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Corbett A, Williams G, Creese B, Hampshire A, Palmer A, Brooker H, Ballard C. Impact of Short-Term Computerized Cognitive Training on Cognition in Older Adults With and Without Genetic Risk of Alzheimer's Disease: Outcomes From the START Randomized Controlled Trial. J Am Med Dir Assoc 2024:S1525-8610(24)00224-X. [PMID: 38642588 DOI: 10.1016/j.jamda.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To establish the impact of a 3-minute computerized cognitive training program (START) on cognition in older adults with and without genetic risk of Alzheimer's disease. DESIGN Two-arm randomized controlled trial of the START program. SETTING AND PARTICIPANTS Remote online trial in adults older than 50 taking part from home. METHODS The trial compared the START program with placebo in 6544 people older than 50. Primary outcome was executive function measured through Trailmaking B, with other secondary cognitive measures. Genetic risk profile and ApoE4 status were determined by Illumina Array. RESULTS START conferred benefit to executive function, attention, memory, and a composite measure, including in people with the ApoE4 genotype. CONCLUSIONS AND IMPLICATIONS The 3-minute START task offers a means of supporting cognitive health in older adults and could be used at scale and within a precision medicine approach to reduce risk of cognitive decline in a targeted way.
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Affiliation(s)
- Anne Corbett
- Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Gareth Williams
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Byron Creese
- Division of Psychology, Department of Life Sciences, Brunel University, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Adam Hampshire
- Division of Psychology, Department of Life Sciences, Brunel University, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Abbie Palmer
- Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Clive Ballard
- Department of Clinical Biosciences, University of Exeter Medical School, University of Exeter, Exeter, UK
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Gabb VG, Blackman J, Morrison HD, Biswas B, Li H, Turner N, Russell GM, Greenwood R, Jolly A, Trender W, Hampshire A, Whone A, Coulthard E. Remote Evaluation of Sleep and Circadian Rhythms in Older Adults With Mild Cognitive Impairment and Dementia: Protocol for a Feasibility and Acceptability Mixed Methods Study. JMIR Res Protoc 2024; 13:e52652. [PMID: 38517469 PMCID: PMC10998181 DOI: 10.2196/52652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Sleep disturbances are a potentially modifiable risk factor for neurodegenerative dementia secondary to Alzheimer disease (AD) and Lewy body disease (LBD). Therefore, we need to identify the best methods to study sleep in this population. OBJECTIVE This study will assess the feasibility and acceptability of various wearable devices, smart devices, and remote study tasks in sleep and cognition research for people with AD and LBD. METHODS We will deliver a feasibility and acceptability study alongside a prospective observational cohort study assessing sleep and cognition longitudinally in the home environment. Adults aged older than 50 years who were diagnosed with mild to moderate dementia or mild cognitive impairment (MCI) due to probable AD or LBD and age-matched controls will be eligible. Exclusion criteria include lack of capacity to consent to research, other causes of MCI or dementia, and clinically significant sleep disorders. Participants will complete a cognitive assessment and questionnaires with a researcher and receive training and instructions for at-home study tasks across 8 weeks. At-home study tasks include remote sleep assessments using wearable devices (electroencephalography headband and actigraphy watch), app-based sleep diaries, online cognitive assessments, and saliva samples for melatonin- and cortisol-derived circadian markers. Feasibility outcomes will be assessed relating to recruitment and retention, data completeness, data quality, and support required. Feedback on acceptability and usability will be collected throughout the study period and end-of-study interviews will be analyzed using thematic analysis. RESULTS Recruitment started in February 2022. Data collection is ongoing, with final data expected in February 2024 and data analysis and publication of findings scheduled for the summer of 2024. CONCLUSIONS This study will allow us to assess if remote testing using smart devices and wearable technology is a viable alternative to traditional sleep measurements, such as polysomnography and questionnaires, in older adults with and without MCI or dementia due to AD or LBD. Understanding participant experience and the barriers and facilitators to technology use for research purposes and remote research in this population will assist with the development of, recruitment to, and retention within future research projects studying sleep and cognition outside of the clinic or laboratory. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52652.
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Affiliation(s)
- Victoria Grace Gabb
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Jonathan Blackman
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hamish Duncan Morrison
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Bijetri Biswas
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Haoxuan Li
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
- King's College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Nicholas Turner
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Rosemary Greenwood
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Research & Innovation, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Amy Jolly
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - William Trender
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Alan Whone
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Elizabeth Coulthard
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
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Della Monica C, Ravindran KKG, Atzori G, Lambert DJ, Rodriguez T, Mahvash-Mohammadi S, Bartsch U, Skeldon AC, Wells K, Hampshire A, Nilforooshan R, Hassanin H, The Uk Dementia Research Institute Care Research Amp Technology Research Group, Revell VL, Dijk DJ. A Protocol for Evaluating Digital Technology for Monitoring Sleep and Circadian Rhythms in Older People and People Living with Dementia in the Community. Clocks Sleep 2024; 6:129-155. [PMID: 38534798 DOI: 10.3390/clockssleep6010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Sleep and circadian rhythm disturbance are predictors of poor physical and mental health, including dementia. Long-term digital technology-enabled monitoring of sleep and circadian rhythms in the community has great potential for early diagnosis, monitoring of disease progression, and assessing the effectiveness of interventions. Before novel digital technology-based monitoring can be implemented at scale, its performance and acceptability need to be evaluated and compared to gold-standard methodology in relevant populations. Here, we describe our protocol for the evaluation of novel sleep and circadian technology which we have applied in cognitively intact older adults and are currently using in people living with dementia (PLWD). In this protocol, we test a range of technologies simultaneously at home (7-14 days) and subsequently in a clinical research facility in which gold standard methodology for assessing sleep and circadian physiology is implemented. We emphasize the importance of assessing both nocturnal and diurnal sleep (naps), valid markers of circadian physiology, and that evaluation of technology is best achieved in protocols in which sleep is mildly disturbed and in populations that are relevant to the intended use-case. We provide details on the design, implementation, challenges, and advantages of this protocol, along with examples of datasets.
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Affiliation(s)
- Ciro Della Monica
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Kiran K G Ravindran
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Giuseppe Atzori
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Damion J Lambert
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Thalia Rodriguez
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- School of Mathematics & Physics, University of Surrey, Guildford GU2 7XH, UK
| | - Sara Mahvash-Mohammadi
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford GU2 7XH, UK
| | - Ullrich Bartsch
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Anne C Skeldon
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- School of Mathematics & Physics, University of Surrey, Guildford GU2 7XH, UK
| | - Kevin Wells
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford GU2 7XH, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College, London W12 0NN, UK
| | - Ramin Nilforooshan
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- Surrey and Borders Partnership NHS Foundation Trust Surrey, Chertsey KT16 9AU, UK
| | - Hana Hassanin
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- Surrey Clinical Research Facility, University of Surrey, Guildford GU2 7XP, UK
- NIHR Royal Surrey CRF, Royal Surrey Foundation Trust, Guildford GU2 7XX, UK
| | | | - Victoria L Revell
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
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Hampshire A, Azor A, Atchison C, Trender W, Hellyer PJ, Giunchiglia V, Husain M, Cooke GS, Cooper E, Lound A, Donnelly CA, Chadeau-Hyam M, Ward H, Elliott P. Cognition and Memory after Covid-19 in a Large Community Sample. N Engl J Med 2024; 390:806-818. [PMID: 38416429 PMCID: PMC7615803 DOI: 10.1056/nejmoa2311330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear. METHODS We invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating ("brain fog"). RESULTS Of the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no-Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (-0.23 SD [95% confidence interval {CI}, -0.33 to -0.13] and -0.24 SD [95% CI, -0.36 to -0.12], respectively); larger deficits as compared with the no-Covid-19 group were seen in participants with unresolved persistent symptoms (-0.42 SD; 95% CI, -0.53 to -0.31). Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., -0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, -0.20 to -0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, -0.35 SD; 95% CI, -0.49 to -0.20). Results of the analyses were similar to those of propensity-score-matching analyses. In a comparison of the group that had unresolved persistent symptoms with the no-Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (-0.33 to -0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported. CONCLUSIONS Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain. (Funded by the National Institute for Health and Care Research and others.).
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Affiliation(s)
- Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Adriana Azor
- Department of Brain Sciences, Imperial College London, London, UK
| | - Christina Atchison
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - William Trender
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter J. Hellyer
- Centre for Neuroimaging Sciences, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | | | - Masud Husain
- Nuffield Dept Clinical Neurosciences & Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Graham S. Cooke
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Emily Cooper
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Adam Lound
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Christl A. Donnelly
- School of Public Health, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Marc Chadeau-Hyam
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Paul Elliott
- School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Health Data Research UK London at Imperial, London UK
- UK Dementia Research Institute at Imperial, London UK
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5
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Fanshawe JB, Sargent BF, Badenoch JB, Saini A, Watson CJ, Pokrovskaya A, Aniwattanapong D, Conti I, Nye C, Burchill E, Hussain ZU, Said K, Kuhoga E, Tharmaratnam K, Pendered S, Mbwele B, Taquet M, Wood GK, Rogers JP, Hampshire A, Carson A, David AS, Michael BD, Nicholson TR, Paddick SM, Leek CE. Cognitive domains affected post-COVID-19; a systematic review and meta-analysis. Eur J Neurol 2024:e16181. [PMID: 38375608 DOI: 10.1111/ene.16181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/23/2023] [Accepted: 11/29/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE This review aims to characterize the pattern of post-COVID-19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation. METHODS A systematic review and meta-analysis of neurocognitive sequelae following COVID-19 was conducted, following PRISMA-S guidelines. Studies were included if they reported domain-specific cognitive assessment in patients with COVID-19 at >4 weeks post-infection. Studies were deemed high-quality if they had >40 participants, utilized healthy controls, had low attrition rates and mitigated for confounders. RESULTS Five of the seven primary Diagnostic and Statistical Manual of Mental Disorders (DSM-5) cognitive domains were assessed by enough high-quality studies to facilitate meta-analysis. Medium effect sizes indicating impairment in patients post-COVID-19 versus controls were seen across executive function (standardised mean difference (SMD) -0.45), learning and memory (SMD -0.55), complex attention (SMD -0.54) and language (SMD -0.54), with perceptual motor function appearing to be impacted to a greater degree (SMD -0.70). A narrative synthesis of the 56 low-quality studies also suggested no obvious pattern of impairment. CONCLUSIONS This review found moderate impairments across multiple domains of cognition in patients post-COVID-19, with no specific pattern. The reported literature was significantly heterogeneous, with a wide variety of cognitive tasks, small sample sizes and disparate initial disease severities limiting interpretability. The finding of consistent impairment across a range of cognitive tasks suggests broad, as opposed to domain-specific, brain dysfunction. Future studies should utilize a harmonized test battery to facilitate inter-study comparisons, whilst also accounting for the interactions between COVID-19, neurological sequelae and mental health, the interplay between which might explain cognitive impairment.
