Reducing incident delirium and cognitive decline in coronary artery bypass grafting

Coronary artery bypass grafting is a type of heart surgery, however poor cognitive outcomes such as delirium and cognitive decline are common in older adults.  We are running a randomized controlled trial testing the effects of a pre-habilitation and re-habilitation cognitive training program on cognitive outcomes in these patients.

CAIN members involved: Hannah Keage, Danielle Greaves, Erica Ghezzi, Ashleigh Smith
Collaborators: Dr Daniel Davis (UCL), A/Prof Peter Psaltis (SAHMRI), Dr Amit Lampit (UMelbourne), Dr Alice Bourke (Royal Adelaide Hospital)

Representative publication: doi: 10.1016/j.ijcard.2019.04.065

Neurophysiology of delirium risk

Delirium is characterised by acute and fluctuating impairments in cognition and arousal, affecting around one third of older adults in hospital.  We are prospectively collecting electroencephalogram data prior to an elective procedure and incident delirium post-procedure to identify brain vulnerability for delirium.

CAIN members involved: Monique Boord, Hannah Keage, Scott Coussens
Collaborators: Dr Daniel Davis (UCL), Dr Alice Bourke (Royal Adelaide Hospital), Dr Daniel Feuerriegel (UMelbourne) and A/Prof Marta Garrido (UMelbourne)

Representative publication: doi: 10.1001/jamapsychiatry.2016.3423

Using Virtual Reality to Improve Apathy in Residential Aged Care

Apathy is a commonly reported symptom in older adults residing in aged care and may be associated with an increased risk of cognitive decline. Reminiscence therapy, a powerful way of providing a connection with a person’s past, has demonstrated results in improving mood symptoms and quality of life. This research will focus on reducing levels of apathy, combining both reminiscence therapy and immersive virtual reality.

CAIN members involved: Dimitrios Saredakis, Tobias Loetscher and Hannah Keage
Collaborators: Megan Corlis
Representative publication: doi:10.2196/17632

Safe use of virtual reality

When a person puts on a VR headset, their brain must integrate the new perceptual information of the virtual environment. The virtual then becomes the new reality, and a person can accurately interact in this environment. Upon exiting VR and returning to the real world, a person may experience visual and cognitive after-effects resulting from subtle differences between the two environments. Health and safety issues may arise from these side-effects. This research aims to understand VR side-effects and provide practical recommendations for using these technologies across disciplines and industries.

CAIN members involved: Tobias Loetscher, Ancret Szpak, Stefan Michalski, Dimitrios Saredakis
Collarborators: Prof Mark Billinghurst, A/Prof Celia Chen, A/Prof Ross Clark

Representative publications: doi: 10.3389/fnhum.2020.00096 & 10.1109/ACCESS.2019.2940073

Virtual Reality Skills Training

A vital element of VR training is the transfer of learnt skills from a virtual environment to the real world. Many industries are taking an interest in skills training in VR because of the flexibility and exciting possibilities VR has to offer. Current popular applications of VR training include sports, education, medicine and retail. Understanding the benefits and limitations of skills transfer from VR training to the real world is an essential component of the research we do.

CAIN members involved: Tobias Loetscher, Ancret Szpak, Stefan Michalski
Collaborators: Caroline Ellison, Mark Billinghurst, Gun Lee, Jun Ahn

Representative publication: doi: 10.1371/journal.pone.0222351

Dementia Knowledge

With no cure for dementia and strong evidence for modifiable risk factors, it is imperative that the public are knowledgeable about dementia and how they can reduce their risk.  We are running several studies that aim to measure knowledge of dementia and its risk factors in the Australian public.

CAIN members involved: Alana Nagel, Gabrielle Villani, Hannah Keage, Tobias Loetscher, Ashleigh Smith

Anticholinergic medications and cognition

Cognitive side effects of anticholinergic medications in older adults are well documented (including delirium and dementia), with resultant deprescribing efforts apparent globally.  Whether these poor cognitive outcomes are observed in children has not been systematically investigated.  We are conducting meta-analyses and empirical studies on the associations between anticholinergic medication use and cognition in children. 

