The NIMROD Study

Neuroimaging of Inflammation in Memory and Other Disorders.
This is an exciting and very important study about the role of inflammation in dementia and related disorders.

NIMROD Aims

This study aims to understand the role of inflammation in several forms of dementia, memory loss and depression. It also aims to understand the changes in the immune system, from immune cells circulating in the blood.

To achieve this, NIMROD looks at brain changes in dementia, depression and related disorders in several different ways – changes in brain structure and function, psychology and memory, and inflammation. We will also look at the blood, for tell tale signs of inflammation or differences in the immune system.

Background

There are several different causes of memory problems in later life, including mild cognitive impairment, Alzheimer’s disease, frontotemporal dementia, Lewy body dementia and vascular dementia. People with depression can also have memory problems.
Considerable progress has been made over the last decade in understanding the brain changes associated with memory problems and dementia, a lot is still not known. It has been established that subtle but persistent inflammation in the brain (neuroinflammation) is associated with many of these disorders. However, it is not know whether this inflammation drives the dementia processes, or is a natural reaction to the dementia process. It is not known how differences in which bits of the brain are more inflamed related to differences in symptoms. Finally, it is not know how well the inflammation can be detected in a blood sample.

If inflammation is causing or worsening the dementia process, then it may be possible to develop new treatments to help prevent dementia and other memory problems getting worse. It may also be possible to use blood tests of inflammation to predict which individuals are more at risk of dementia, or at risk of rapid worsening.

Brain imaging, with Magnetic Resonance Imaging (MRI), can be used to look at brain structure and function in great detail. However, brain imaging with positron emission tomography (PET) can be used to detect the presence of inflammation in the brain.

Where is NIMROD taking place?

The study is based at the Cambridge University Hospitals NHS Foundation Trust (Addenbrooke’s Hospital, Cambridge Biomedical Campus) and University of Cambridge (including the Wolfson Brain Imaging Centre), it is a collaboration with Cambridgeshire and Peterborough NHS Foundation Trust and we are fortunate also to have the close involvement of Norfolk and Suffolk NHS Foundation Trust and South Essex NHS Foundation Trust. It is mainly funded by the NIHR Biomedical Research Unit in Dementia (BRU).

What does NIMROD involve?

A full information sheet with all the necessary information is available on request, and would be given to any potential particpants before they decide whether to take part. The following is a summary of the study.
NIMROD invites participants with the following diagnoses:

• a) probable Alzheimer’s disease or
• b) probable Lewy body disease or
• c) late life depression or
• d) frontotemporal dementia (progressive aphasias as well as the frontal and behavioural variants) or
• e) vascular dementia or
• f) mild cognitive impairment
• g) healthy adults

Participants need to have a good grasp of English, in order for us to interpret the results of memory tests (except people with language problems resulting from their illness, such as a primary progressive aphasia). Participants must be safe to have an MRI, which unfortunately excludes people with some types of metallic implant (pacemakers, stents)or claustrophobia. Hip and knee repalcements, dentures and plates to fix broken bones are OK.

Participants will have three brain scans (two of them usually done on the same day). One is a magnetic resonance imaging (“MRI”) scan. The other two are positron emission tomography (“PET”) scans, which use faintly radioactive ‘dye’ that show up areas of inflammation and brain change.

A blood sample is used for analysis of inflammation a genes (and storage in anticipation of even better techniques being developed in the future). Some may also be invited to undergo a lumbar puncture to look at cerebrospinal fluid, again for analysis and storage. This test uses local anaesthetic and is undertaken by specially trained and experiened members of staff.

Participants will be tested in terms of memory, language, vision and attention.

In most cases these cognitive assessments can take place at home. Where possible, these will be repeated annually for three years. The brain scanning must take place at Cambridge.

NIMROD People

A large study like NIMROD requires a whole team. Some of the team work ‘behind the scenes’ to ensure top quality brain scans and cutting edge tests of the immune system. However, the people you might meet during participation include:

Chief investigator: Professor John O’Brien
Co-Chief Investigator: Professor James Rowe
Study Co-ordinator George Savulich

For further information or a copy of the Patient Information Sheet, please contact:

George Savulich  (gjs46@medschl.cam.ac.uk)

Research Assistant
Department of Psychiatry
Herchel Smith Building
Robinson Way
Cambridge, CB2 0SZ
Tel: (+44) (0)1223 768003