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Affiliation(s)
- Jack B Fanshawe
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Brendan F Sargent
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - James B Badenoch
- Barts Health NHS Trust, London, UK
- Preventive Neurology Unit, Queen Mary University of London, London, UK
| | - Aman Saini
- School of Life and Medical Sciences, University College London, London, UK
| | - Cameron J Watson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daruj Aniwattanapong
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Isabella Conti
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charles Nye
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Ella Burchill
- Division of Psychiatry, University College London, London, UK
| | - Zain U Hussain
- NHS Greater Glasgow and Clyde, Glasgow, UK
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Khanafi Said
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Elinda Kuhoga
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Kukatharmini Tharmaratnam
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Sophie Pendered
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Bernard Mbwele
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Maxime Taquet
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Greta K Wood
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Anthony S David
- Division of Psychiatry, University College London, London, UK
| | - Benedict D Michael
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Charles E Leek
- Department of Psychology, University of Liverpool, Liverpool, UK
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Vetere G, Williams G, Ballard C, Creese B, Hampshire A, Palmer A, Pickering E, Richards M, Brooker H, Corbett A. The relationship between playing musical instruments and cognitive trajectories: Analysis from a UK ageing cohort. Int J Geriatr Psychiatry 2024; 39:e6061. [PMID: 38281509 DOI: 10.1002/gps.6061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND The accumulation of age-associated cognitive deficits can lead to Mild Cognitive Impairment (MCI) and dementia. This is a major public health issue for the modern ageing population, as it impairs health, independence and overall quality of life. Keeping the brain active during life has been associated with an increased cognitive reserve, therefore reducing the risk of cognitive impairment in older age. Previous research has identified a potential relationship between musicality and cognition. OBJECTIVES Explore the relationship between musicality and cognitive function in a large cohort of older adults. METHODS This was a nested study within the PROTECT-UK cohort, which collects longitudinal computerised assessments of cognitive function in adults over 40. Participants were invited to complete the validated Edinburgh Lifetime Musical Experience Questionnaire (ELMEQ) to assess their musical experience and lifetime exposure to music. Linear regression analysis was performed using cognitive data from PROTECT-UK. RESULTS Analysis identified an association between musicality and cognition in this cohort. Playing a musical instrument was associated with significantly better performance in working memory and executive function. Significant associations were also found between singing and executive function, and between overall musical ability and working memory. CONCLUSIONS Our findings confirm previous literature, highlighting the potential value of education and engagement in musical activities throughout life as a means of harnessing cognitive reserve as part of a protective lifestyle for brain health.
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Affiliation(s)
- Gaia Vetere
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Gareth Williams
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Clive Ballard
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Byron Creese
- Division of Psychology, Department of Life Sciences, Brunel University, London, UK
| | - Adam Hampshire
- Division of Brain Sciences, & Dementia Research Institute Care Research & Technology Centre, Imperial College London, London, UK
| | - Abbie Palmer
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ellie Pickering
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Megan Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Anne Corbett
- University of Exeter Medical School, University of Exeter, Exeter, UK
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7
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Schweizer S, Leung JT, Trender W, Kievit R, Hampshire A, Blakemore SJ. Changes in affective control covary with changes in mental health difficulties following affective control training (AffeCT) in adolescents. Psychol Med 2024; 54:539-547. [PMID: 37609895 PMCID: PMC7615678 DOI: 10.1017/s0033291723002167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Everyday affective fluctuations are more extreme and more frequent in adolescence compared to any other time in development. Successful regulation of these affective experiences is important for good mental health and has been proposed to depend on affective control. The present study examined whether improving affective control through a computerised affective control training app (AffeCT) would benefit adolescent mental health. METHODS One-hundred and ninety-nine participants (11-19 years) were assigned to complete 2 weeks of AffeCT or placebo training on an app. Affective control (i.e. affective inhibition, affective updating and affective shifting), mental health and emotion regulation were assessed at pre- and post-training. Mental health and emotion regulation were assessed again one month and one year later. RESULTS Compared with the placebo group, the AffeCT group showed significantly greater improvements in affective control on the trained measure. AffeCT did not, relative to placebo, lead to better performance on untrained measures of affective control. Pre- to post-training change in affective control covaried with pre- to post-training change in mental health problems in the AffeCT but not the placebo group. These mental health benefits of AffeCT were only observed immediately following training and did not extend to 1 month or year post-training. CONCLUSION In conclusion, the study provides preliminary evidence that AffeCT may confer short-term preventative benefits for adolescent mental health.
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Affiliation(s)
- Susanne Schweizer
- School of Psychology, University of New South Wales, Kensington, Sydney, Australia
- Department of Psychology, University of Cambridge, Cambridge, England
| | - Jovita T Leung
- Institute of Cognitive Neuroscience, University College London, London, England
| | - William Trender
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, England
| | - Rogier Kievit
- Cognitive Neuroscience Department, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, England
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, England
- Institute of Cognitive Neuroscience, University College London, London, England
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8
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Akhanemhe R, Stevelink SAM, Corbett A, Ballard C, Brooker H, Creese B, Aarsland D, Hampshire A, Greenberg N. Is lifetime traumatic brain injury a risk factor for mild cognitive impairment in veterans compared to non-veterans? Eur J Psychotraumatol 2024; 15:2291965. [PMID: 38174433 PMCID: PMC10769549 DOI: 10.1080/20008066.2023.2291965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Background: Traumatic brain injury (TBI) is prevalent in veterans and may occur at any stages of their life (before, during, or after military service). This is of particular concern, as previous evidence in the general population has identified TBI as a strong risk factor for mild cognitive impairment (MCI), a known precursor of dementia.Objectives: This study aimed to investigate whether exposure to at least one TBI across the lifetime was a risk factor for MCI in ageing UK veterans compared to non-veterans.Method: This cross-sectional study comprised of data from PROTECT, a cohort study comprising UK veterans and non-veterans aged ≥ 50 years at baseline. Veteran and TBI status were self-reported using the Military Service History Questionnaire (MSHQ) and the Brain Injury Screening Questionnaire (BISQ), respectively. MCI was the outcome of interest, and was defined as subjective cognitive impairment and objective cognitive impairment.Results: The sample population comprised of veterans (n = 701) and non-veterans (n = 12,389). TBI was a significant risk factor for MCI in the overall sample (OR = 1.21, 95% CI 1.11-1.31) compared to individuals without TBI. The prevalence of TBI was significantly higher in veterans compared to non-veterans (69.9% vs 59.5%, p < .001). There was no significant difference in the risk of MCI between veterans with TBI and non-veterans with TBI (OR = 1.19, 95% CI 0.98-1.45).Conclusion: TBI remains an important risk factor for MCI, irrespective of veteran status. The clinical implications indicate the need for early intervention for MCI prevention after TBI.
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Affiliation(s)
- Rebecca Akhanemhe
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute for Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sharon A. M. Stevelink
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute for Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychological Medicine, Institute for Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | | | | | - Bryon Creese
- Division of Psychology, Department of Life Sciences, Brunel University London, London, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Adam Hampshire
- Department of Medicine, Imperial College London, London, UK
| | - Neil Greenberg
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute for Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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9
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Vinao-Carl M, Gal-Shohet Y, Rhodes E, Li J, Hampshire A, Sharp D, Grossman N. Just a phase? Causal probing reveals spurious phasic dependence of sustained attention. Neuroimage 2024; 285:120477. [PMID: 38072338 DOI: 10.1016/j.neuroimage.2023.120477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023] Open
Abstract
For over a decade, electrophysiological studies have reported correlations between attention / perception and the phase of spontaneous brain oscillations. To date, these findings have been interpreted as evidence that the brain uses neural oscillations to sample and predict upcoming stimuli. Yet, evidence from simulations have shown that analysis artefacts could also lead to spurious pre-stimulus oscillations that appear to predict future brain responses. To address this discrepancy, we conducted an experiment in which visual stimuli were presented in time to specific phases of spontaneous alpha and theta oscillations. This allowed us to causally probe the role of ongoing neural activity in visual processing independent of the stimulus-evoked dynamics. Our findings did not support a causal link between spontaneous alpha / theta rhythms and behaviour. However, spurious correlations between theta phase and behaviour emerged offline using gold-standard time-frequency analyses. These findings are a reminder that care should be taken when inferring causal relationships between neural activity and behaviour using acausal analysis methods.
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Affiliation(s)
- M Vinao-Carl
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK.
| | - Y Gal-Shohet
- Department of Medical Physics and Engineering, University College London, London, UK
| | - E Rhodes
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK
| | - J Li
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK
| | - A Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - D Sharp
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK; UK Dementia Research Institute, Care Research and Technology Centre (UK DRI-CRT), Imperial College London, London, UK
| | - N Grossman
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK.
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10
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Sabatini S, Wahl HW, Diehl M, Clare L, Ballard C, Brooker H, Corbett A, Hampshire A, Stephan BCM. Testing Bidirectionality in Associations of Awareness of Age-Related Gains and Losses With Physical, Mental, and Cognitive Functioning Across 1 Year: The Role of Age. J Gerontol B Psychol Sci Soc Sci 2023; 78:2026-2036. [PMID: 37801677 PMCID: PMC10699739 DOI: 10.1093/geronb/gbad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVES The bidirectionality between self-perceptions of aging and health-related outcomes may depend on age group. Therefore, we tested such bidirectionality among individuals in late midlife (50-64 years), young-old age (65-74 years), and old-old age (75+ years), taking advantage of the construct of Awareness of Age-Related Change (AARC) and its 2-dimensionality in terms of AARC-gains and AARC-losses. Various conceptualizations of physical, mental, and cognitive functioning were used as outcomes. METHODS Data from 2 measurement occasions (2019 and 2020) from the UK PROTECT study for individuals in late midlife (N = 2,385), young-old age (N = 2,430), and old-old age (N = 539) were used. Data on self-reported functional difficulties, depression, anxiety, and performance on four computerized cognitive tasks (i.e., verbal reasoning, paired associate learning, self-ordered search, and digit span) providing a score for verbal reasoning and a score for working memory were analyzed using cross-lagged panel models. RESULTS Across all 3 age groups, the bidirectional associations of AARC-gains with indicators of functioning were not significant, whereas higher AARC-losses significantly predicted slightly greater functional difficulties and higher depression and anxiety levels. Higher AARC-losses predicted slightly poorer Verbal Reasoning only in old-old age and poorer Working Memory predicted slightly higher AARC-losses only in young-old age. The remaining associations of AARC-losses with cognitive tasks were not statistically significant. DISCUSSION In accordance with previous research targeting other indicators of self-perceptions of aging, this study supported a stronger impact of AARC-losses on indicators of physical functioning and mental health than vice versa from midlife to old-old age.
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Affiliation(s)
- Serena Sabatini
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Hans-Werner Wahl
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Manfred Diehl
- Department of Human Development and Family Studies, Colorado State University, Forth Collins, Colorado, USA
| | - Linda Clare
- Medical School, University of Exeter, Exeter, UK
| | | | - Helen Brooker
- Medical School, University of Exeter, Exeter, UK
- Ecog Pro Ltd, Bristol, UK
| | - Anne Corbett
- Medical School, University of Exeter, Exeter, UK
| | - Adam Hampshire
- Social, Genetic, and Developmental Psychiatry Centre, King’s College London, London, UK
| | - Blossom C M Stephan
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Bentley, Australia
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11
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Tiego J, Trender W, Hellyer PJ, Grant JE, Hampshire A, Chamberlain SR. Measuring Compulsivity as a Self-Reported Multidimensional Transdiagnostic Construct: Large-Scale ( N = 182,000) Validation of the Cambridge-Chicago Compulsivity Trait Scale. Assessment 2023; 30:2433-2448. [PMID: 36680457 DOI: 10.1177/10731911221149083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Compulsivity has potential transdiagnostic relevance to a range of psychiatric disorders, but it has not been well-characterized and there are few existing measures available for measuring the construct across clinical and nonclinical samples that have been validated at large population scale. We aimed to characterize the multidimensional latent structure of self-reported compulsivity in a population-based sample of British children and adults (N = 182,145) using the Cambridge-Chicago Compulsivity Trait Scale (CHI-T). Exploratory structural equation modeling provided evidence for a correlated two-factor model consisting of (a) Perfectionism and (b) Reward Drive dimensions. Evidence was obtained for discriminant validity in relation to the big five personality dimensions and acceptable test-retest reliability. The CHI-T, here validated at extremely large scale, is suitable for use in studies seeking to understand the correlates and basis of compulsivity in clinical and nonclinical participants. We provide extensive normative data to facilitate interpretation in future studies.