CAIN members involved: Hannah Keage, Erica Ghezzi, Michelle Chan
Collaborators: Dr Lisa Kalisch (UniSA), Kathryn Richardson (University of East Anglia)

Social cognition in ageing

We know so much about how performance in some cognitive domains change across adulthood, e.g. attention decreases from the 20s and vocabulary knowledge increases to the 60s, and only decreases thereafter.  We know very little about how social cognitive performance changes across adulthood.  We will identify age-related patterns of performance for the social cognitive domains of theory of mind (affective and cognitive) and emotional evaluation.

CAIN members involved: Hannah Keage, Amy Jarvis, Stephanie Wong
Collaborators: A/Prof Gail Robinson (UQ), Dr Rachel Stephens (UAdelaide), Dr Michael Weightman (UAdelaide)

Wellbeing training program for older adults

We are working with The City of Onkaparinga to co-design a wellbeing training program for older adults.  This program will then be implemented within the council, along with partner councils, with the aim to the improve wellbeing of older adults in our local communities.  By co-designing the program, our hope that it will be relevant to, and engaging for, older adults.

CAIN members involved: Stephanie Wong, Hannah Keage, Tobias Loetscher, Ashleigh Smith
Collaborators: Dr Mel Hull (UniSAOnline), Mr Lui Di Venuto (City of Onkaparinga), Dr Maria Shialis (City of Onkaparinga)

Cancer-related Cognitive Impairment

Cancer related cognitive impairment (CRCI) is commonly experienced by cancer patients following cancer treatment. Patients report problems in the domains of memory, processing speed, attention and executive function. CRCI generally improves over time; however, some report symptoms persisting for a decade. This research aims to understand which cancer patients experience CRCI and the impact of these cognitive difficulties on everyday life. 

CAIN members involved: Amanda Hutchinson & Elise Thompson

Development of Risk Models for Cognitive Decline and Delirium in Aortic Stenosis and Transcatheter Aortic Valve Implantation  (TAVI)

This study aims to identify risk factors for a deterioration in thinking and memory skills after a type of heart procedure known as transcatheter aortic valve implantation (TAVI). These changes may be short-term (such as delirium) or long-term cognitive decline. 
Another part of this study will compare participants undergoing TAVI and the control participants before the TAVI procedure i.e. the baseline data. This analysis will identify if participants with aortic stenosis compared with participants without aortic stenosis have different motor symptoms (walking, eye movement, voice, swallowing), mood, behaviour, brain activity (measured non-invasively using electroencephalogram or EEG), and their genotype taken from a saliva sample.

CAIN members involved: Hannah Keage, Tobias Loetscher, Erica Tilley, Danielle Greaves
Collaborators Dr Peter Psaltis (SAHMRI) and Dr Daniel Davis (UCL)

Representative publication: doi: 10.1016/j.amjcard.2020.04.023

Cognitive reserve

There is an individual variability in how people cope with brain injury, including age- and dementia-related neuropathologies.  Two people with the same brain injury can experience very different cognitive impairments, one may have dementia whilst the other may have no clinical impairments.  This phenomenon is known as cognitive reserve.  Here at CAIN we are investigating the neural mechanisms and cognitive consequences of cognitive reserve using a variety of techniques, including electroencephalography, Magnetic Resonance Imaging, and Transcranial Magnetic Stimulation.

CAIN members involved: Louise Lavrencic, Hannah Keage, Scott Coussens Collaborators: Dr Owen Churches, Mike Ridding and Dr Mitch Goldsworthy (University of Adelaide), Dr Thais Minett and Elijah Mak (University of Cambridge), and Dr Blossom Stephan (Newcastle University)

Risk judgement

We have around a 1 in a million chance of dying from an accident every day, and this acute risk is quantified as 1 MicroMort.  We increase our risk through activity choices and MicroMorts index their acute risk of death. We are running a number of behavioural and electrophysiological studies investigating how people understand risks associated with everyday activities (outside of gambling/financial risk).

