Title: Exploring transitions from hospitals to care homes: the role of cognitive impairment
Researcher: Dr Jenni Harrison
Telephone: 0131 242 6371
Each year in Scotland around half of those who are newly admitted to a hospital come directly from a hospital setting. This is despite policy guidance across the UK arguing that care home admission from acute hospital settings be avoided. Despite this being an everyday occurrence in hospitals across the UK, our understanding of this area is extremely limited.
I have planned a series of six related projects to help explore this topic in greater depth, including: looking at predictors of care home admission from acute hospital settings worldwide in a systematic review; working to develop a search filter to identify care home research; using routinely collected health and social care data to explore practice in Scotland and more in-depth work focused on staff perspectives on this critically important issue. Wherever possible, the role of dementia and delirium will be specifically explored to better understand the influence of these conditions on care home admission from hospital.
Title: Dementia in the 1932 Scottish Mental Survey Cohort: is there evidence of geographical clustering?
Researcher: Dr Tom Russ
Health service planning assumes a uniform spread of dementia across the country. However there is evidence that young-onset dementia, at least, is not randomly distributed geographical clusters have been developed. This has not been investigated for the much more common late-onset dementia.
Evidence of clustering of dementia would allow more efficient use of scarce health service resources but also, potentially more importantly, could help identify socio-enviromental factors that increase or decrease the risk of developing dementia. This opens the possibility of altering that risk and potentially protecting someone, at least partially, from developing dementia.
I am attempting to identify which of the participants in the 1932 Scottish Mental Survey have developed dementia using record linkage to hospital discharge and death certificate data, in addition to accessing a sample of primary care records. Mapping the location of these individuals at birth, age 11 (when they took part in the Survey) and at diagnosis will allow the geographical spread of dementia cases in a narrow age cohort in Scotland to be investigated.
Title: Visuospatial Perception and Motor Control in Posterior Cortical Atrophy (PCA), Corticobasal Degeneration (CBD) and related Neurodegenerative Diseases
Researcher: Harriet Ingle
One subtype of Alzheimer’s Disease (AD) is Posterior Cortical Atrophy (PCA). One of the defining features of PCA is a younger age of onset than typical AD. PCA is a rare, progressive dementia and is associated with a number of other neurodegenerative pathologies such as Creutzfeldt-Jacob Disease, AD, and Lewy body dementia. PCA patients often display fewer memory deficits, better verbal fluency, and greater insight into their diagnosis than those diagnosed with typical AD. Everyday symptoms which PCA patients may have include difficulties in reading, writing, and using familiar objects, as well as trouble interpreting road signs, and getting lost on familiar routes. These symptoms can often be misinterpreted as having their origins in the eyes, rather than the brain.
The unique symptom profile of PCA and the unusually young age of onset mean that this subtype can often go undiagnosed for years at a time. There is some evidence suggesting that the clinical profile of typical AD and PCA may overlap in the latter stages of PCA disease progression, therefore PCA and AD may be part of the same disease process – or they may be clinically distinct syndromes.
The visual and co-ordination problems associated with PCA can be tested using a range of simple attention and movement tasks. However, very few quantitative studies have been conducted with PCA patients. Further research to more fully understand the deficits observed in PCA patients would be a valuable step towards more effective diagnosis and better-targeted therapeutic strategies for this relatively newly-recognized form of dementia. Detailed research into AD subtypes, including PCA, will also shed light on the question of whether AD is a spectrum of disease, with different subtypes appearing somewhere across a shared scale, or whether these subtypes are actually clinically different from each other. This would allow for sensitive and specific screening tools to be developed to identify the unique symptoms of these subtypes of AD early, and prevent misdiagnosis and therefore delays in treatment. These specific problems with vision and movement may exist on a greater scale in other related diseases, such as in typical AD. Therefore a formal investigation into the prevalence and severity of these symptoms across a range of related diagnoses will grant an insight into an as-yet understudied area.
The aims of this research are; to investigate the visual, movement, and attention deficits which are characteristic of PCA and other subtypes of AD such as Corticobasal Degeneration (CBD), Primary Progressive Aphasia (PPA), as well as typical AD using a range of visual, attention, and movement tests, both in the clinic and in the lab. This will help to identify whether PCA and other subtypes of AD represent part of a common spectrum of impairment with typical AD, or whether they are distinct syndromes. This will allow the development of a sensitive and specific screening tool to be used in clinics to detect the earliest stages of symptom development for these rare diagnoses.
Validation of the Dimensional Apathy Scale and exploration of apathy subtypes in dementia
Reseacher: Dr Ratko Radakovic
Apathy is a debilitating behaviour observed in dementia and is characterised by reduced motivation relating to goal direct behaviour. Apathy is often regarded and assessed as a singular concept despite research showing it to have a multidimensional substructure related to motivational deficits of organizational, emotional and initiation behaviour. My research looks to validate and implement a novel apathy measure, the Dimensional Apathy Scale, which quantifies different apathetic subtype impairments independent of motor disability. Following the validation of the Dimensional Apathy Scale, the profile of apathy and its impact in dementia, specifically Alzheimer’s disease, will be explored. The overarching aim of this research is to establish this new measure in a clinical setting, encouraging more comprehensive assessment of such a complex syndrome.