIL.
OKAY, SO THAT'S -- YOU'D HAVE
TO REALLY -- THAT'S WORKING
MEMORY.
AND THE LAST ONE IS PERCEPTUAL
REPRESENTATION SYSTEMS.

The caption changes to “Perceptual Representation Systems: Important for the identification of words and objects on the basis of their form and structure.”

He continues SO I SHOW YOU THIS, YOU DON'T
EVEN HAVE TO THINK.
YOU KNOW THIS IS A PENCIL,
OKAY, IN YOUR MIND SO
PERCEPTION JUST DOES IT
AUTOMATICALLY OR IF YOU READ
THE WORD C-A-T WHEN YOU'RE
READING A NOVEL YOU DON'T HAVE
TO THINK C-A-T IS A CAT.
YOU CAN SEE IT AUTOMATICALLY SO
THE PERCEPTUAL SYSTEMS OF THE
BRAIN IS ANOTHER MEMORY
SYSTEMS.
THE POINT I WANNA MAKE TO YOU
VERY STRONGLY IS THAT THERE IS
NO DISEASE OUT THERE THAT
AFFECTS ALL THOSE MEMORY
SYSTEMS SO IF YOU CAN IDENTIFY
WHICH ONES ARE DAMAGED YOU CAN
WORK AROUND IT AND DO
COMPENSATIONS.
OKAY, SO TO PUT IT ALL TOGETHER
FOR YOU HERE WITH THIS
WONDERFUL NEW RESEARCH, NEW
SCIENCE.
YOU'RE DRIVING DOWN THE 401,
OKAY, THE 401, NO, YOU'RE
DRIVING DOWN THE 404, RIGHT,
THE ONE THAT GOES IN THE LAKE,
RIGHT?

He uses the laser pointer to point at a new slide that shows a diagram.

