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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
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
Early Intervention For Amnestic Mild Cognitive Impairment : A Randomised Trial Of Memory Management
Funder
National Health and Medical Research Council
Funding Amount
$577,556.00
Summary
It is increasingly recognised that Alzheimer’s disease can emerge slowly over years and persons presenting with memory impairment, or mild cognitive impairment (MCI), are at increased risk of developing Alzheimer’s disease. Following diagnosis of MCI, active management through symptomatic drug treatment remains equivocal, therefore, memory impairment continues to be troublesome and patients and families are seeking interventions that offer improvement in quality of life. Cognitive interventions ....It is increasingly recognised that Alzheimer’s disease can emerge slowly over years and persons presenting with memory impairment, or mild cognitive impairment (MCI), are at increased risk of developing Alzheimer’s disease. Following diagnosis of MCI, active management through symptomatic drug treatment remains equivocal, therefore, memory impairment continues to be troublesome and patients and families are seeking interventions that offer improvement in quality of life. Cognitive interventions are low cost and, where effective, can provide a stand-alone intervention or add value to the pharmacological approach. The primary aim of this study is to evaluate whether an early intervention program of memory training is effective in improving use of memory strategies in everyday life, and whether this has psychological and emotional benefits for individuals with MCI and their families. We will evaluate through a randomised controlled trial the efficacy of a memory-group program which will involve the family and patient, rather than just the person with MCI, in developing increased awareness of memory issues and specific strategies to prevent memory failures. Over successive cohorts recruited from memory clinics, families will be randomly assigned to either an immediate intervention or a delayed intervention (waiting-list control) group. We will also recruit a sample of healthy older adults who will be similarly randomised into early and late intervention groups. Healthy older adults will provide a means of establishing whether any improvements in the MCI groups are (i) to the same extent as healthy older adults and (ii) to normative levels. Evaluation will be at pre- and post-intervention and at six months follow-up on tests of memory, questionnaires of knowledge and use of memory strategies in everyday life, and appraisal of level of wellbeing. Information about memory and systematic training in compensatory memory skills are expected to significantly improve the capacity of patients and families to cope with everyday memory difficulties. Through active participation in the management of memory impairment, it is expected that the level of wellbeing will increase, for both patient and families.Read moreRead less
Neuroscience On Barriers In Development (NEUROBID)
Funder
National Health and Medical Research Council
Funding Amount
$600,927.00
Summary
The program aims to understand normal and disturbed brain barrier function in development to devise ways of preventing or ameliorating neurological conditions in infants or adult neurological disorders with developmental origins. Unique features of transport mechanisms across brain barriers will be used to design novel methods of targeting therapeutic macromolecular and cellular agents to the brain barriers and transporting them into brain for treatment of neurological diseases in young and old.
Hypoglycaemia In Young Patients With Type 1 Diabetes: Pathophysiology, Predisposition And Preventive Strategies
Funder
National Health and Medical Research Council
Funding Amount
$2,680,000.00
Summary
The vision of this proposal is to bring together an active team of experienced investigators that will address important clinical problems affecting the management of children and adolescents with type 1 diabetes. Along with facilities and resources already under development, the program will further establish a core of investigators dedicated to patient centred and clinical research that will facilitate scientific advances to be put into practice. The incidence of type 1 diabetes is continuing ....The vision of this proposal is to bring together an active team of experienced investigators that will address important clinical problems affecting the management of children and adolescents with type 1 diabetes. Along with facilities and resources already under development, the program will further establish a core of investigators dedicated to patient centred and clinical research that will facilitate scientific advances to be put into practice. The incidence of type 1 diabetes is continuing to increase particularly in the young. As we enter the 21st century, insulin treatment aimed at restoring blood glucose levels as close to the normal as possible remains the most effective way to prevent the devastating long-term complications of the disease. Unfortunately this is difficult to achieve largely because insulin therapy is frequently associated with the development of low blood glucose or hypoglycaemia. Hyperglycaemia results in unpleasant symptoms if mild but if severe it can produce convulsions or unconsciousness. The fear of hypoglycaemia is ever present for the patient and their family, this not only significantly impairs quality of life but importantly also severely restricts attempts to control diabetes. One of the major goals of this research program will be to address important unanswered questions related to the development of hyperglycaemia in children and adolescents with diabetes. The research team will examine in detail the protective physiological mechanisms against hyperglycaemia that are deranged in diabetes, they will also study more closely those situations that are known to predispose to hyperglycaemia such as sleep and exercise as well as how the brain is affected as blood glucose falls. By taking this approach we hope to be able to devise management strategies that will lessen the impact of hyperglycaemia in diabetes treatment. It is anticipated that this in turn will contribute to the prevention of diabetes complications as well as reduce the burden of the disease for the patient and his or her family. A second goal of this research program will be to develop an internationally unique resource that will be available to all diabetes investigators. We will build on an already established population based database of all the children and adolescents with diabetes in Western Australia as well as complete a DNA bank of these patients and their families. Thus in addition to bringing together an effective team of researchers, this program will further develop resources that can be central to addressing other important questions related to the causes of diabetes and its complications.Read moreRead less
