The Mechanism, Predictive Value And Impact Of Apathy In Patients With Alzheimers Disease And Their Caregivers
Funder
National Health and Medical Research Council
Funding Amount
$542,370.00
Summary
Behavioural and psychological symptoms of dementia have been consistently associated with increased patients’ distress, and are considered by caregivers as the most difficult symptoms to manage. Apathy is the state of loss of motivation and emotional withdrawal that occurs in a high proportion of patients with Alzheimer’s disease. These patients require more management and support, given their reliance on others to schedule their activities and initiate behaviours even when they are still capabl ....Behavioural and psychological symptoms of dementia have been consistently associated with increased patients’ distress, and are considered by caregivers as the most difficult symptoms to manage. Apathy is the state of loss of motivation and emotional withdrawal that occurs in a high proportion of patients with Alzheimer’s disease. These patients require more management and support, given their reliance on others to schedule their activities and initiate behaviours even when they are still capable of performing the activities. In spite of the high frequency of apathy in dementia and the high potential of negative effects on patients and caregivers, little is known about the cause of this phenomenon, its potential influence upon the long-term progression of Alzheimer’s disease, and on its impact upon caregivers’ emotional well-being. The main aim of our proposal is to examine the mechanism, clinical relevance and impact of apathy in Alzheimer’s disease. More specifically, we will determine whether apathy predicts more severe depression, increasing motor problems, and a faster progression of cognitive and functional problems. Using state-of-the-art neuroimaging techniques we will examine the association between apathy and abnormalities in specific brain regions. Finally, we will examine whether caregivers of patients with apathy have relatively more severe emotional problems, a higher care giving burden and poor quality of life.Read moreRead less
Cognitive Outcome And Therapeutic Interventions For Coronary Artery Disease.
Funder
National Health and Medical Research Council
Funding Amount
$392,104.00
Summary
Dementia is recognized as an increasingly important factor affecting quality of life as people age. Deaths from heart disease are declining, in part due to improved surgical techniques and to the use of less invasive methods to keep arteries open such as coronary stenting. It is now well known that 20 to 60% of patients experience some degree of impairment in thinking ability (cognitive impairment) after cardiac surgery, that this will persist in some of these individuals for years and may incre ....Dementia is recognized as an increasingly important factor affecting quality of life as people age. Deaths from heart disease are declining, in part due to improved surgical techniques and to the use of less invasive methods to keep arteries open such as coronary stenting. It is now well known that 20 to 60% of patients experience some degree of impairment in thinking ability (cognitive impairment) after cardiac surgery, that this will persist in some of these individuals for years and may increase the risk of long-term problems. Cognitive impairment affects people in many ways. While it is not yet known whether the occurrence of cognitive impairment predisposes to dementia, it is thought that Mild Cognitive Impairment (MCI) may do so. We propose to explore the link between MCI and Post Procedural Cognitive Deficit (PPCD) in patients with coronary disease from before the first point of objective diagnosis, i.e. prior to the coronary angiogram, and over a 12-month period, through and subsequent to further treatment interventions such as stenting or cardiac surgery. Our Pilot data suggest that PPCD does indeed occur after angiography, and we propose to identify how long this lasts, whether MCI predisposes to it and whether it is better to wait until it resolves before further interventions are undertaken. In this way we hope to identify the safest treatment strategy for patients with coronary disease that will minimize the occurrence of Cognitive Deficit and possibly longer-term cognitive changes after investigation and treatment for their symptoms.Read moreRead less
The Effect Of Music On Agitated Behaviours In Older People With Dementia: A Randomised Control Trial
Funder
National Health and Medical Research Council
Funding Amount
$153,634.00
Summary