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Affiliation(s)
| | | | | | | | | | - Samuel R Chamberlain
- University of Southampton, UK
- Southern Health NHS Foundation Trust, NHS, Southampton, UK
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12
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Violante IR, Alania K, Cassarà AM, Neufeld E, Acerbo E, Carron R, Williamson A, Kurtin DL, Rhodes E, Hampshire A, Kuster N, Boyden ES, Pascual-Leone A, Grossman N. Publisher Correction: Non-invasive temporal interference electrical stimulation of the human hippocampus. Nat Neurosci 2023; 26:2252. [PMID: 37957321 PMCID: PMC10689236 DOI: 10.1038/s41593-023-01517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Ines R Violante
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - Ketevan Alania
- Department of Brain Sciences, Imperial College London, London, UK
- UK Dementia Research Institute, Imperial College London, London, UK
| | - Antonino M Cassarà
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Esra Neufeld
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Emma Acerbo
- Institut de Neurosciences des Systèmes, Aix-Marseille University, INSERM, Marseille, France
- Department of Neurology and Neurosurgery, Emory University Hospital, Atlanta, GA, USA
| | - Romain Carron
- Institut de Neurosciences des Systèmes, Aix-Marseille University, INSERM, Marseille, France
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France
| | - Adam Williamson
- Institut de Neurosciences des Systèmes, Aix-Marseille University, INSERM, Marseille, France
- International Clinical Research Center, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Danielle L Kurtin
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Edward Rhodes
- Department of Brain Sciences, Imperial College London, London, UK
- UK Dementia Research Institute, Imperial College London, London, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Niels Kuster
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
- Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Edward S Boyden
- Departments of Brain and Cognitive Sciences, Media Arts and Sciences, and Biological Engineering, McGovern and Koch Institutes, Massachusetts Institute of Technology, Cambridge, MA, USA
- Howard Hughes Medical Institute, Cambridge, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Nir Grossman
- Department of Brain Sciences, Imperial College London, London, UK.
- UK Dementia Research Institute, Imperial College London, London, UK.
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13
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Gruia DC, Trender W, Hellyer P, Banerjee S, Kwan J, Zetterberg H, Hampshire A, Geranmayeh F. IC3 protocol: a longitudinal observational study of cognition after stroke using novel digital health technology. BMJ Open 2023; 13:e076653. [PMID: 38000822 PMCID: PMC10679983 DOI: 10.1136/bmjopen-2023-076653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Stroke is a major cause of death and disability worldwide, frequently resulting in persistent cognitive deficits among survivors. These deficits negatively impact recovery and therapy engagement, and their treatment is consistently rated as high priority by stakeholders and clinicians. Although clinical guidelines endorse cognitive screening for poststroke management, there is currently no gold-standard approach for identifying cognitive deficits after stroke, and clinical stroke services lack the capacity for long-term cognitive monitoring and care. Currently, available assessment tools are either not stroke-specific, not in-depth or lack scalability, leading to heterogeneity in patient assessments. METHODS AND ANALYSIS To address these challenges, a cost-effective, scalable and comprehensive screening tool is needed to provide a stroke-specific assessment of cognition. The current study presents such a novel digital tool, the Imperial Comprehensive Cognitive Assessment in Cerebrovascular Disease (IC3), designed to detect both domain-general and domain-specific cognitive deficits in patients after stroke with minimal input from a health professional. To ensure its reliability, we will use multiple validation approaches, and aim to recruit a large normative sample of age-matched, gender-matched and education-matched UK-based controls. Moreover, the IC3 assessment will be integrated within a larger prospective observational longitudinal clinical trial, where poststroke cognition will be examined in tandem with brain imaging and blood biomarkers to identify novel multimodal biomarkers of recovery after stroke. This study will enable deeper cognitive phenotyping of patients at a large scale, while identifying those with highest risk of progressive cognitive decline, as well as those with greatest potential for recovery. ETHICS AND DISSEMINATION This study has been approved by South West-Frenchay Research Ethics Committee (IRAS 299333) and authorised by the UK's Health Research Authority. Results from the study will be disseminated at conferences and within peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05885295. Stage: Pre-results.
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Affiliation(s)
- Dragos-Cristian Gruia
- Department of Brain Sciences, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - William Trender
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter Hellyer
- Centre for Neuroimaging Sciences, IoPPN, King's College London, London, UK
| | - Soma Banerjee
- Department of Brain Sciences, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Kwan
- Department of Brain Sciences, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, Institute of Neurology, UCL, London, UK
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Goteborg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UK Dementia Research Institute, UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Fatemeh Geranmayeh
- Department of Brain Sciences, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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14
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Cousins O, Schubert JJ, Chandra A, Veronese M, Valkimadi P, Creese B, Khan Z, Arathimos R, Hampshire A, Rosenzweig I, Ballard C, Corbett A, Aasland D, Velayudhan L, O'Neill M, Collier D, Awais R, Sander K, Årstad E, Howes O, Turkheimer F, Hodges A. Microglial activation, tau and amyloid deposition in TREM2 p.R47H carriers and mild cognitive impairment patients: a multi-modal/multi-tracer PET/MRI imaging study with influenza vaccine immune challenge. J Neuroinflammation 2023; 20:272. [PMID: 37990275 PMCID: PMC10664604 DOI: 10.1186/s12974-023-02945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Microglia are increasingly understood to play an important role in the pathogenesis of Alzheimer's disease. The rs75932628 (p.R47H) TREM2 variant is a well-established risk factor for Alzheimer's disease. TREM2 is a microglial cell surface receptor. In this multi-modal/multi-tracer PET/MRI study we investigated the effect of TREM2 p.R47H carrier status on microglial activation, tau and amyloid deposition, brain structure and cognitive profile. METHODS We compared TREM2 p.R47H carriers (n = 8; median age = 62.3) and participants with mild cognitive impairment (n = 8; median age = 70.7). Participants underwent two [18F]DPA-714 PET/MRI scans to assess TSPO signal, indicative of microglial activation, before and after receiving the seasonal influenza vaccination, which was used as an immune stimulant. Participants also underwent [18F]florbetapir and [18F]AV1451 PET scans to assess amyloid and tau burden, respectively. Regional tau and TSPO signal were calculated for regions of interest linked to Braak stage. An additional comparison imaging healthy control group (n = 8; median age = 45.5) had a single [18F]DPA-714 PET/MRI. An expanded group of participants underwent neuropsychological testing, to determine if TREM2 status influenced clinical phenotype. RESULTS Compared to participants with mild cognitive impairment, TREM2 carriers had lower TSPO signal in Braak II (P = 0.04) and Braak III (P = 0.046) regions, despite having a similar burden of tau and amyloid. There were trends to suggest reduced microglial activation following influenza vaccine in TREM2 carriers. Tau deposition in the Braak VI region was higher in TREM2 carriers (P = 0.04). Furthermore, compared to healthy controls TREM2 carriers had smaller caudate (P = 0.02), total brain (P = 0.049) and white matter volumes (P = 0.02); and neuropsychological assessment revealed worse ADAS-Cog13 (P = 0.03) and Delayed Matching to Sample (P = 0.007) scores. CONCLUSIONS TREM2 p.R47H carriers had reduced levels of microglial activation in brain regions affected early in the Alzheimer's disease course and differences in brain structure and cognition. Changes in microglial response may underlie the increased Alzheimer's disease risk in TREM2 p.R47H carriers. Future therapeutic agents in Alzheimer's disease should aim to enhance protective microglial actions.
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Affiliation(s)
- Oliver Cousins
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Julia J Schubert
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Avinash Chandra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Mattia Veronese
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
- Department of Information Engineering, University of Padua, 35131, Padua, Italy
| | - Polena Valkimadi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, EX1 2HZ, UK
- Division of Psychology, Department of Life Sciences, Brunel University London, London, UB8 3PH, UK
| | - Zunera Khan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Ryan Arathimos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Adam Hampshire
- Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Ivana Rosenzweig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, EX1 2HZ, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, EX1 2HZ, UK
| | - Dag Aasland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Latha Velayudhan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | | | | | - Ramla Awais
- Centre for Radiopharmaceutical Chemistry, University College London, London, WC1E 6BS, UK
| | - Kerstin Sander
- Centre for Radiopharmaceutical Chemistry, University College London, London, WC1E 6BS, UK
| | - Erik Årstad
- Centre for Radiopharmaceutical Chemistry, University College London, London, WC1E 6BS, UK
| | - Oliver Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Federico Turkheimer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK
| | - Angela Hodges
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RT, UK.
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15
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Aakre JA, Schulz J, Ballard C, Corbett A, Bjorvatn B, Aarsland D, Creese B, Hampshire A, Brooker H, Testad I. Self-reported sleep fragmentation and sleep duration and their association with cognitive function in PROTECT, a large digital community-based cohort of people over 50. Int J Geriatr Psychiatry 2023; 38:e6022. [PMID: 37929864 DOI: 10.1002/gps.6022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Sleep is vital for normal cognitive function in daily life, but is commonly disrupted in older adults. Poor sleep can be detrimental to mental and physical health, including cognitive function. This study assessed the association between self-reported short (<6 h) and long (>9 h) sleep duration and sleep fragmentation (3≥ nightly awakenings) in cognitive function. METHODS Cross-sectional data from 8508 individuals enroled in the PROTECT study aged 50 and above formed the basis of the univariate linear regression analysis conducted on four cognitive outcomes assessing visuospatial episodic memory (VSEM), spatial working memory, verbal working memory (VWM), and verbal reasoning (VR). RESULTS Short (ß = -0.153, 95% CI [-0.258, -0.048], p = 0.004) and long sleep duration (ß = -0.459, 95% CI [-0.826, -0.091], p = 0.014) were significantly associated with poorer cognitive performance in VWM. Long sleep duration (ß = -2.986, 95% CI [-5.453, -0.518], p = 0.018) was associated with impaired VR. Short sleep (ß = -0.133, 95% CI [-0.196, -0.069], p = <0.001) and sleep fragmentation (ß = -0.043, 95% CI [-0.085, -0.001], p = 0.043) were associated with reduced VSEM. These associations remained significant when including other established risk factors for dementia and cognitive decline (e.g., depression, hypertension). CONCLUSIONS Our findings suggest that short and long sleep durations and fragmented sleep, may be risk factors for a decline in cognitive processes such as working memory, VR and episodic memory thus might be potential targets for interventions to maintain cognitive health in ageing.
