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In a new study, researchers at Lawson Health Research Institute and Western University are demonstrating that gait, or motion testing, while simultaneously performing a cognitively demanding task can be an effective predictor of progression to dementia and eventually help with earlier diagnosis. To date, there is no definitive way for health care professionals to forecast the onset of dementia in a patient with memory complaints.

Dr. Manuel Montero-Odasso, a Lawson scientist, geriatrician at St. Joseph’s Health Care London, and associate professor in the Division of Geriatric Medicine at Western University’s Schulich School of Medicine & Dentistry, is leading the “Gait and Brain Study.” His team is assessing up to 150 seniors with mild cognitive impairment (MCI), a slight decline of memory and other mental functions which is considered a pre-dementia syndrome, in order to detect an early predictor of cognitive and mobility decline and progression to dementia.

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Dr. Montero-Odasso with study participant, Roy Bratty

“Finding methods to detect dementia early is vital to our ability to slow or halt the progression of the disease,” says Dr. Montero-Odasso. The study, funded by the Canadian Institutes of Health Research, followed participants for six years and included bi-annual visits. Researchers asked participants to walk while simultaneously performing a cognitively demanding task, such as counting backwards or naming animals. Those individuals with MCI that slow down more than 20 per cent while performing a cognitively demanding task are at a higher risk of progressing to dementia.

“While walking has long been considered an automatic motor task, emerging evidence suggests cognitive function plays a key role in the control of walking, avoidance of obstacles and maintenance of navigation,” says Dr. Montero-Odasso. “We believe that gait, as a complex brain-motor task, provides a golden window of opportunity to see brain function.”

The “gait cost,” or speed at which participants completed a single task (walking) versus a dual-task, was higher in those MCI individuals with worse episodic memory and who struggle with executive functions such as attention keeping and time management.

“Our results reveal a ‘motor signature’ of cognitive impairment that can be used to predict dementia,” adds Dr. Montero-Odasso. “It is conceivable that we will be able to diagnose Alzheimer’s disease and other dementias before people even have significant memory loss. Our hope is to combine these methods with promising new medications to slow or halt the progression of MCI to dementia.”

The study, “Association of Dual-Task Gait with Incident Dementia in Mild Cognitive Impairment”, was published in the journal, JAMA NEUROLOGY.

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Members of the study’s research team, from left to right: Korbin Blue, Research Assistant (Co-op Student); Yanina Sarquis-Adamson, Lab Research Assistant; Frederico Faria, Post-Doctoral Fellow; Dr. Montero Odasso, Director, Gait and Brain Lab; research participant; Alanna Black, Lab Research Coordinator; Stephanie Cullen, Research Assistant (Undergraduate Student); and, Navena Lingum, Research Assistant (Master Student). 

The American Shoulder and Elbow Surgeons association has awarded a team of London researchers the 2017 Charles S. Neer Award for Clinical Science, one of the most prestigious awards in the areas of shoulder and elbow surgical research in North America.

The award recognizes the scientists’ development of the PCR-RFLP (polymerase chain reaction restriction fragment length polymorphism) assay, a test that can accurately identify Propionibacterium acnes (P acnes) infection of the shoulder within 24 hours. Current methods take an average of six or more days, and are prone to sample contamination and false-positive results.

“We are incredibly honoured to receive this award,” says Dr. David O’Gorman, Lawson scientist, Co-Director of Molecular and Cellular Research at the Roth McFarlane Hand and Upper Limb Centre (HULC) at St. Joseph’s Health Care London, and senior author of the publication. “We believe it illustrates the high quality of research being done at Lawson and marks the beginning of another clinically relevant research program at HULC.”

P acnes is a type of bacteria typically found deep in the hair follicles and sebaceous pores of the skin. A P acnes infection of the shoulder is a common and serious complication that occurs after arthroplasty (surgery to replace a damaged joint, most commonly with artificial material). It can cause pain in the shoulder joint and often loosens the implant. In most cases, the patient requires additional surgery to remove the infection and replace the implant.

It can be difficult to diagnose a P acnes infection as it often presents without symptoms that would be characteristic of an infection, such as pain, skin reddening or wound drainage. The prevalence of P acnes in the deeper layers of the skin also increases the chance of sample contamination and false-positive results making it hard to isolate and identify in a pathology lab.

Currently P acnes infection is identified by administering a tissue swab for anaerobic culture, which takes an average of six or more days but could take up to three weeks. This technique also carries substantial risk of contamination from the adjacent skin and other sites where P acnes is present.

