Improving diagnostic MRI for vulnerable dementia patients
Supervisors: Akram Hosseini
Research proposal
It is estimated that approximately 850,000 people in the UK have dementia. The diagnosis can be challenging with up to 30-50% incorrect or uncertain diagnoses in patients with young-onset dementia. MRI techniques have increased sensitivity in identifying active brain pathology such as brain tumour and ischaemia as well as differentiating various dementia syndrome. Although MRI is easily accessible, relatively cost-effective, non-invasive with lack of exposure to radiation, obtaining good quality images is dependent on patient’s tolerance of dark and noisy tunnel without moving during the image acquisition. This can be particularly challenging in dementia patients with co-existing chronic pain, backache and mental health disorders. The behavioural changes may be an intrinsic part of the early onset dementia syndrome (e.g. behavioural variant-frontotemporal dementia) or reactive anxiety/depression related to impaired cognition. In older patients, superimposed mental health issues (e.g. visual hallucinations in Dementia with Lewy Body, Posterior Cortical Atrophy or Alzheimer’s disease) can complicate MRI tolerance. Further, the use of sedation in predominantly older patients with systemic co-morbidities carries risks and can adversely affect the quality of images due to delirium, polypharmacy interactions and early-phase sleep movements.
While there is an increasing evidence on the superiority of using high resolution multi-modal MRI techniques over conventional MR methods, the current sequences at ultrahigh field MRI require further work to become more patient friendly.
We have recently started conducting CogNID study (Cognitive and Neuroimaging in neuroDegenerative disorders) using the SPMIC MRI scanners. The study aims to recruit at least 100 participants who present to the Working Age Dementia clinics, and Cognitive Disorders Across Lifespan at Queen’s Medical Centre, and prospectively study their disease progression both cognitively and radiologically. The available clinical and cognitive profile for the study participants would facilitate focusing on the areas of the brain that clinically matters to vulnerable patients. For instance, a short temporal lobe sequence would be more relevant for the diagnosis of
Alzheimer’s disease, whereas imaging nigrosum and the brain stem could be the diagnostic key in Dementia with Lewy Body.
In addition to shortening the time of image acquisition, we can study whether other facilitating measures such as introductory movie, accompanied family members, prior home visit by Research Nurses could improve the limitations in utilising diagnostic MRI for vulnerable dementia patients.
The proposal will be planned as:
- Optimising the structural MR sequences on healthy volunteers
- Testing the optimised sequences on healthy elderly people and CogNID cohort with classified clinical and cognitive phenotypes (including biochemical cerebrospinal fluid data and genetic assessments).
- Intervention trials such as pre-MRI tour, trial of dummy scanner, introductory video, presence of Research Nurse prior and during MRI, listening to the music or watching movie during the scans.
Overview. The University of Nottingham is offering talented graduates the opportunity to apply for EPSRC-funded places in our four cohort-based thematic doctoral training programmes starting in October 2018.