CAIN members involved: Hannah Keage, Tobias Loetscher, Scott Coussens, Dilushi Chandrakumar
Collaborators: Stefan Bode & Daniel Feuerriegel (UMelbourne)

Representative publication: doi: 10.1371/journal.pone.0207356

Verbal fluency in Mild Cognitive Impairment

The goal of the current study is to devise a more versale paradigm than the classic verbal fluency task where people list as many words beginning with a specific letter (e.g. ‘s’) or that are part of a certain category (e.g. animals). Instead we aim to gauge word meaning in a broad sense, controls the executive aspects of language, is sensitive to different domains and types of dementia, and would result in a diagnostic tool in both detection and tracking of treatment outcomes.

CAIN members involved: Hannah Keage, Scott Coussens, Danielle Greaves
Collaborators: Owen Churches, Simon DeDeyne (The University of Melbourne) and Marijn van Vliet (Aalto University)

Forget Me Not - An intergenerational school program

Adolescents and younger children typically have limited knowledge and poor attitudes towards dementia and people living with dementia. Intergenerational programs aim to increase this knowledge and foster positive attitudes towards dementia. Our work in the ‘Forget Me Not’ project aims to connect school aged students with older adults living with dementia. Through weekly art and gardening sessions, we hope to bridge the gap between these two populations. Ultimately, this project is the first step in building a more dementia-friendly community in South Australia. Organisations involved: CAIN, UNSW, Unley Primary School, The City of Unley and ECH.

CAIN members involved: Ashleigh Smith, Tobias Loetscher, Hannah Keage, Mel Hull, Samantha Lai and Georgina Kamm.

Representative publication: doi: 10.3389/fpubh.2020.00248

Cerebrovascular functioning in Parkinson’s Disease

The mechanisms which lead to cognitive dysfunction in Parkinson’s disease are poorly understood.  One proposed mechanism is impairment of the ability of the brain’s neurovasculature to regulate blood flow in response to changes in brain activity.  This study will investigate whether responsiveness of the cerebrovascular system differs in Parkinson’s patients with and without cognitive impairment, compared to neurologically healthy controls, in the face of increasing cognitive demand. 

CAIN members involved: Hannah Keage,  Daria Gutteridge, Dimitrios Saredakis
Collaborator Dr Lyndsey Collins-Praino (University of Adelaide)

Representative publication: doi: 10.1016/j.jns.2019.116578

Spatial perception in Cervical Dystonia

Cervical Dystonia (CD) is a neurological disorder characterised by involuntary neck muscle contractions that may lead to abnormal head and neck postures. The objective of this study is to investigate the consequences of an abnormal lateral head posture on spatial perception and participation in everyday life.

CAIN members involved: Dr Tobias Loetscher, Rebecca Callahan, Emily Rosenich, and collaborator Professor Lynley Bradnam (Auckland).

Representative publications:
doi: 10.1080/13803395.2019.1629394
doi: 10.1080/09638288.2018.1528636

Expectation and repetition suppression in the visual system

We are consistently bombarded by visual stimuli, and the brain has a variety of strategies to exploit the dynamics of our visual environment. For example, repetition of a stimulus leads to exposure-dependent changes in response properties of cortical neurons, known as repetition suppression or neuronal adaptation. We are investigating some of the factors that modulate the magnitude of repetition effects, including temporal attention (i.e. attention focused in time) and expectations about the images that we will see in the immediate future. To investigate this we use a combination of event-related potential, fast periodic visual stimulation and multivariate pattern classification methods.

CAIN members involved: Daniel Feuerriegel, Hannah Keage, Scott Coussens
Collaborators: Bruno Rossion (University of Louvain) and Owen Churches

Representative publication: doi: 10.1016/j.neuroimage.2017.12.029

Neurovascular coupling in Vascular Cognitive Impairment No Dementia

The early detection of brain changes leading to cognitive impairment and dementia is critically important for early intervention.  We know that vascular risk factors such as smoking, high blood pressure and being overweight (particularly in mid-life) increases the risk of dementia in later life.  This study investigates associations between cardiovascular health and cognitive function, from mid to late-life, and the role of neurovascular coupling in these effects.

CAIN members involved: Hannah Keage, Ashleigh Smith, Daniel Feuerriegel and Danielle Greaves.

Representative publication: doi:10.3389/fneur.2020.00643