The PCR-RFLP assay can identify P acnes in tissue from a shoulder biopsy within a 24-hour period. The extremely sensitive technology also has the ability to detect fewer than ten P acnes cells in the sample, which may decrease the false-positive rate in cultures caused by swab contamination.

“The accuracy of this test and the shorter period of time needed for identification can help with treatment decision making, targeted antibiotic therapy, and monitoring to minimize implant failure and revision surgery,” explains Dr. O’Gorman, who is also an Assistant Professor in the Departments of Surgery and Biochemistry at Western University’s Schulich School of Medicine & Dentistry. “We hope that the test can be further developed into a ‘point of case’ assay that can detect P acnes in tissue samples in real time while the patient is undergoing shoulder surgery.”

Since the PCR and RFLP mapping used for the assay are techniques routinely performed in many clinical microbiology and pathology labs, the test would be a cost-efficient approach not restricted to highly specialized research labs.

Other scientists who were part of the study include Dr. George Athwal and Dr. Kenneth Faber, HULC orthopaedic surgeons, Lawson scientists and Schulich professors; Ana Pena Diaz, research technician for the HULC Molecular and Cellular Biology Research Lab; and Scott Holmes, a medical student and Schulich Research Opportunities Program participant who was primarily responsible for designing and optimizing the assay.

Both Dr. O’Gorman and Dr. Faber are also members of Western’s Bone and Joint Institute.

“A rapid method for detecting Propionibacterium acnes in surgical biopsy specimens from the shoulder” was published in the Journal of Shoulder and Elbow Surgery (JSES). 

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3D imaging technology could improve outcomes for patients with breast cancer

During a conventional digital 2D mammogram, two x-ray images are taken of the breast, one from top-to-bottom and another from side-to-side at an angle. This technology is limited by the overlapping breast tissue that occurs from the required compression of the breast, and breast abnormalities may be hidden. A study at Lawson is looking to determine if digital breast tomosynthesis, a type of 3D imaging, is better at detecting breast tissue abnormalities than the 2D mammography regularly used today. Read more. 

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Antioxidants in the brain linked to improved treatment results in patients with psychosis

Once patients with psychosis start treatment, some get better in weeks while it can take months for others. A research team from Lawson and Western University studied antioxidant levels in the brain, and found that these chemicals, which rid the body of normal metabolic biproducts called free radicals, may improve outcomes of early intervention in psychosis. Read more. 

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Researchers awarded $4.8 million to validate locally developed test, EpiSign, for first-line diagnostic testing of rare hereditary disorders 

A clinical trial named “EpiSign-CAN,” led by researchers at Lawson was awarded $4.8 million to measure the clinical impact of a new molecular genomics test for diagnosing genetic neurodevelopmental conditions. The diagnostic test, called EpiSign, uses machine learning to analyze the EpiSign Knowledge Database. This database compiles information on rare genetic diseases using laboratory analyses of the entire genome, referred to as the epigenome, from patients with suspected genetic abnormalities. Read more.

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Perceptions of confidentiality for Canadian Veterans discussing moral injuries

Lawson researchers are exploring Canadian Veterans’ beliefs about confidentiality in mental health care and whether those beliefs act as a barrier to seeking treatment for a type of trauma known as moral injury. Moral injury describes psychological distress following events where a person performs, witnesses or fails to prevent acts that conflict with deeply held moral standards. Evidence suggests that moral injuries are on the rise among deployed members of the Canadian Armed Forces, and that those exposed to such events are at a higher risk of developing post-traumatic stress disorder and depression. Read more.

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New device could reduce COVID-19 infection risk and demand for invasive ventilators

Researchers designed a non-invasive ventilation mask that could significantly reduce aerosolization – the production of airborne respiratory droplets that may contain viruses or bacteria – when treating patients with COVID-19. The new device aims to reduce infection risks associated with non-invasive ventilation and lessen the demand for invasive ventilators. It is currently being tested through a clinical trial with patients at London Health Sciences Centre (LHSC). Read more.

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Researchers first in world to profile the body’s immune response to COVID-19

By studying blood samples from critically ill patients at LHSC, researchers identified a unique pattern of six molecules that could be used as therapeutic targets to treat COVID-19. Studies show that part of what makes the virus so deadly is that the body mounts an overreactive immune response as the virus grows and replicates. This response releases inflammatory molecules in order to fight the virus, but also destroys healthy cells and organs in the process. Read more.

