Cognitive medicine - focus on cerebrovascular disease
Short description
The term cognition describes the human brain’s ability to learn, think, and process information. For a normal daily life to be possible, cognitive functions must be intact. Impairment of cognitive functions results in difficulties in coping with both complex and everyday activities, such as daily planning, meeting the demands of work life, managing finances, preparing food, keeping order, socializing, or cultivating interests. Impaired cognitive functions also lead to an increased sensitivity to stress.
Alzheimers disease and cerebrovascular disease are the quantitatively most important causes of cognitive impairment in adults. These, and other similar disorders, such as Lewy body disease and frontotemporal dementia, are the main focus of the research group.
Research at the Memory clinic
The Gothenburg MCI study is a large, prospective, clinical study, initiated in 1999. With this study, we aim to investigate why some patients with mild cognitive impairment (MCI) develop dementia, while others do not. Another important aim is to clarify the borders and overlap between closely related dementia disorders. The Gothenburg MCI study is also the source of several substudies.
Patients aged between 50 and 79 seeking care for cognitive difficulties and diagnosed with MCI or mild dementia are included into the Gothenburg MCI study. The diagnosis of MCI or mild dementia is made using simple clinical instruments, independently of neuropsychological assessment. Patients who exhibit signs of severe concurrent psychiatric or somatic disorder are not included. All participants are examined at baseline, and after 2, 4, 6, and 10 years. Clinical and biochemical analyses of blood and cerebrospinal fluids are made at all examinations. The clinical examination consists of a systematic anamnesis with instruments designed to pick up on symptoms reported by participants and their relatives, as well as cognitive, neurological, psychiatric, and somatic status. Symptoms attributable to different brain regions are examined, as well as depressive symptoms. A comprehensive neuropsychological assessment is made at baseline, and after 2 and 6 years. Genetic analyses are carried out at baseline, MRI and SPECT at baseline and after 2 years. Healthy controls are recruited via associations for senior citizens, and go through the same procedures as the patients.
When possible, the patient meets the same staff (teams consisting of a physician, a licensed psychologist, a counselor, and a nurse) throughout the study period.
Data collection is integrated into clinical practice. This places high demands of logistics and cooperation on the people who work with the study.
To date, over 600 participants have been included, 400 have been followed up after 2 years, 200 after 4 years, 100 after 6 years, and 20 after 10 years. 150 healthy controls have been included, 70 have been followed up after 2 years, 50 after 4 years, and 30 after 6 years.
Participants in Gothenburg Mild Cognitive Impairment study are investigated with different techniques.
Illustration: Jacob Stålhammar
Some examples of our special studies
One substudy deals with the borders and overlap between cerebral small vessel disease and Alzheimer’s disease. Small vessel disease is the most common vascular cognitive disorder. It presents with executive impairments, gait disturbance, and white matter changes on MRI. Characteristic for Alzheimer’s disease are memory impairments and grey matter changes. In both diseases the metabolism of beta-amyloid is disturbed. The diseases occur both separately and in mixed forms. The aim of this specific study is to discriminate between the two diseases by means of analysis of cognitive profiles, image analysis of the hippocampi and the white matter, biochemical analysis of beta-amyloid peptides, enzyme and immune activity in the extracellular matrix, and analysis of synaptic function. Furthermore, we aim to ascertain when mixed forms are present during early and later stages of the disease process. The results are expected to impact, among other things, selection processes in clinical trials.
In another substudy, we aim to investigate what characterizes patients with cognitive impairments who later recover to normal function. Educational level and other socioeconomic factors may be of importance. Larger hippocampi and amygdala nuclei may be protective, as well as well-developed neural networks.
A third substudy investigates if physical activity may improve cognitive function in patients with mild cognitive impairment.
Members
Principal Investigator
Anders Wallin, professor
Senior and postdoctoral researchers
Carl Eckerström
Marie Eckerström
Michael Jonsson
Petronella Kettunen
Erik Olsson
Jacob Stålhammar
Johan Svensson
Doctoral students
Elin Axelsson
Anna Molinder
Patrick Quinlan
Students
Zinab Alhossani
Adrian Gimdal
Alexandra Horvath
Research nurse
Ann-Christin Näslund
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Local (examples)
The Neurochemical pathophysiology and diagnostics research unit at the Sahlgrenska academy, University of Gothenburg. Our groups collaborate routinely for biochemical analyses of clinical samples of cerebrospinal fuid, as well as in several projects aiming to find new biomarkers for vascular cognitive disorder and dementia.
The Adult Development and Aging (ADA - Gero Group) at the Institute of Psychology, University of Gothenburg. Our groups collaborate in studying physical activity and cognition, as well as with analyses of complex longitudinal relationships.
Stroke- cognition. Several studies have shown that stroke may cause cognitive impairment and dementia symptoms, however, it is unclear if the cognitive symptoms are progressive or stationary. In progressive cases, it is unclear whether the progression is due to an Alzheimer process, the vascular disease in it self, or a combination.
Congestive heart failure. The aim is to investigare whether patients with congestive heart failure develop cognitive symptoms, and if so, how they present, if they lead to disability, what causes them, and how they can be prevented.
In collaboration with the Institute for stress medicine, we are investigating the nature and triggering factors behind cognitive symptoms in patients with stress syndrome.
The EyeDem study aims to investigate if there is a connection between positive biomarkers for Alzheimer’s disease and degenerative eye diseases (macular degeneration, glaucoma, cataract).
National
Swedish Brain Power (SBP) is a project aimed at eg integrating clinical MCI and dementia research in Gothenburg, Malmö, and Stockholm, and to build a common national research database, as well as to analyse data from the national diagnosis registry for dementia diseases SveDem.
International
The Leukoaraiosis and Disability in the elderly (LADIS)-study is a European prospective studie of non demented subjects with varying degrees of white matter changes, as measured with magnetic resonance imaging techniques. The main finding so far is that white matter changes contribute to the development of disability.
The MedCoast Gothenburg Oslo (GO-MCI)-study is a sister study to the Gothenburg MCI study, focusing on the contribution of white matter changes and vascular factors to the development of Alzheimer’s disease and vascular cognitive disorder.
Financiers
The work of the research group is made possible with funding from
- ALF
- Alzheimerfonden
- Axel Linders stiftelse
- Fredrik och Ingrid Thurings stiftelse
- Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse
- Stiftelsen Demensfonden
- Stiftelsen för Gamla Tjänarinnor
- Stiftelsen Handlanden Hjalmar Svenssons forskningsfond
- Stiftelsen Psykiatriska Forskningsfonden
- Stiftelsen Wilhelm och Martina Lundgrens Vetenskapsfond
- Swedish Brain Power
- Vetenskapsrådet
