BSMS > Research > Neuroscience > Centre for Dementia Studies > Research > Modifiable risk factors in dementia

Modifiable risk factors in dementia

Can we prevent or slow the progression of dementia by changing our lifestyle? The Centre for Dementia Studies and the Dementia Research Unit has an established programme of research into modifiable risk factors in dementia such as diet, exercise, blood pressure and sleep.

A pilot study on the variability of sleep and its association with daily variation in cognition and functioning in older adults

Sleep plays a role in restoring and repairing the body and mind, preventing illness, brain development, and memory consolidation and learning. As we age sleep quantity, quality and efficiency decreases. Poor quality sleep, lack of sleep and sleep disorders are associated with neurocognitive disorders. However, the existing literature on sleep focuses mostly on individual mean averages, but as sleep is naturally variable and sleep patterns change across the lifespan, intra-individual variability (IIV), which quantifies the daily variation around the mean is more appropriate to sleep research. However, this kind of study in older adults with neurocognitive disorders is rare and existing results are mixed.

At the CDS and in collaboration with Surrey Sleep Research Centre, University of Surrey, we’re carrying out a pilot study to document sleep patterns over 2 weeks in older adults with mild Alzheimer’s disease (AD), mild cognitive impairment (MCI) and no memory impairments (controls). We’ll also explore the relationship between the IIV of sleep and the IIV of cognitive functioning in older adults. Participants aged 65-85 years will be recruited from memory clinics and the local community. They will be visited by a researcher in their homes twice (2 weeks apart) to administer a range of measures on sleep quality, cognitive ability, activities of daily living, and well-being. All participants will wear an Actiwatch (activity & light monitor worn on wrist) for 2 weeks to measure sleep/wake patterns. The researcher will take daily cognitive measures over the phone (except on Sundays). Everyday (except Sundays) participants will also complete a diary on sleep, memory slips and mood. We will examine the association between daily sleeping patterns and daily cognitive and functional performance. It is hoped that the results of this study will inform a larger scale study on sleep and cognitive and functional performance in older adults, which will ultimately inform advice on optimal sleep behaviour for older adults.

CI: Dr Sara Balouch
Senior Supervisor: Dr Naji Tabet
Status: Write up and dissemination

Blood pressure, inflammation and cognition in Alzheimer's disease

High blood pressure (hypertension) is associated with an increased risk for developing Alzheimer’s disease, whereas after diagnosis there tends to be a drop in blood pressure (hypotension).

Inflammation is the body’s normal response to damage, and so there is an inflammatory response in the blood vessels due to hypertension. However, inflammation can become harmful to the blood vessels if it becomes chronic. This can make vessels less elastic and so unable to cope with times of hypotension.

This study will look at cognition in Alzheimer's patients to see if there is a relationship with blood pressure, inflammation and brain imaging data. Cognitive testing will be a short series of thinking, memory and attention tasks. Blood pressure will be quantified from measurements at times of cognitive testing, as well as GP history of blood pressure readings. Inflammation will be measured from biomarkers taken from a small blood sample from each subject at the time of testing. Participants will have been offered MRI brain scanning as part of their diagnosis and this data will also be analysed. MRI is a non invasive routine procedure. Participants will be invited to take part in follow up repeat of the procedure in around one year.

The results of this study will provide information on the vascular influence on the cognitive development in Alzheimer's. This could help provide treatment and prevention options for those with dementia or high risk populations. As the cause of Alzheimer's is still unknown, it is important to increase our understanding of the development of the disease as its incidence in the world's population continues to grow.

Funded by: BSMS and Sussex Partnership NHS Foundation Trust
CI: Lucy Nelson, PhD Student (BSMS)
Lead Supervisor: Dr Naji Tabet
Status: Completed

Exercise, diet and cognition in older adults

There is increasing interest in diet and exercise in the management of memory complaints.

Recent research has shown that maintaining a healthy lifestyle through adequate diet and physical activity may have a direct effect on cognition in older people. Understanding the role of diet and exercise is important especially as no disease modifying treatment exists for any of the dementia disorders. Several studies have investigated the influence of diet and/or exercise among healthy older people on cognition and the rate of progression into dementia. However, little research has been carried out so far on the potential effect of diet and exercise in slowing down cognitive decline in people already diagnosed with memory impairment. The main aim of this longitudinal study is to investigate the effects of diet and exercise on the cognitive decline in dementia patients. A secondary aim is to assess the potential influence of diet and exercise on the levels of relevant biomarkers, which may provide an indicator of the biological effect of diet and exercise.

