"Am I the right way up?" - Investigating balance problems in posterior cortical atrophy

Read about a research project we funded: "Am I the right way up?" investigating balance problems in posterior cortical atrophy 

Lead Investigator: Dr Sebastian Crutch

Institution: University College London

Grant type: Project Grant
Duration: 36 months

Amount: £278,850

Why did we fund this project?

Comments from members of our Research Network:

'A good application on a topic which has to date not received much attention in the field of dementia research'

'It will be of great help to provide guidelines to carers and especially healthcare staff'  

'This application appears to offer real hope for the understanding and treatment of balance problems associated with dementia'

What do we already know?

Posterior cortical atrophy (PCA) is a rare form of Alzheimer's disease that primarily affects the back of the brain, particularly the areas known as the parietal lobes. People with PCA have difficulty with seeing what and where things are. Their memory usually remains relatively well-preserved in the earlier stages; however as the disease progresses this is also affected.  

Most previous studies of PCA have focused on the problems with vision, but the researchers on this project have uncovered a host of additional, less understood problems. The researchers are especially interested in the problems that can arise from a disordered sense of balance. Balance can be affected in both PCA and in the later stages of the common form of Alzheimer's disease. Issues that arise from this disordered sense include some people not knowing if they are 'the right way up' and the observation that dizziness and leaning to one side are often seen in people affected by PCA.  

Very little is known about what is behind the balance problems seen in people with Alzheimer's disease and PCA. There have been a few studies examining the role of the inner-ear sensory system that contributes to detection of movement and balance (called the vestibular system) in people with the common form of Alzheimer's disease. However, there have been no studies investigating balance problems in PCA. 

What does this project involve?

Information about balance comes from a combination of visual clues, sensing by the vestibular system and signals from muscles and joints (called proprioception). This information is processed by the parietal lobes in the brain, which are damaged in PCA. This project aims to understand how processing of this information goes wrong in PCA.

Dr Crutch and his colleagues aim to determine how often these problems with balance affect people with PCA and Alzheimer's disease and the impact that these have on their daily lives. They also aim to find out which parts of the balance system are not functioning correctly in these cases.  

The study builds on preliminary work begun by Dr Crutch and his colleagues and will involve volunteers with PCA, Alzheimer's disease or no dementia diagnosis. Experiments will include testing the volunteers' perception of the orientation of certain objects and their response to moving objects. The researchers will also investigate the role of the vestibular system by using a small electric current to stimulate this system and analysing the difference in responses between the volunteer groups.  

How will this benefit people with dementia?

The project is aiming to improve understanding, detection and management of the unusual symptoms of PCA and Alzheimer's disease, and provide a rounded account of its impact on people's lives. This will help people who are experiencing these symptoms and their carers to understand what is happening and why, and how best to cope with these challenges. 

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