He continues SO YOU'RE DRIVING DOWN THE 404
AND YOU'RE FLOODED BY ALL KINDS
OF SENSORY INFORMATION AND THIS
LITTLE BUFFER, SENSORY BUFFER,
OKAY, AND ALL THE DIFFERENT
SENSORY SYSTEMS, BUFFER, WHICH
IS JUST FOR A COUPLE OF
MILLISECONDS, 200 -- A QUARTER
OF A SECOND AND JUST GOES
THROUGH THERE, FLUSHES THROUGH
THERE LIKE NIAGARA FALLS.
IF YOU DECIDE TO PAY ATTENTION
TO SOMETHING, OH, I CAN SEE AN
APPLE TREE THERE AND THIS APPLE
TREE THERE REMINDS ME OF A
SPECIFIC EPISODE WITH MY
GRANDMOTHER IN THE KITCHEN AND
WE WERE COOKING AN APPLE PIE
AND THIS EPISODIC MEMORY AND
THE WORDS I'M USING IS ALL
BROUGHT INTO THIS.
OKAY, I'M REGISTERING BECAUSE
I'M PAYING ATTENTION, RIGHT, IN
THIS WORKING MEMORY AND I'M
RETRIEVING IT AND TELLING MY
PASSENGER ABOUT THIS.
THEN THE INFORMATION COMES IN
HERE OR IF I DECIDE TO KEEP
SOME INFORMATION, SOMETHING
NEW, A NEW NAME TONIGHT, I'M
GOING TO ENCODE IT INTO LONG-
TERM MEMORY AND THEN YOU KNOW,
WITH NORMAL AGING, WITH THE BIG
BREAKDOWN IS REALLY WITH
RETRIEVAL, OKAY?
NOW WITH DEMENTIA AND IT
AFFECTS THE BRAIN AND AS YOU
PROCEED THE FOUR A's YOU KNOW,
THE SEMANTIC MEMORY, EPISODIC
MEMORY, ALL THESE ARE AFFECTED
EXCEPT YOU KNOW, OTHERS THAT
ARE NOT AFFECTED LIKE
PROCEDURAL UH, PROCEDURAL
MEMORY.
NOW ANOTHER POINT I WANT TO
MAKE TO YOU WITH ALL THESE
OTHER MEMORY SYSTEMS REMEMBER
THE CONNECTIONS BETWEEN THE
BRAIN AND COMPLEX BEHAVIOUR IS
VERY TIED TOGETHER SO ALL THESE
DIFFERENT MEMORY SYSTEMS, OKAY?
SEMANTIC, EPISODIC MEMORY IS
VERY MUCH RELATED TO THE
HIPPOCAMPUS REGION WHICH
CONSOLIDATES NEW MEMORIES
IMPLICIT OR SUBCONSCIOUS, OKAY,
THESE ARE MORE LIKE WHEN YOU'RE
AWARE YOU HAVE TO BE AWARE,
CONSCIOUS MEMORIES.
EXPLICIT.
IMPLICIT MEANING SUBCONSCIOUS
IF YOU WISH.
YOU KNOW, YOU DON'T HAVE TO
EXPLAIN HOW YOU'VE LEARNED TO
RIDE A BICYCLE, YOU JUST DO IT.
YOU'VE BEEN CONDITIONED TO EAT
EVERY MEAL AT 12 NOON.
THESE ARE...
[stammering ]
THIS IS REALLY PROCESSED BY THE
OLD BRAIN.
WE CALL IT THE CEREBELLUM AND
OTHER REGIONS CALLED THE BASAL
FOREBRAIN.
WORKING -- SHORT-TERM MEMORY IS
VERY MUCH RELATED WITH A
MACHINE, A POWERFUL MACHINE
CALLED THE THALAMUS CONNECTED
WITH THE FRONTAL SYSTEMS SO ALL
THESE DIFFERENT -- WHAT'S
AMAZING NOW IS THAT WE'RE
TRYING -- WE'RE NOW CONNECTING
THOSE COMPLEX BEHAVIOURS, FOR
EXAMPLE WE'RE JUST PURE
PSYCHOLOGICAL BEFORE AND SEE
HOW THEY'RE CONNECTED WITH THE
INSIDE BRAIN, OKAY?
AND THIS PICTURE HERE IS IF YOU
HAD AN AMNESIC PATIENT IN AN
ENVIRONMENT LIKE THIS, THIS IS
AN ENVIRONMENT WHERE I WORK,
YOU WOULD NEVER KNOW HE HAS A
PROBLEM, YOU KNOW WHY?
IF HE'S IN THIS ENVIRONMENT
WHAT IS THERE TO REMEMBER THE
TREES THERE, THERE'S MOVE, ALL
THE INFORMATION, THE COFFEE
SHOP IS THERE.
YOU CAN SMELL THE COFFEE.
EVERYTHING IS THERE.
SO WHEN YOU COMPENSATE THE
ENVIRONMENT THIS PERSON WHEN
HE'S NOT IN ANY PARTICULAR
CONTEXT IN A ROOM HE'S TOTALLY
OUT OF IT BUT WHEN HE'S IN A
VERY RICH ENVIRONMENT YOU'D
NEVER KNOW EXCEPT IF YOU LEFT
AND CAME BACK HE NEVER SAW YOU.
YOU'D LOOK FAMILIAR BUT HE
WOULD NEVER, NEVER REMEMBER BUT
YOU KNOW, I'M TELLING YOU, ONCE
WE UNDERSTAND HOW ALL THIS
WORKS WE CAN PERFORM SOME GREAT
ADJUSTMENT PROCEDURES...
[stammering ]
COMPENSATIONS.

A scene from the movie Lion King appears. It shows a woman wearing traditional clothes and deer jumping.

He continues SO YOU ARE GOING TO SEE THE
LION KING, OKAY, YOU DON'T HAVE
MEMORY PROBLEMS.
WHAT HAPPENS, YOU KNOW, YOU
CAN'T REMEMBER EVERYTHING,
EVERYTHING, EVERYTHING.
WE -- WE PRUNE A LOT IN THE
BRAIN.
A LOT OF PRUNING, OKAY.
PRUNING IN THE BRAIN.
SO UH, UH, BECAUSE TO BE
EFFICIENT YOU DON'T WANT TO
REMEMBER EVERYTHING.
YOU WANNA GET RID OF A LOT OF
STUFF SO MEMORY PROBLEMS IS ONE
THING BUT FORGETTING, KNOWING
HOW TO FORGET THAT'S ALSO VERY
IMPORTANT, THAT'S ANOTHER
LECTURE, OKAY?

