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Dr. Manuel Montero-Odasso’s research demonstrates that gait testing, such as walking while performing a cognitively demanding task like counting backwards (dual-task gait),can be an effective predictor of progression to dementia. In a new study, a team at Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry has discovered changes to the brain that correspond to these findings. 

These changes identify a brain mechanism that corresponds with slow dual-task gait among older adults with mild cognitive impairment (MCI), an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Through their work Dr. Montero-Odasso and his team have found that a high dual-task gait cost, or a significant slowdown in walking speed when dual-tasking, is associated with a two- to three-fold increased risk of progression to dementia. However, the brain mechanism underlying this association was unclear.

To address this research question, Dr. Montero-Odasso partnered with Robert Bartha, PhD, an imaging scientist at Schulich Medicine & Dentistry and Robarts Research Institute at Western University. The team used magnetic resonance imaging (MRI) to examine the medial temporal areas of the brain, particularly the hippocampus, the parahippocampal gyrus, and the entorhinal cortex, which are regions particularly vulnerable to degeneration in Alzheimer’s disease. Participants were 40 older adults with MCI taking part in Dr. Montero-Odasso’s “Gait and Brain Study” at St. Joseph’s Health Care London’s Parkwood Institute. 

The researchers found that participants with higher dual-task gait costs had a smaller grey matter volume in the left entorhinal cortex. Although grey matter volume loss is a common finding in people with Alzheimer’s disease, it is still unclear which areas of the brain are first affected by neurodegeneration. This finding points to the entorhinal cortex as a susceptible brain region in early stages of cognitive decline. This is in line with previous studies reporting that progression to Alzheimer’s disease is associated with volume loss in the entorhinal cortex.

The study therefore suggests that cognitive and motor dysfunction in older adults with MCI share common changes to the brain. This further supports that dual-task gait changes may be a measurable motor marker for neurological degeneration happening in Alzheimer’s disease.

“These novel results show that early brain changes common to pre-dementia states can be manifested by the way patients walk,” says Dr. Montero-Odasso, scientist at Lawson, geriatrician at St. Joseph’s Health Care London, and professor at Schulich Medicine & Dentistry. “This evidence supports walking while performing a cognitively demanding task as an important way to help predict dementia.”

The study, “Entorhinal Cortex Volume Is Associated With Dual-Task Gait Cost Among Older Adults With MCI: Results From the Gait and Brain Study,” is published in The Journals of Gerontology: Series A.

The ICES Faculty Scholars Program has officially launched the call for applications to its fourth training cycle (2019-2021).

This two-year, part-time learning opportunity is open to Ontario-based academic researchers who are passionate about population health and health services research, and wish to obtain an appointment as an ICES Scientist,

The program was established at ICES Western in 2013 as part of its strong focus on supporting trainees and new investigators. By leveraging partnerships with other ICES sites and in conjunction with an interactive e-learning environment, faculty from different regions are able to fully participate in the ICES Faculty Scholars program. 

Scholars will have access to:
 

• Training in the use of Ontario’s health administrative databases for research.
• Seminars on advanced methods relevant to population health research.
• Opportunities for collaboration with experts across the ICES network.
• Individual project mentorship and data analytic support to develop and complete one or more research studies using Ontario’s health administrative databases.

Hear from successful ICES Faculty Scholars:

“The methods of planning and completing an ICES project are unique. This program is the best possible way to demystify the process and produce high quality work from the outset. The amount of support is outstanding, so you have confidence that your work will be successful.”
Dr. Andrew Appleton, Assistant Professor, General Internal Medicine, Western University

“The Faculty Scholars Program is extremely well structured and run. The Program provides a positive and open learning environment for Scholars to ask questions and learn about the administrative and practical aspects pertaining to conducting research at ICES.”
Dr. James Crispo, Researcher, Health Sciences North Research Institute

Applications for the 2019–2021 program will be accepted until January 18, 2019. Any questions regarding the program, applications or eligibility can be directed to @email. 

Go to the ICES website for more information on the ICES Faculty Scholars Program. 

ICES is a not-for-profit research institute encompassing a community of research, data and clinical experts. With its growing network across the province, ICES researchers are able to access a vast and secure array of health-related data to evaluate health care delivery and outcomes. Learn more about ICES Western.

After suffering a heart attack, some patients develop a microvascular obstruction, an area of the injured heart with extremely poor blood flow. These patients are at an increased risk of developing heart failure in the future.

Medical imaging technologies such as magnetic resonance imaging (MRI) and positron emission tomography (PET) can be used to study the remodeling process after a heart attack that can lead to a microvascular obstruction. However, poor blood flow makes it difficult to get contrast agents into the obstruction. Contrast agents are used in medical imaging to show contrast between different types of tissue, such as damaged and healthy tissue.

