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One small vessel stroke? One giant problem for humankind
Professor Joanna Wardlaw CBE, University of Edinburgh, delivered this year's Keynote Lecture at Lancaster House.
Professor Wardlaw addressed 'small vessel disease' which is the most common cause of vascular dementia. Although vascular dementia is the second most common form of dementia, for too long there has been insufficient research into this disease.
Prof Edwin van Beek - Research in a Nutshell, 2018
Recent work has investigated age differences in brain activity modulated by the neurotransmitter dopamine during new memory encoding, & the strategic processing of memory retrieval cues, previously shown to differ according to age.
A key set of questions concerns the significance of older adults’ activation of additional brain regions in functional imaging studies compared to young adults. Does this 'over-activation' reflect compensation, or just deterioration and neural inefficiency?
Competing theories based on these ideas predict specific changes in the patterns of activity across the brain during cognitive tasks, such as reduced lateralisation in older adults. Testing these theories therefore depends on a clear characterisation of observed patterns of brain activity. The study described in this video involved a collaboration with Karl Friston from UCL. In it, we introduced a new multivariate approach to inferences about patterns of cortical coding in ageing in a functional magnetic resonance imaging (fMRI) study of memory encoding. We found age-related differences in the spatial deployment as well as the lateralisation of activity in frontal cortex.
Furthermore drugs such as heme arginate, which up-regulate, HO-1 & can protect from AKI & are now being tested in renal transplantation.
Stroke, the world’s second biggest killer, is most often due to a blockage of a brain blood vessel by blood clot. Drugs that dissolve clots or prevent them from forming improve the chance of recovery after stroke, but they also increase the chance of bleeding; when bleeds occur into the brain they are particularly severe. Most stroke patients need to take drugs that affect blood clotting at some point in their illness, ranging from potent ‘clot busting’ drugs to less risky drugs like aspirin.
If a doctor could reliably select which patients were helped rather than harmed by these drugs, this would be a big step forward. I hope to develop a method to predict which stroke patients are more likely to be harmed (by bleeding) than benefit (by avoiding forming blood clots) from medicines that affect clotting. This will lead to better decisions for each individual patient, and better treatment policies. This study will use the best information from existing methods as well as from newer technologies (e.g. blood tests and brain imaging) to ensure effective & personalised decisions for each stroke patient.
The aims of this symposium were to bring together the stakeholders in research imaging management including range of professionals from research imaging centres, professional organisations whose members use imaging in research, ethicists, research funders & regulatory bodies.
Perfect vision: new imaging centre transforms parient experiece
The work of the state-of-the-art Clinical Research Imaging Centre (CRIC) at the Queen's Medical Research Institute (QMRI) is likely to bring substantial benefits to patients. The £20 million Centre is equipped with the latest technology, including a positron tomography (PET) scanner, used in cancer diagnosis; a high-resolution computed tomography (CT) scanner, for investigation of the heart & coronary arteries; & a magnetic resonance imaging (MRI) scanner, used to research conditions such as psychosis.
Professor Wardlaw discusses clot busting treatments and neuroimaging research.
Clot busting treatment
Patients given a clot-busting drug within six hours of a stroke are more likely to make a better recovery than those who do not receive the treatment.
The multi-centre, randomised study of more than 3000 patients is the world's largest ever trial of the drug rt-PA, which is given intravenously to patients who have suffered an acute ischemic stroke.
The international trial - known as IST-3 - has found that for every 1000 patients given the clot-busting treatment within three hours of stroke, 80 more will survive & live without help from others than if they had not been given the drug.
The findings of the study, led by the University, have been published in The Lancet alongside an analysis of all other trials of the drug that have been carried out in the past 20 years.
Professor Joanna Wardlaw on clot bursting treatment.
Prof Wardlaw discusses Stroke and Small Vessel Disease in Neuroimaging research.
Professor Joanna Wardlaw on neuroimaging research.
Usually this process starts in the laboratory, & proceeds through animal models of the disease to human clinical trial. However, attrition rates are high, & most treatments which show apparent promise in animal studies are not effective when tested in humans. We’re interested in why this might be.
One major issue is experimental design; many laboratory experiments do not take the simple precautions to avoid bias that would be considered standard in clinical trials, & we have shown that these experiments consistently overstate how effective treatments are in the laboratory models. As we’ve explored this more deeply, it seems that this is an issue across the life sciences, not just in preclinical disease modeling.
Our work therefore involves (i) understanding which sources of bias are most important, to provide empirically based recommendations for improvement; (ii) developing new laboratory research paradigms (such as multi centre animal studies) where such sources of bias can be better controlled; & (iii) developing techniques to test the validity of conclusions drawn from laboratory research to guide both further work in the laboratory and the design of human clinical trials.
Professor Stephan Lawrie on Scanning for a Diagnosic Test for Schizophrenia.
Brain imaging can be used to distinguish patients with schizophrenia from their relatives, & from other patients with major psychiatric disorders such as bipolar disorder & autism.
This talk takes a journey through these investigations, lay out the evidence & show how outcomes may be enhanced & possibly even prevent psychosis in high risk populations.
Recorded on 24 October 2013 at The University of Edinburgh's Anatomy Lecture Theatre.
Videos from stroke trials & research
There are three videos for health professionals, specifically about certain stroke trials, such as IST3 and RIGHT-2, which require consultants to register with the VMC to gain login details, prior to gaining access to the videos.
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However, our video on Improving the Outcome of Strokes is available for everyone to view here: