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THE NATURAL HISTORY OF COGNITIVE IMPAIRMENT AND DEMENTIA IN A STROKE COHORT
Funder
National Health and Medical Research Council
Funding Amount
$290,747.00
Summary
In a current NHMRC-funded study, we have examined 200 stroke patients (and 100 control subjects) at 3 months after a stroke and one year later, and identified those who have impairment in memory and other cognitive functions. We have also studied these subjects in detail from a psychiatric perspective and performed brain scans on them using magentic resonance imaging. We find that many stroke patients have problems with their cognitive functioning which has a major impact on their lives. A large ....In a current NHMRC-funded study, we have examined 200 stroke patients (and 100 control subjects) at 3 months after a stroke and one year later, and identified those who have impairment in memory and other cognitive functions. We have also studied these subjects in detail from a psychiatric perspective and performed brain scans on them using magentic resonance imaging. We find that many stroke patients have problems with their cognitive functioning which has a major impact on their lives. A large number also become depressed. These consequences of stroke are not given sufficient importance by clinicians. The fact that stroke is a common problem in the elderly, and our society is aging, makes this a problem of major public health significance. In the new proposal, we plan to study these subjects up to 3 years with repeat neuropsychiatric assessments and brain scans to investigate the natural history of stroke-related cognitive impairment. We will determine whether further new cases of dementia develop in the period 1-3 years, what happens to the brain lesions picked up on brain scans, and how these deficiencies affect the patients' living status and their longevity. We will be able to determine the factors that lead to a good outcome, and suggest strategies that may be applicable to improve the functioning of these individuals.Read moreRead less
An Extended Follow-up Of Stroke Patients For Cognitive Impairment And Neuropsychiatric Disorders: Sydney Stroke Study
Funder
National Health and Medical Research Council
Funding Amount
$321,800.00
Summary
Vascular Dementia (VaD) is the second most common cause of dementia after Alzheimer's disease. In fact, it may be a preventable cause of dementia. Yet it has been relatively neglected by researchers until the last decade, which has seen an upsurge of interest in this disorder. There is no consensus on the criteria for dementia. The profile of early cognitive impairment due to vascular factors is still poorly understood, and the longitudinal course of VaD as defined by modern criteria has not bee ....Vascular Dementia (VaD) is the second most common cause of dementia after Alzheimer's disease. In fact, it may be a preventable cause of dementia. Yet it has been relatively neglected by researchers until the last decade, which has seen an upsurge of interest in this disorder. There is no consensus on the criteria for dementia. The profile of early cognitive impairment due to vascular factors is still poorly understood, and the longitudinal course of VaD as defined by modern criteria has not been studied. There have been few studies of the progressive changes in MRI in patients with cerebrovascular disease. The overlap of VaD and Alzheimer's disease (AD) remains a problem for taxonomists and clinicians. One approach to the study of VaD is to examine a high risk group of subjects longitudinally to determine the early features, the risk factors and progressive changes. With this in mind, we began studying a cohort of stroke patients who are at high risk of VaD, in 1997-1999, and are following them longitudinally. The follow-up is now in its third year, and three neuropsychological assessments and two MRI-MRS scans have been performed. We propose to extend the follow-up to 5 years, with repeat neuropsychiatric, neuropsychological and MRI-MRS investigations, and wherever possible to necropsy, to determine the nature of vascular pathology that underlies cognitive impairment. Our cohort of stroke patients is arguably the most comprehensively assessed such cohorts internationally, and presents an excellent opportunity for a long-term follow-up study.Read moreRead less
Effects Of Prism Adaptation On Space Perception Following Chronic And Reversible Cortical Lesions
Funder
National Health and Medical Research Council
Funding Amount
$319,336.00
Summary
Damage to one side of the brain following a stroke often produces a debilitating disorder called spatial neglect. Affected patients persistently ignore objects, sounds or touches on the side of space opposite their brain injury. This disorder occurs despite normal sensory function, and reflects damage to the brain's internal representations of one side of space, causing patients to behave as if that side of space no longer exists. Spatial neglect is difficult to rehabilitate and is a major predi ....Damage to one side of the brain following a stroke often produces a debilitating disorder called spatial neglect. Affected patients persistently ignore objects, sounds or touches on the side of space opposite their brain injury. This disorder occurs despite normal sensory function, and reflects damage to the brain's internal representations of one side of space, causing patients to behave as if that side of space no longer exists. Spatial neglect is difficult to rehabilitate and is a major predictor of poor functional recovery after stroke, but there are no effective treatments for it. A promising new treatment for spatial neglect has been recently discovered, which involves patients practicing pointing to a visual target while wearing spectacle-mounted prism lenses that systematically correct for their altered view of the world. Following a brief period of this training, patients' show increased ability to perceive visual objects presented to the previously neglected side of space. Studies have shown that the prism treatment can have long-term benefits for many neglect sufferers. However, it is not known what the brain mechanisms underlying the treatment effects are, and to what degree the effects generalize to all affected senses. The proposed project aims to investigate whether prism treatment ameliorates spatial neglect of sounds as well as visual objects in a group of stroke patients. The project will also systematically examine which part of the brain is critical for the beneficial effects of prism treatment by using focal magnetic stimulation to create reversible, virtual lesions in the brains of healthy participants. Addressing these issues has clear implications for identifying suitable candidates for the treatment, and for understanding how the sensory world is represented in the human brain.Read moreRead less
Novel Approaches To Improve Cognitive Recovery Following Stroke And Traumatic Brain Injury
Funder
National Health and Medical Research Council
Funding Amount
$344,724.00
Summary
Stroke and traumatic brain injury costs the Australian economy over $13 billion, annually. Both disorders result in impaired cognition that impedes individuals’ return to the community. Current rehabilitation strategies, however, fail to adequately rehabilitate cognitive deficits following these disorders. My fellowship will develop new strategies to improve rehabilitation of cognitive functions by using cutting-edge neuroimaging and electrophysiological techniques.
