Investigating the efficacy of an online intervention aiming to increase respite use amongst carers of people with dementia: Roles of motivational enhancement and professional delivery
The benefits of respite for both carers and people with dementia are well established. However, research indicates many carers and people with dementia are reluctant to use respite services and strategies. This project aims to understand these barriers and learn more about ways to facilitate carers’ use of respite services and strategies by developing and comparing three online programs. The first program will include motivation enhancing activities, such as developing a ‘respite goal’, and will be delivered by a health professional. The second program will include motivation enhancing activities in a self-paced format (i.e., not delivered by a health professional). The third program will provide education about respite services and strategies only. By directly comparing the outcomes of these programs, project findings will provide valuable information to inform the design of future online programs to support carers of people with dementia accessing respite services and strategies.
Apathy in older community-dwelling persons: improving assessment, investigating its association with immune markers, differentiating from depression and fatigue and modelling its longitudinal course
Apathy, or loss of motivation leading to disability, is experienced by many community-dwelling older people, and is one of the most common symptoms of neurological and psychiatric disorders. People with apathy have poorer functioning, cognition and quality of life, yet it is relatively poorly understood and commonly unrecognised. There may be underlying biological causes for apathy, which if understood could help in its diagnosis and treatment. This project thus aims to: provide an in-depth synthesis of previously published studies looking at whether apathy may be associated with the presence of biomarkers; investigate whether apathy, depression and fatigue are distinct phenomena, by examining their longitudinal associations with biomarkers such as cytokines using data from epidemiological cohort studies; and compare methods of measuring apathy by interview, questionnaire and experimental tasks.
Computerised cognitive training in insidious late life cognitive decline
A randomised clinical trial is currently being conducted at the Brain and Mind Centre, University of Sydney. The Trajectories trial will examine the efficacy of computerised cognitive training in reducing the rate of decline in memory and other cognitive abilities (Phase I). Trajectories will also examine whether booster doses of the computerised cognitive training are able to maintain cognitive gains in the long-term (Phase II). Recruited individuals are those aged 60 and over with clinical memory decline (but do not meet the diagnostic criteria for dementia and free from other neurological and psychological disorders). Magnetic Resonance Imaging (MRI), neuropsychological testing and behavioural outcomes will be measured at baseline and each time point of the trial (at baseline, after phase I and after phase II). Further, this trial will investigate whether baseline qualities (brain volume, gene expressions) may determine for whom computerised cognitive training benefits most i.e. baseline predictors of response.
How do people with and without dementia use anticoagulants? Systematic literature review and analyses of PBS data
Oral anticoagulants are medicines used to prevent stroke, heart attack and other blood clots. People with dementia are less likely to be prescribed anticoagulants than people without dementia, although they are equally likely to experience stroke. The most commonly prescribed anticoagulant is warfarin. Warfarin may cause serious adverse effects including bleeding in gastrointestinal tract or brain. Newer direct oral anticoagulants (DOACs) offer potential advantages to people with dementia as they don’t require a regular blood test, have fewer interactions and have more convenient dosing. However, the safety of DOACs has not been established for people with dementia. People with dementia were excluded from participating in clinical trials of DOACs. This research will investigate how anticoagulants are being prescribed to Australians with dementia. This will help to target interventions to minimise the risks associated with anticoagulant use. This research will assist clinicians to better care for people with dementia.
The role of plasmalogen and other lipids in Alzheimer's disease
Early diagnosis and treatment of Alzheimer’s disease is believed to offer the best outcomes for patients. However, current methods to identify the disease before symptoms are evident are both expensive and invasive. Lipids (fats) are important molecules that are present in our cells and blood. Previous work has demonstrated differences in how lipids are regulated in Alzheimer’s disease. In this project, we will use new technology to measure over 500 lipids in a single drop of blood. We will perform these measurements on 5,000 samples from 1000 individuals to identify lipids which good markers of the disease. These will be used to develop a method for the early detection of Alzheimer’s disease.