[ Laughter ]

Guy continues
SO NO PROBLEM, BEAUTIFUL, OKAY,
NOW THE NEXT WEEK, OKAY, WHAT
YOU REMEMBER BECAUSE APPARENTLY
THE TICKET IS JUST SEEING THIS
AFRICAN WOMAN SING.
APPARENTLY SHE'S SOMETHING
ELSE.
SO THIS IS VERY STRIKING, ONE
WEEK LATER WHAT YOU DO YOU
REMEMBER THE SINGER BUT ALL THE
OTHER DETAILS ARE BECOMING TO
WASHED OUT.
THREE MONTHS LATER WHAT HAPPENS
ALL THE DETAILS ARE WASHED OUT
BUT YOU REALLY REMEMBER THIS
FEATURE.
IT'S KIND OF THE WAY IT WORKS
IN THE BRAIN.
YOU HAVE ALZHEIMER'S I'LL SHOW
YOU WHAT HAPPENS, OKAY.
[speaking French ]
IN THE HERE AND NOW.
OKAY, IN EARLY MODERATE
ALZHEIMER'S.
[speaking French ]
BUT THEN THEY WALK OUT OF THE
THEATRE, OKAY, NOT EVEN 15
MINUTES WHOOPS, WASHED OUT.
NOT THREE MONTHS LATER, THE
NEXT MORNING IT'S ALL WASHED
OUT, OKAY?
SO IT'S LIKE A TEFLON IN SOME
WAYS, OKAY, SO JUST TO GIVE YOU
AN IDEA OF NORMAL, ABNORMAL
AGING, OKAY?

A white layer slowly hides the picture.

He continues SO I'M ALMOST FINISHED, I'M
ALMOST FINISHED.
SO NOW THE LAST ONE E, OKAY,
EXECUTIVE FUNCTIONS.
ABILITY TO PLAN AND EXECUTE
COMPLEX MOTOR PROGRAMS OR WE
CALL THOSE BEHAVIOURS, OKAY?
FRONTAL SYSTEMS IS WHAT
DISTINGUISHES US FROM YOU KNOW,
OTHER PRIMATES AND ANIMALS.
SO BASICALLY WHAT HAPPENS WITH
PATIENTS WITH FRONTAL -- AND
BELIEVE ME THERE'S A LOT OF
THAT STUFF.
FRONTAL -- WE HAVE A LOT, OKAY?
NICE, BARE IN FRONT.

[Laughter ]

