Year:  2009-2012

Staff:  Melbourne: Nicola Lautenschlager (NARI and University of Melbourne), David Ames, Keith Hill, Elizabeth Cyarto, Courtney Hempton, Emma Renehan (NARI), Dina LoGiudice (Melbourne Health); Perth: Kay Cox, Osvaldo Almeida, Leon Flicker, Christopher Beer (University of Western Australia); Brisbane: Gerard Byrne, Kana Appadurai (University of Queensland)

Summary:

The primary aim of this 3-site multicentre randomised controlled trial (RCT) is to establish whether physical activity (PA) can decrease the rate of cognitive decline amongst patients with mild to moderate Alzheimer’s Disease (AD). The main hypothesis is that participants with mild to moderate AD who are randomised to a program of PA will experience significantly less cognitive decline by the end of the intervention than participants with mild to moderate AD randomised to usual care.  Previously, some of the researchers involved in this study successfully developed a PA program for participants with mild cognitive impairment (FABS) and tested this program in a pilot study with patients with mild to moderate AD.

After a baseline visit participants will be randomised to either the intervention (PA) or usual care. Participants are patients with mild to moderate AD living in Perth, Melbourne or Brisbane and their carer. The intervention will be based on the Stages of Change model and will comprise three components: the PA program, the behavioural intervention package, and telephone monitoring. Pedometers will be used to monitor PA level. We will use a series of well-established tests and instruments to collect cognitive, physical and clinical parameters.

The primary outcome is cognitive decline measured with the ADAS-cog. In the pilot study, participants in the usual care group (n=10) deteriorated in 6 months 4.47 ± 6.36 points whereas the patients in the intervention group (n=12) deteriorated 2.21 ± 4.88 points. Secondary outcomes are quality of life, functional level, physical fitness and health measures. Should our main hypothesis be confirmed, a systematic program of PA would have the potential benefit of providing an affordable and relatively simple intervention. By delaying deterioration in patients with mild to moderate AD, we may be able to postpone disability, prolong independent living and potentially reduce the costs associated with care.

Funding source: National Health & Medical Research Council (NHMRC)

Year: 2006-2010 (current)

Staff:

David Ames (study leader), Kathryn Ellis (study manager)

AIBL management committee: David Ames (study leader), Kathryn Ellis (study manager), Christopher Rowe, Ralph Martins, Colin Masters, Andrew Milner, Peter Hudson, Lindsay Bevege, Kiara Bechta-Metti

All full list of AIBL collaborators can be found at www.aibl.nnf.com.au

Summary: The Australian Imaging Biomarkers and Lifestyle Flagship Study of Ageing (AIBL) is one of the few large-scale longitudinal studies of Alzheimer’s disease. AIBL is a multi-centre prospective study of neuroimaging, biomarkers, clinical and neuropsychological measures, and lifestyle patterns in a cohort of 1000 volunteers comprised of patients with Alzheimer’s disease (AD), Mild Cognitive Impairment (MCI) and healthy volunteers. The AIBL study aims to improve understanding of the pathogenesis, early diagnosis and clinical course of AD. At baseline, each volunteer completed the international physical activity questionnaire, a food frequency questionnaire, a comprehensive clinical and neuropsychology battery, and provided an 80ml blood sample for clinical pathology, biomarker analysis and storage in liquid nitrogen. In addition, 250 of the cohort (25% from each group) received a [C-11]PIB PET scan as a measure of in vivo amyloid and a MRI scan. The study was launched in November 2006 and comprehensive baseline data collection has been completed. Follow up assessments (18 month post-baseline) have now commenced.