Funded by: ESRC and Sussex Partnership NHS Foundation Trust
CI: Nicholas Farina, Senior Research Fellow
Status: Completed

Effectiveness of exercise in slowing down cognitive decline in Alzheimer's disease: the action for health with exercise in Alzheimer's disease (ahead) feasibility study

Physical activities and exercise can be beneficial in relation to cardiovascular, respiratory and musculoskeletal systems. There is now increasing evidence that appropriate levels of exercise can also be helpful for mood and cognition.

For example, NICE recommends exercise in the management of mild depression. Recent studies following up people with no memory problems have shown that those who exercise regularly are less likely to develop dementia and Alzheimer's disease (AD) compared to those who do not exercise.

Much less is known about the effect of exercise, if any, in slowing down the rate of cognitive decline in patients already diagnosed with early AD. The aim of this feasibility study is to shed light on this issue by assessing the effect of exercise in individuals with AD. This is a crossover trial, in which participants will be randomly allocated into one of two groups. One group will receive the exercise intervention first, which involves a home-based exercise program delivered twice weekly for 12 weeks. The second group will have contact from the research team encouraging them to think about increasing levels of activity into their daily routines.

At the end of the 12 week period, the second group receives the exercise intervention and the first group receives contact from the research team encouraging them to maintain the exercise program. This feasibility study will help in gaining information about the recruitment process, the exercise delivery, the rate of dropout, the cognitive assessment and other important factors which can influence the design of a larger study. The potential for added effect of appropriate dietary intake will also be evaluated. All participants agreeing to take part in this study will be asked to complete a dietary questionnaire to shed light on the quality and frequency of dietary intake components.

Funded by: Sussex Partnership NHS Foundation Trust
CI: Dr Cassandra Richardson
Lead Supervisor: Dr Naji Tabet
Status: Completed

BACKGROUND IMAGE FOR PANEL

VAMiD: The acceptability of wearing activity monitors in older adults with dementia.

What is the aim of the research?
To understand whether people with dementia find it acceptable to wear activity monitors as a means to measure physical activity over a prolonged period of time. We are also interested to find out your opinions about the device.

What will the information be used for?
The information we collect will be used to inform clinicians and researchers about peoples’ views of wearing activity monitors. This will hopefully allow for the wider use of activity monitors in people with dementia and understand what device features are best suited for use in this population.

CI: Dr Nicolas Farina
Status: Complete
Outputs:

Farina, N, Sherlock, G, Thomas, S, Lowry, RG, & Banerjee, S (2019). Acceptability and feasibility of wearing activity monitors in community‐dwelling older adults with dementia. International journal of geriatric psychiatry, 34(4), 617-624 https://doi.org/10.1002/gps.5064

PHYSIQOL: Physical activity and quality of life in people with dementia

At present, there is a lack of literature exploring the relationship between physical activity and quality of life in people with dementia, most notably in observational studies. Whilst exercise interventions do exist, they tend not to measure disease-specific quality of life, and the interventions themselves are not specifically designed to improve it. Notably, these exercise interventions may lose the meaningfulness that is associated with naturalistic physical activity habits (i.e. habitual physical activity). In this study, a prospective mixed-methods design will allow us to observe how physical activities are related to quality of life, with a particular focus on individuals’ perceptions of physical activity. This is a substudy of the existing MODEM study (http://www.modem-dementia.org.uk/), and allows us to use previously collected data to identify factors that may influence both physical activity participation and its impact on quality of life.

Funded: ESRC (no cost extension)
CI: Dr Nicolas Farina
Status: Write-up
Outputs:

Farina, N., Williams, A., Clarke, K., Hughes, L. J., Thomas, S., Lowry, R. G., & Banerjee, S. (2020). Barriers, motivators and facilitators of physical activity in people with dementia and their family carers in England: dyadic interviews. Aging & mental health, 1-10. https://doi.org/10.1080/13607863.2020.1727852