He continues SO WHAT YOU
WOULD DO WITH THOSE PATIENTS
WOULD BE THEY TEND TO FOCUS ON
A SMALL, SMALL, LITTLE DETAIL
WHEN YOU HAVE DAMAGE THERE AND
YOU CAN'T PULL BACK.
PULL BACK AND LOOK AT THE TOTAL
CONTEXT.
YOU ASK HIM WHAT LETTER DO YOU
SEE HERE?
THEY TELL YOU N.
I SAID DO YOU SEE ANOTHER
LETTER?
HE SAYS YES, N.
THAT'S IT?
THERE'S ANOTHER N HERE, MY
THERE'S A LOT A OF N's.
SO THEY CAN'T PULL BACK.
THEY GET STUCK ON THE SMALL
DETAILS.
OKAY, THEY GET VERY, VERY
PULLED TO A SALIENT FEATURE.
THIS IS AN ALZHEIMER'S PATIENT
WE SAW EARLIER AND WE FOLLOWED
THEM EVERY SIX MONTHS, OKAY?
AND YOU'D ASK HIM DRAW A CLOCK
AND DRAW ALL THE NUMBERS AND
SET THE TIME AT 10 AFTER 11.
SOUNDS EASY, SOUNDS EASY BUT
YOU KNOW THAT 10 AFTER IS NOT A
10 IT'S A TWO.
YOU HAVE TO ABSTRACT, IT'S VERY
COMPLEX.
WHAT DO THEY DO?
THEY GET STUCK TO THE VERY
SALIENT INFORMATION.
TEN, 11, 10, 11, RIGHT AND THEY
DO IT WRONG.
YOU CAN GIVE THEM AN IQ TEST
THEY DO VERY WELL BECAUSE YOU
KNOW IT OR YOU DON'T.
YOU GIVE THEM THIS SMALL TASK
THEY CAN'T DO THAT.
HERE HE WAS ABLE TO DO IT.
THEY PUT THE ONE HERE.
UH, AND THEY WERE ABLE TO DO
IT.
HERE, NO WAY, 10, 11.
HERE, 10, 11 BUT THERE'S
ANOTHER PROBLEM HERE.
IT'S CALLED PERCEPTUAL NEGLECT
WHEN YOU HAVE DAMAGE OF THE
ASSOCIATION AREA OF THE RIGHT
TEMPORAL UH, REGION YOU TEND
NOT TO PAY ATTENTION TO THE
OPPOSITE SIDE, THE LEFT SIDE SO
YOU CAN SEE HOW THIS WORKS,
OKAY?
SO NOW HOW THIS FRONTAL
FUNCTIONS OR OTHER DIMENSIONS
CAN AFFECT WORKING IN THE
ENVIRONMENT?
OKAY, THEY'RE COMING TO MY
OFFICE, OKAY, A PATIENT WITH
FRONTAL DYSFUNCTIONS, THEY'RE
COMING TO OFFICE AND ALL THOSE
DIMENSIONS HAVE YOU KNOW
FRONTAL DYSFUNCTIONS BECAUSE
FRONTAL LOBE IS A BIG, BIG
PORTION.
WHAT THEY DO, I SIT OVER HERE
AND I WATCH THOSE PATIENTS
COMING IN.

A picture of an elevator appears. He points at it.

He continues YOU KNOW WHAT THEY DO?
IF YOU WANNA GO UP TO MY UNIT
OKAY, YOU HAVE TO PRESS HERE TO
GO UP, PRESS HERE TO GO DOWN.
YOU KNOW WHAT THEY DO?
THEY PRESS THE OBVIOUS THING
WHICH IS THE BIG ARROW AND IT
DOESN'T WORK.
THE DOORS OPEN, WHAT DO THEY
SEE A SIGN THAT SAYS DO NOT
ENTER.
IT ACTUALLY SAYS DO NOT SMOKE
BUT RED SIGN, DON'T COME IN AND
THEY START LOOKIN' CONFUSED,
HUH?
OKAY, THEN THEY GET INTO THE
ELEVATOR.
SOMEBODY NICE BRINGS THEM IN
THERE.
I WANNA SEE WHO?
THE NAME -- DOCTOR PROULX, YEAH,
FOURTH FLOOR AND THE DOORS OPEN
ON THE SECOND FLOOR AND LOOK
WHAT YOU GET, OKAY?
WHEN THE DOORS OPEN, OKAY,
TYPICAL HOSPITAL, EH?
LOOK AT THAT, 2F, THAT A WAY.
2E, THAT A WAY.
EDUCATION ON THE FLOOR.

[Laughter ]

He continues 2X, 2X, WHERE IS
THAT?
WHAT'S THIS?
WHAT'S THE LOGIC?
WELL, IT TOOK ME A LONG, LONG,
LONG TIME BUT THERE WAS ANOTHER
FRENCHMAN AT BAYCREST WHO
CHARTED A PHYSICAL PLAN.

[ Laughter ]

He continues IT TOOK ME TWO
YEARS TO FIGURE OUT WHAT HE
MEANT BY 2H AND IT WAS LIKE
HADMINISTRATION.

[ Laughter ]

He continues AND THIS POOR
FELLOW, YOU KNOW, HAS DIED, YOU
KNOW SO TOUCH WOOD, OKAY, HE'S
DEAD NOW.
COME IN?
OKAY, SO, OKAY,
NOW SO LET'S...
AND THIS IS MY OFFICE, LOOK AT
THAT.
EXIT THAT A WAY, THAT A WAY,
EXIT.