Funding source: CSIRO Flagship Collaboration Cluster Funding

Year:  2006-2007; 2009

Staff:  Keith Hill, Kirsten Moore, Marcia Fearn, Sue Hunt, Dina LoGuidice, Marlena Klaic, Courtney Hempton (2006-2007); Betty Haralambous, Sue Hunt, Courtney Hempton, Xiaoping Lin, Veelyn Tan, Claudia Meyer, Karen Borschmann, Sue Williams, Paul Jeffrey, Dina LoGuidice, Kirsten Moore, David Ames and Jach Sach (2009)

Summary: In 2007, NARI developed the Dementia Resource Guide for the Australian Government Department of Health and Ageing, with the aim of improving the care and quality of life of people with dementia. The evidence-based Guide contains information, resources, tools, guidelines and best practice principles for staff in community, residential and health care settings as well as carers and people with dementia. The Guide was developed through a comprehensive stocktake and evaluation of over 700 existing dementia related resources. Over 300 of these resources were selected for inclusion in the Guide. After developing a draft, the Guide was piloted in eleven sites representing most Australian States and Territories across metropolitan, rural and regional locations as well as community, residential and health care settings. The sites also included a service that predominately provided care to Aboriginal and Torres Strait Islanders and one to people from Culturally and Linguistically Diverse backgrounds. Feedback from the pilot led to revision of the Guide with the final Guide made available in hard copy and website formats in June 2008.

The Hon. Justine Elliot, Minister for Ageing launched the Dementia Resource Guide at Hammond Care’s 7th Biennial International Dementia Conference at Darling Harbour in Sydney in June 2008.

In 2009, the Australian Government Department of Health and Ageing contracted NARI to undertake a review of the Dementia Resource Guide during March to July 2009. The review will include an update of resources and an evaluation of the uptake and dissemination of the Guide. Outcomes of the review will be available after July 2009.

Funding source: Australian Government Department of Health and Ageing

Click here to access the online version of the Dementia Resource Guide

Year:  2005-2007

Staff:  Keith Hill, Freda Vrantsidis, Dina LoGiudice, David Basic, Jeff Rowland, David Conforti, Jan Harry, Katherine Lucerne, Rob Prowse

Summary: The primary aims of this study were to validate the RUDAS in populations outside the South West Sydney area where the tool was developed and to validate the tool in subjects with mild to moderate dementia (the original study was over represented with moderate to severe subjects). A secondary aim of the study was to compare the RUDAS with two existing assessment tools – the MMSE and the GPCOG. This study was a joint project involving NARI, the Royal Melbourne Hospital (Royal Park Campus), the Royal Adelaide Hospital and the Liverpool Hospital. Patients were recruited in Melbourne and Adelaide from memory clinics and control patients were recruited from various outpatient services/community programs. One hundred and fifty one participants were recruited. Results from this study indicate that the RUDAS is a valid screening tool for cognitive impairment that can be used in multiple settings and in people with a broad range of cognitive function. Performance on the RUDAS correlated highly with the MMSE and GPCOG. The RUDAS was equally effective as the MMSE and GPCOG in its predictive accuracy but had some advantages over the other tools. Further investigation of the RUDAS is warranted. 

Click Here to Download the Final Report  

Year:  2004-05

Summary: Undertaken in conjunction with the CSIRO P-Health Flagship Program a current study at NARI will determine whether voluntary increases in brain blood flow can arrest or reverse the progression of memory deficits in mild cognitively impaired patients. The study employs a biofeedback method in which participants view a graphic representation of their brain blood flow on a computer screen and, with training, learn to increase the rate at which blood flows through a region of the brain that has a role in short term memory function. Participants attend two biofeedback sessions per week for twenty weeks. To determine whether the ability to increase blood perfusion in the brain has any beneficial cognitive effects, participants undertake a weekly computer-based set of tasks that measure short-term memory capacity, reaction time and divided attention capacity. In addition, participants are monitored using questionnaires that serve as indices of cognition, anxiety, depression and beliefs about health and wellbeing to determine whether these factors might be associated with changes in cognitive status and memory function.

