Dementia

HEALTH INFORMATION

Understanding the difference between dementias

WHAT WE KNOW

Dementia is a group of brain disorders that affect a person’s memory, thinking and ability to interact socially. It is caused by damaged nerve cells that may occur in several areas of the brain. As a result, people experience dementia differently, depending on which area of their brain is affected. The dementia types are classified in a variety of ways, often according to what they have in common or whether they worsen over time (progressive dementias).

Some dementias, such as those caused by a reaction to medications or an infection, are reversible with treatment.

Progressive dementias

Types of dementias that are not reversible and worsen over time include:

  • Alzheimer’s diesase
  • Vascular dementia
  • Lewy body dementia
  • Frontotemporal dementia

OUR LATEST RESEARCH

The ChoLesterol cohort mEta Analysis foR incident dementia and cognitive decline (CLEAR) study

The CLEAR study will provide us with a better understanding of the ways that cholesterol and the different types of cholesterol may affect the risk of developing cognitive decline or dementia. 

The Life-Course Blood Pressure Cognition (LCBP-COG) study

The LCBP-COG study will provide us with a better understanding of the ways that high blood pressure can increase the risk of cognitive decline or dementia over the lifecourse.

The General Practice Knowledge Translation (GP-KT) project

The General Practice Knowledge Translation (GP-KT) project is an online survey designed to help us understand what people already know about dementia risk and dementia risk reduction in frontline healthcare settings.

In particular we are keen to understand the barriers that might delay or prevent dementia risk reduction activities so that we can work to reduce these over time.

At the moment we are recruiting Australian General practitioners and their teams. International versions are the survey are also in development.

Behavioural Symptoms in Dementia (BeSyDe)

It is estimated that 1.2 million Australians are currently caring for someone with dementia. Caring for somebody with dementia can become more complicated by the presence of behavioural problems (e.g. depression, anxiety, apathy, aggression) in the person with dementia. These behavioural problems can contribute significantly to carer burden and distress. This study aims to improve our understanding of how interactions between the carer and the care-recipient affect behavioural problems in dementia. A better understanding of these interactions will help us develop programmes which can be used to assist the carer and those suffering from dementia to minimise the negative impact of problem behaviours in dementia.

BPSD PLUS: A person-centred approach to managing behavioural and psychological symptoms of dementia

Rates of behavioural and psychological symptoms of dementia (BPSD) amongst people living in residential aged care facilities (RACF) are high. Over 90% of Australian aged care residents exhibit clinically significant BPSD. Physical aggression, agitation and disinhibition, especially when severe, are difficult to manage and can put patients, carers and other residents at risk. Management of BPSD has recently become a focus of attention for the Australian Government, especially in relation to inappropriate overprescribing of antipsychotics. The discrepancy between international and national recommendations and the continued over-prescription of medication to manage BPSD must be addressed. Australia urgently needs better programs to support RACF to implement non-pharmacological, cost-effective management programs.

NHMRC Dementia Centre for Research Collaboration

The NHMRC Dementia Centre for Research Collaboration (DCRC) was established in 2006 under the Australian Government’s Dementia Initiative.  DCRC projects are diverse and map onto the priorities of the NHMRC National Network for Dementia Research (NNIDR). A key focus is applied research on topics meaningful to people with dementia and their family carers.

There are three DCRC hubs located at UNSW, NeuRA and QUT, respectively. The three-hub framework aims to grow partnerships and strengthen ties with consumers and service providers, Dementia Training Australia and Dementia Support Australia in order to progress prevention, assessment, care and translation of knowledge into everyday practice, as well as building the next generation of dementia researchers.

The primary focus of the DCRC NeuRA hub is risk reduction and prevention including individual, community and population-based interventions targeting lifestyle risk factors for dementia.

The flagship project of the DCRC NeuRA hub is the International Research Network on Dementia Prevention (IRNDP). Founded in 2017, the IRNDP is a multinational network bringing together researchers who are working to reduce the risk of dementia across the world. For more information on the network, visit the IRNDP website, including news and updates, an evidence hub on cohort studies, an evidence synthesis on clinical trials, and information on how to join.

The DCRC is funded by the National Health and Medical Research Council.

NHMRC Centre of Research Excellence in Cognitive Health

The Centre of Research Excellence in Cognitive Health focuses on the integrally linked areas of optimising cognitive health and the prevention of cognitive decline.

The centre aims to:

  • Build the evidence base in cognitive health promotion and prevention of cognitive decline, focussing on evaluating putative new risks and under researched areas
  • Develop methods of transferring, translating and implementing established findings, through the development and evaluation of interventions
  • Model population level impacts of cognitive impairment and risk modification to quantify potential economic benefits of risk reduction and to inform policy.

The CRE Cognitive Health led by Professor Kaarin Anstey is a collaboration between Chief and Associate Investigators from the Australian National University, University of Melbourne, University of New South Wales, Australian Catholic University, Baker IDI Heart and Diabetes Institute and University of Exeter.

For more information about the CRE Cognitive Health, please visit the centre website, including more information on research themes, news and events, and recent publications.

The CRE Cognitive Health is funded by the National Health and Medical Research Council.

International Research Network on Dementia Prevention

Globally, dementia cases are increasing at a rate of 21 per cent annually, and most of these are occurring in low to middle-income countries. With no cure for neurodegeneration or the diseases that cause dementia, there is an urgent need to link both knowledge translation and researchers more closely together in a global effort to tackle prevention more effectively.

Founded in 2017, the International Research Network on Dementia Prevention (IRNDP) is a multinational network bringing together researchers who are working to reduce the risk of dementia across the world.