The development and evaluation of an educational program for the care of older people with dementia in emergency departments
Outcomes from this project will contribute to improving the way older people with dementia are cared for in emergency departments (ED). It will enable translating available evidence into clinical practice by developing adaptable educational programs for ED staff. We will work closely with experts - people living with dementia and carers and health care professional in emergency medicine and nursing, and dementia care- to develop this program by reviewing the literature and using experts’ ED clinical experiences. The program will enable older people with dementia presenting to EDs to receive guideline-supported care and improved health outcomes. For example, this educational intervention will ensure that people with dementia are screened for delirium and properly assessed for pain (so that pain is identified and managed) in ED. Finally the educational program’s implementation in two Australian EDs will occur. Feedback gathered from attendees will be used to further improve the program.
A novel approach to enhance cognitive function and promote synaptic plasticity
Alzheimer's disease (AD) is a severe burden on the Australian health care system and affects about 30% of the population over 65 years of age. While we have made significant advances in understanding the mechanisms of AD pathology, we are yet to develop an effective therapeutic that tackles not only the issues of memory loss but also the underlying brain neurodegeneration, such as the degeneration of the basal forebrain cholinergic neurons. Our lab has generated a cell permeable peptide (c29) that enhances the signalling potential of the low reserves of growth factors, a feature of the brains of people with AD, as well as promoting neuronal survival. This project will make new versions of the c29 peptide to improve its drug-like properties and will test the ability of c29 to enhance cognitive functioning in mice, with the aim of demonstrating the promise of this molecule as a therapeutic to treat AD.
Does social competence impact quality of life for people with a diagnosis of dementia
The symptoms associated with dementia are many and varied. Until now, much of the research has focused on changes in memory and the ability to perform activities that we do every day such as cooking and driving. However, many people with dementia and their carers report other subtle changes in behaviour, such as those that occur in social situations and in relationships. Performing well in social situations requires people to be able to pick up on social cues such as facial expressions and subtle vocal and language changes that suggest someone is meaning something else than what they are saying. Failure to interpret these social cues correctly can be damaging to relationships with caregivers and can lead to social isolation. Whilst researchers have been able to show that some people with a diagnosis of dementia do have trouble with social cues (known as social cognition), they have not yet looked at whether problems with social cognition are related to overall quality of life. This project will examine whether impairments in social cognition affect quality of life and the quality of relationships with the caregiver. Results from this project may provide us with the information required to develop management strategies to help maintain relationships for longer.
Body, Brain, Life Project for Mild Cognitive Impairment (BBL-MCI): A randomised controlled trial of multidomain dementia prevention for mild cognitive impairment
Mild cognitive Impairment (MCI) is a condition in which there are problems in memory, thinking, planning and/or language, as diagnosed by doctor. These problems are not severe enough to be diagnosed with dementia, however people with MCI have a high risk of developing dementia in the future. BBL-MCI is a 12-week program to educate participants about dementia and make lifestyle changes to diet, physical exercise, brain exercise and improve overall health to lower dementia risk.
"Beauty and the brain" - A novel approach to anhedonia in dementia
Try to imagine a world in which you could no longer experience beauty or pleasure in your daily life. Anhedonia refers to a loss of pleasure and has typically been studied in psychiatric disorders. Many of the diagnostic features of frontotemporal dementia, however, suggest the presence of anhedonia, such as social withdrawal, loss of interest in previous hobbies and activities, and apathy. The implications of anhedonia are stark, yet no study to our knowledge has systematically investigated anhedonia in younger-onset dementia. We will measure the experience of pleasure in response to viewing pieces of art and listening to music. Neuroimaging analyses will allow us to determine the association between damage to the brain in dementia and anhedonia. Our study will provide critical data regarding the subjective experience of the individual living with dementia and the utility of music and art to improve overall wellbeing and quality of life.
Hotspots of dementia risk in Australian communities: an approach to better targeting preventive interventions
Chronic illnesses such as dementia, diabetes and cardiovascular disease are predicted to rise significantly in Australia over the next few decades, posing challenges that will need to be met by effective preventive medicine strategies and health services planning.
This project will develop and apply new methodologies to identify hotspots of dementia risk in local communities using general practice records and spatial analysis techniques. This will allow interventions to be targeted at the right place, at the right time, and to the right people. It will also examine the possible link between hotspot areas and built environment characteristics and lifestyle. We hypothesise that dementia risk hotspots will be highly clustered in environments with higher densities of fast-food outlets, lower socio-economic areas, and fewer green spaces that support physical activity. This work will provide an innovative tool to help address the predicted dramatic rise of dementia in Australian communities and the technique can be used for other chronic diseases.
