Sleep is a fundamental biological requirement for human health. Poor sleep quality and increased sleep fragmentation increases the risk of dementia and cognitive decline. More specifically, poor sleep quality is considered to be an underlying cause of cerebral small vessel disease (CSVD), a common feature of the ageing brain that affects the small vessels of the brain. It is a slowly progressing disease that gradually lead to cognitive impairment, physical disabilities and emotion change with ageing.
The sleep-related mechanisms promoting CSVD are not yet clear, but it is thought that marked increases in blood pressure and heart rate via activation of the sympathetic nervous system that occurred during sleep arousals in ageing people is a key factor. Because sleep quality decreases with normal ageing, and older adults take longer to fall asleep, have lighter sleep and more frequent arousals that fragment sleep, the primary aim of this project is to determine the role of nocturnal cardiovascular surges in the development of small vessel vasculopathy in CSVD that leads to pre-clinical neurological dysfunction.
Cerebral small vessel disease (CSVD) is a common feature of the ageing brain. It affects the small vessels of the brain and causes up to 45% of dementia and 20% of strokes. Management of the traditional risk factors of CSVD is still the main approach for treating or preventing CSVD, because there is evidence that brain damage can be reversed or delayed in the early stages of the disease.
The diagnosis and monitoring of CSVD relies on imaging findings. However, there is currently no MRI protocol able to identify early stage CSVD or to monitor disease progression in the early stages, when disease management would be of most benefit. In fact, more advanced imaging techniques are required to detect a subtler level of damage, when brain damage can still be reversed with medical and lifestyle interventions.
Thus, the aim of this project is to develop an advanced imaging protocol to characterise the burden of early CSVD in mid-life. Each MR imaging technique in this new protocol focuses on one mechanistic aspect of vascular damage including gross structural changes in the grey and white matter, fine structural changes in white matter and brain microvasculature neurochemical and perfusion abnormalities.
Improving time to surgery for older people who have broken a hip.
National and International Guidelines and Standards of Care suggest that people who fall and fracture their hip should have an operation to fix the hip within 48 hours of presentation to hospital. However data from the ANZ Hip Fracture Registry suggests that many hospitals across Australia and New Zealand struggle to meet this target. The main reasons for delay to surgery are 1) getting access to theatre time, 2) getting medical clearance to proceed with the operation and 3) difficulties managing people on blood thinning agents in preparation for an operation.
Four major hospitals in NSW will aim to markedly improve their time to surgery for people who have broken a hip – Prince of Wales Hospital, St George Hospital, The Sutherland Hospital and Liverpool Hospital.
Clinicians and managers will work in partnership to identify delays that occur and develop solutions that ultimately ensure that older people with a hip fracture get high quality evidence based care.
GOAL – By the end of 2020, 85% of people will have their surgery within 48 hours