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Affiliation(s)
- Jon Arild Aakre
- Centre for Age-Related Medicine - SESAM, Stavanger University Hospital, Stavanger, Norway
- Department of Health & Community Sciences, Faculty of Health & Life Sciences, University of Exeter, Exeter, UK
| | - Jörn Schulz
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Clive Ballard
- Department of Clinical Biosciences, Faculty of Health & Life Sciences, University of Exeter, Exeter, UK
| | - Anne Corbett
- Department of Health & Community Sciences, Faculty of Health & Life Sciences, University of Exeter, Exeter, UK
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine - SESAM, Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Byron Creese
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Division of Psychology, Department of Life Sciences, Brunel University London, London, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | | | - Ingelin Testad
- Centre for Age-Related Medicine - SESAM, Stavanger University Hospital, Stavanger, Norway
- Department of Health & Community Sciences, Faculty of Health & Life Sciences, University of Exeter, Exeter, UK
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16
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Corbett A, Williams G, Creese B, Hampshire A, Hayman V, Palmer A, Filakovzsky A, Mills K, Cummings J, Aarsland D, Khan Z, Ballard C. Cognitive decline in older adults in the UK during and after the COVID-19 pandemic: a longitudinal analysis of PROTECT study data. Lancet Healthy Longev 2023; 4:e591-e599. [PMID: 37924840 PMCID: PMC10720396 DOI: 10.1016/s2666-7568(23)00187-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/21/2023] [Accepted: 08/24/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Although the long-term health effects of COVID-19 are increasingly recognised, the societal restrictions during the COVID-19 pandemic hold the potential for considerable detriment to cognitive and mental health, particularly because major dementia risk factors-such as those related to exercise and dietary habits-were affected during this period. We used longitudinal data from the PROTECT study to evaluate the effect of the pandemic on cognition in older adults in the UK. METHODS For this longitudinal analysis, we used computerised neuropsychology data from individuals aged 50 years and older participating in the PROTECT study in the UK. Data were collected from the same participants before the COVID-19 pandemic (March 1, 2019-Feb 29, 2020) and during its first (March 1, 2020-Feb 28, 2021) and second (March 1, 2021-Feb 28, 2022) years. We compared cognition across the three time periods using a linear mixed-effects model. Subgroup analyses were conducted in people with mild cognitive impairment and in people who reported a history of COVID-19, and an exploratory regression analysis identified factors associated with changes in cognitive trajectory. FINDINGS Pre-pandemic data were included for 3142 participants, of whom 1696 (54·0%) were women and 1446 (46·0%) were men, with a mean age of 67·5 years (SD 9·6, range 50-96). Significant worsening of executive function and working memory was observed in the first year of the pandemic across the whole cohort (effect size 0·15 [95% CI 0·12-0·17] for executive function and 0·51 [0·49-0·53] for working memory), in people with mild cognitive impairment (0·13 [0·07-0·20] and 0·40 [0·36-0·47]), and in people with a history of COVID-19 (0·24 [0·16-0·31] and 0·46 [0·39-0·53]). Worsening of working memory was sustained across the whole cohort in the second year of the pandemic (0·47; 0·44-0·49). Regression analysis indicated that cognitive decline was significantly associated with reduced exercise (p=0·0049; executive function) and increased alcohol use (p=0·049; working memory) across the whole cohort, as well as depression (p=0·011; working memory) in those with a history of COVID-19 and loneliness (p=0·0038; working memory) in those with mild cognitive impairment. In the second year of the pandemic, reduced exercise continued to affect executive function across the whole cohort, and associations were sustained between worsening working memory and increased alcohol use (p=0·0040), loneliness (p=0·042), and depression (p=0·014) in those with mild cognitive impairment, and reduced exercise (p=0·0029), loneliness (p=0·031) and depression (p=0·036) in those with a history of COVID-19. INTERPRETATION The COVID-19 pandemic resulted in a significant worsening of cognition in older adults, associated with changes in known dementia risk factors. The sustained decline in cognition highlights the need for public health interventions to mitigate the risk of dementia-particularly in people with mild cognitive impairment, in whom conversion to dementia within 5 years is a substantial risk. Long-term intervention for people with a history of COVID-19 should be considered to support cognitive health. FUNDING National Institute for Health and Care Research.
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Affiliation(s)
- Anne Corbett
- University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - Gareth Williams
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Byron Creese
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Vincent Hayman
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Abbie Palmer
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Akos Filakovzsky
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Kathryn Mills
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Zunera Khan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Clive Ballard
- University of Exeter Medical School, University of Exeter, Exeter, UK
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17
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Liu C, Albertella L, Lochner C, Tiego J, Grant JE, Ioannidis K, Yücel M, Hellyer PJ, Hampshire A, Chamberlain SR. Conceptualising compulsivity through network analysis: A two-sample study. Compr Psychiatry 2023; 127:152429. [PMID: 37832377 DOI: 10.1016/j.comppsych.2023.152429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Compulsivity is a transdiagnostic construct crucial to understanding multiple psychiatric conditions and problematic repetitive behaviours. Despite being identified as a clinical- and research-relevant construct, there are limited insights into the internal conceptual structure of compulsivity. To provide a more nuanced understanding of compulsivity, the current study estimated the structure of compulsivity (indexed using the previously validated Cambridge-Chicago Compulsivity Trait Scale, CHI-T) among two large-scale and geographically distinct samples using the network estimation method. The samples consisted of a United Kingdom cohort (n = 122,346, 51.4% female, Mean age = 43.7, SD = 16.5, range = 9-86 years) and a South Africa cohort (n = 2674, 65.6% female, Mean age = 24.6, SD = 8.6, range = 18-65 years). Network community analysis demonstrated that compulsivity was constituted of three interrelated dimensions, namely: perfectionism, cognitive rigidity and reward drive. Further, 'Completion leads to soothing' and 'Difficulty moving from task to task' were identified as core (central nodes) to compulsivity. The dimensional structure and central nodes of compulsivity networks were consistent across the two samples. These findings facilitate the conceptualisation and measurement of compulsivity and may contribute to the early detection and treatment of compulsivity-related disorders.
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Affiliation(s)
- Chang Liu
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Victoria, Australia.
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Victoria, Australia
| | - Christine Lochner
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Western Cape, South Africa
| | - Jeggan Tiego
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Victoria, Australia
| | - Jon E Grant
- Department of Psychiatry & Behavioural Neuroscience, University of Chicago, Chicago, USA
| | - Konstantinos Ioannidis
- Department of Psychiatry, Faculty of Medicine, University of Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Victoria, Australia
| | - Peter J Hellyer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK
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18
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Zhao S, Toniolo S, Hampshire A, Husain M. Effects of COVID-19 on cognition and brain health. Trends Cogn Sci 2023; 27:1053-1067. [PMID: 37657964 PMCID: PMC10789620 DOI: 10.1016/j.tics.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/03/2023]
Abstract
COVID-19 is associated with a range of neurological, cognitive, and mental health symptoms both acutely and chronically that can persist for many months after infection in people with long-COVID syndrome. Investigations of cognitive function and neuroimaging have begun to elucidate the nature of some of these symptoms. They reveal that, although cognitive deficits may be related to brain imaging abnormalities in some people, symptoms can also occur in the absence of objective cognitive deficits or neuroimaging changes. Furthermore, cognitive impairment may be detected even in asymptomatic individuals. We consider the evidence regarding symptoms, cognitive deficits, and neuroimaging, as well as their possible underlying mechanisms.
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Affiliation(s)
- Sijia Zhao
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK.
| | - Sofia Toniolo
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; Wellcome Trust Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford OX2 6AE, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, 926 Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; Wellcome Trust Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford OX2 6AE, UK.
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19
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Violante IR, Alania K, Cassarà AM, Neufeld E, Acerbo E, Carron R, Williamson A, Kurtin DL, Rhodes E, Hampshire A, Kuster N, Boyden ES, Pascual-Leone A, Grossman N. Non-invasive temporal interference electrical stimulation of the human hippocampus. Nat Neurosci 2023; 26:1994-2004. [PMID: 37857775 PMCID: PMC10620081 DOI: 10.1038/s41593-023-01456-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 09/06/2023] [Indexed: 10/21/2023]
Abstract
Deep brain stimulation (DBS) via implanted electrodes is used worldwide to treat patients with severe neurological and psychiatric disorders. However, its invasiveness precludes widespread clinical use and deployment in research. Temporal interference (TI) is a strategy for non-invasive steerable DBS using multiple kHz-range electric fields with a difference frequency within the range of neural activity. Here we report the validation of the non-invasive DBS concept in humans. We used electric field modeling and measurements in a human cadaver to verify that the locus of the transcranial TI stimulation can be steerably focused in the hippocampus with minimal exposure to the overlying cortex. We then used functional magnetic resonance imaging and behavioral experiments to show that TI stimulation can focally modulate hippocampal activity and enhance the accuracy of episodic memories in healthy humans. Our results demonstrate targeted, non-invasive electrical stimulation of deep structures in the human brain.
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Affiliation(s)
- Ines R Violante
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - Ketevan Alania
- Department of Brain Sciences, Imperial College London, London, UK
- UK Dementia Research Institute, Imperial College London, London, UK
| | - Antonino M Cassarà
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Esra Neufeld
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Emma Acerbo
- Institut de Neurosciences des Systèmes, Aix-Marseille University, INSERM, Marseille, France
- Department of Neurology and Neurosurgery, Emory University Hospital, Atlanta, GA, USA
| | - Romain Carron
- Institut de Neurosciences des Systèmes, Aix-Marseille University, INSERM, Marseille, France
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France
| | - Adam Williamson
- Institut de Neurosciences des Systèmes, Aix-Marseille University, INSERM, Marseille, France
- International Clinical Research Center, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Danielle L Kurtin
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Edward Rhodes
- Department of Brain Sciences, Imperial College London, London, UK
- UK Dementia Research Institute, Imperial College London, London, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Niels Kuster
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
- Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Edward S Boyden
- Departments of Brain and Cognitive Sciences, Media Arts and Sciences, and Biological Engineering, McGovern and Koch Institutes, Massachusetts Institute of Technology, Cambridge, MA, USA
- Howard Hughes Medical Institute, Cambridge, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Nir Grossman
- Department of Brain Sciences, Imperial College London, London, UK.
- UK Dementia Research Institute, Imperial College London, London, UK.
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20
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Turner SG, Brooker H, Ballard C, Corbett A, Hampshire A, Sabatini S. The Role of Awareness of Age-Related Change in the Longitudinal Association between Pain and Physical Activity. Int J Aging Hum Dev 2023:914150231208686. [PMID: 37899713 DOI: 10.1177/00914150231208686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
We examined how physical pain impacts the developmental construct of Awareness of Age-Related Change (AARC-gains and AARC-losses) and, in turn, how AARC mediates and moderates the association between pain and subsequent physical activity. We used longitudinal data from 434 participants of the UK PROTECT Study (mean age = 65.5 years; SD = 6.94 years). We found that pain in 2019 predicted higher AARC-losses (β = .07; p = .036) and less physical activity (β = -.13; p-value = .001) in 2020. Additionally, we found that AARC-losses partially mediated, but did not moderate, the association of pain in 2019 and physical activity in 2020. AARC-losses may explain physical inactivity in middle-aged and older adults experiencing pain. Incorporating developmental constructs such as AARC into theories and empirical studies on pain and pain management may be necessary to more fully capture people's responses to pain.