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Study suggests that surgery may be superior treatment for chronic sciatica

In a randomized controlled trial, surgery was found to be superior to non-operative therapy in the treatment of chronic sciatica. Chronic sciatica can be caused by a disc herniation which compresses a nerve in the lumbar spine causing pain from the lower back to the leg. The primary treatment options for sciatica are surgery or non-operative care. Researchers conducted this study to test if a surgical treatment called microdiscectomy results in better patient outcomes for those with chronic sciatica compared to non-operative care. Read more.

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Researchers unravel two mysteries of COVID-19

A team from Lawson and Western University made significant steps forward in understanding COVID-19 through two back-to-back studies. In one study, the team identified six molecules that can be used as biomarkers to predict how severely ill a patient will become. In the other study, they were the first to reveal a mechanism causing blood clots in COVID-19 patients and potential ways to treat them. The studies were conducted by analyzing blood samples from critically ill patients at LHSC. Read more.

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Gut microbiome may influence how cancer patients respond to oral therapies, study suggests

A study from Lawson and Western illustrated how the gut microbiome interacts with an oral medication in prostate cancer patients, suggesting bacteria in the gut play a role in treatment outcomes. The findings highlight how the drug abiraterone acetate is metabolized by bacteria in the gut to reduce harmful organisms while promoting those that fight cancer. The research team suspects this is one of many examples of how the microbiome influences our response to medications. Read more.

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First Contrast Enhanced Spectral Mammography guided biopsy in North America

Researchers at Lawson performed the first breast biopsy guided by Contrast Enhanced Spectral Mammography (CESM) in North America on June 12, 2020. CESM is a novel diagnostic imaging tool that is able to detect cancerous lesions at a greater rate than standard mammography, and at close rate to MRI. The procedure is faster and more accurate, comfortable and cost effective than an MRI biopsy. Read more.

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Assessing the pandemic's impact on Canadian Veterans and their spouses

A project from Lawson and the Centre of Excellence on Post-Traumatic Stress Disorder (PTSD) hopes to discover the impact the COVID-19 pandemic is having on the mental health of Canadian Veterans and their spouses. They are partnering with up to 1,000 Canadian Veterans and 250 spouses of Canadian Veterans. Through online surveys, the project will hear directly from Veterans and their spouses to assess the pandemic’s effects on their well-being over time. Read more.

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Fecal transplants show promise as treatment for non-alcoholic fatty liver disease

A randomized controlled trial found that fecal transplants in patients with non-alcoholic fatty liver disease (NAFLD) results in a reduction in how easily pathogens and other unwanted molecules pass through the human gut and into circulation, known as intestinal permeability. The results could have implications for the treatment of numerous conditions including metabolic syndrome and autoimmune diseases. Read more.

Lawson researchers impact the lives of people not just locally, but around the world with groundbreaking studies and translational research that enhances care, health and wellbeing.
Here are some of the research highlights of 2021.

Differences in walking patterns could predict type of cognative decline in older adults

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Canadian researchers are the first to study how patterns in the way older adults walk could more accurately diagnose different types of dementia and identify Alzheimer’s disease. A new study by a Canadian research team, led by London researchers from Lawson Health Research Institute and Western University, evaluated the walking patterns and brain function of 500 participants currently enrolled in clinical trials. Read more.

COVID-19 shown to leave a unique lung fingerprint

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Kidney transplant patient experiences positive recovery with the help of a simple device

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Air pollution exposures contributes to childhood asthma, population-based study shows

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Getting the data on homelessness

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Examining the health impact the COVID-19 pandemic is having on mothers and their new babies

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New therapeutic tool proven effective for MS patients with mental health challenges

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Researchers using MRI scans to pinpoint moral injury effects in health care workers

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Moral injury refers to an injury to an individual’s moral conscious, which can produce profound emotional guilt and shame. Recognizing this is a growing concern, a London research team from Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry is examining moral injury amongst health care workers by imaging the effects on the brain. Read More.

Scientists studying carbon monoxide as a possible treatment for sepsis

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Global study on heart valve repair surgery will improve patient outcomes around the world

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Researchers at Lawson Health Research Institute and Western University had a leading role in a new global study that will change the way surgeons repair leaky valves in the heart. It’s one of the most common heart valve conditions, affecting around two per cent of the population, where many patients don’t even realize they have a leaky valve and are asymptomatic, often presenting to doctors once they are late stage into the disease. Read more.

New study will assess fecal transplants in treatment of pancreatic cancer

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