Benjamin Wilk, a PhD candidate at Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry, will investigate whether a hybrid PET/MRI system and a new method of administering contrast agents can allow researchers to image microvascular obstructions and study these “hidden” regions in the heart.

Contrast agents are usually injected as a bolus, meaning the entire injection is administered immediately. In this study, participants will instead receive a constant infusion of an MRI contrast agent and PET tracer, which means the injection will be delivered over the course of an hour. The MRI contrast agent they are using is sensitive to blood flow and scar tissue, and the PET tracer is sensitive to inflammatory cells.

This will allow researchers to study the anatomy, blood flow and inflammatory processes in microvascular obstructions a week after heart attack. Participants will then be imaged again after six weeks to study the long-term effects on heart function.

“Studying the heart after a heart attack using novel contrast agent injection strategies with simultaneous PET/MRI could provide crucial information for treatment planning, helping us reduce the number of people affected by heart failure in the future,” says Wilk. “This project could also lead to further research into finding better ways to administer PET tracers and MRI contrast agents. These methods could be applied to different diseases as well.”

Wilk received a Lawson Internal Research Fund (IRF) Studentship to conduct the study, which will be supervised by Dr. Frank Prato, Assistant Director, Lawson and leader of the Lawson Imaging research program at St. Joseph’s Health Care London.

“Lawson's IRF is valuable for students for many reasons. It not only allows us to conduct further research, it also enriches our experience by giving us opportunities to write grants and attend conferences,” adds Wilk.

The IRF is designed to provide Lawson scientists the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph’s Health Care Foundation).

Normally samples of bacteria must be removed from their microbiome environment for analysis, which can lead to changes in their metabolic activity and other behaviors, hindering our ability to accurately study the gut or urogenital microbiome.

“This could be avoided if we are able to observe the bacteria in the body using Magnetic Resonance Imaging (MRI),” says Sarah Donnelly, MSc student at Lawson Health Research Institute and the Department of Microbiology and Immunology and collaborative Molecular Imaging program at Western University’s Schulich School of Medicine & Dentistry.

She is investigating the possibility of using magnetically-labelled bacteria with MRI to more directly study microbial interactions in urological and other conditions.

“The hope is that in the future we can use imaging technologies to visualize aspects of the microbiome in its healthy state compared to diseased states to see the early signs of disease and take preventative measures or allow for early intervention,” she says.

Donnelly has received a Lawson Internal Research Fund (IRF) Studentship to conduct the study, which will be supervised by Dr. Jeremy Burton, scientist in Lawson’s Human Microbiome and Probiotics research program at St. Joseph’s Health Care London (St. Joseph’s) and appointed to the Departments of Surgery and Microbiology & Immunology at Schulich Medicine & Dentistry; and Dr. Donna Goldhawk, scientist in Lawson’s Imaging research program at St. Joseph’s and assistant professor in the Department of Medical Biophysics at Schulich Medicine & Dentistry.

Escherichia coli (E. coli) are a common bacterium found in the human gut microbiome and frequently cause non-intestinal conditions like urinary tract infections. The researchers will program E. coli to express an iron uptake gene, magA. This gene is taken from another type of bacteria called magnetotactic because of their response to Earth’s magnetic field. The researchers will study whether the increase in iron uptake caused by magA expression will allow MRI to detect the magnetic signal more clearly than it would in images of untransformed E.coli. This would make it possible to see the bacteria’s behavior in living subjects without removing the bacteria cells from the microbiome environment.

They will then use this technique to study how magA labelled bacteria affect biofilm on medical devices. A biofilm is a structure produced when certain bacteria adhere to a surface and then stick together.

They will also analyze how lithotripsy affects the bacteria’s spatial distribution and interactions in three-dimensional models of kidney stones. Lithotripsy uses shockwaves to break up kidney stones into smaller pieces that are able to pass naturally out of the body. However, these shockwaves not only affect kidney stones. The waves are sent throughout the tissue, and the bacteria living on these tissues may also be affected.

“While lithotripsy is effective in treating kidney stones, we don’t know the side effects of lithotripsy on the microbiome. The shockwaves could disturb the bacteria, potentially leading to diseases caused by an imbalance between helpful and harmful bacteria,” says Donnelly.

These laboratory models will allow the researchers to perform studies in vivo (in animal models) in the future.

“Health research is very important for the development of new technologies and treatments but it is often difficult to secure funding. The IRF program allows students to pursue research that would not otherwise be possible,” explains Donnelly.

The IRF is designed to provide Lawson scientists and students the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph’s Health Care Foundation).

Prostate cancer is the most commonly diagnosed cancer among Canadian men. However, with improved testing and better treatment options, the number of deaths from the disease has been declining over the last several years.

