October 2017 Newsletter

16 October 2017
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The Inbetweeners” - Living well with Mild Cognitive Impairment

Many New Zealanders over the age of 65 will experience some changes to their memory and thinking as they get older. They may be more forgetful than before, find it difficult to think of words they once knew, or lose the thread of conversations more easily. To a certain extent this is all a normal part of ageing. When those changes go beyond what you would normally expect for people of that age, they enter a kind of grey-zone between ‘normal’ age-related decline and ‘dementia’, a grey-zone that we call ‘mild cognitive impairment’ (MCI).

Some people with MCI will go on to develop dementia, but this isn’t true for everyone. In fact, research suggests that one in five people diagnosed with MCI will return to normal cognitive functioning within a few years. Many others will remain stable for several years or more without progressing to dementia. It is thus an ambiguous diagnosis, since it can be temporary, permanent, or transitional for any individual. This makes it a very difficult diagnosis to wrap your head around.

In 2015, BRNZ funded a two year study into the ways that people with MCI live with and respond to changes in their memory and thinking. The study, led by Nicola Kayes, aims to understand how people experience those changes, and to identify the supports and strategies people with MCI use to cope. Two years on, and after interviewing many New Zealanders living with the condition, Nicola and her team have found some interesting results.

There were a number of challenges, priorities, and barriers to care which were concerning for individuals with MCI and their families; however Nicola discovered a concern which overshadowed most others: profound uncertainty. The diagnosis of MCI left people unsure about what to expect for the future. Would they get better? Would they continue to get worse? What part of their experience was normal ageing, and what was the diagnosable problem? Caught in a kind of cognitive ‘no man’s land’, people can find it tremendously difficult to navigate life with MCI.

Their resilience in the face of that uncertainty has been remarkable. Despite very limited external support, people with MCI and their families have shown themselves to be tremendously adaptable, developing home-grown strategies for dealing with the day-to-day challenges of MCI. In order to help share those strategies with the broader MCI community, Nicola has been working with people with MCI, and their families, to develop a new interactive website. The website, currently in development, will provide a space for people experiencing changes to their memory and thinking to share their stories, tips and tricks with one another.

 

 

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Mind-body therapy to combat cognitive decline

When you think about yourself do you imagine yourself as a whole, or do you focus on individual parts of your body? For most people it’s normally the former, but when our health becomes compromised by aches, pains, or breakages, it’s typical to focus on the troubled areas. For the most part this makes sense; it makes sure attention and treatments get delivered to the right places. But in the case of ageing-related health issues, it can be hard to know where to focus your attention.

One of the biggest issues for the ageing population is muscle weakness and physical frailty, which leads to an increased incidence of falls and possible head injuries. Thus, a great amount of effort goes in to reducing the risk injury, both in the community and in residential aged care facilities. However, targeting physical frailty as the solution may not be enough to effectively reduce the risk of harm.

Dementia, which impacts up to 80% of individuals in residential aged care, is another major risk factor for falls. The balance problems, impaired judgement, sensory impairments and difficulty in avoiding hazards means that people with dementia are up to 8 times more likely to have falls than people without the condition. An innovative new study, funded by BRNZ, is addressing this problem by treating the ageing brain and the ageing body simultaneously.

The study, spearheaded by Professor Ngaire Kerse, is combining physical exercise and cognitive stimulation for adults in aged care. The physical exercise plays two main roles: to strengthen the body, and to improve cognitive well-being. Similarly, the cognitive stimulation is offered in the hope of improving a person’s overall alertness, and their level of engagement in the physical training programme. By combining the two, not only should the risk of falls be reduced, but the physical and mental wellbeing of the individuals should also improve.

Pathological ageing is a complex process of interacting changes that require a whole body approach to mitigate their effects. By training the body and the mind together, Ngaire and her team could dramatically improve the quality of life for people in their golden years.

 

 

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Tohu Hiranga – For Merit

“We all inherit legacies,” Professor Richie Poulton says to a crowded lecture theatre, “I more than most.” Seventeen years ago Richie was put in charge of an incredible legacy, The Dunedin Study. The study has followed the lives of 1037 people born between April 1972 and March 1973 at Queen Mary Maternity Hospital in Dunedin. Richie jokes that people in the international community initially shrugged their findings off, after all, what could a study from the bottom of the world really tell them about their own communities? As it turns out the results of this ‘bottom of the world’ study have been more impactful than even its creators could have expected.

With their amazingly high retention rates, and consistent multidisciplinary approach, the Dunedin Study has built a truly holistic view not only of life growing up in New Zealand, but of what happens to us as we age in general. That legacy is the first piece of the puzzle, but it’s not the whole story. Research, even extraordinary research, can’t effect change on its own. For that you need a champion, someone who can show it off, even to those who don’t want to know. In 2014 Richie took up a part-time position as science adviser to the Ministry of Social Development. Then, in 2016 he and his team released the wildly successful documentary series ‘Why am I?’. He is in a position to effect real change not just in policy, but in how people see themselves and one another.