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Affiliation(s)
- Shelbie G Turner
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, NY, USA
| | | | | | | | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
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21
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Atchison CJ, Davies B, Cooper E, Lound A, Whitaker M, Hampshire A, Azor A, Donnelly CA, Chadeau-Hyam M, Cooke GS, Ward H, Elliott P. Long-term health impacts of COVID-19 among 242,712 adults in England. Nat Commun 2023; 14:6588. [PMID: 37875536 PMCID: PMC10598213 DOI: 10.1038/s41467-023-41879-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
The COVID-19 pandemic is having a lasting impact on health and well-being. We compare current self-reported health, quality of life and symptom profiles for people with ongoing symptoms following COVID-19 to those who have never tested positive for SARS-CoV-2 infection and those who have recovered from COVID-19. Overall, 276,840/800,000 (34·6%) of invited participants took part. Mental health and health-related quality of life were worse among participants with ongoing persistent symptoms post-COVID compared with those who had never had COVID-19 or had recovered. In this study, median duration of COVID-related symptoms (N = 130,251) was 1·3 weeks (inter-quartile range 6 days to 2 weeks), with 7·5% and 5·2% reporting ongoing symptoms ≥12 weeks and ≥52 weeks respectively. Female sex, ≥1 comorbidity and being infected when Wild-type variant was dominant were associated with higher probability of symptoms lasting ≥12 weeks and longer recovery time in those with persistent symptoms. Although COVID-19 is usually of short duration, some adults experience persistent and burdensome illness.
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Affiliation(s)
- Christina J Atchison
- School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Bethan Davies
- School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Emily Cooper
- School of Public Health, Imperial College London, London, UK
| | - Adam Lound
- School of Public Health, Imperial College London, London, UK
| | - Matthew Whitaker
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Adriana Azor
- Department of Brain Sciences, Imperial College London, London, UK
| | - Christl A Donnelly
- School of Public Health, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
- MRC Centre for Global infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Marc Chadeau-Hyam
- School of Public Health, Imperial College London, London, UK
- Health Data Research (HDR) UK London at Imperial College, London, UK
| | - Graham S Cooke
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- MRC Centre for Global infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Paul Elliott
- School of Public Health, Imperial College London, London, UK.
- Imperial College Healthcare NHS Trust, London, UK.
- MRC Centre for Environment and Health, Imperial College London, London, UK.
- Health Data Research (HDR) UK London at Imperial College, London, UK.
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK.
- UK Dementia Research Institute at Imperial College, London, UK.
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22
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Kurtin DL, Araña‐Oiarbide G, Lorenz R, Violante IR, Hampshire A. Planning ahead: Predictable switching recruits task-active and resting-state networks. Hum Brain Mapp 2023; 44:5030-5046. [PMID: 37471699 PMCID: PMC10502652 DOI: 10.1002/hbm.26430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/08/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
Switching is a difficult cognitive process characterised by costs in task performance; specifically, slowed responses and reduced accuracy. It is associated with the recruitment of a large coalition of task-positive regions including those referred to as the multiple demand cortex (MDC). The neural correlates of switching not only include the MDC, but occasionally the default mode network (DMN), a characteristically task-negative network. To unpick the role of the DMN during switching we collected fMRI data from 24 participants playing a switching paradigm that perturbed predictability (i.e., cognitive load) across three switch dimensions-sequential, perceptual, and spatial predictability. We computed the activity maps unique to switch vs. stay trials and all switch dimensions, then evaluated functional connectivity under these switch conditions by computing the pairwise mutual information functional connectivity (miFC) between regional timeseries. Switch trials exhibited an expected cost in reaction time while sequential predictability produced a significant benefit to task accuracy. Our results showed that switch trials recruited a broader activity map than stay trials, including regions of the DMN, the MDC, and task-positive networks such as visual, somatomotor, dorsal, salience/ventral attention networks. More sequentially predictable trials recruited increased activity in the somatomotor and salience/ventral attention networks. Notably, changes in sequential and perceptual predictability, but not spatial predictability, had significant effects on miFC. Increases in perceptual predictability related to decreased miFC between control, visual, somatomotor, and DMN regions, whereas increases in sequential predictability increased miFC between regions in the same networks, as well as regions within ventral attention/ salience, dorsal attention, limbic, and temporal parietal networks. These results provide novel clues as to how DMN may contribute to executive task performance. Specifically, the improved task performance, unique activity, and increased miFC associated with increased sequential predictability suggest that the DMN may coordinate more strongly with the MDC to generate a temporal schema of upcoming task events, which may attenuate switching costs.
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Affiliation(s)
- Danielle L. Kurtin
- NeuroModulation Lab, Department of Psychology, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
- Department of Brain Sciences, Faculty of MedicineImperial College LondonLondonUK
| | | | - Romy Lorenz
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK
- The Poldrack LabStanford UniversityStanfordCaliforniaUSA
- Department of NeurophysicsMax‐Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
| | - Ines R. Violante
- NeuroModulation Lab, Department of Psychology, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of MedicineImperial College LondonLondonUK
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23
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Taquet M, Skorniewska Z, Hampshire A, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Greening NJ, Mansoori P, Harrison EM, Docherty AB, Lone NI, Quint J, Sattar N, Brightling CE, Wain LV, Evans RE, Geddes JR, Harrison PJ. Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization. Nat Med 2023; 29:2498-2508. [PMID: 37653345 PMCID: PMC10579097 DOI: 10.1038/s41591-023-02525-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
Post-COVID cognitive deficits, including 'brain fog', are clinically complex, with both objective and subjective components. They are common and debilitating, and can affect the ability to work, yet their biological underpinnings remain unknown. In this prospective cohort study of 1,837 adults hospitalized with COVID-19, we identified two distinct biomarker profiles measured during the acute admission, which predict cognitive outcomes 6 and 12 months after COVID-19. A first profile links elevated fibrinogen relative to C-reactive protein with both objective and subjective cognitive deficits. A second profile links elevated D-dimer relative to C-reactive protein with subjective cognitive deficits and occupational impact. This second profile was mediated by fatigue and shortness of breath. Neither profile was significantly mediated by depression or anxiety. Results were robust across secondary analyses. They were replicated, and their specificity to COVID-19 tested, in a large-scale electronic health records dataset. These findings provide insights into the heterogeneous biology of post-COVID cognitive deficits.
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Affiliation(s)
- Maxime Taquet
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Olivia C Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Matthew Richardson
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Omer Elneima
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish J C McAuley
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M Saunders
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Victoria C Harris
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester, UK
| | - Neil J Greening
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Ewen M Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | | | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Christopher E Brightling
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Louise V Wain
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rachael E Evans
- The institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
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24
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Blackman J, Morrison HD, Gabb V, Biswas B, Li H, Turner N, Jolly A, Trender W, Hampshire A, Whone A, Coulthard E. Remote evaluation of sleep to enhance understanding of early dementia due to Alzheimer's Disease (RESTED-AD): an observational cohort study protocol. BMC Geriatr 2023; 23:590. [PMID: 37742001 PMCID: PMC10518099 DOI: 10.1186/s12877-023-04288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Sleep and circadian rhythm disorders are well recognised in both AD (Alzheimer's Disease) dementia and MCI-AD (Mild Cognitive Impairment due to Alzheimer's Disease). Such abnormalities include insomnia, excessive daytime sleepiness, decreased sleep efficiency, increased sleep fragmentation and sundowning. Enhancing understanding of sleep abnormalities may unveil targets for intervention in sleep, a promising approach given hypotheses that sleep disorders may exacerbate AD pathological progression and represent a contributory factor toward impaired cognitive performance and worse quality of life. This may also permit early diagnosis of AD pathology, widely acknowledged as a pre-requisite for future disease-modifying therapies. This study aims to bridge the divide between in-laboratory polysomnographic studies which allow for rich characterisation of sleep but in an unnatural setting, and naturalistic studies typically approximating sleep through use of non-EEG wearable devices. It is also designed to record sleep patterns over a 2 month duration sufficient to capture both infradian rhythm and compensatory responses following suboptimal sleep. Finally, it harnesses an extensively phenotyped population including with AD blood biomarkers. Its principal aims are to improve characterisation of sleep and biological rhythms in individuals with AD, particularly focusing on micro-architectural measures of sleep, compensatory responses to suboptimal sleep and the relationship between sleep parameters, biological rhythms and cognitive performance. METHODS/DESIGN This observational cohort study has two arms (AD-MCI / mild AD dementia and aged-matched healthy adults). Each participant undergoes a baseline visit for collection of demographic, physiological and neuropsychological information utilising validated questionnaires. The main study period involves 7 nights of home-based multi-channel EEG sleep recording nested within an 8-week study period involving continuous wrist-worn actigraphy, sleep diaries and regular brief cognitive tests. Measurement of sleep parameters will be at home thereby obtaining a real-world, naturalistic dataset. Cognitive testing will be repeated at 6 months to stratify participants by longitudinal disease progression. DISCUSSION This study will generate new insights particularly in micro-architectural measures of sleep, circadian patterns and compensatory sleep responses in a population with and without AD neurodegenerative change. It aims to enhance standards of remotely based sleep research through use of a well-phenotyped population and advanced sleep measurement technology.
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Affiliation(s)
- Jonathan Blackman
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Hamish Duncan Morrison
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Victoria Gabb
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Bijetri Biswas
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
| | - Haoxuan Li
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Nicholas Turner
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
| | - Amy Jolly
- Faculty of Medicine, Imperial College London, London, SW7 2AZ UK
| | - William Trender
- Faculty of Medicine, Imperial College London, London, SW7 2AZ UK
| | - Adam Hampshire
- Faculty of Medicine, Imperial College London, London, SW7 2AZ UK
| | - Alan Whone
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Elizabeth Coulthard
- Bristol Medical School, University of Bristol, Bristol, BS2 8DZ UK
- Bristol Brain Centre, North Bristol NHS Trust, Bristol, BS10 5NB UK
- Bristol Medical School, Learning & Research Building, Southmead Hospital, University of Bristol, Bristol, BS10 5NB UK
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Lerede A, Rodgers J, Middleton RM, Hampshire A, Nicholas R. Patient-reported outcomes in multiple sclerosis: a prospective registry cohort study. Brain Commun 2023; 5:fcad199. [PMID: 37605775 PMCID: PMC10440194 DOI: 10.1093/braincomms/fcad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/20/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023] Open
Abstract
Registries have the potential to tackle some of the current limitations in determining the long-term impact of multiple sclerosis. Online assessments using patient-reported outcomes can streamline follow-up enabling large-scale, long-term, cost-effective, home-based, and patient-focused data collection. However, registry data are sparsely sampled and the sensitivity of patient-reported outcomes relative to clinician-reported scales is unknown, making it hard to fully leverage their unique scope and scale to derive insights. This retrospective and prospective cohort study over 11 years involved 15 976 patients with multiple sclerosis from the United Kingdom Multiples Sclerosis Register. Primary outcomes were changes in two patient-reported outcomes: Multiple Sclerosis Impact Scale motor component, and Multiple Sclerosis Walking Scale. First, we investigated their validity in measuring the impact of physical disability in multiple sclerosis, by looking at their sensitivity to disease subtype and duration. We grouped the available records (91 351 for Multiple Sclerosis Impact Scale motor and 68 092 for Multiple Sclerosis Walking Scale) by these two factors, and statistically compared the resulting groups using a novel approach based on Monte Carlo permutation analysis that was designed to cope with the intrinsic sparsity of registry data. Next, we used the patient-reported outcomes to draw novel insights into the developmental time course of subtypes; in particular, the period preceding the transition from relapsing to progressive forms. We report a robust main effect of disease subtype on the patient-reported outcomes and interactions of disease subtype with duration (all P < 0.0001). Specifically, patient-reported outcomes worsen with disease duration for all subtypes (all P < 0.0001) apart from benign multiple sclerosis (Multiple Sclerosis Impact Scale motor: P = 0.796; Multiple Sclerosis Walking Scale: P = 0.983). Furthermore, the patient-reported outcomes of each subtype are statistically different from those of the other subtypes at all time bins (Multiple Sclerosis Impact Scale motor: all P < 0.05; Multiple Sclerosis Walking Scale: all P < 0.01) except when comparing relapsing-remitting multiple sclerosis with benign multiple sclerosis and primary progressive multiple sclerosis with secondary progressive multiple sclerosis. Notably, there were statistically significant differences between relapsing-remitting and progressive subtypes at disease onset. Critically, the patient-reported outcomes are sensitive to future transitions to progressive subtypes, with individuals who transition presenting with higher patient-reported outcomes in their relapsing-remitting phase compared to individuals who don't transition since onset (all P < 0.0001). Patient-reported outcomes capture different patterns of physical worsening over disease length and across subtypes; therefore, they are a valid tool to measure the physical impact of multiple sclerosis over the long-term and cost-effectively. Furthermore, more advanced physical disability manifests years before clinical detection of progressive subtypes, adding evidence to the presence of a multiple sclerosis prodrome.