Scientists at Lawson Health Research Institute are working to continue this trend by testing improved prostate cancer imaging using a new molecule. Known as a Prostate Specific Membrane Antigen (PSMA) probe, the new molecule is used in Positron Emissions Tomography (PET) scans. The probe targets PSMA, a unique molecule on prostate cancer cells, to provide highly specific images for better diagnosis and management of patient disease.

PET probes are used in imaging to correctly diagnose cancer. The probes are injected into a patient where they spread to identify sites of disease. The most common PET probes are suitable for many types of cancer, but are not as sensitive in identifying prostate cancer. PSMA probes provide higher accuracy by targeting PSMA molecules, which are highly over-expressed on prostate cancer cells.

PSMA probes are gaining popularity across the globe. This specific probe is a molecule called 18F-DCFPyL and was developed by Dr. Martin Pomper at the John Hopkins Hospital in Baltimore. Dr. Pomper, also a Scientific Advisor to Lawson’s prostate imaging team, worked in collaboration with Canada’s Centre for Probe Development and Commercialization (CPDC) to bring the probe to our nation.

Lawson’s Canadian Institutes of Health Research (CIHR) Team in Image Guidance for Prostate Cancer gained early access to the PSMA probe due to a history of close collaboration with Dr. Pomper and the CPDC. Marking the first time a PSMA probe has been used in Canada, the team captured PET/MRI and PET/CT images from a 64-year-old prostate cancer patient on March 18, 2016 at St. Joseph’s Hospital.

“This is a tremendous step forward in the management of prostate cancer,” said Dr. Glenn Bauman, a Lawson scientist and Radiation Oncologist at London Health Sciences Centre. “PSMA probes have the potential to provide increased accuracy and detection which leads to better, personalized treatment.”

Lawson plans to study the probe with an additional 20 men over the next two years as part of an ongoing clinical trial funded by the Ontario Institute for Cancer Research (OICR). Lawson scientists are working with researchers across Ontario to develop other clinical trial protocols that will use 18F-DCFPyL to measure responses to drug treatments and to evaluate men with suspected recurrence of prostate cancer after radiotherapy.

“The goal of these studies it to establish the value of PSMA probes, particularly18F-DCFPyL, and provide evidence to support the use of these probes in routine clinical care,” said Dr. Bauman.

Donor funding through London Health Sciences Foundation was one catalyst in this research, providing initial funding to hire Research Associate, Catherine Hildebrand, who set up citywide cancer imaging workshops and helped the team prepare successful grant applications to secure key funding from CIHR and OICR.

LONDON, ON- Strokes affect approximately 400,000 Canadians each year and can be debilitating. They can negatively affect a person’s cognition and mobility, and severely impact mental health and wellbeing.

 

A team at Lawson Health Research Institute are looking to improve mental health treatments and resources for patients who have experienced a stroke. The team will recruit 100 stroke patients to assess whether the completion of a guided therapy program can improve mental health and quality of life.

“More than sixty per cent of patients experience depression after stroke,” says Dr. Robert Teasell, Lawson Scientist and Physiatrist at St. Joseph’s Health Care London’s Parkwood Institute. “Having a stroke itself makes people more vulnerable and makes people feel their lives have changed negatively.”

During stroke rehabilitation, patients are typically offered mental health treatments, but the research team say it is post rehabilitation that stroke patients tend to experience worsening depression.

“Publicly funded allied health care services are available at inpatient and outpatient care; however, psychology is often limited across the rehabilitation continuum from acute to community care,” says Dr. Swati Mehta, Lawson Scientist. “We are looking at how we can provide a program that is cost effective to help those who have these barriers to access mental health services.”

“Patients have described to me that they feel like they have been dropped off a cliff because of the lack of resources once their programs have ended,” adds Dr. Teasell.

The study will examine the use of cognitive behavioral therapy (CBT), which is an evidence based psychological intervention that aims to provide people with increased coping ability and self-efficacy. Participants will complete a 10-week guided program with specific targeted lessons, tailored to the needs of those post stroke, delivered virtually through a trained clinician. They will then complete a questionnaire to see if there have been any improvements to self-efficacy and emotional wellbeing.

“We have found this form of therapy (CBT) has been very effective and feasible for spinal cord injury patients with mild traumatic brain injury and we want to see how a modified version could potentially help those with stroke and depression,” says Randy Upper, Clinical Research Associate at Lawson.

If CBT is proven effective through this study, Dr. Mehta hopes it will encourage similar programming that would be available to stroke patients after rehab.

“We are hoping we can connect with community organizations and work with them to implement this program in a service delivery model that would be easily accessible for stroke patients living in the community.”

Recruitment for this study is currently underway, those interested in taking part can email Dr. Swati Mehta at: @email