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 Australasian, Multi-centre, Randomized, Double-blind, Placebo-controlled Trial Of The Efficacy Of Fluoxetine In Improving Functional Recovery After Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$2,306,367.00
Summary
Stroke is one of the top three causes of disability. Treatments that improve recovery after stroke are lacking. We reviewed the world literature and found a number of very small studies which, together, suggest that the antidepressant drug, fluoxetine, may improve the recovery in stroke patients. AFFINITY is a large trial in 1600 Australians and New Zealanders with stroke which aims to find out whether taking fluoxetine for 6 months after a stroke improves recovery compared to a placebo.
Psychosocial Disability And Return To Work In Younger Stroke Survivors
Funder
National Health and Medical Research Council
Funding Amount
$511,216.00
Summary
Each year about 12,000 Australians of working age survive a stroke. These younger survivors have responsibility for generating an income or providing care for families and state that their main objective is to return to work for financial reasons and to help rebuild confidence and independence. This observational 3 year study will determine thefactors are associated with returning to work, improving the wellbeing of thousands of stroke survivors and their families using multivariate regression.
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
Acute Vertigo In Emergency Departments: Distinguishing Between Central And Peripheral Causes By Objective Measure Of Oculomotor Examination (HINTS)
Funder
National Health and Medical Research Council
Funding Amount
$181,065.00
Summary
The goal of this work is to provide a quantitative objective measure of HINTS for developing an automatic diagnostic decision tool to differentiate vestibular neuritis (peripheral) and stroke (central) in patients presenting in emergency department for acute vestibular syndrome. Video oculography makes interpretation of the results more reliable. Video oculography goggles will be used as part of a systematic training program to enhance frontline clinician skills in eye movement examination.
Improving The Identification, Management And Outcome Of People With Depression And Other Chronic Diseases
Funder
National Health and Medical Research Council
Funding Amount
$476,728.00
Summary
My research is designed to reduce depression and help people with chronic disease have a better quality of life. I will work with Aboriginal and/or Torres Strait Islander communities to improve how depression is identified, prevented and treated. I will work with the general community who have major depression, depression that is difficult to treat and people with depression and chronic disease to improve their outcomes. I will also aim to improve the recovery of people who have had a stroke.
Centre For Translational Neuroscience: A Modular Platform For Translating Discovery Into Health Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$2,623,735.00
Summary
Clinical Centre of Research Excellence in Translational Neuroscience will provide people, pathways and resources to create a novel platform to take the outputs of Neuroscience Discovery programs though to improved patient outcomes for common brain diseases. A critical role will be to train and equip the best and brightest of the next generation of researchers to undertake internationally competitive translational neuroscience research that makes a difference to the health of our community.
Developing A Prototype Of A Next Generation Brain Computer Interface
Funder
National Health and Medical Research Council
Funding Amount
$837,398.00
Summary
Persons affected by quadriplegia and hemiplegia from stroke and spinal cord injury have few treatment options. Brain Machine Interfaces reconnect brain to a prosthetic limb, bypassing damaged nervous system. Our group has developed a BMI that can be implanted minimally-invasively, inside a blood vessel in the brain. We propose to manufacture a world-first device for a human clinical trial pilot study. The aim is to restore mechanical control over the physical environment for a paralysed patient.
Sympathetic Control Of Cutaneous Blood Flow And Blood Pressure In Human Spinal Cord Injury
Funder
National Health and Medical Research Council
Funding Amount
$242,002.00
Summary
While spinal cord injury can cause devastating changes in the nervous system paralysis and loss of sensation relatively little is known about changes to the sympathetic nervous system. The sympathetic nervous system is intimately involved in the ongoing control of blood pressure, blood flow and temperature control. Loss of sympathetic control can occur following spinal cord injury. Interruption of descending pathways can result in partial or complete loss of sympathetic outflow from the thoracol ....While spinal cord injury can cause devastating changes in the nervous system paralysis and loss of sensation relatively little is known about changes to the sympathetic nervous system. The sympathetic nervous system is intimately involved in the ongoing control of blood pressure, blood flow and temperature control. Loss of sympathetic control can occur following spinal cord injury. Interruption of descending pathways can result in partial or complete loss of sympathetic outflow from the thoracolumbar segments. Complete decentralization can result in autonomic dysreflexia (autonomic hyperreflexia), in which sensory stimuli originating below the lesion evoke a reflex increase in sympathetic drive to the blood vessels, causing them to constrict. Because of this, blood pressure may rise suddenly and remain at such high levels that stroke and (occassionally) cardiac arrest may occur. This phenomenon, autonomic dysreflexia, is considered a medical emergency. The typical subjective signs of autonomic dysreflexia include a throbbing headache, tingling in the head or nasal congestion; sweating and flushing above the lesion are clinical signs that prompt medical staff to measure blood pressure and to locate the source of sensory irritation (usually a distended bladder or impacted colon, sometimes a pressure sore or ingrown toenail). Commonly, however, subclinical episodes go undetected, and this phenomenon of silent dysreflexia is of increasing concern. This project will develop means of assessing the integrity and state of the sympathetic nervous system below a lesion in patients with spinal cord injury and characterize the firing properties of reflexly activated sympathetic neurones.Read moreRead less