The COGFAST study website
Sarah Barnfield
How can we improve public
awareness of research into
the prevention of dementia?
uThe
office for national statistics
‘Half of the UK working
population have a reading age
of 11 of younger!’
What is the Newcastle Cognitive
Function after Stroke (CogFAST) cohort?
• Began in 1999 and still on going today
• Involved 355 elderly stroke patients
• Scientists looked for risk factors that led to the development of dementia over time.
What were the CogFAST Findings?
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Stroke survivors are at a significantly greater risk of developing dementia
than those who have not suffered a stroke
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There are modifiable life style risk factors that can be altered to reduce this
risk.
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Lay summary: Scientific research is summarised and written in easily
understandable language.
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Lay people: People who are neither academic researchers nor health or social
care professionals.
An interesting finding from the focus
group
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‘I’d hate to think people are ticking off the calendar waiting
to be that 1 in 4 with dementia in 4 years time’
The process of creating one lay summary will be
demonstrated in the figures below:
Controls
Numberof
people
Figure 1, first draft taken to Focus group 1
Laysummary 3:
Hippocampal NeuronalAtrophy andCognitiveFunctioninDelayedPoststrokeandAging-RelatedDementias.
What isthehippocampus? Thehippocampusisfoundinthemiddleofthebrainandisimportantforlearningand
memory. The name ‘hippocampus’comesfromtheancientGreekwordforseahorse.Itwasgiventhisnameasitis
similar shapetoaseahorse.ThehippocampusissplitupintoareascalledCA1,CA2andCA3andCA4.
Poststroke
dementia
16
Vascular
dementia
13
Mixed
dementia
16
Alzheimers
disease
14
Total
95
We lookedatneuronaldensityandneuronalvolumesinareasCA1andCA2ofthehippocampus.
Brainfunctionwastestedevery year untilthepeopleinstudydied.
What brainfunctiontestdidweuse? WelookedatbrainfunctionusingtheCambridgeCognitiveExamination(CAMCOG). Itis
apaper andpenciltestthatgivesyouascoreonyourbrainfunctiontotestyourmemoryandexecutivefunctionandoverall
brainfunction.
What isexecutivefunction?Executivefunction allowsustobeabletoplan,solveproblemsandmakedecisions.
What didtheyfind?
What ishippocampal neuronalatrophy?Thisiswhenthehippocampusshrinksinsize.Tomeasureneuronalatrophy,
we measure neuronaldensityandneuronalvolume.
What areneurons? Thereare around86billionneuronsinthehumanbrain.Neuronsarenervecellsthatreceiveand
sendmessagesinthebrain.
What isneuronaldensity? Neuronaldensityishowcompacttheneuronsareinagivenspace.
What isneuronalvolume? Thisishowbigtheneuronis.
What isdementia? Dementia happenswhenourbrainfunctionisbadenoughthatitaffectsusindailylife.Thereare
differenttypesofdementia, themostcommonare:
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Alzheimer’s disease
•
Vasculardementia
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Mixeddementia
Alzheimers diseaseoccurswhenthebrainisdamagedparticularlyinthehippocampusandcausesmemoryproblems.
Vasculardementia isduetoproblemswiththesupplyofbloodtothebrainwhichmayhavebeencausedbyastrokeor
acollectionofsmallstrokes.Mixeddementia iswhereyoucanhavemore than1typeofdementia.
What isastroke? Astrokehappenswhenalarge bloodvesselinthebrainbecomesblocked.Ifnotenoughbloodgetsto
thebrain, braincellsdonotgetenoughoxygenandcandie.
Whyare wedoingthisstudy? PreviousstudiesusingMRIscanshaveshownthatadecreaseinthesizeofthemedial
temporal lobe(whichislocatedinthemiddleofthebrain)isassociatedwithpoststrokedementiainolderpeople.
What aretheaimsofthisstudy? Thisstudyusedamicroscopetolookatchangesinstructureandfunctionofthe
hippocampus.Wewantedtolookatthedifferencesinpeople’sbrainswhohaddifferenttypesofdementiaandthose
whohadastrokebutdidnothavedementia.
What didthisstudyinvolve?
Thisstudylookedatthebrainsof95people.36peoplehadtakenpartintheCOGFASTstudy.Theyweresplitinto2
groups.22hadastrokebutnodementiabeforetheydied.14hadastrokeandhaddevelopeddementiabeforethey
died.The researchers alsoincludedsomeothergroupsofpeoplewhohadnothadastrokebuthadalsodonatedtheir
brainstotheNewcastlebrainbank.14were controlswhohadneverhadastrokeordementia. Theremainder hadother
typesofdementia showninthetablebelow.
14
Poststroke,
nodementia
22
Total CAMCOG (brain function) Score
Average Memory Score
Average Executive Function Score
Average number of months until death
3 months after stroke
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People who have had a stroke but do
not have dementia
89
17
22
63.5
People with post stroke dementia
64
10
16
64.4
Thatpeople withpoststrokedementiahadlower memory, executive functionandoverallCAMCOGscoresthanthose
whohadastrokebutdidnothavedementia.
