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
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
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
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
Evidence For Psychological And-or Educational Interventions For Cancer-related Fatigue: A Systematic Review
Funder
National Health and Medical Research Council
Funding Amount
$28,283.00
Summary
Potential benefits to the community: Fatigue is one of the most common and distressing symptoms experienced by people with cancer and can exacerbate the experience of other symptoms, negatively affect mood, and impact on function and quality of life. Understanding which interventions are effective in helping people cope with cancer-related fatigue is important to inform decision-making by consumers, clinicians working in palliative care and policy makers. Objectives: This study aims to systemati ....Potential benefits to the community: Fatigue is one of the most common and distressing symptoms experienced by people with cancer and can exacerbate the experience of other symptoms, negatively affect mood, and impact on function and quality of life. Understanding which interventions are effective in helping people cope with cancer-related fatigue is important to inform decision-making by consumers, clinicians working in palliative care and policy makers. Objectives: This study aims to systematically review the evidence for psychological and-or educational interventions for managing cancer-related fatigue. Methods: This study will use the Cochrane Collaboration’s methodology to search, critically appraise, and analyse randomised controlled trials of psychological and-or educational interventions. This will involve collaboration with consumers and with the Cochrane Pain, Palliative Care, and Supportive Care Collaborative Review Group. This review will inform decision-making at all levels, assist in research translation and identify further gaps in the research regarding this distressing symptom.Read moreRead less
Improving Identification And Treatment Of Early-onset Behaviour Disorders In Children
Funder
National Health and Medical Research Council
Funding Amount
$498,869.00
Summary
Most mental health problems begin in childhood and adolescence. Of these, oppositional-defiant and conduct problems in childhood are the most common precursor of all types of adult mental health problems. These children are the most common referral to child mental health clinics but little is known about which of these children will go in which direction i.e., good health, chronic antisocial behaviour, depression and anxiety, substance abuse, the psychoses. Progress in more accurately defining s ....Most mental health problems begin in childhood and adolescence. Of these, oppositional-defiant and conduct problems in childhood are the most common precursor of all types of adult mental health problems. These children are the most common referral to child mental health clinics but little is known about which of these children will go in which direction i.e., good health, chronic antisocial behaviour, depression and anxiety, substance abuse, the psychoses. Progress in more accurately defining subgroups of these children would have huge implications for early intervention for mental health problems in our community. This project proposes the first large scale analysis of genetic distributions through to behavioural and treatment factors that characterise and differentiate a large representative sample of children with conduct problems. The project will test a model of child psychopathology that links genotype, via environmental risk and emotion processing problems, to an improved diagnostic-phenotypic model for treatment of the major childhood disorder. Clinical research activities will be structured into three intersecting arms: first, identifying the genetic and behavioural subtypes of early-onset conduct problems; second, innovative treatments for these children, and third, the dissemination of findings to these children and their families via the health care system. The research will build new collaborations between established and internationally recognised clinical research teams in childhood mental health, biological psychiatry, genetics and the Child and Adolescent Mental Health Statewide Network (CAMHSNET). CAMHSNET have specific responsibilities to NSW Health for expert advice and input on the development of child mental health services directions, dissemination, training, and effectiveness research.Read moreRead less
The Investigation Of Innovative Telemedicine Models To Support Palliative Care Delivery In Rural And Remote Australia
Funder
National Health and Medical Research Council
Funding Amount
$86,870.00
Summary
This project will investigate the impact of videophone communication between patients wishing to remain at home for their palliative care and their outreach nurses in a remote setting. Patients visited at home will be identified by their palliative care nurses and asked to give consent to have a videophone installed. The carers and nurses will evaluate the impact of the videophones using a questionnaire at the completion of the episode of care. Because suitable telephone lines are available thro ....This project will investigate the impact of videophone communication between patients wishing to remain at home for their palliative care and their outreach nurses in a remote setting. Patients visited at home will be identified by their palliative care nurses and asked to give consent to have a videophone installed. The carers and nurses will evaluate the impact of the videophones using a questionnaire at the completion of the episode of care. Because suitable telephone lines are available throughout most country areas and the devices are portable and as easy to use as a telephone the use of videophones between palliative care nurses and remote nurses or between patients, if effective, will be widely applicable.Read moreRead less