Functional Stroke: A New Challenge for Stroke Services and Neuropsychiatry
Professor Anthony David | University College London | 27 April 2022
The advent of specialised stroke services globally has had a major impact on stroke mortality and morbidity by reducing the delays in getting effective treatments to patients. However, an inevitable consequence of these services is that they ‘sweep up’ people with non-stroke diagnoses (‘mimics’) including those with functional neurological disorders. Those with functional strokes are not well catered for by these services although their precise needs are poorly understood. Professor David presents data on the prevalence of this problem from around the world as well as detailed clinical information from a London centre and puts forward some ideas on what we might do about it.
Professor Rajesh Kalaria | Newcastle University | 16 November 2021
Dementia develops in 30% of elderly people who survive after stroke. Various brain structure changes associated with neurodegenerative dementias such as total cerebral volume, medial temporal lobe atrophy and cortical thinning, also relate to cognitive dysfunction in cerebrovascular disease. Professor Kalaria provides selected updates on the clinicopathological aspects of the primarily MRC funded Cognitive Function after Stroke (CogFAST) study, which began some 20 years ago. This study demonstrates the association of coronary artery stenosis with stroke injury and suggests that coronary artery disease also enhances SVD type of pathology contributing to development of dementia in post-stroke survivors.
The work is supported by the Medical Research Council (UK), the Dunhill Medical Trust (UK), the Royal Society, Alzheimer’s Research UK (ARUK) and Alzheimer’s Society (AS), UK.
Wisdom, Ageing, and the Pandemics
Professor Dilip Jeste | University of California San Diego | 29 September 2021
Discussed in religions and philosophies for millennia, wisdom is a topic of growing empirical research since the 1970s. Wisdom is a complex personality trait with several specific components: empathy/compassion, emotional regulation, self-reflection, decisiveness amid uncertainty, and spirituality. In near future, neurobiological procedures such as targeted brain stimulation as well as neuro-psycho-tropic drugs may be developed to enhance components of wisdom. Our studies have shown a strong inverse association between wisdom and loneliness. This suggests relevance of wisdom in the current era of behavioral pandemics of loneliness and associated suicides and opioid-related deaths. Wisdom, through its association with well-being, happiness, and health is perhaps the best means of achieving successful ageing.
Preventing Dementia: What Should We Do?
Professor Gill Livingston | University College London | 25 August 2021
Professor Livingston discusses the evidence that dementia is preventable, the potentially reversible risks with consistent, high-quality evidence and other factors with increasing evidence. She talks about how risks differ between and within populations. She discusses what we can do in terms of changes in policy and what action individuals can take.
Improving the Diagnosis and Management of Lewy Body Dementia
Professor John O’Brien | University of Cambridge | 21 July 2021
Lewy body dementia, comprising both dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), has an even worse outcome than other dementias in terms of functional decline, reduced quality of life and increased mortality. Despite revisions in diagnostic criteria and the availability of some diagnostic biomarkers, many cases remain misdiagnosed. There are some effective treatments for Lewy body dementia and its symptoms, but there is considerable heterogeneity in approaches to management. This lecture updates current thinking on how to improve both diagnosis and management, and describes results of a recent study which has developed new management guidelines to assist clinicians to optimise management of people who have Lewy body dementia.
Update on Cognitive Reserve
Professor Yaakov Stern | Columbia University | 26 May 2021
Professor Stern gives a brief history of the concepts underlying reserve, including brain reserve, cognitive reserve and brain maintenance. The research approaches to understanding the neural basis of these concepts will be discussed. He describes the progress of a program designed to come to consensus on operational definitions for terms related to reserve and resilience among human and animal researchers. Professor Stern also shares some new data exploring the neural implementation of cognitive reserve.
Population Studies and our Ageing Brains Today
Professor Carol Brayne | University of Cambridge | 28 April 2021
This presentation includes a brief resume of research in older populations led from Cambridge that have informed current clinical understanding and policy regarding services and prevention for and of dementia, including across generations. These population studies have more recently been ‘re-purposed’ with enthusiasm from participants into a trial platform. The presentation will cover the major findings from the studies, reflections on their contribution to our general understanding of ageing and the brain, and adapting to both a trial and COVID follow-ups.
Super Ageing and… Super-Duper Ageing?
Professor Roddy Roediger | Washington University in St. Louis | 17 February 2021
Super ageing was originally defined as a condition of people over 80 (average, 83 years old) who performed as well as people 50 to 65 (average age of 61) on one memory test, the Rey Auditory Verbal Learning Test (RAVLT). Hearing about this phenomenon, and seeing the attention the concept aroused, reminded me of research that Mark McDaniel and I did in the mid-2000s when we had two grants to study false memories in older adults. In general, we showed that older adults show more errors in three false memories paradigms than do younger adults. However, in each case, a subgroup of older adults (the highest scorers on a battery of 5 tests purposed to measure frontal lobe functioning), show both veridical and false recall that is equal to that of younger adults in these same paradigms. Unfortunately, we made the mistake of following the standard in the literature and we called these “high frontal functioning older adults.” However, because we showed older adults (average age, 75) performed as well as college students (and presumably better than average 60 year olds), should we now label them super-duper agers?
Diagnosing Alzheimer’s Disease in the Biomarker Era: Promises and Pitfalls
Professor Ron Petersen | Mayo Clinic | 9 December 2020
The landscape for making the diagnosis of Alzheimer’s Disease (AD) is changing. Formerly, the diagnosis of AD was a clinical-pathological process relying on a typical clinical presentation and confirmed at autopsy. With the advent of AD biomarkers, the situation has evolved. Now with AD imaging or fluid biomarkers, conclusions about an AD component can be inferred in life. However, this approach presents concerns. Does this mean that AD clinical research without biomarkers is invalid? What about pathological co-morbidities? This discussion will address these issues and attempt to look at the future of AD research and clinical practice.
Brain Vascular Function in Ageing and Cognitive Impairment
Professor Hanzhang Lu | Johns Hopkins University | 9 November 2020
Ageing results in profound changes in the brain’s blood supply, energy metabolism, and microvascular function. Cognitive impairment and dementia are associated with further detrimental changes. Professor Lu will present recent results on how brain physiology is altered in aging and cognitive impairment, using advanced magnetic resonance imaging (MRI) techniques. Studies using both human and animal subjects will be presented. The relationship between brain physiology and cognitive function as well as Alzheimer’s pathological markers will be discussed.