This study uses a cost effective non-pharmacological intervention, that being music therapy to improve quality of life (QOL) in people with dementia. Dementia results in a decline in mood and cognitive functioning and the emergence of behaviour problems that include aggressive acts, agitation, and sleep-wake and rest-activity pattern disturbance. Aggressive behaviour is a common burden for caregivers in residential and family care. The subsequent stress that aggression places on caregivers can l ....This study uses a cost effective non-pharmacological intervention, that being music therapy to improve quality of life (QOL) in people with dementia. Dementia results in a decline in mood and cognitive functioning and the emergence of behaviour problems that include aggressive acts, agitation, and sleep-wake and rest-activity pattern disturbance. Aggressive behaviour is a common burden for caregivers in residential and family care. The subsequent stress that aggression places on caregivers can lead to staff and family burn out, an increase in restraint use, and decreased quality of care. Research suggests that disruptive behaviours are recognised as a predictor in staff resignation and carer stress, both of which add significantly to the current costs of aged care. This project therefore has the potential to benefit both people living with dementia and their carers. The positive outcomes of music on people of all ages and health status have been established in various clinical settings. Recent research suggests that music therapy may be useful in the management of disruptive behaviours in people with dementia. Music therapy for people with dementia has the potential to improve their quality of life (QOL) through an improvement in depression, and a reduction in aggression and agitation. This study will investigate the effect of a live music program (where participants use their voices and instruments to perform and create music) on agitated behaviours in older people with dementia. It will provide evidence contributing to better understandings about music therapy and its contribution to QOL and disruptive behaviours in people with dementia that can be transferred to other settings such as the community and home based care of people with dementia.Read moreRead less
Deficits Of Insight And Judgment In Alzheimers Disease: Diagnostic Strategy And Clinical Significance
Funder
National Health and Medical Research Council
Funding Amount
$459,983.00
Summary
During the next three decades the number of persons older than 85 years will more than double, and the health care need of this burgeoning population are assuming greater importance. Recent studies suggest that the prevalence of dementia in Australia will increase from 172 000 cases in 2000 to 588 000 in 2050. This rapid increase in number of dementia cases will result in an increasing burden for caregivers, and in financial terms, for the working-age population. One of the main clinical problem ....During the next three decades the number of persons older than 85 years will more than double, and the health care need of this burgeoning population are assuming greater importance. Recent studies suggest that the prevalence of dementia in Australia will increase from 172 000 cases in 2000 to 588 000 in 2050. This rapid increase in number of dementia cases will result in an increasing burden for caregivers, and in financial terms, for the working-age population. One of the main clinical problems suffered by individuals of dementia is psychological and behavioural changes such as poor insight, irritability and apathy. These problems account for a large proportion of medical expenses, predict early institutionalization, and are associated with poor quality of life of caregivers. Unfortunately, little is known about the true frequency of problems of insight in dementia, about their impact upon caregivers, and about how to best diagnose the problems of loss of insight and judgment in this condition. Our study will examine the frequency and clinical correlates of poor insight and judgment in dementia, it will establish whether these problems predict other common behavioural problems of Alzheimer’s disease such as apathy and dangerous behaviours, and will demonstrate the reliability and validity of a specific instrument to measure insight and judgment in dementia. This will facilitate the early recognition and adequate treatment of behavioural problems in patients with dementia; it will improve patients’ quality of life, and will have a positive impact on both caregivers’ psychological well-being and on clinical practice.Read moreRead less
RCT Of Risperidone Versus Haloperidol Versus Placebo With Rescue Haloperidol In Delirium In Palliative Care
Funder
National Health and Medical Research Council
Funding Amount
$50,000.00
Summary
A simple definition of delirium is an acute confusional state that occurs when someone is unwell. It can manifest with many symptoms of varying severity, including confusion, restlessness, poor concentration and disturbance of sleep pattern. Delirium is a common problem when someone is unwell. Experience suggests that medications such as haloperidol and risperidone may be useful in managing these symptoms, however these have not been studied in detail in palliative care. This study is comparing ....A simple definition of delirium is an acute confusional state that occurs when someone is unwell. It can manifest with many symptoms of varying severity, including confusion, restlessness, poor concentration and disturbance of sleep pattern. Delirium is a common problem when someone is unwell. Experience suggests that medications such as haloperidol and risperidone may be useful in managing these symptoms, however these have not been studied in detail in palliative care. This study is comparing the three approaches: use of risperidone given regularly, use of haloperidol given regularly, and use of haloperidol given as needed for symptoms of agitation, hallucinations and restlessness related to delirium in patients being cared for in palliative care settings. This study will compare how well these medications control delirium symptoms (from health professional, patient and caregiver perspectives) and also monitor their side effects over a five-day period, and follow longer term outcomes for 6 months (function and location of care).Read moreRead less