Retinal Vascular Signs As Predictors Of Systemic Disease Outcomes: 10-year Evolution In A Population-based Cohort
Funder
National Health and Medical Research Council
Funding Amount
$389,575.00
Summary
Recent U.S. data from two population-based studies have highlighted retinal microvascular signs as being predictive of systemic vascular and other important health outcomes in middle-aged or older individuals, particularly stroke and heart attack and mortality, independent of traditional vascular risk factors. The present application proposes to evaluate the 10-year development and progression of retinal microvascular signs and their relations to the development of stroke and other important sys ....Recent U.S. data from two population-based studies have highlighted retinal microvascular signs as being predictive of systemic vascular and other important health outcomes in middle-aged or older individuals, particularly stroke and heart attack and mortality, independent of traditional vascular risk factors. The present application proposes to evaluate the 10-year development and progression of retinal microvascular signs and their relations to the development of stroke and other important systemic health outcomes in the population-based cohort of residents attending the Blue Mountains Eye Study (BMES. Two types of retinal signs will be evaluated: firstly, the presence of specific clinical signs, such as focal narrowing of small retinal vessels (arterioles), nicking of retinal veins as arterioles cross them or presence of retinopathy (haemorrhages and other signs) secondly, measures of generalized retinal vessel calibre (narrowing) using a computer-assisted method developed for the U.S. studies. We will also develop new grading methods for two other signs. Late and will compare computer-assisted grading from 35mm slides to automated grading of vessels using a scanning device (being developed) to screen the eyes of older persons. This project builds upon our current 3-year NHMRC grant (ID153948; 2001-2003) Retinal vascular signs as risk markers for incident stroke or cerebrovascular death: A population-based assessment . In the last 2 years, this has explored different aspects of measurement and grading of these signs, has documented their relation to blood pressure and has begun to assess whether these features predict vascular events and other systemic outcomes in older Australians. The new project will assess the evolution of retinal microvascular signs over a 10-year period, using data and retinal photographs from the 10-year examinations of the BMES cohort, currently being collected, in a further current NHMRC grant (ID211069; 2002-2004).Read moreRead less
What Is The Burden Of Dementia In Urban Dwelling Indigenous Australians?
Funder
National Health and Medical Research Council
Funding Amount
$1,571,527.00
Summary
The main aim of this research project is to determine what proportion of Aboriginal people aged 45 years and older who live in urban areas of NSW, have dementia. We hope to establish what types of dementia occur amongst Aboriginal people, what the causes are, and how we can best measure dementia. We will also focus on what types of problems dementia causes for both people with the condition and their carers. What is the meaning of dementia for Aboriginal people themselves?
Neural Mechanisms Of Language Facilitation In Aphasia Due To Transcranial Direct Current Stimulation.
Funder
National Health and Medical Research Council
Funding Amount
$523,192.00
Summary
This project will assess the underlying neural mechanisms by which neurostimulation improves impaired language functions after stroke (aphasia). This will be accomplished by using a novel combination of functional magnetic resonance imaging and simultaneous transcranial direct current stimulation (tDCS) administered to different brain regions. These studies will provide crucial information necessary to optimise future clinical trials that combine tDCS with language therapy.
Cognitive Decline In Type 2 Diabetes: Investigating The Contribution Of Neurodegeneration And Cerebrovascular Disease
Funder
National Health and Medical Research Council
Funding Amount
$608,520.00
Summary
Dementia occurs more commonly than expected in diabetes but the reasons are unknown. There could be a build up of deposits of the toxic protein in the brain that causes Alzheimer's disease. A new technique, using Positron Emmission Tomography (PET scans), will be used to answer this question in combination with MRI scans and serial cognitive testing in patients considered to be at-risk for dementia. The study will help direct research efforts aimed at dementia prevention and treatment.