It is known that about 10% of patients over the age of 55 have difficulty with cognition and thinking 3 months after surgery and anaesthesia. Over 2 million operations involving anaesthesia are administered in Australia every year and increasingly the patients are elderly and thus exposed to the risk of cognitive decline after surgery. We have preliminary data showing that people who have mild changes in cognitive function before the surgery (known as mild cognitive impairment) are susceptible t ....It is known that about 10% of patients over the age of 55 have difficulty with cognition and thinking 3 months after surgery and anaesthesia. Over 2 million operations involving anaesthesia are administered in Australia every year and increasingly the patients are elderly and thus exposed to the risk of cognitive decline after surgery. We have preliminary data showing that people who have mild changes in cognitive function before the surgery (known as mild cognitive impairment) are susceptible to further cognitive decline after anaesthesia and surgery. In order to explore the relationship between preoperative cognitive function and postoperative cognitive decline we plan to measure cognition in patients scheduled for elective hip replacement surgery. This is done by asking patients to complete a standard battery of cognitive tests. We will be then able to identify those patients who already have mild cognitive impairment before surgery and by repeated testing after the operation will be able to demonstrate if preoperative cognitive status is a determinant of postoperative cognitive dysfunction. The primary aim of the research is to test whether cognitive impairment before surgery leads to cognitive deficit after surgery in patients over the age of 65 undergoing total hip replacement surgery. The study will also establish the prevalence of pre-operative mild cognitive impairment and the magnitude of postoperative cognitive dysfunction after surgery in this patient group. The study will explore the relationship between preoperative cognitive status and postoperative cognitive deficit , providing information about the incidence, natural history and risk factors of postoperative cognitive deficit. This work will enable further research to isolate specific causative factors and identify therapeutic and prophylactic strategies.Read moreRead less
ANTIPODES The Australian National Trial Investigating Post-Operative Deficit, Early Extubation And Survival
Funder
National Health and Medical Research Council
Funding Amount
$370,509.00
Summary
Brain damage following cardiac surgery is an unfortunate but common complication occuring variously in 30-80% of patients. Although severe strokes are uncommon (<1%), more subtle effects such as forgetfulness or behaviour changes may persist and make daily living difficult. Many attempts have been made to identify the exact cause of the brain damage, but no answer has been forthcoming. Recently, the introduction of modern anaesthetic techniques, which allow patients to wake up quickly after t ....Brain damage following cardiac surgery is an unfortunate but common complication occuring variously in 30-80% of patients. Although severe strokes are uncommon (<1%), more subtle effects such as forgetfulness or behaviour changes may persist and make daily living difficult. Many attempts have been made to identify the exact cause of the brain damage, but no answer has been forthcoming. Recently, the introduction of modern anaesthetic techniques, which allow patients to wake up quickly after the operation, have given strong indications that they may also cause less brain damage. We plan to test this aspect of modern anaesthesia, by comparing the results of tests for brain damage after anaesthesia that has been given by traditional methods and the recent method which allows patients to wake up quickly.Read moreRead less
Clinical Feasibility Study Of Omega-3 PUFA Therapy For The Reduction Of Post-cardiac Surgery Atrial Arrhythmias
Funder
National Health and Medical Research Council
Funding Amount
$442,092.00
Summary
The aim of this study is to determine the molecular and clinical impact of omega-3 polyunsaturated fatty acids (PUFA) pre-treatment 2 weeks before cardiac surgery in 150 patients. The outcome of this proposal will indicate proof of molecular concepts, clinical feasibility and specific design elements of a future, large scale, placebo controlled, prospective randomised trial of oral therapy with omega-3 polyunsaturated fatty acids (PUFA). Recently, omega-3 PUFA via fish diet was reported to be li ....The aim of this study is to determine the molecular and clinical impact of omega-3 polyunsaturated fatty acids (PUFA) pre-treatment 2 weeks before cardiac surgery in 150 patients. The outcome of this proposal will indicate proof of molecular concepts, clinical feasibility and specific design elements of a future, large scale, placebo controlled, prospective randomised trial of oral therapy with omega-3 polyunsaturated fatty acids (PUFA). Recently, omega-3 PUFA via fish diet was reported to be linked to low incidence of AF. The main aim is to provide a cheap and safe preventative therapy against post-operative atrial fibrillation (AF), a key heart rhythm disorder that occurs in at least 1 in 4 patients after heart surgery and increases post-operative complications, limits recovery and increases hospital stay and cost. Biochemical study elements are important to gain valuable insight into the molecular mechanisms (directly in human heart) that underlie post-operative heart rhythm disorder and may delineate new more precise molecular targets for therapy. No previous clinical study has ever examined whether omega-3 PUFA therapy prevents post-operative heart rhythm disorder. Use of 3g-day omega-3 PUFA pre-treatment in the surgical setting has been shown to be safe in a number of small studies, including our own. Our preliminary data indicates that therapy increases heart and blood content of omega-3 PUFA ~2-fold, and reduces the incidence of AF. Post-operative AF is an expensive resource burden in all cardiothoracic surgery units of Australian hospitals and targets key health priorities. Due to the non-patentable nature of omega-3 PUFA, significant industry based support for clinical research is limited. A positive outcome would rapidly pave the way for widespread use in elective surgery. Reduced length of hospital stay, cost-savings, and the increase in productivity as healthy individuals return to their communities would nationally repay the investment many fold.Read moreRead less
