Dementia shrinks the brain’s white matter—the wiring that carries signals between neurons—and this project will use a new type of MRI scan to spot that damage earlier than ever before. The problem is that vascular cognitive impairment, caused by poor blood flow to the brain, accounts for at least one in five dementia cases, yet current scans cannot reliably distinguish it from Alzheimer’s disease in its early stages. Without a clear diagnosis, patients may receive treatments that do not help. The researchers aim to combine two existing MRI techniques—one that measures blood flow and another that tracks water diffusion through tissue—into a single, rapid scan. They will also build new mathematical models based on detailed measurements of human brain tissue, both healthy and diseased. If successful, the scan could give clinicians a practical tool to diagnose vascular dementia earlier and more accurately. That would allow patients to receive appropriate care sooner and help researchers design better clinical trials for treatments that target the vascular causes of cognitive decline, rather than testing drugs that work only for Alzheimer’s.
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The term "dementia" is used to describe a syndrome that results, initially, in cognitive function impairment and in many cases, a descending staircase of psychological dysfunction, leading eventually to death. It is a major socio-economic challenge with care costs approaching 1% of global GDP. Several conditions that lead to serious loss of cognitive ability are grouped under this syndrome, including Alzheimer's disease (AD), Vascular Dementia (VaD), Frontotemporal Dementia, etc. A high publicity announcement was made in 2012, by the Prime Minister, emphasising the high priority that should be given to dementia-related research and that funding will more than double in the immediate future, to partially remedy the fact that the overwhelming impact of the syndrome has been over-looked (Guardian, 26/3/12). On Dec 2013, the G8 Summit hosted in London brought together G8 ministers, researchers, pharmaceutical companies, and charities to develop co-ordinated global action on dementia. Dementia has marked adverse effects on the quality of life of tens of millions of people (both patients and carers) and exerts tremendous pressure on healthcare systems, especially when clear trends towards an ageing population, changing environmental influences and contemporary lifestyle choices are considered. Ca. 35M people suffer from dementia worldwide, a figure to quadruple by 2050. Europe and North America share a disproportionally high burden: the effects of ageing are particularly stark for these regions, exacerbating the healthcare provision implications. The Clinical Relevance: Vascular Cognitive Impairment (VCI). VCI defines alterations in cognition attributable to cerebrovascular causes, ranging from subtle or fixed deficits to full-blown dementia. VCI is a wide and accepted term referring to the "syndrome with evidence of clinical stroke or subclinical vascular brain injury and cognitive impairment affecting at least one cognitive domain", with resulting VaD being its most severe form. VaD is responsible for at least 20% of dementias, second only to AD, with a prevalence doubling every 5. 3 years. Several trials examined cholinesterase inhibitors for the treatment of vascular dementia, but the benefits are very modest, except in the individuals with a combination of AD and VaD. Vascular changes result in white matter (WM) damage (leukoaraiosis), which profoundly affect the fidelity of the information transfer underlying brain function and cognitive health8. Cerebral Magnetic Resonance Imaging (MRI) of Diffusion and Perfusion. MRI is a medical imaging technique affording non-invasive investigation of anatomy and tissue function, which is particularly suited to studying cognitive disorders due to its sensitivity and reliability. Our main interest is to characterise vascular and non-vascular tissues using quantitative diffusion and perfusion MR. Our overall aim is to characterise and quantify early differential alterations in brain blood transport and subsequent microstructural tissue damage using one-stop-shop perfusion/diffusion MR GSI incorporating novel MR signal models and optimal MR sequence design based on new human brain histomorphometric data in health and disease.
Alejandro Frangi (Principal Investigator)Aneurin Kennerley (Co-Investigator)Annalena Venneri (Co-Investigator)Derek Jones (Co-Investigator)Geoff Parker (Co-Investigator)Iain Wilkinson (Co-Investigator)John Highley (Co-Investigator)Paul Ince (Co-Investigator)Zeike Taylor (Co-Investigator)
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