Research

The Geriatric Medicine research programme focuses primarily on locomotor, stroke and cognitive topics.

Alasdair MJ Maclullich

1. Cerebrospinal fluid studies of delirium
Multiple studies examining potential cerebrospinal fluid biomarkers of delirium. Collaborations with the Universities of Oslo and Amsterdam

2. Neuropsychology of delirium
Studies examining the nature of neuropsychological deficits in delirium, using objective measures of attention, visual perception, and other cognitive domains. Much of the work has involved the Edinburgh Delirium Test Box (versions 1 and 2), a purpose-built computerised device which allows testing of attentional deficits.

3. Neuroimaging of delirium
Longitudinal studies of neuroimaging predictors and consequences of delirium

4. Development of new tests of delirium for clinical use
The 4 A’s Test or 4AT (see www.the4AT.com) was developed (with Dr Tracy Ryan and Dr Helen Cash) to provide a brief and robust screening test for delirium and cognitive impairment.

Gillian E Mead

Professor Mead's major area of interest is in 'Life after Stroke'. Despite major advances in the acute management of stroke, it is still the major cause of adult disability. She is currently leading a UK, multicentre trial, with Professor Martin Dennis, to determine whether fluoxetine after stroke will improve recovery; this work involves collaborations with colleagues in Australia and Sweden. She also leads programmes of work in post-stroke fatigue and  exercise after stroke. With Professor Alasdair MacLullich, she is leading work on delirum after stroke.
She is also interested in the role of exercise for promoting mental wellbeing. She is lead author of the Cochrane review of Exercise for depression, and is developing new research with Professor Stephen Lawrie to determine how exercise might improve quality of life in people with schizophrenia.
She has expertise in longitudinal cohort studies, cross-sectional studies, randomised controlled trials of simple and complex interventions, and systematic reviews.
She is National Institute of Health Age and Ageing speciality Group lead for Scotland.

1. Scoping the provision of exercise services in Scotland for people after stroke
This new project will start in March 2009 and will map provision of exercise services for people after stroke and devise best practice guidelines which will inform the future development of exercise services for people after stroke.

2. Longitudinal cohort study of fatigue after stroke, and associations with physical inactivity
This project will seek to determine the natural history of fatigue after stroke, and the relationship between fatigue and physical inactivity. It will start in March 2009 and will run for almost three years.

3. Goal setting in exercise after stroke
This PhD project in collaboration with Queen Margaret University will seek to determine the role of goal setting in patients after stroke referred for community exercise classes.

4. Evaluation of Telemedicine for brain attacks
This project will determine whether telemedicine improves access to acute stroke treatments and secondary prevention, and whether it is acceptable to patients and carers.

5. Fatigue after stroke
We will systematically review all available studies to determine a) independent risk factors for fatigue and b) effectiveness of treatments for post-stroke fatigue.

6. Exercise for depression
This project systematically reviewed all randomised trial evidence on exercise for depression.

7. Exercise after stroke
We have performed our own randomised trial of exercise after stroke, and are currently systematically reviewing all available evidence for the Cochrane Collaboration.


John M Starr

1. A Randomised Controlled Trial of Continuous Positive Airway Pressure Treatment in Older People with Obstructive Sleep Apnoea Hypopnoea Syndrome (PREDICT)With Dr Mary Morrell, Dr Renata Riha, Dr Robert Davies, Professor Andrew Nunn, Professor Mark Sculpher, Dr Susan Griffin, Professor John Stradling, Professor Neil Douglas, Dt Anita Simonds & Dr Mark Elliott
Funded by NIHR (HTA)
Study now closed and analysis ongoing.

2. Lothian Birth Cohort 1921 Wave 5
With Professor Ian Deary & Dr Tom Booth
Funded by MRC
This is the fifth wave of a longitudinal study of people born in 1921 with age 11 IQ data. Participants previously seen at ages 79, 83, 87 & 90.
Commencing shortly.

3. Lothian Birth Cohort 1936 Wave 3
With Professor Ian Deary & Professor Joanna Wardlaw
Funded by Age UK
This is the third wave of a longitudinal study of people born in 1936 with age 11 IQ data. Participants previously seen at ages 70 and 73. A further wave is planned at age 79.

4. Lifelong health and wellbeing of the 6-Day Sample of the Scottish Survey 1947
With Professor IJ Deary, Professor A MacLullich, Professor L Paterson, Professor D Batty, Professor J Elliot & Dr C Dibben
Funded by Joint UK Research Councils (LLHWB)
This is a study of people born on the first day of alternate months of 1936 with age 11 IQ data and detailed follow up to age 27.

5. Towards onset prevention of cognition decline in adults with Down syndrome (the TOP-COG study)
With Professor S-A Cooper, Professor M Caslake, Professor J Evans, Dr A Hassiotis, Professor A Holland, Professor A Jahoda, Dr A McConnachie, Professor J Morrison, Dr H Ring & Professor F Sullivan
CSO funded
This is a feasibility RCT of simvastatin in adults with Down syndrome to prevent dementia/cognitive decline.

Other projects:

I currently supervise the following PhD students:

Alixe Kilgour (clinical research fellow) – muscle size and its brain structure/function correlates
Tom Russ (clinical research fellow) – spatial clustering of dementia in Scotland
Amanda Barugh (clinical research fellow) – glucocorticoids and stroke
Lewis Killin – short term memory binding in dementia
Ratko Radakovic – apathy in dementia and MND
Anna Lloyd – qualitative longitudinal study of frailty
Aja Murray – the selection problem
Sarah McGrory – item response theory for scales used  in people with dementia

Susan D. Shenkin

1. Life course influences on cognitive ability and cerebrovascular disease
Collecting birth parameters from births in 1936 in Lothian and Aberdeen, to assess influence of early life on cognitive ability, and neuroimaging parameters (using the Lothian and Aberdeen Birth Cohorts 1936 http://www.lothianbirthcohort.ed.ac.uk/). These data can be compared with that collected for 1921 to investigate changes and similarities with time.

2. Epigenetic influences on vascular cognitive impairment

Starting with a systematic literature review, plan to investigate mechanisms underlying programming of vascular cognitive impairment, particularly epigenetic changes in genes related to the hypothalamic-pituitary-adrenal axis.

3. Cortisol dysregulation and CT scan measures of brain atrophy and white matter lesions in stroke patients
A pilot project to investigate cortisol dysregulation after stroke in participants in the Edinburgh Fatigue After Stroke Study. Also investigating the use of routinely collected CT scans to measure of brain atrophy and white matter lesions in these patients, and relationship with cortisol dysregulation.

4. Predicting outcomes for older patients admitted to hospital
Using data routinely collected on older people admitted to the Royal Infirmary and Western General Hospital  (Elderly Care Assessment Team (ECAT) and Team 65 respectively) we aim to investigate factors which predict outcomes, particularly in those with pre-existing or new cognitive impairment

5. Brain imaging in Normal Subjects (BraINS)
I am part of a multidisciplinary group called Brain Imaging in Normal Subjects (BraINS) led by Prof JM Wardlaw developing  a bank of ‘normal’ brain images from those which have already been collected for various research studies. This will allow access to images with comprehensive meta-data on physical and cognitive characteristics. I have responsibility for development of the meta-data schema.

6. Diagnosis and monitoring of delirium
Project coordinated by Prof MacLullich to develop a new neuropsychological instrument for the diagnosis and monitoring of delirium (the 4AT).

Link to the collection of BMJ Statistics notes. A very useful source of information for all those involved in research:

http://www-users.york.ac.uk/~mb55/pubs/pbstnote.htm