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Affiliation(s)
- Annalaura Lerede
- Department of Brain Sciences, Imperial College London, London W120BZ, UK
| | - Jeff Rodgers
- Population Data Science, Swansea University Medical School, Swansea SA2 8PP, UK
| | - Rod M Middleton
- Population Data Science, Swansea University Medical School, Swansea SA2 8PP, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London W120BZ, UK
| | - Richard Nicholas
- Department of Brain Sciences, Imperial College London, London W120BZ, UK
- Population Data Science, Swansea University Medical School, Swansea SA2 8PP, UK
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26
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Crook-Rumsey M, Daniels SJC, Abulikemu S, Lai H, Rapeaux A, Hadjipanayi C, Soreq E, Li LM, Bashford J, Jeyasingh-Jacob J, Gruia DC, Lambert D, Weil R, Hampshire A, Sharp DJ, Haar S. Multicohort cross-sectional study of cognitive and behavioural digital biomarkers in neurodegeneration: the Living Lab Study protocol. BMJ Open 2023; 13:e072094. [PMID: 37536971 PMCID: PMC10401246 DOI: 10.1136/bmjopen-2023-072094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION AND AIMS Digital biomarkers can provide a cost-effective, objective and robust measure for neurological disease progression, changes in care needs and the effect of interventions. Motor function, physiology and behaviour can provide informative measures of neurological conditions and neurodegenerative decline. New digital technologies present an opportunity to provide remote, high-frequency monitoring of patients from within their homes. The purpose of the living lab study is to develop novel digital biomarkers of functional impairment in those living with neurodegenerative disease (NDD) and neurological conditions. METHODS AND ANALYSIS The Living Lab study is a cross-sectional observational study of cognition and behaviour in people living with NDDs and other, non-degenerative neurological conditions. Patients (n≥25 for each patient group) with dementia, Parkinson's disease, amyotrophic lateral sclerosis, mild cognitive impairment, traumatic brain injury and stroke along with controls (n≥60) will be pragmatically recruited. Patients will carry out activities of daily living and functional assessments within the Living Lab. The Living Lab is an apartment-laboratory containing a functional kitchen, bathroom, bed and living area to provide a controlled environment to develop novel digital biomarkers. The Living Lab provides an important intermediary stage between the conventional laboratory and the home. Multiple passive environmental sensors, internet-enabled medical devices, wearables and electroencephalography (EEG) will be used to characterise functional impairments of NDDs and non-NDD conditions. We will also relate these digital technology measures to clinical and cognitive outcomes. ETHICS AND DISSEMINATION Ethical approvals have been granted by the Imperial College Research Ethics Committee (reference number: 21IC6992). Results from the study will be disseminated at conferences and within peer-reviewed journals.
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Affiliation(s)
- Mark Crook-Rumsey
- UK Dementia Research Institute, Basic and Clinical Neuroscience, King's College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
| | - Sarah J C Daniels
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Subati Abulikemu
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Helen Lai
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Adrien Rapeaux
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Charalambos Hadjipanayi
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Eyal Soreq
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Lucia M Li
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - James Bashford
- UK Dementia Research Institute, Basic and Clinical Neuroscience, King's College London, London, UK
| | - Julian Jeyasingh-Jacob
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Dragos C Gruia
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Damion Lambert
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- University of Surrey, United Kingdom Dementia Research Institute, Guildford, UK
| | - Rimona Weil
- National Hospital for Neurology and Neurosurgery, UCLH, London, UK
| | - Adam Hampshire
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - David J Sharp
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Shlomi Haar
- UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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Cheetham NJ, Penfold R, Giunchiglia V, Bowyer V, Sudre CH, Canas LS, Deng J, Murray B, Kerfoot E, Antonelli M, Rjoob K, Molteni E, Österdahl MF, Harvey NR, Trender WR, Malim MH, Doores KJ, Hellyer PJ, Modat M, Hammers A, Ourselin S, Duncan EL, Hampshire A, Steves CJ. The effects of COVID-19 on cognitive performance in a community-based cohort: a COVID symptom study biobank prospective cohort study. EClinicalMedicine 2023; 62:102086. [PMID: 37654669 PMCID: PMC10466229 DOI: 10.1016/j.eclinm.2023.102086] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 09/02/2023] Open
Abstract
Background Cognitive impairment has been reported after many types of infection, including SARS-CoV-2. Whether deficits following SARS-CoV-2 improve over time is unclear. Studies to date have focused on hospitalised individuals with up to a year follow-up. The presence, magnitude, persistence and correlations of effects in community-based cases remain relatively unexplored. Methods Cognitive performance (working memory, attention, reasoning, motor control) was assessed in a prospective cohort study of participants from the United Kingdom COVID Symptom Study Biobank between July 12, 2021 and August 27, 2021 (Round 1), and between April 28, 2022 and June 21, 2022 (Round 2). Participants, recruited from the COVID Symptom Study smartphone app, comprised individuals with and without SARS-CoV-2 infection and varying symptom duration. Effects of COVID-19 exposures on cognitive accuracy and reaction time scores were estimated using multivariable ordinary least squares linear regression models weighted for inverse probability of participation, adjusting for potential confounders and mediators. The role of ongoing symptoms after COVID-19 infection was examined stratifying for self-perceived recovery. Longitudinal analysis assessed change in cognitive performance between rounds. Findings 3335 individuals completed Round 1, of whom 1768 also completed Round 2. At Round 1, individuals with previous positive SARS-CoV-2 tests had lower cognitive accuracy (N = 1737, β = -0.14 standard deviations, SDs, 95% confidence intervals, CI: -0.21, -0.07) than negative controls. Deficits were largest for positive individuals with ≥12 weeks of symptoms (N = 495, β = -0.22 SDs, 95% CI: -0.35, -0.09). Effects were comparable to hospital presentation during illness (N = 281, β = -0.31 SDs, 95% CI: -0.44, -0.18), and 10 years age difference (60-70 years vs. 50-60 years, β = -0.21 SDs, 95% CI: -0.30, -0.13) in the whole study population. Stratification by self-reported recovery revealed that deficits were only detectable in SARS-CoV-2 positive individuals who did not feel recovered from COVID-19, whereas individuals who reported full recovery showed no deficits. Longitudinal analysis showed no evidence of cognitive change over time, suggesting that cognitive deficits for affected individuals persisted at almost 2 years since initial infection. Interpretation Cognitive deficits following SARS-CoV-2 infection were detectable nearly two years post infection, and largest for individuals with longer symptom durations, ongoing symptoms, and/or more severe infection. However, no such deficits were detected in individuals who reported full recovery from COVID-19. Further work is needed to monitor and develop understanding of recovery mechanisms for those with ongoing symptoms. Funding Chronic Disease Research Foundation, Wellcome Trust, National Institute for Health and Care Research, Medical Research Council, British Heart Foundation, Alzheimer's Society, European Union, COVID-19 Driver Relief Fund, French National Research Agency.
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Affiliation(s)
- Nathan J. Cheetham
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Rose Penfold
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Vicky Bowyer
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Carole H. Sudre
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Liane S. Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Khaled Rjoob
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, United Kingdom
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Marc F. Österdahl
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Nicholas R. Harvey
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | | | - Michael H. Malim
- Department of Infectious Diseases, King's College London, London, United Kingdom
| | - Katie J. Doores
- Department of Infectious Diseases, King's College London, London, United Kingdom
| | - Peter J. Hellyer
- Centre for Neuroimaging Sciences, King's College London, London, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- King's College London & Guy's and St Thomas' PET Centre, King's College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Emma L. Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Guy's & St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Guy's & St Thomas's NHS Foundation Trust, London, United Kingdom
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28
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Sabatini S, Turner S, Brooker H, Ballard C, Corbett A, Hampshire A. Physical and mental health conditions account for variability in awareness of age-related changes. Front Psychiatry 2023; 14:1152177. [PMID: 37539325 PMCID: PMC10394239 DOI: 10.3389/fpsyt.2023.1152177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Background The concept of Awareness of Age-Related Changes captures people's perceptions of the positive (AARC-gains) and negative (AARC-losses) age-related changes they experience in several life domains, including their health. We investigated the cross-sectional associations of number and type of physical and mental health conditions with AARC-gains and AARC-losses. Methods The sample comprised 3,786 middle-aged and older adults (mean age = 67.04 years; SD = 6.88) participating to the UK PROTECT study. We used hierarchical regression models to analyze whether after having included sociodemographic variables (model 1), number of physical (model 2) and of mental (model 3) health conditions explained a significant additional amount of variance in AARC-gains and AARC-losses, and whether the association between number of conditions and AARC depended on participants' age. We used multiple regression models to analyze the associations of types of physical and mental health conditions with AARC-gains and AARC-losses. Results A higher number of physical health conditions was associated with higher AARC-gains and higher AARC-losses, but the association did not depend on participant age. After controlling for the number of physical health conditions, a higher number of mental health conditions was associated with higher AARC-losses but not with AARC-gains, and the association was stronger among older participants. Small effects were found between greater AARC-gains and current cancer and between greater AARC-losses and diagnoses of mild cognitive impairment, Parkinson's disease, arthritic condition, cancer in full remission, osteoporosis, depression, anxiety disorders, and personality disorder. The remaining health conditions were either negligibly or non-statistically related to AARC-losses. Conclusion Middle-aged and older adults having more physical health conditions and more mental health conditions may be at higher risk of negative views on their own aging. However, specific physical health conditions, such as arthritis, and certain mental health conditions, such as depression, may make adults particularly vulnerable to negative age-related perceptions.
