PhD Studentship: The Controlled Spreading of Wnt Receptors Determines Signalling in the Tumour Microenvironment

About the GW4 BioMed2 Doctoral Training Partnership

The partnership brings together the Universities of Bath, Bristol, Cardiff (lead) and Exeter to develop the next generation of biomedical researchers. Students will have access to the combined research strengths, training expertise and resources of the four research-intensive universities, with opportunities to participate in interdisciplinary and 'team science'. The DTP already has over 90 studentships over 6 cohorts in its first phase, along with 58 students over 3 cohorts in its second phase. 

Research Theme: Neuroscience & Mental Health

Project Summary: What is it like to have advanced dementia? How do changes in sleep and awareness impact the behaviour and quality of life of people living with advanced dementia? How can we be sure that our interventions are making a genuinely positive difference? This PhD project will address these fundamental questions by translating recent breakthroughs in cognitive neuroscience to improve understanding of sleep disturbance, awareness, and the care needs of people with advanced dementia. It will use state-of-the-art EEG, physiological and behavioural biomarkers of sleep, awareness, and emotional response to provide a unique understanding of advanced dementia.

Project Description: 

BACKGROUND: Sleep disturbance and fluctuations in awareness and arousal are common in dementia, particularly in advanced dementia. These include excessive daytime sleepiness, sleep fragmentation, sundowning, apparent fluctuations in consciousness and disrupted circadian rhythms. Sleep disturbance causes significant challenges and distress to patients and carers. It is associated with behavioural and psychological symptoms (BPSD) including agitation, apathy and wandering, and reduced function and compliance with activities of daily living. It can be very challenging for carers to manage sleep disturbance, with night-time wandering and daytime apathy associated with the need for people with dementia to move into residential care.

Unfortunately, people with advanced dementia living in care homes are often under stimulated, spending large periods of time in their rooms with limited social contact or engagement. In communal areas people are often left to sleep in chairs and this may even be encouraged as it may reduce demands on under resourced and overworked carers. However, does this represent good care, or good quality of life and wellbeing for people with dementia?

A number of fundamental questions require urgent answers:

• Is sleep disturbance an inevitable feature of advanced dementia?
• Are changes in level of arousal simply related to sleep or are epileptic phenomena being routinely missed?
• Is there variability and precipitating and perpetuating factors that could be the target of interventions to manage sleep disturbance, BPSD, and improve quality of care and quality of life and wellbeing for people with dementia and their carers?
• It is also unclear why and how changes in sleep occur with progression of dementia into the severe and end of life stages, and whether sleep markers could be used to personalise care, predict end of life or BPSD and measure sleep interventions.

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