So when, as part of this year’s Queen’s birthday celebrations, Richie was named Companion of the New Zealand Order of Merit for his services to science and health research, it came as no surprise… to everyone except him. “Stunned mullet wouldn't be too far from the truth,” he says, “I had to check the envelope that I'd tossed on the table – to make sure it was addressed to me”. For Richie it’s all about the study, about the members, about making sure that he and his team are doing the absolute best with the information they’re given. He’s done a fantastic job so far, and will continue to do so long into the future. We hope he’ll take this opportunity to take a breath, and a look back at all that hard work, and know that the legacy he passes on will be even more impressive than the one he received.

 

 

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Dementia Prevention Research Clinic for Dunedin

In November this year, BRNZ will launch the second clinic in our Dementia Prevention Research Clinic (DPRC) Network, this time in Dunedin. The Clinic, led by Dunedin DPRC Director Dr Nick Cutfield, will work alongside the one established last year in Auckland, and in coming months, Christchurch.

Knowledge is power, and in the face of increasing dementia diagnoses, we need as much information as we can get. By bringing together the experiences of those diagnosed with dementia we stand to get a clearer, more holistic view of how the disorder progresses in New Zealand, what predictors there are for its progression, and what to do about it.

BRNZ’s clinics offer an exciting opportunity for people in the earliest stages of dementia to join a longitudinal study which could help improve the lives of others. Dementia is one of the most socially and medically harmful effects of ageing, and by enhancing our understanding of how it develops we will be in a much better position to help the more than sixty-thousand New Zealanders who live with this profoundly life-altering disorder.

 

 

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Maintaining Independence with Parkinson’s disease

In 2016 Professor John Dalrymple-Alford, from the University of Canterbury, and Professor Leigh Hale, from the University of Otago, took lead of a project to address the cognitive decline experienced by many people with Parkinson’s disease. We tend to think of Parkinson’s as a motor disease, causing tremors and rigidity, but the problems these people have are far broader than that. “Most people with Parkinson’s disease will eventually develop some mild cognitive impairment,” says John, and like the rest of the disease, these cognitive changes are difficult to predict. “On average, older people with Parkinson’s disease are at greater risk of later dementia that other people of a similar age.”

For now we don’t know which individuals with Parkinson’s disease will go on to develop dementia, or how fast their cognitive decline will be. While John and his team have other projects dedicated to finding answers to that problem, this project is focused on what might be done to improve people’s chances in the meantime. “Evidence suggests that keeping physically, socially, and mentally active may be helpful in slowing down cognitive decline in general,” he says, “we wanted to look at that with Parkinson’s disease patients.”

The study, funded by BRNZ, aimed to test that idea out by putting volunteers with Parkinson’s disease through a unique combination of physical and mental training. Together the training regime aimed to strengthen the body, the connection between body and brain, and to train specific brain networks which are impacted during the progression of Parkinson’s disease. “There are multiple networks in the brain which control brain functions,” John says, “and we wanted something more targeted and more effective than just saying ‘do more crosswords’.” It was a lot to ask of people, especially considering that each person involved was dealing with a progressive disease, but they managed it nonetheless. “They’ve been brilliant,” John says, “they really have been fantastic.”

This first stage of the study took eight months of intensive training and effort by their dedicated participants, and John expects this initial phase to be completed in the next month or so. Follow-ups have already begun, and will continue for most of the next year in order to keep an eye on how people are doing. As of now John says there is no real sign if it worked or not, and given the unpredictability of dementia in Parkinson’s disease it may be a few years before they have a more complete picture of the study’s impact. It’s not uncommon that people who work closely with vulnerable members of society become very concerned about giving false hope, and John is no exception. He says that, for now, he just hopes that the study has given some benefit to those involved; both in the training group and the active control which ran alongside it.

At this stage this work isn’t a therapy, and is not expected to be a cure, but it may prove to be a drug-free way of supporting Parkinson’s disease treatments in the future. People with this disorder currently face an uncertain future and little is known about how the disease will progress for each individual. Nonetheless, John, Leigh, and their team hope that their study will open a door towards some long-term benefits. Will it be successful? Watch this space!

 

 

Wananga 2017

Auckland-based researchers invited to the Tāmaki wānanga at Hoani Waititi marae

All Auckland-based research leaders, fellows, students and clinicians affiliated with Brain Research New Zealand – Rangahau Roro Aotearoa are invited to the Tāmaki wānanga at Hoani Waititi marae on Tuesday 14 of November.

The purpose of this visit is to engage directly with the Māori community for your research efforts and to get feedback on how to direct your research efforts in consultation with the Māori community in the future.
 
Venue:  Hoani Waititi marae
Address: 451 W Coast Rd, Auckland 0602
Date: Tuesday 14 November
Time: 9am-3pm
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RSVP and inquiries: Email Dianne Stacevicius or ring her on (09) 9238212 by Friday 3 November for catering purposes.