Abstract

This study is the first to objectively investigate the extent of subjective awareness in severe dementia, its underlying neural correlates and whether awareness changes with environmental stimuli. Transcranial Magnetic Stimulation (TMS), Electroencephalography (EEG), Event Related Potentials (ERPs) and functional Magnetic Resonance Imaging (fMRI) are robust techniques for assessing awareness in clinical groups who are unable to communicate. I will now apply these in dementia to investigate:

1) The variation in the level of awareness in people with severe dementia, using TMS-EEG markers.

2) In response to visual and auditory stimuli, is there ERP and fMRI evidence of brain activity beyond primary sensory cortices in a fronto-parietal network, reflecting preservation of higher level awareness in people with severe dementia?

3) The correlation between different objective biomarkers of subjective awareness, severity of dementia, and clinical and caregiver judgements of subjective awareness.

The results will elucidate what people with severe dementia subjectively experience and to what extent they are aware of people and their environment. This novel understanding will support meaningful interactions and communication with family and caregivers, and enable the targeting of interventions and optimisation of environments to improve awareness, quality of life and care for people with severe dementia.