[Laughter]

He continues I WANNA GET IN
SOMEWHERE, RIGHT?
YOU HAVE -- YOU CAN'T GET IN NO
HOSPITAL.
SO THE PROBLEM
THE PATIENT -- THE PROBLEM THAT
I SAW IT TOOK TWO HOURS, THAT
WAS WITHIN NORMAL RANGE.
NOT REMEMBERING HIS WIFE WAS
THE PROBLEM, OKAY?
NO, YOU THINK
THIS IS FUNNY, IT'S NOT ALL
THAT FUNNY, MY FRIENDS, OKAY.

A picture of a toilet with several holding bars and protections appears.

He continues HOW YOU FLUSH THE DAMN THING,
OKAY?

[Laughter]

He continues THIS IS WHERE I
WORK WE SPECIALIZE IN COGNITIVE
DISORDERS.
YOU KNOW, ASTRONAUTS CAN'T DO
THIS.

[ Laughter]

He continues YOU GOT TO FLUSH
IT IN THE BACK AND ONE OF THOSE
GIZMOS, YOU KNOW, AND THEN WHEN
I GOT THERE IN '86, OKAY, SO
WE'RE BEHAVIOUR NEUROLOGISTS,
BEHAVIOUR PSYCHOLOGISTS, NEURO-
PSYCHIATRISTS.
SPECIALISTS GALORE, HUH?
IT SAID HERE PULL CHAIN FOR
HELP.

[Laughter]

Guy continues AND THEY PUT
MASKING TAPE OVER HERE AND THEY
PUT A LITTLE SIGN WITH AN
EXCLAMATION MARK AND A STAR
THAT SAYS “DO NOT PULL THE
CHAIN TO FLUSH THE TOILET.”

[Laughter]

He continues SO EH, MY
FRIENDS, I TELL YOU, THE LINE
HERE, WE CAN -- YOU KNOW,
HERE'S ANOTHER EXAMPLE OF
CONFUSED PATIENTS, RIGHT?...WAS IT THE PATIENT WHO WAS
CONFUSED OR WAS THE ENVIRONMENT
CONFUSING OR WAS THE
ENVIRONMENT DISABLING?
OH, YES, NOT ONLY THAT, MY
FRIENDS, I THINK THAT
CONFUSING, DISABLING
ENVIRONMENTS, STRESSFUL
ENVIRONMENTS COULD ACTUALLY IF
YOU FOLLOW MY LOGIC COULD
ACTUALLY EXACERBATE THE DISEASE
PROCESS, MAKE IT WORSE, OKAY,
REALLY.
SO YOU CAN REDUCE A LOT OF
DISABILITY BY UH, BY UH, A LOT
OF DISABILITY BY REALLY LOOKING
AT THE ENVIRONMENT AND REDUCING
THE -- MAKE THEM A LOT MORE
FUNCTIONAL.
OKAY, LAST FEW SLIDES IS TO
TALK ABOUT SOME EXCITING NEW
DEVELOPMENTS IN THE FIELD,
OKAY.
SO EARLY INTERVENTION IS REALLY
WHERE IT'S GOING AND VERY HOT.
MCI's MYOCOGNITIVE IMPAIRMENT,
REMEMBER THAT.
ALL NEW AREAS OF RESEARCH.
CLINICAL RESEARCH.
SO MCI...
[ stammering ]
WITH THIS IT'S VERY
INTERESTING.
THIS IS CLINICAL RESEARCH.
WE'RE NOT DOING THIS
CLINICALLY.
WE'RE DOING RESEARCH ON IT AND
VERY INTERESTING.
WHAT WE SEE HERE MEDICAL
DOCTORS, FAMILY DOCTORS ALWAYS
SEND PEOPLE, YOU KNOW, BECAUSE
MEDICINE IS PATHOLOGY, YOU
KNOW, WHEN YOU'RE DYSFUNCTIONAL
YOU'RE SENT TO A -- YOU GO TO
SEE A DOCTOR WHEN THINGS ARE
NOT WORKING AND THEY GO AND SEE
THE DOCTOR AND SAY WELL, MY
MEMORY IS NOT WHAT IT WAS, YOU
KNOW, THEY HAVE SUBJECTIVE
MEMORY COMPLAINTS BUT THE
DOCTOR ASKS QUESTIONS ABOUT HOW
THEY WERE WORKING OUT AT HOME.
THEY'RE DOING VERY WELL IN
THEIR DAILY ACTIVITIES.
REMEMBER DEMENTIA WE SAID
PEOPLE BECOME DEPENDENT OF
THEIR ACTIVITIES OF DAILY
LIVING.
THEY'RE NOT DEPENDENT, THEY'RE
DOING FINE.
SO THE MEDICAL FAMILY DOCTOR
SAYS COME AND SEE ME IN SIX
MONTHS.
THEY COME AND SEE HIM IN SIX
MONTHS, THEY'RE STILL DOING
OKAY, OKAY, NOW WHEN THEY START
BECOMING DYSFUNCTIONAL THEY
SEND HIM TO SPECIALISTS,
BEHAVIOURAL NEUROLOGIST, NEURO-
PSYCHOLOGIST AND THAT'S WHEN WE
SEE THEM.
WHAT WE'RE DOING NO WE GO TO
THE FAMILY DOCTOR'S OFFICE AND
WE SAY WHEN YOU SEE SOMEBODY --
WHEN YOU SEE SOME OF YOUR
PATIENTS WHO HAVE SUBJECTIVE
MEMORY COMPLAINTS, CAN WE SEE
THEM?
WE SEE THEM, WE GIVE THEM
MEMORY TESTS AND WE TAKE THOSE
WHO HAVE SIGNIFICANT PROBLEMS
ON MEMORY, ONE, THEY HAVE A
PROBLEM ON MEMORY.
WE BRING THEM IN, OKAY, AND
WHEN WE FOLLOW THESE PEOPLE
OVER FIVE YEARS 50, OVER 50 percent OF
THESE PEOPLE CONVERT INTO FULL
BLOWN DEMENTIA.
SOME DON'T, WHY DON'T THEY?
WE HAVE TO STUDY ALL OF THAT,
OKAY, SO WHEN YOU FOLLOW PEOPLE
WHO PROGRESS INTO DEMENTIA,
HAVE EARLY SIGNS, WE FIND NEW
EXCITING THINGS.