Our lives depend upon maintaining the correct body temperature. Failure to regulate it properly may be lethal. This is particularly true in the elderly, who are more susceptible on the one hand to heat stroke and on the other to hypothermia. Many die each year from both these causes. Body temperature is regulated by the brain, yet our understanding of how and where in the brain this happens is poor. This proposal aims to work out the 'wiring diagram' of brain temperature control pathways in rats ....Our lives depend upon maintaining the correct body temperature. Failure to regulate it properly may be lethal. This is particularly true in the elderly, who are more susceptible on the one hand to heat stroke and on the other to hypothermia. Many die each year from both these causes. Body temperature is regulated by the brain, yet our understanding of how and where in the brain this happens is poor. This proposal aims to work out the 'wiring diagram' of brain temperature control pathways in rats and to begin to extend this knowledge to humans. This work will generate new knowledge about a vital function. The insights obtained will inform and guide future strategies in aged care, intensive care and perioperative care.Read moreRead less
PREOPERATIVE RISK FACTORS, ADVERSE OUTCOMES AND EFFECTS OF EPIDURAL AND SPINAL ANAESTHESIA
Funder
National Health and Medical Research Council
Funding Amount
$66,110.00
Summary
Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. P ....Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. Providing clear answers to both questions requires careful analysis of large amounts of data in which systematic and random errors have been minimised. Databases from well-designed and supervised clinical trials represent an invaluable resource in this regard because they have been compiled through the rigorous application of unambiguous definitions and protocols during the process of recording, coding and entering the information. By bringing together the resources and expertise of the MASTER Trial group and the Collaborative Overview of Randomised of Trials of Regional Anaesthesia (CORTRA), both of which are major international projects led from the Australasian region, we have a unique opportunity to provide exceptionally robust answers to some of the most challenging issues in anaesthesia. The combined study of two large international databases will provide a more precise quantitative analysis of the components of preoperative risk and their relationship to life threatening post operative complications, and the possible role of epidural and spinal anaesthesia in minimising risk by reducing the frequency of these complications.Read moreRead less
Fighting Mental Disorders: Using Mental Imagery To Disarm Symptoms And Enhance Treatment.
Funder
National Health and Medical Research Council
Funding Amount
$415,218.00
Summary
This proposal will conduct the first pre-clinical and clinical research utilising mental imagery to disarm symptoms and enhance treatment of multiple mental disorders by controlling the strength of mental imagery. This fellowship represents the first attempt to alleviate symptoms by developing a cognitive-neuroscience method to control the strength of traumatic imagery and to show a causative means of enhancing imagery strength to boost the success rate of cognitive therapy involving imagery.
Cardiac Intervention, Surgery And Cognitive Outcome (CISCO) Study
Funder
National Health and Medical Research Council
Funding Amount
$367,739.00
Summary
We propose to investigate the association between the presence of coronary artery disease and changes in brain function after therapeutic interventions. Patients undergoing surgery for coronary heart disease are prone to experience changes in mental function and higher level thought processes (cognition) after surgery, especially if they are elderly. As the population ages this is becoming a more significant problem. There is some limited evidence that this particular group of patients has a hig ....We propose to investigate the association between the presence of coronary artery disease and changes in brain function after therapeutic interventions. Patients undergoing surgery for coronary heart disease are prone to experience changes in mental function and higher level thought processes (cognition) after surgery, especially if they are elderly. As the population ages this is becoming a more significant problem. There is some limited evidence that this particular group of patients has a higher incidence of cognitive impairment than the normal population even before they present for surgery, because cardiovascular disease has also been shown to be associated with changes in cognition. To investigate this, we will measure cognitive status in patients over the age of 55 who have coronary artery disease and are being investigated with coronary angiography. This will provide an indication of the baseline cognitive status in patients presenting with coronary vascular disease. We will use validated neuropsychological tests that have been used to assess potsoperative cognitive decline. These tests are sufficiently sensitive to detect subtle changes in a number of areas of thought processing (cognitive domains) and thus identify those subjects who have cognitive impairment. Patients will then go on to be treated by surgery or angioplasty. We will continue to test these patients at time intervals for 3 months in order to track the changes in cognition in each treatment group. Thus we will be in the position to compare how these modalities of treatment for heart disease impact on patients mental function and cognition. In addition we will be able to tell whether a 'recovery' period might be of benefit following coronary angiography. If we are able to demonstrate different cognitive outcomes from different treatments and also an association with pre-existing cognition, this will guide clinical decision making to minimise harm to the brain.Read moreRead less
The development of predictive brain function in preschool children. This project aims to track developmental changes in brain activity and connectivity in typically developing three-to-six year-old children. The preschool years are a time of huge change in children's cognitive abilities, but little is known of the corresponding changes in brain function. This work will use child-optimised magnetoencephalography to test the hypothesis that early cognitive development is characterised by refinemen ....The development of predictive brain function in preschool children. This project aims to track developmental changes in brain activity and connectivity in typically developing three-to-six year-old children. The preschool years are a time of huge change in children's cognitive abilities, but little is known of the corresponding changes in brain function. This work will use child-optimised magnetoencephalography to test the hypothesis that early cognitive development is characterised by refinement of the brain's innate ability to generate predictions about the sensory environment. The resulting insights could improve understanding of neurodevelopmental disorders such as autism.Read moreRead less
Dynamics of word recognition: new insight from the reach-to-touch paradigm. This project will introduce a new behavioural reach-to-touch paradigm for studying basic cognitive processes such as word recognition. The advantage of this paradigm is that it is able to measure cognitive processes moment-by-moment as they unfold over time. This will provide new insights into the temporal dynamics of basic cognitive processing.