Funding source:   CSIRO

Summary: In patients with dementia, the capacity to comprehend music is commonly retained even when language abilities have been lost. Case studies suggest that music may have beneficial effects on the cognitive and social capabilities of dementia patients. NARI's researchers have been able to provide the first objective evidence to support these observations. Using a novel measure of vascular flow together with an EEG coherence measure of cortical brain function, we show that behavioural changes associated with music are accompanied by improved vascular function and a clear pattern of coherent brain activity in patients with Alzheimer's disease.

Summary: Research indicates advances in the assessment and management of dementia are beneficial. Unfortunately the vast majority of this research has been performed on non-Indigenous groups and therefore cannot be easily translated to Australian Indigenous communities. The limited data available indicate there may be a higher prevalence of dementia in Indigenous communities, with cerebrovascular disease, injury and excessive alcohol use being common underlying and potentially reversible causes. Further research is needed to determine the magnitude of the problem of dementia in the Indigenous population. Before this can be ascertained an appropriate means of assessing a person with memory problems and possible dementia needs to be developed in a culturally sensitive manner. This study is working to develop and validate an assessment tool that is specific for those of Indigenous background. A study will then be performed to determine the prevalence and underlying causes of dementia, in a representative sample of older Indigenous people living in the Kimberley region of Western Australia. This will have significant implications for the planning of effective and culturally appropriate services for older Indigenous people with dementia and their families and carers.

Summary: The most obvious behavioural signs of delirium are deficits in attention and memory. We are using electrophysiological measures of brain function in conjunction with passive tasks to determine where, in the chain of information processing of auditory stimuli, people with delirium show deficits. We have found that there are no significant differences between young and old subjects in pre-attentional and later attentional phases critical to sensory memory formation. Having confirmed the methodology we are now undertaking the next phase of the study in which we are examining and comparing the responses of delirious and demented patients.

Summary: Approximately 10-15% of patients with mild cognitive impairment (MCI) tend to progress to clinically probable Alzheimer's disease. This clinical study aims to identify patients with MCI, using a combined diagnostic approach. The combined use of CogState and the patent skin test (Patent No: 2003905207) will increase the accuracy of diagnosing MCI and, therefore, help in identifying early the people at risk of developing Alzheimer's disease.

Summary: Early and accurate diagnosis of Alzheimer's disease (AD) is essential to provide appropriate treatment. This study examined the effectiveness of a novel skin test for early diagnosis of AD (Patent No: 2003905207) that is based on detecting peripheral vascular deficiency. This novel non-invasive skin test has potential clinical use as an early diagnostic marker of AD. Early diagnosis leads to early treatment and better management.

Year: 2002-06 (current) 

Summary: The study's primary objective is to examine the possibility that a stimulating cognitive environment, characterised by a music intervention, could additively enhance Alzheimer's disease (AD) patient responsiveness to a pharmaceutical intervention, as assessed by both peripheral and central physiological measures and a psychometric measure of cognitive status (MMSE).

Funding source: Pfizer Neuro Science Research Grant

Summary: This study aimed to identify the vascular toxic effects of the amyloid beta protein involved in the pathology of Alzheimer's disease. This project has major clinical implications because it identifies vascular toxins that contribute to the disease's development and this is important, as these vascular elements are potentially readily reversible risk factors. Interventions to reduce or reverse these vascular effects could be effective in retarding the progress of Alzheimer's disease.

Summary: This is the first study to attempt to assess the effectiveness of available medications for Alzheimer's disease (AD) to modulate the vascular toxic effects of amyloid beta protein. The aim is to examine the possibility that a simple assessment of peripheral vascular responses in AD patients could indicate the effectiveness of medications in modulating the disease pathology. If successful, the project's results could provide enormous cost savings to the Australian health system and improve patient well-being by enabling systematic evaluation of the benefits of medications.

For information about Pain: Dementia and Memory Loss go to the Research / Pain / Dementia and Memory Loss section of our web site, link here ....