A slide shows the different areas of the human brain.

He continues WE FIND THAT THIS AREA HERE OF
THE BRAIN, THIS IS THE FIRST
ONE TO BE DAMAGED.
THE SECOND ONE IS THE
HIPPOCAMPUS, EPISODIC MEMORY.
IT'S VERY IMPORTANT OVER HERE
LAYING DOWN NEW MEMORIES AND
THIS FRONTAL SYSTEMS HERE ARE
THE THIRD ONE TO GO
DOWN, OKAY?
SO NOW IF WE MAKE THE
CONNECTION WITH EVERYTHING
ELSE, GO DOWN LOWER INTO THE
BRAIN I TOLD YOU A LITTLE BIT
BEFORE ABOUT THE BASAL
FOREBRAIN ALZHEIMER'S DISEASE
AND THEN THESE LITTLE NUCLEI
CAN BE SUB-DIVIDED INTO THREE.
THE FIRST ONE TO BE DETERIORATE
IS THIS ONE.
SO THIS ONE PROJECTS THESE
NEUROTRANSMITTERS...
[ stammering ]
NEUROTRANSMITTERS PROJECT INTO
WHERE?
THE HIPPOCAMPUS AND THE
INTERNAL CORTEX.
THIS ONE IS THE SECOND INTO THE
FRONTAL SYSTEMS SO YOU KNOW
WHAT YOU'RE SEEING IS THE
COMPLEX BEHAVIOUR AS THEY GET
WORSE, AS THEY DETERIORATE
MATCH WITH THE BRAIN--
[ stammering ]
REGIONS, ANATOMY AND
NEUROTRANSMITTERS AND THOSE
NEUROTRANSMITTERS ARE CALLED
THE COLNARGIC SYSTEM.
BY THE WAY ALL THE DRUGS THAT
WE NOW GIVE TO THE PEOPLE WHO
HAVE ALZHEIMER'S ARE COLNARGIC
ENHANCING DRUGS AND WE'RE NOW
TRYING TO TWEAK ALL OF THIS
BECAUSE YOU KNOW, THOS
COLNARGIC ENHANCING DRUGS --
THE COLNARGIC SYSTEMS ACTUALLY
ACTIVATES DIFFERENT TYPES OF
RECEPTORS.
NICOTINIC, MUSCARINIC,
DIFFERENT TYPES OF RECEPTORS
YOU KNOW, SO WE WANNA TWEAK
THAT IN RESEARCH AND TRY TO BE
A LOT MORE SOPHISTICATED AND
MAYBE ONE DAY WE'LL GET EVEN
CLOSER TO THOSE CURES.
STROKES, OKAY, THERE'S NEW
PROTOCOLS NOW, STROKES IN THE
BRAIN IS A BIT LIKE A BRUISED
APPLE.
YOU CAN HAVE THIS AREA OF
DAMAGE HERE AND AFTER A LITTLE
WHILE THIS SURROUNDING AREA, WE
CALL PENUMBRA AFFECT IN THE
BRAIN DIE OUT, OKAY, SO NOW
WHAT THEY DO WHEN PEOPLE HAVE A
STROKE ATTACK, ANOTHER STROKE
YOU CALL IT A STROKE ATTACK.
THEY GO TO THE HOSPITAL.
THEY GIVE THEM A CERTAIN DRUG,
OKAY, AND WHAT THAT DRUG DOES
IS THAT IT KIND OF PUTS ALL THE
REGIONAL NEURONS AROUND HERE TO
SLEEP A LITTLE BIT AND THEN
AFTER THAT THEY WITHDRAW THIS
DRUG AND WHAT YOU GET IS YOU
CONTAIN THE DAMAGE SO WHAT THAT
MEANS IN TERMS OF THE BRAIN IS
