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
An Efficacy Study Of A Cognitive-communicative Intervention To Improve Transition To Residential Care In Dementia
Funder
National Health and Medical Research Council
Funding Amount
$681,083.00
Summary
The transition from home to a residential aged care facility (RACF) is a potentially traumatic process that has a negative impact on the health and well-being of both people with dementia and their caregivers. This project will develop an intervention program for people with dementia that maximizes their ability to learn and retain functional skills and that enhances the communicative competence of both people with dementia and their carergivers. This will serve to minimize the stress and disori ....The transition from home to a residential aged care facility (RACF) is a potentially traumatic process that has a negative impact on the health and well-being of both people with dementia and their caregivers. This project will develop an intervention program for people with dementia that maximizes their ability to learn and retain functional skills and that enhances the communicative competence of both people with dementia and their carergivers. This will serve to minimize the stress and disorientation, as well as accompanying increased risk of illness, of entering residential care. We will investigate whether this intervention program has good outcomes both for the people with dementia as well as their caregivers. The research will develop guidelines for the development of best-practice policies for service providers and the government, which will assist both health workers and homebased caregivers to better manage the transition of people with dementia from home to the RACF environment.Read moreRead less
THE DETECTION AND MANAGEMENT OF DEMENTIA IN GENERAL PRACTICE.
Funder
National Health and Medical Research Council
Funding Amount
$499,977.00
Summary
This research aims to examine a new method and practice guidelines for detection of early dementia. General practitioners will be screened on their ability to diagnose and manage dementia and to distinguish it from other diseases. Patient outcomes - including quality of life, depression, and satisfaction with care and referral indicators - will be examined.
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