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Neuronaldensityandneuronalvolumewaslower inevery type ofdementiacomparedtothecontrols.
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There wasnotmuchdifferenceinneuronalvolumeinpeople withPSNDandthecontrolsforCA1andCA2.
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Thosewhohadlowerbrainfunctionscoresfromthepencilandpaperbraintesthadsmallerneuronalvolumes.
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Thosewhohadlowermemory scoreshadlowerneuronvolumes.
Keymessage: Ifwecouldfindtreatmentstostopthebrainshrinkingthenthisshouldmeanthatfewerpeoplewillget
dementia after astroke.
Comments:
Figure 2, second draft taken to Focus group 2
The followingresearchis forinterest only:
What didwefind?
Laysummary3:Howisthesizeofthebrainaffectedindifferenttypesofdementia?
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•
Theaims ofthisstudy: Toseeifthere were differencesinsizeofthehippocampusinthebraininpeoplewho
haddifferenttypesofdementia andthosewhohadastrokebutdidnothavedementia.Thisstudyhopedtofind
thatshrinkageinthe hippocampusvariedinthesedifferentgroups.
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Whyare wedoingthisstudy? PreviousstudiesusingMRIscanshaveshownthatadecreaseinthesizeofthe
hippocampusisfoundinolderpeoplewhohavedementia.
What wedid
The scientistsfolloweddifferentgroupsofolderpeoplewhowereovertheage of75throughouttheirlifeuntil
theydied.
-Onegrouphadastroke
-Onegrouphaddementia
-Onegrouphadastrokeanddementia
-Onegroupdidnothaveastrokeordementia
Fromthe age of75untiltheydied,abrainfunctiontestwasdoneeveryyear.They metwith aresearcher who
didthebraintestbyaskingquestions.ThebraintestiscalledaCambridgeCognitive Examination(CAMCOG).
After theydied,95brainswerelookedat usingamicroscope.Theylookedatchangesinsizeofthehippocampus.
Thatpeople withstrokeanddementia hadlower braintestscoresthanthosewhodidnothaveastrokeordementia.
The sizeofthehippocampuswassmallestinpeoplewhohaddementiacomparedtothepeoplewhodidnothavea
strokeordementia.
Asthebrainfunctiontestloweredsodidthesizeofthehippocampus.
Keymessage: Thissuggeststhatthosewhosebraintestsbecomeworsewithtimeareata higherriskofdevelopingdementia.
Unfortunately,theCAMCOGtestistoocomplicatedtobedoneyourself,thereforescientistsaredevelopingabraintestthat
peoplecandothemselveseach year. Ifthescoreisbecomingworseyear afteryear thisisanearly warningsignthattheycould
develop dementia.
We already knowthatsmoking,highbloodpressure,highcholesterol,lackofexerciseandtoomuchalcoholaccelerate
dementia. We allknowthatwe shoulddobetterwiththesebutwewouldprobablybemoremotivated tochangeourlifestyle
ifwe couldseeourbraintestbecomingworseeachyear. Wecouldalsoaskadoctortocheckourbloodpressureand
cholesteroltoseeiftheseproblemsneed tablets.
Quick-readSummary
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Aswe age, neurons(braincells)dieandthiscausesourbraintoshrink.
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The aimwastosee ifthesizeofthebrainhadanaffectonbrainfunctionwhichcouldpredictdementia.
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We lookedatbrainsizesindifferentgroupsofpeopleovertheageof75.Theyeitherwere: healthy, haddementia, had
astroke, orhadbothastrokeanddementia.Wethendidabraintestoneachpersontolookattheirbrainfunction.
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We foundthatpeoplewhohadastrokeanddementiahadmuchsmallerbrainsthantherestofthegroupsofpeople.
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Thosewhohadlowerscoresintheirbrainfunction,particularlyinmemorytests,hadthesmallestbrains.
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Brainshrinkage isasignofbraindamage.The moreyourbrainshrinksthemorelikely youaretodevelop dementia.
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We donothavetreatmentstostopthebrainshrinking.But,thisresearchhasshownthatlivingahealthylifestylewill
reduceourriskofgettingdementia. Thosethatwere healthy hadtheleastbrainshrinkage. Formoreinformationon
howtoleada healthylifestyle, please clickonthetab‘Riskfactorsfordementia’.
u The
CogFAST website
https://research.ncl.ac.uk/cogfast/home/
The internet as a dissemination tool
The office for national statistics state that regular internet use continues to rise, with more than 8 in 10
people going online almost every day in 2016
•
Information can be quickly reached
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Offer access to a wider audience than printed materials
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The website can be easily updated
Acknowledgements
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I would like to thank my supervisors, Professor Raj Kalaria, Dr Louise Allan
and Dr Ellen Tullo for their mentoring, supervision and guidance throughout
this project.
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I would also like to thank the Voice North participants who volunteered
their time to participate in the focus groups.
u Thank
u Any
you for listening
questions?