THAT YOU CAN CONTAIN THE DAMAGE
FROM THE REGION HERE AND YOU
CAN REDUCE THE DEGREE OF
COGNITIVE DISORDERS
DRAMATICALLY BECAUSE OF THOSE
NEW MEDICAL PROCEDURES.
WE HEAR A LOT -- WE HEAR ABOUT
STEM CELLS.
WE NOW KNOW THAT THERE ARE STEM
CELLS WHERE?
IN THE HIPPOCAMPUS.
WILL WE BE ABLE TO...
[ stammering ]
COAX SOME OF THOSE CELLS ONE
DAY WELL, THERE'S A LOT OF
RESEARCH.
WE'RE NOT THERE.
YOU'LL BE HEARING A LOT ABOUT
THAT.

A picture of an old man playing chess appears.

He continues YOU ARE ACTUALLY AND THEN YOU
SEE PATIENTS, THIS MAN HERE HAD
A STROKE ON THE RIGHT SIDE OF
HIS BRAIN, OKAY, AND WHAT WE
HAVE HIM DO IS VERY, VERY
SPECIFIC PROBLEMS RELATED TO
HIS PROBLEM -- TO HIS DISEASE,
TO HIS BRAIN DAMAGE WHICH IS A
PERCEPTUAL PROBLEM.
YOU HAVE TO HAVE HIM DO A
PERCEPTUAL TASK.
YOU TRAIN HIM ON THIS FOR TWO
OR THREE WEEKS AND THIS MAN HAD
DAMAGE ABOUT TWO YEARS AGO SO-
CALLED RECOVERED AND WHAT WE
SEE IN THE BRAIN IS THAT WE CAN
NOW LOOK AT THE BRAIN.
WHAT HAPPENS IS THAT THE BRAIN,
THE PART OF THE BRAIN, THE LEFT
SIDE WHICH IS NOT DAMAGED IS
COMPENSATING SO WE CAN SEE NOW
IF WE DO APPROPRIATE TRAINING
OF BEHAVIOURS VERY WELL
TARGETED THOSE BEHAVIOURS
ENTRAIN OR ACTIVATE NERVE
GROWTH FACTORS IN THE BRAIN AND
BY COMBINING YOU KNOW, DRUGS
WITH VERY SPECIFIC BEHAVIOURS,
YOU KNOW WE CAN GET A LOT MORE
EFFECTIVE RESULTS AND THEN THE
BRAIN CAN COMPENSATE ON THIS
CASE, THE OPPOSITE SIDE OF THE
BRAIN SHOWED MORE ACTIVITY.
SO TO RECAP, OKAY, I'VE TALKED
ABOUT THE BRAIN, OKAY, I'VE
TALKED ABOUT BEHAVIOUR,
ENVIRONMENT, YOU KNOW, WE'RE
GETTING TO ACTUALLY TACKLE THE
BRAIN DISORDER ITSELF.
I TALKED ABOUT COMPENSATION.
I WANT TO MINIMIZE THAT, OKAY,
BECAUSE I HAVE A MEDICAL
PROBLEM, RIGHT?
I CAN'T SEE, OKAY, AND BECAUSE
I HAVE THIS MEDICAL PROBLEM,
IT'S PROGRESSIVE.
THE OPHTHALMOLOGIST SAYS, GUY,
IT'S GETTING WORSE AND WORSE
AND BELIEVE ME, IT'S BAD.
I PAY 300 DOLLARS EXTRA TO LOOK GOOD,
OKAY?
IT'S BAD.
AND BECAUSE OF THIS BIOLOGICAL
PERMANENT PROBLEMS, IT TENDS TO
GET WORSE.
I HAVE A TERRIBLE DISABILITY.
I CAN'T DRIVE MY CAR.
I'M TOTALLY DYSFUNCTIONAL.