IRNDP aims to:

  • Increase dementia risk reduction messaging worldwide
  • Develop targeted research to answer questions about the detailed impact of known and emerging risk factors in preventing dementia
  • Welcome membership from researchers in both high and low or middle income countries
  • Collaborate and work closely with public health stakeholders, policy makers and those who have a diagnosis of dementia and carers.

The goals of the IRNDP have particular relevance in low- to middle-income (LMIC) countries as exposure to lifestyle and clinical risk factors becomes more common as LMIC economies grow.

While there are many current overlapping public health, patient, research, policy and practice initiatives aimed at prevention or treatment of dementia, IRNDP is the first single collaborative network of researchers to focus attention on prevention that is truly global.

For further information, visit the IRNDP website, including news and updates, an evidence hub on cohort studies, an evidence synthesis on clinical trials, and information on how to join the network.

IRNDP is chaired by Professor Kaarin Anstey and is a project of the Dementia Centre for Research Collaboration funded by the NHMRC National Institute for Dementia Research (NNIDR).

The Dementia Risk Factors and Assessment (DemRisk) program

The Dementia Risk Factors and Assessment (DemRisk) program involves over ten years of research performed by the Anstey group on the identification and assessment of risk factors for Dementia.

The DemRisk program includes:

  • Systematic reviews and meta-analyses of dementia risk and protective factors
  • Analysis of cohort studies to identify dementia risk and protective factors
  • Development of evidence-based interventions for dementia risk reduction
  • Development of innovative e-learning resources to support dementia risk reduction
  • Development of risk assessment tools validated for assessing individual exposure to risk factors known to be associated with an increased risk of developing dementia
  • Development of guidelines (e.g. physical activity guidelines) to reduce risk of cognitive decline and dementia in collaboration with other researchers and organisations including the World Health Organisation
  • Training of early career researchers with a focus on identifying and targeting dementia risk

Read Professor Kaarin Anstey and Dr Ruth Peters’ recent invited commentary on second-hand smoke as an under-recognised risk factor for cognitive decline here. You can also watch Professor Anstey’s NeuRAtalk on ageing well to reduce your risk of dementia here.

Cognitive training correlates

Investigation of the correlates of brain training based on data from a National Health survey.

Modifiable risk factors for dementia

An umbrella review synthesizing the quality and quantity of evidence for risk factors associated with dementia.

World Heath Organisation (WHO) Guidelines for the reducing the risk of cognitive decline and dementi

Systematic review of reviews were conducted to synthesize the available evidence for interventions for risk factors associated with cognitive declines and dementia. This research was used to inform WHO guideline development.

Sex differences in the incidence and prevalence of dementia

A systematic review and meta-analyses of global dementia incidence and prevalence comparing differences between males and females, derived from prospective population-based cohort studies.

Care of Older People in Surgery

Each year the number of older people undergoing surgery increases. Although evidence is well established that older age and frailty are associated with greater risk of poorer postoperative outcomes, there is little evidence to date to establish whether outcomes can be improved through geriatric intervention.

Causes, consequences and costs of injury-related hospitalisations for people with dementia: identify

This research program explores the influence of dementia on the pattern of hospital admissions, clinical care, health outcomes and economic costs of older people with an injury-related hospitalisation. It provides data on the impact of injury on a person with dementia and the health system more generally.

Preventing Falls in Older Adults with Cognitive Impairement or Dementia (IFOCIS)

The IFOCIS study aims to determine the ability of an individualised exercise and home hazard reduction program to reduce the rates of falls in older people living in the community with cognitive impairment or dementia. To do this, we have two groups– an ‘intervention’ group and a ‘control’ group. The Intervention program involves: an exercise program and a home hazard reduction program delivered by experienced therapists tailored to the participant’s cognitive and physical abilities. Carers are an integral part of the intervention team, as some participants require supervision for exercise sessions. We work with carers to help them understand how to get the best from the participant they are caring for, in terms of their ‘functional cognition’, completing the exercises and preventing falls.

Taking this individual approach means that participants can have very different cognitive abilities and still be included in our study. No other study has done this to date.

All participants will undergo an assessment at baseline with re tests at 6 and 12 months to compare each of these groups on things like strength & balance. The primary outcome is the rate of falls during the 12 month study period which is collected using falls diaries on a monthly basis.

Recruitment for the project is now in the 2nd year. We have enrolled 184 participants and their carers into the trial from the Prince of Wales hospital / NeuRA site and the Hornsby hospital site. We hope to have 360 participants enrolled by the end of 2017. We continue to recruit from Prince of Wales and Hornsby hospital wards and outpatient clinics and other Sydney metropolitan hospital dementia day clinics.

Understanding and preventing physical and cognitive decline and falls in older people with dementia

Falls and functional decline are common in people with dementia. Falls are more likely to result in injury, death and institutionalisation when compared to older people without dementia. There is limited evidence that falls can be prevented in people with dementia. Strategies aimed at maintaining independence and preventing decline and falls are urgently needed. This research will a) further our understanding of fall risk and functional decline and b) explore novel fall and decline prevention programs, including the use of technology in older people with dementia.

Falls, ageing and dementia in Indigenous Australians

We aim to identify determinants for the high prevalence of dementia in Indigenous Australians, and will now extend these findings by exploring determinants for the high prevalence of falls.

Koori Growing Old Well Study

The primary aim of a proposed longitudinal study is to find the reasons for the high dementia rates (three times non-Indigenous rates) in urban/regional Aboriginal people.

What else is happening in Dementia research at NeuRA?

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