The Role Of Metabolic And Inflammatory Factors In Cognitive Decline And Cerebrovascular Pathology In The Elderly
Funder
National Health and Medical Research Council
Funding Amount
$945,987.00
Summary
Metabolic factors and measures of inflammation in the body have recently been shown to influence mental function and increase the risk of developing age-related disorders such as Alzheimer’s disease. The influence metabolic factors and inflammation have on function of the ageing brain is likely to be determined by complex interplay between many factors, such as physical health, lifestyle, nutrition and our genes. By studying these factors and how they relate to one another in large groups of eld ....Metabolic factors and measures of inflammation in the body have recently been shown to influence mental function and increase the risk of developing age-related disorders such as Alzheimer’s disease. The influence metabolic factors and inflammation have on function of the ageing brain is likely to be determined by complex interplay between many factors, such as physical health, lifestyle, nutrition and our genes. By studying these factors and how they relate to one another in large groups of elderly individuals, we will be able to determine the role these factors play in brain ageing. In addition we will be able to determine an ‘at risk’ profile for elderly individuals for accelerated ageing effects. Identification of this profile is important as it will allow the development of interventions which may prevent or delay the onset of cognitive decline in late life. We plan to study the impact of metabolic and inflammatory factors on brain ageing and in two groups of elderly individuals both of which are currently being studied in detail by our research team. By using these existing groups we will minimize the costs associated with our research, but maximize the research benefit and the benefit to society. Our groups include a large community sample of elderly individuals aged 70-90 years and a large group of elderly twins aged over 65 years. Our use of twins for the study is particularly important as it will help us separate genetic and environmental influences on the measures. We will measure multiple metabolic and inflammatory factors in the body and determine their relationship to detailed tests of cognitive function and to cerebrovascular pathology on brain magnetic resonance imaging. We will look at how these factors relate to one another and which factors are most strongly associated with accelerated ageing. We will be able to follow subjects in each group over a 2 year interval to see which factors most strongly predict change in cognitive function and cerebrovascular pathology over time. Our research is unique in its inclusion of multiple factors which may affect brain ageing, its ability to look in detail at the contribution of genetic influences on metabolic and inflammatory factors, and in our planned follow-up of these individuals.Read moreRead less
Identification And Quantification Of Risk Of Falls In Cognitively Impaired Older Adults
Funder
National Health and Medical Research Council
Funding Amount
$530,741.00
Summary
This study represents the first systematic approach to understanding the complex interaction of factors that contribute to risk of falling in cognitively impaired older people. The results will provide much needed information on how to intervene to prevent falls and fractures in this high risk population. In the last decade, 25 randomised controlled trials have been published which show it is possible to prevent falls in older people. However, a major disappointing outcome of research in this fi ....This study represents the first systematic approach to understanding the complex interaction of factors that contribute to risk of falling in cognitively impaired older people. The results will provide much needed information on how to intervene to prevent falls and fractures in this high risk population. In the last decade, 25 randomised controlled trials have been published which show it is possible to prevent falls in older people. However, a major disappointing outcome of research in this field is that trials that have included or specifically focused on older people with cognitive impairment have been unsuccessful in preventing falls. Cognitive impairment has long been known to be a major risk factor for falls and fractures but little research has been undertaken to understand the underlying mechanisms as to why this is the case. It is likely that previous falls prevention trials involving people with cognitive impairment were unsuccessful because they did not directly assess mechanisms for falls in this group and simply translated intervention strategies from studies undertaken in cognitively intact older people. This study aims to develop our understanding of the important factors that contribute to risk of falling in older people with cognitive impairment and dementia. Participants will be recruited from a number of sources including hospitals, out-patient clinics, retirement villages, hostels etc. Whilst some participants will be able to consent to take part, all participants must have a nominated person responsible. Consenting participants will undergo a series of assessments, the majority of which can be undertaken in their own home. These will include medical and medication history, measures of gait and balance and tests assessing performance of different regions of the brain. An MRI scan will allow us to determine whether risk of falling relates to any specific pathology in different parts of the brain. We anticipate that we will be able to identify which risk factors and underlying mechanisms are most strongly associated with falling in cognitively impaired older people. We then hope to use the information to design targeted and tailored intervention strategies to reduce falls and fractures in this high risk population.Read moreRead less