Development of staging criteria to distinguish preclinical tauopathies from primary age-related tauopathy (PART)
The Rosemary Foundation Travel Fellowship will enable Dr Forrest to present her research at the 10th International Conference on Frontotemporal Dementias in Munich, 2016. She will also spend time in the laboratory of prominent neuropathologist, Associate Professor Kovacs at the Institute of Neurology, Medical University of Vienna. Associate Professor Kovacs is internationally recognised for his contributions in the neuropathology of normal aging, diseases characterised by the deposition of a protein called tau such as frontotemporal dementia and Alzheimer’s disease and other neurodegenerative diseases. He is a member of an international consortium that recently developed harmonised classification criteria for two novel tau-depositing pathologies. Both of these newly classified tau pathologies have implications for defining ‘normal’ age-related changes in the brain, and tau-related mechanisms in frontotemporal dementia versus Alzheimer’s disease. Visiting the Kovacs laboratory will provide Dr Forrest with the opportunity to gain first hand experience in the identification and characterisation of these novel pathologies, and broaden her knowledge of better-established tau pathologies.
Meeting the support needs of family carers of people living with dementia in the community: Potential translation into practice
Family carers of people with dementia can experience significant stress and consequent poor health. The Carer Support Needs Assessment Tool is a questionnaire that is used within the context of a person-centred approach. The approach was developed for use in palliative care to help family carers identify and prioritise their needs and access appropriate support. In a recent trial in home-based palliative care, use of this approach resulted in a significant reduction in carer strain. This project aims to translate the approach for use in home-based care for people with dementia. Community care coordinators from one aged-care provider are implementing the approach with 35 family carers. Family carers’ and care providers’ perspectives are being evaluated. If found to be useful, this innovative practice change offers a novel way for community-based health care providers to engage with family carers of people with dementia and empower them to sustain their caregiving role.
Selectively vulnerable neurons in Alzheimer’s disease: functional and morphological changes in healthy ageing and early Alzheimer's disease
The indcidence of Alzheimer’s disease is highly correlated with ageing, and it is known that the altered behaviour of neurons play an important role in memory loss in healthy aging. In Alzheimer’s disease severe memory deficts are caused by the dysfunction and death of a select group of neurons, yet it is not understood why these particular neurons are susceptible. Dr Woodhouse' fellowship will determine how the connections and activity of these vulnerable neurons are changed in healthy aging and early Alzheimer’s disease and aim to answer the following questions:
- Do neurons that are vulnerable in Alzheimer’s disease have a signature of changes in healthy ageing that might predispose them to be susceptible in Alzheimer’s disease?
- Do these vulnerable neurons have a distinct set of changes in their connections and activity in early Alzheimer’s disease?
- Can we identify novel targets in these vulnerable neurons for the development of new therapeutics for Alzheimer’s disease?
This fellowship will significantly advance our knowledge by producing information essential for understanding how neurons function in healthy ageing and how this is altered in the group of vulnerable neurons in Alzheimer’s disease. Understanding the mechanisms underlying the selective vulnerability of this important group of neurons in Alzheimer’s disease will potentially lead to the development of new therapeutics for Alzheimer’s disease.
3D Virtual Worlds are graphical computer applications which can simulate the real life. Users of these worlds can interact with these worlds via their own digital and graphical self-representations known as ‘avatars’. These worlds are accessible to users via Internet-connected personal computers. This technology enables people with lower mobility such as people with dementia to be able to experience things that they have experienced in their past life but are no longer able to experience very often due to their low mobility. For people living with dementia in long-term care, engagement in pleasurable activities and a feeling of control over their lives are essential for good quality of life , while depression is associated with poor quality of life. Consistent with this, when long-term care residents are actively engaged, they report improved quality of life and reduced depression. This project seeks to determine whether the use of 3D Virtual World technology by residents living with dementia in long-term care is meaningful and feasible, and if it can contribute to a higher quality of life for people with dementia.