The aim of this project is to design and implement a broad-ranging research program that produces in-depth knowledge of motorcycle rider behaviour, performance, and safety that can be used to inform and develop a broad, and integrated package of countermeasures and-or public policies to improve the safety of motorcycle riders. A key focus of the research program will be on the identification and characterisation of errors that give rise to incidents and crashes involving motorcycle riders. Austr ....The aim of this project is to design and implement a broad-ranging research program that produces in-depth knowledge of motorcycle rider behaviour, performance, and safety that can be used to inform and develop a broad, and integrated package of countermeasures and-or public policies to improve the safety of motorcycle riders. A key focus of the research program will be on the identification and characterisation of errors that give rise to incidents and crashes involving motorcycle riders. Australian motorcycle riders are three times more likely to be involved in a casualty crash than car drivers, and comprised 14% of the national road toll in 2005. The proposed research program aims to improve motorcycle safety by developing appropriate countermeasures that will be derived from the findings of simulator experiments, on-road studies, focus groups, and surveys. The results of these studies will be used to develop guidelines and recommendations for improving motorcycle safety.Read moreRead less
Does Vitamin D Supplementation Reduce Cognitive Decline?
Funder
National Health and Medical Research Council
Funding Amount
$646,601.00
Summary
Australia's population is ageing rapidly and so is the frequency of age-related disorders. Dementia is one of the most frequent mental health disorders of older people and one of the leading causes of years of life lost due to disability in Australia. Mild Cognitive Impairment (MCI) in old age is considered an important clinical state predictive of future cognitive decline. There is increasing evidence that the onset of dementia can be delayed with targeting potentially modifiable risk factors. ....Australia's population is ageing rapidly and so is the frequency of age-related disorders. Dementia is one of the most frequent mental health disorders of older people and one of the leading causes of years of life lost due to disability in Australia. Mild Cognitive Impairment (MCI) in old age is considered an important clinical state predictive of future cognitive decline. There is increasing evidence that the onset of dementia can be delayed with targeting potentially modifiable risk factors. Vitamin D is important for healthy bones and muscle function, but is now also discussed as being important for healthy brain function. The purpose of this randomised placebo-controlled clinical trial is to investigate whether supplementation with vitamin D for 18 months in older adults with MCI who have low vitamin D levels, can help to reduce cognitive decline. 110 older adults with MCI will be randomised (by chance, like the flip of a coin) to either active treatment or placebo. Their cognition (such as memory) performance, quality of life and functional level will be compared at 6, 12, and 18 months. If our hypothesis is confirmed, vitamin D supplementation might prove to be a simple, effective and inexpensive way of delaying cognitive decline in people at risk for dementia. This could lead to the reconsideration of current sun exposure policies in Australia and the more widespread use of food fortification and supplementation.Read moreRead less
Prospective Study Of The Emergence Of Syndromal And Sub Syndromal Anxiety And Depression During Cognitive Decline.
Funder
National Health and Medical Research Council
Funding Amount
$555,696.00
Summary
In older people it is well known that memory impairment and cognitive decline are associated with depression and anxiety. However, it is remains quite uncertain which comes first. For a long time it had been thought that deteriorating brain function associated with ageing and the development of dementia is also the cause of new symptoms of depression and anxiety found in older people. Recently, some evidence has emerged to challenge this hypothesis. So we plan to study this question in detail wi ....In older people it is well known that memory impairment and cognitive decline are associated with depression and anxiety. However, it is remains quite uncertain which comes first. For a long time it had been thought that deteriorating brain function associated with ageing and the development of dementia is also the cause of new symptoms of depression and anxiety found in older people. Recently, some evidence has emerged to challenge this hypothesis. So we plan to study this question in detail with data from an existing longitudinal study of ageing women.Read moreRead less