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Affiliation(s)
- Serena Sabatini
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Shelbie Turner
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, NY, United States
| | - Helen Brooker
- University of Exeter Medical School, Exeter, United Kingdom
- Ecog Pro Ltd, Bristol, United Kingdom
| | - Clive Ballard
- University of Exeter Medical School, Exeter, United Kingdom
| | - Anne Corbett
- University of Exeter Medical School, Exeter, United Kingdom
| | - Adam Hampshire
- Social, Genetic, and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
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29
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Bălăeț M, Kurtin DL, Gruia DC, Lerede A, Custovic D, Trender W, Jolly AE, Hellyer PJ, Hampshire A. Mapping the sociodemographic distribution and self-reported justifications for non-compliance with COVID-19 guidelines in the United Kingdom. Front Psychol 2023; 14:1183789. [PMID: 37539003 PMCID: PMC10395087 DOI: 10.3389/fpsyg.2023.1183789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
Which population factors have predisposed people to disregard government safety guidelines during the COVID-19 pandemic and what justifications do they give for this non-compliance? To address these questions, we analyse fixed-choice and free-text responses to survey questions about compliance and government handling of the pandemic, collected from tens of thousands of members of the UK public at three 6-monthly timepoints. We report that sceptical opinions about the government and mainstream-media narrative, especially as pertaining to justification for guidelines, significantly predict non-compliance. However, free text topic modelling shows that such opinions are diverse, spanning from scepticism about government competence and self-interest to full-blown conspiracy theories, and covary in prevalence with sociodemographic variables. These results indicate that attempts to counter non-compliance through argument should account for this diversity in peoples' underlying opinions, and inform conversations aimed at bridging the gap between the general public and bodies of authority accordingly.
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Affiliation(s)
- Maria Bălăeț
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Danielle L. Kurtin
- Neuromodulation Lab, Department of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Dragos C. Gruia
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Annalaura Lerede
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- UKRI Centre for Doctoral Training in AI for Healthcare, Department of Computing, Imperial College London, London, United Kingdom
| | - Darije Custovic
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- UK Dementia Research Institute: Care Research & Technology, London, United Kingdom
| | - William Trender
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Engineering and Physical Sciences Research Council CDT Neurotechnology, Imperial College London, London, United Kingdom
| | - Amy E. Jolly
- NMR Unit, Queen Square Multiple Sclerosis Centre, UCL, Queen Square Institute of Neurology, Department of Neuroinflammation, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Peter J. Hellyer
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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30
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Bălăeț M, Trender W, Hellyer PJ, Hampshire A. Associations between the use of psychedelics and other recreational drugs with mental health and resilience during the COVID-19 pandemic. Front Psychiatry 2023; 14:1184681. [PMID: 37398594 PMCID: PMC10307955 DOI: 10.3389/fpsyt.2023.1184681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
The large-scale disruption to peoples' daily lives during the COVID-19 pandemic provides a context for examining whether use of substances such as psychedelics in a naturalistic (outside of a controlled environment) setting, is associated with better mental wellbeing and resilience relative to those who use other drugs, or who do not use drugs at all. We interrogate data from the Great British Intelligence Test and identify that 7.8% out of N = 30,598 unique respondents used recreational drugs inclusive of psychedelics, cannabis, cocaine, and MDMA during the COVID-19 pandemic. Recruitment materials did not mention drug use would be surveyed, thereby enabling us to model the relationship with mood and resilience in people who had not specifically self-selected themselves for a 'drug' study. We report that people form clusters, characterized by different real-world patterns of drug use, and the majority of psychedelics users also use cannabis. However, a subset of cannabis users do not use psychedelics, enabling a subtractive comparison. Those who primarily used psychedelics and cannabis during the COVID-19 pandemic had worse mood self-assessment and resilience scores compared to those who never used drugs or primarily used cannabis. This pattern was also evident for other recreational drug use clusters, except for those who primarily used MDMA and cannabis, who had better mood but were of too low incidence to have confidence in this estimate. These findings cast light on the significant differences in mental wellbeing between users of different drugs and the non-user population during a global-crisis and call for future research to explore the pharmacological, contextual and cultural variables associated with these differences, their generalisability and causal links with greater precision.
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Affiliation(s)
- Maria Bălăeț
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - William Trender
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- Engineering and Physical Sciences Research Council CDT Neurotechnology, Imperial College London, London, United Kingdom
| | - Peter J. Hellyer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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31
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Sabatini S, Wilton-Harding B, Ballard C, Brooker H, Corbett A, Hampshire A, Windsor TD. Bidirectional Associations of Awareness of Age-Related Change and Attitudes Towards Own Aging With Social Media Use. J Gerontol B Psychol Sci Soc Sci 2023:7161370. [PMID: 37177879 PMCID: PMC10394997 DOI: 10.1093/geronb/gbad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES We test whether higher awareness of age-related gains (AARC-gains), lower awareness of age-related losses (AARC-losses), and more positive attitudes towards own aging (ATOA) are cross-sectionally related to more frequent social media use. We also investigate the strength and direction of the associations of AARC-gains, AARC-losses, and ATOA with social media use over one-year, from before to after the onset of the COVID-19 pandemic. METHODS We used cross-sectional data of 8320 individuals (mean age= 65.95 years; SD= 7.01) and longitudinal data of a subsample of 4454 individuals participating to the UK PROTECT study in 2019 and 2020. We used ordered regression models, linear regression models, and tests of interaction. Models were adjusted for age, sex, education, and employment. RESULTS Higher AARC-gains and more positive ATOA, but not AARC-losses, were cross-sectionally associated with more frequent social media use. Social media use become more frequent at follow-up. In the longitudinal models controlling for baseline levels of the outcome variable, more frequent baseline social media use predicted increases in AARC-gains, whereas baseline AARC-gains did not significantly predict frequency of social media use at follow-up. Baseline frequency of social media use did not significantly predict AARC-losses, nor ATOA at follow-up, whereas lower levels of AARC-losses and more positive ATOA predicted more frequent social media use at follow-up. DISCUSSION Although effect sizes were small, decreasing negative views on aging may help increase engagement of middle-aged and older people with social media. At the same time, fostering social media use could promote positive self-perceptions of aging.
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Affiliation(s)
- Serena Sabatini
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Clive Ballard
- University of Exeter Medical School, Exeter, United Kingdom
| | - Helen Brooker
- University of Exeter Medical School, Exeter, United Kingdom
- Ecog Pro Ltd, Bristol, United Kingdom
| | - Anne Corbett
- University of Exeter Medical School, Exeter, United Kingdom
| | - Adam Hampshire
- Social, Genetic, and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | - Tim D Windsor
- Social Sciences, Flinders University, Adelaide, Australia
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Del Giovane M, Trender WR, Bălăeţ M, Mallas EJ, Jolly AE, Bourke NJ, Zimmermann K, Graham NS, Lai H, Losty EJ, Oiarbide GA, Hellyer PJ, Faiman I, Daniels SJ, Batey P, Harrison M, Giunchiglia V, Kolanko MA, David MC, Li LM, Demarchi C, Friedland D, Sharp DJ, Hampshire A. Computerised cognitive assessment in patients with traumatic brain injury: an observational study of feasibility and sensitivity relative to established clinical scales. EClinicalMedicine 2023; 59:101980. [PMID: 37152359 PMCID: PMC10154960 DOI: 10.1016/j.eclinm.2023.101980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
Background Online technology could potentially revolutionise how patients are cognitively assessed and monitored. However, it remains unclear whether assessments conducted remotely can match established pen-and-paper neuropsychological tests in terms of sensitivity and specificity. Methods This observational study aimed to optimise an online cognitive assessment for use in traumatic brain injury (TBI) clinics. The tertiary referral clinic in which this tool has been clinically implemented typically sees patients a minimum of 6 months post-injury in the chronic phase. Between March and August 2019, we conducted a cross-group, cross-device and factor analyses at the St. Mary's Hospital TBI clinic and major trauma wards at Imperial College NHS trust and St. George's Hospital in London (UK), to identify a battery of tasks that assess aspects of cognition affected by TBI. Between September 2019 and February 2020, we evaluated the online battery against standard face-to-face neuropsychological tests at the Imperial College London research centre. Canonical Correlation Analysis (CCA) determined the shared variance between the online battery and standard neuropsychological tests. Finally, between October 2020 and December 2021, the tests were integrated into a framework that automatically generates a results report where patients' performance is compared to a large normative dataset. We piloted this as a practical tool to be used under supervised and unsupervised conditions at the St. Mary's Hospital TBI clinic in London (UK). Findings The online assessment discriminated processing-speed, visual-attention, working-memory, and executive-function deficits in TBI. CCA identified two significant modes indicating shared variance with standard neuropsychological tests (r = 0.86, p < 0.001 and r = 0.81, p = 0.02). Sensitivity to cognitive deficits after TBI was evident in the TBI clinic setting under supervised and unsupervised conditions (F (15,555) = 3.99; p < 0.001). Interpretation Online cognitive assessment of TBI patients is feasible, sensitive, and efficient. When combined with normative sociodemographic models and autogenerated reports, it has the potential to transform cognitive assessment in the healthcare setting. Funding This work was funded by a National Institute for Health Research (NIHR) Invention for Innovation (i4i) grant awarded to DJS and AH (II-LB-0715-20006).
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Affiliation(s)
- Martina Del Giovane
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - William R. Trender
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Maria Bălăeţ
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Emma-Jane Mallas
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Amy E. Jolly
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, Queen Square, WC1N 3BG, London, United Kingdom
| | - Niall J. Bourke
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, SE5 8AB, London, United Kingdom
| | - Karl Zimmermann
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Neil S.N. Graham
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Helen Lai
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Ethan J.F. Losty
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Garazi Araña Oiarbide
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Peter J. Hellyer
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, SE5 8AF, London, United Kingdom
| | - Irene Faiman
- Clinical Neuropsychology Service, St George's University Hospital NHS Foundation Trust, Blackshaw Road, SW17 0QT, London, United Kingdom
| | - Sarah J.C. Daniels
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Philippa Batey
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- The Helix Centre, Imperial College London, and the Royal College of Arts, St. Mary’s Hospital, 3rd Floor Paterson Building, 20 South Wharf Road, Paddington, W2 1PE, London, United Kingdom
| | - Matthew Harrison
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- The Helix Centre, Imperial College London, and the Royal College of Arts, St. Mary’s Hospital, 3rd Floor Paterson Building, 20 South Wharf Road, Paddington, W2 1PE, London, United Kingdom
| | - Valentina Giunchiglia
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Magdalena A. Kolanko
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Michael C.B. David
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Lucia M. Li
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Célia Demarchi
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Daniel Friedland
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - David J. Sharp
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College and the University of Surrey, 9th Floor, Sir Michael Uren Hub, 86 Wood Ln, W12 0BZ, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, United Kingdom. Burlington Danes, The Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom
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Creese B, Arathimos R, Aarsland D, Ballard C, Brooker H, Hampshire A, Corbett A, Ismail Z. Late-life onset psychotic symptoms and incident cognitive impairment in people without dementia: Modification by genetic risk for Alzheimer's disease. Alzheimers Dement (N Y) 2023; 9:e12386. [PMID: 37139261 PMCID: PMC10150165 DOI: 10.1002/trc2.12386] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/01/2023] [Indexed: 05/05/2023]
Abstract
Introduction Late-life onset psychosis is associated with faster progression to dementia in cognitively normal people, but little is known about its relationship with cognitive impairment in advance of dementia. Methods Clinical and genetic data from 2750 people ≥50 years of age without dementia were analyzed. Incident cognitive impairment was operationalized using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and psychosis was rated using the Mild Behavioral Impairment Checklist (henceforth MBI-psychosis). The whole sample was analyzed before stratification on apolipoprotein E (APOE) ε4 status. Results In Cox proportional hazards models, MBI-psychosis had a higher hazard for cognitive impairment relative to the No Psychosis group (hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 2.2-6, p < 0.0001). The hazard for MBI-psychosis was higher in APOE ε4 carriers and there was an interaction between the two (HR for interaction: 3.4, 95% CI: 1.2-9.8, p = 0.02). Discussion Psychosis assessment in the MBI framework is associated with incident cognitive impairment in advance of dementia. These symptoms may be particularly important in the context of APOE genotype.