The role of epigenetics in Alzheimer’s disease, using mice as a model species
Ageing causes our cells to decline in both integrity and function. In healthy cells, our genes are tightly regulated so that the correct combination of genes are switched on, or off, at the proper time to allow for learning and memory to occur. This is achieved by the addition or removal of small chemical residues on top of the DNA, and the study of these processes is known as epigenetics. Epigenetic marks on our DNA can change during ageing, and diseases occur when this happens too quickly or in an uncontrolled way.
Proper epigenetic control must be maintained during ageing and Mr Phipps' PhD project raises the possibility that epigenetic dysregulation plays an important role in Alzheimer’s disease progression. The overall aim of his PhD is to identify epigenetic alterations associated with Alzheimer’s disease. Preliminary data has revealed that epigenetic changes do occur in people with Alzheimer’s disease. However, existing knowledge of the epigenetic alterations in Alzheimer’s disease is extremely limited, highlighting that new knowledge in this area is critical.
At completion of Mr Phipps' PhD he will understand whether distinct epigenetic signatures are associated with different stages of disease in Alzheimer’s disease, and if epigenetic changes occur in specific cell types in the brain or are dependent on proximity to AD pathology. These findings will significantly advance the understanding of the role of epigenetic dysregulation in Alzheimer’s disease and could also identify new clinical treatments for people with Alzheimer’s disease.
Making the right connections: Working with people with dementia and their families to reduce word finding difficulties in everyday communication
A common difficulty experienced by people with dementia is the inability to find the right words when speaking. This results in feelings of severe frustration and often leads to withdrawal from social situations. Such difficulties are frequently felt just as acutely by family members. This study proposes to build on a highly successful therapy program that has been piloted by the applicant that has shown to significantly improve the word finding abilities of people with one form of dementia, i.e. Primary Progressive Aphasia (PPA). The study proposes to further develop the novel intervention and carry out 20 intervention studies that involve 10 people with Alzheimer’s disease and 10 people with PPA. This intervention is unique in that it not only builds on our knowledge that people with PPA and Alzheimer’s disease do retain the ability to learn/relearn words, but it extends to providing people with successful strategies to use in conversation and everyday speaking situations. The intervention is also tailored to the needs of the individual and works closely with family members to ensure they are well supported. As well as assisting the person with dementia and their families, this study will provide important information for speech pathologists and other health professionals on what aspects of therapy work best and for whom. It will also assist in developing a better understanding of how language breaks down in dementia and how we might minimise the negative social implications for both those with dementia and their families.
Research suggests that individuals with dementia are less accurate in their ability to recognise emotions such as anger, fear and sadness. This can have a devastating impact on the social behaviour of individuals with dementia and their social relationships. For example, poor emotion recognition abilities predicts increased impact amongst those caring for loved ones with dementia. Oxytocin is a hormone which has been found to improve emotion recognition ability and enhance trust. Dr McCade's project is an intervention programme aimed at individuals with Alzheimer’s disease to improve the accuracy in their emotion recognition and also to reduce caregiver burden in their caregivers (i.e., family members / significant others) via an intranasal administration of oxytocin over a one week period.
Changes in synaptic alterations and its impact on frontotemporal dementia
Frontotemporal dementia is a form of dementia affecting primarily the frontal and temporal part of the brain. It is the second most common form of dementia in people under the age of 65. TDP-43, a DNA processing protein, is one of the main proteins that have been identified to play a role in frontotemporal dementia. Synapses are specialised structures that allow neurons to communicate with each other. Changes in synapses can have serious effects on neurons and if not controlled can cause neuron death. TDP-43 has been shown to affect the number and maturation of synapses. It is feasible that an early disease-causing event in frontotemporal dementia may be changes to synapses. Ms Handley will determine how TDP-43 changes lead to specific pre and post synaptic alterations in vitro using primary neurons.
Evaluation of Psychological Models of Cognitive Ageing: Modifiers of cognitive trajectories in healthy older adults
Cognitive ageing is the process of change in cognitive function that occurs as an individual ages. Reported to typically involve decline in fluid intelligence factors, such as processing speed, executive function and episodic memory, and retention of crystallised intelligence factors, such as knowledge-based numeric and verbal abilities. Estimates of the timing and extent of these changes vary between studies. This may be due to methodological differences, or failure to account for the influence of occult pathology or genetic factors. The aim of this series of studies is to understand the nature and magnitude of age related cognitive decline and the impact of occult pathology and genetics on trajectories of normal cognitive ageing.