He shows his glasses and says NOW THEY CAN'T DO NOTHING RIGHT
NOW BUT THIS THING HERE HAS
BEEN AROUND FOR 300 YEARS AND
I'M TELLING YOU BYE-BYE
DISABILITY.
I'M FUNCTIONAL ALL OF A SUDDEN,
RIGHT?
SO WHEN I TALKED ABOUT THE
DEMENTIA AT THIS LEVEL YOU CAN
GET DRAMATIC IMPROVEMENTS,
OKAY, AT THE BEHAVIOURAL AND
ENVIRONMENTAL LEVELS, OKAY, MY
LAST SLIDE, THE BRAIN FOR US TO
HAVE A MIND, A MIND, TO EXIST
THE MIND HAS -- THE BRAIN HAS
TO BE PLUGGED INTO A CONTEXT,
OKAY, AND I'VE TALKED A LOT
ABOUT ABNORMAL AGING, DEMENTIA,
MEDICAL SCHOOLS, THAT'S WHAT
THAT'S ALL ABOUT AND UH, YOU
KNOW, BUT AGING, AGING IS NOT A
DISEASE, AGING IS A PRIVILEGE.

A new picture displays an old man holding a little baby.

He continues SOME OF US, THIS MAN HAS
ALZHEIMER'S DISEASE IS NOT SO
LUCKY BUT I WANNA POINT OUT
THAT THIS LITTLE GIRL HE HAS IN
HIS ARMS, OKAY, IS AMNESIC.
ALL OF YOU UNTIL THE AGE OF
THREE OR FOUR WERE TOTALLY
AMNESIC, OKAY, AND WHAT'S
HAPPENING?
WHY ARE THEY AMNESIC BECAUSE
THIS GENERATION, OUR GENERATION
PASSES NEW KNOWLEDGE AND NEW
HABITS AND NEW CULTURE TO THIS
SO THEY CAN REWIRE THEIR
PROGRAMS AND THEIR BRAIN
FUNCTIONS.
WHY?
TO BE ABLE TO TAKE THAT WISDOM
AND...
[stammering ]
MAYBE HELP AND ERADICATE SOME
OF THE DISEASE AND MAKE OUR
WORLD A BETTER WORLD.
THANK YOU VERY MUCH FOR THIS
OPPORTUNITY.
I APPRECIATE IT VERY MUCH.

[Applause]

A slate pops up. It reads “For more information about Mini-Med School at the University of Toronto visit us on the web at: www.tvo.org.”

The end credits roll.

Mini-Med School Producer, Wodek Szemberg.

Logos: CEP Local 72 M and Canadian Media Gold.

A Production of TVO Ontario.

Copyright The Ontario Educational Communications Authority 2003.

Watch: Dr Guy Proulx - Part 2