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Affiliation(s)
- Byron Creese
- Department of Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Ryan Arathimos
- Social Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Dag Aarsland
- Department of Old Age PsychiatryInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
- Centre for Age‐Related MedicineStavanger University HospitalStavangerNorway
| | - Clive Ballard
- Department of Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Helen Brooker
- Department of Health and Community SciencesFaculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Adam Hampshire
- Department of Brain SciencesFaculty of MedicineImperial College LondonLondonUK
| | - Anne Corbett
- Department of Health and Community SciencesFaculty of Health and Life SciencesUniversity of ExeterUK
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, and Community Health SciencesHotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
- Department of Health and Community Sciences, Faculty of Health and Life SciencesUniversity of ExeterExeterUK
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Sabatini S, Ukoumunne OC, Ballard C, Collins R, Kim S, Corbett A, Aarsland D, Hampshire A, Brooker H, Clare L. What does feeling younger or older than one's chronological age mean to men and women? Qualitative and quantitative findings from the PROTECT study. Psychol Health 2023; 38:324-347. [PMID: 34353194 DOI: 10.1080/08870446.2021.1960989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We explored which factors are associated with subjective age (SA), i.e. feeling younger, the same as, or older than one's chronological age, and whether these factors differ between men and women and between two age sub-groups. DESIGN Cross-sectional study using qualitative and quantitative data for 1457 individuals (mean age= 67.2 years). MAIN OUTCOME MEASURES Participants reported how old they feel they are and provided comments in relation to their SA judgments. RESULTS By using content analysis participants' comments were assigned to 13 categories, grouped into three higher-order categories (antecedents of age-related thoughts, mental processes, and issues when measuring subjective age). SA may result from the interaction between factors that increase or decrease age-related thoughts and mental processes that individuals use to interpret age-related changes. Chi-squared tests show that individuals reporting an older SA are more likely to experience significant negative changes and to engage in negative age-related thoughts than individuals reporting an age-congruent SA or a younger SA. Women experience a more negative SA and more age-salient events than men. CONCLUSION Individuals reporting an older SA may benefit from interventions promoting adaptation to negative age-related changes. There is the need to eradicate negative societal views of older women.
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Affiliation(s)
- Serena Sabatini
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, United Kingdom
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Rachel Collins
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sarang Kim
- Wicking Dementia Research & Education Centre, University of Tasmania, Hobart, Australia
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Dag Aarsland
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,Ecog Pro Ltd, Bristol, United Kingdom
| | - Linda Clare
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, United Kingdom
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Leng F, Hinz R, Gentleman S, Hampshire A, Dani M, Brooks DJ, Edison P. Neuroinflammation is independently associated with brain network dysfunction in Alzheimer's disease. Mol Psychiatry 2023; 28:1303-1311. [PMID: 36474000 PMCID: PMC10005956 DOI: 10.1038/s41380-022-01878-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/17/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
Brain network dysfunction is increasingly recognised in Alzheimer's disease (AD). However, the causes of brain connectivity disruption are still poorly understood. Recently, neuroinflammation has been identified as an important factor in AD pathogenesis. Microglia participate in the construction and maintenance of healthy neuronal networks, but pro-inflammatory microglia can also damage these circuits. We hypothesised that microglial activation is independently associated with brain connectivity disruption in AD. We performed a cross-sectional multimodal imaging study and interrogated the relationship between imaging biomarkers of neuroinflammation, Aβ deposition, brain connectivity and cognition. 42 participants (12 Aβ-positive MCI, 14 Aβ-positive AD and 16 Aβ-negative healthy controls) were recruited. Participants had 11C-PBR28 and 18F-flutemetamol PET to quantify Aβ deposition and microglial activation, T1-weighted, diffusion tensor and resting-state functional MRI to assess structural network and functional network. 11C-PBR28 uptake, structural network integrity and functional network orgnisation were compared across diagnostic groups and the relationship between neuroinflammation and brain network was tested in 26 Aβ-positive patients. Increased 11C-PBR28 uptake, decreased FA, network small-worldness and local efficiency were observed in AD patients. Cortical 11C-PBR28 uptake correlated negatively with structural integrity (standardised β = -0.375, p = 0.037) and network local efficiency (standardised β = -0.468, p < 0.001), independent of cortical thickness and Aβ deposition, while Aβ was not. Network structural integrity, small-worldness and local efficiency, and cortical thickness were positively associated with cognition. Our findings suggest cortical neuroinflammation coincide with structural and functional network disruption independent of Aβ and cortical atrophy. These findings link the brain connectivity change and pathological process in Alzheimer's disease, and suggest a pathway from neuroinflammation to systemic brain dysfunction.
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Affiliation(s)
- Fangda Leng
- Department of Brain Sciences, Imperial College London, London, UK
- Department of Neurology, Peking University First Hospital, Beijing, PR China
| | - Rainer Hinz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Steve Gentleman
- Department of Brain Sciences, Imperial College London, London, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Melanie Dani
- Department of Brain Sciences, Imperial College London, London, UK
| | - David J Brooks
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Institute of Translational and Clinical Research, University of Newcastle upon Tyne, Newcastle, UK
| | - Paul Edison
- Department of Brain Sciences, Imperial College London, London, UK.
- School of Medicine, Cardiff University, Wales, UK.
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Gruia DC, Combrie S, Coghlin J, Trender W, Hellyer P, Kwan J, Banerjee S, Hampshire A, Geranmayeh F. Abstract WP57: Large-scale Reliability/Validity Assessments And Quantification Of Cognition Within The Imperial College Comprehensive Assessment For Cerebrovascular Disease (IC3): A Novel In-depth, Self-administered, Online Cognitive Tool. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Cognitive difficulties occur in up to 86% of acute stroke cases and persist in a third. There is a growing need for a scalable, cost-effective and in-depth assessment of cognitive function in patients, that enables longitudinal tracking of recovery and better understanding of predictors of long-term cognitive outcomes. This study aims to address this gap by presenting reliability and validity data on a novel self-administered online assessment tool that assesses cognition after stroke.
Method:
This self-administered web-based tool offers an in-depth cognitive profiling through 22 tasks spanning both domain-general (e.g. attention) and domain-specific deficits (e.g. memory, language, visual neglect), together with neuropsychiatric questionnaires. In light of these specifications, the battery has been named IC3 (Imperial College Comprehensive assessment for Cerebrovascular disease;
https://ic3study.co.uk/
)
Results:
We present results outlining the normative ranges for the assessment in 1000+ gender, age and education matched controls and in a modest sample of patients following stroke. Furthermore, we present results showcasing the reliability and validity of the assessment through specificity, sensitivity and test-retest analyses. Finally, we present a novel statistical approach that allows one to tease out motor-driven deficits during response selection, from true cognitive deficits, allowing for a more precise phenotyping of cognition in stroke.
Conclusion:
IC3 is the first assessment to offer in-depth unsupervised cognitive phenotyping of patients following stroke, while also allowing scalable and cost-efficient longitudinal monitoring. It fares well against various reliability/validation metrics and is able to capture cognition in a more precise and scalable manner than currently available assessments, making it an attractive tool for understanding the mechanisms of recovery in a plethora of vascular disorders.
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Affiliation(s)
- Dragos C Gruia
- Dept of Brain Sciences, Imperial College London, London, United Kingdom
| | - Sabia Combrie
- Dept of Brain Sciences, Imperial College London, London, United Kingdom
| | - Joseph Coghlin
- Dept of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - William Trender
- Dept of Brain Sciences, Imperial College London, London, United Kingdom
| | - Peter Hellyer
- Dept of Brain Sciences, Imperial College London, London, United Kingdom
| | - Joseph Kwan
- Imperial College London NHS Trust, London, United Kingdom
| | - Soma Banerjee
- Imperial College London NHS Trust, London, United Kingdom
| | - Adam Hampshire
- Dept of Brain Sciences, Imperial College London, London, United Kingdom
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Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Brooker H, Charlton RA, Happé F. The cognitive profile of middle-aged and older adults with high vs. low autistic traits. Autism Res 2023; 16:429-440. [PMID: 36454212 PMCID: PMC10947177 DOI: 10.1002/aur.2866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
Cognitive differences in memory, information processing speed (IPS), and executive functions (EF), are common in autistic and high autistic trait populations. Despite memory, IPS and EF being sensitive to age-related change, little is known about the cognitive profile of older adults with high autistic traits. This study explores cross-sectional memory, IPS and EF task performance in a large sample of older adults in the online PROTECT cohort (n = 22,285, aged 50-80 years), grouped by high vs. low autistic traits. Approximately 1% of PROTECT participants (n = 325) endorsed high autistic traits [henceforth Autism Spectrum Trait (AST) group]. Differences between AST and age-, gender-, and education-matched comparison older adults (COA; n = 11,744) were explored on memory, IPS and EF tasks and questionnaires administered online. AST had lower performance than COA on tasks measuring memory, working memory, sustained attention, and information processing. No group differences were observed in simple attention or verbal reasoning. A similar pattern of results was observed when controlling for age, and current depression and anxiety symptoms. In addition, AST self-reported more cognitive decline than COA, but this difference was not significant when controlling for current depression symptoms, or when using informant-report. These findings suggest that autistic traits are associated with cognitive function in middle-aged and later life. Older adults with high autistic traits experienced more performance difficulties in a range of memory, IPS and EF tasks compared with the low autistic traits comparison group. Further longitudinal work is needed to examine age-related change in both older autistic and autistic trait populations.
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Affiliation(s)
- Gavin R. Stewart
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Anne Corbett
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Clive Ballard
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Byron Creese
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Helen Brooker
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - Francesca Happé
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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Lennon MJ, Brooker H, Creese B, Thayanandan T, Rigney G, Aarsland D, Hampshire A, Ballard C, Corbett A, Raymont V. Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study. J Neurotrauma 2023. [PMID: 36716779 DOI: 10.1089/neu.2022.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. We examined a subset (n = 15,764) of the PROTECT study, a cohort assessing risk factors for cognitive decline (ages between 50 and 90 years). Participants completed cognitive assessments annually for 4 years. Cognitive tests were grouped using a principal components analysis (PCA) into working memory, episodic memory, attention, processing speed, and executive function. Lifetime TBI severity and number were retrospectively recalled by participants using the Brain Injury Screening Questionnaire (BISQ). Linear mixed models (LMMs) examined the effect of severity of head injury (non-TBI head strike, mTBI, and moderate-severe TBI) and number of mTBI at baseline and over time. mTBI was considered as a continuous and categorical variable (groups: 0 mTBI, 1 mTBI, 2 mTBIs, 3 mTBIs, and 4+ mTBIs). Of the participants 5725 (36.3%) reported at least one mTBI and 510 (3.2%) at least one moderate-severe TBI, whereas 3711 (23.5%) had suffered at worst a non-TBI head strike and 5818 (32.9%) reported no head injuries. The participants had suffered their last reported head injury an average (standard deviation, SD) of 29.6 (20.0) years prior to the study. Regarding outcomes, there was no worsening in longitudinal cognitive trajectories over the study duration but at baseline there were significant cognitive deficits associated with TBI. At baseline, compared with those without head injury, individuals reporting at least one moderate-severe TBI had significantly poorer attention (B = -0.163, p < 0.001), executive scores (B = -0.151, p = 0.004), and processing speed (B = -0.075, p = 0.033). Those who had suffered at least a single mTBI also demonstrated significantly poorer attention scores at baseline compared with the no head injury group (B = -0.052, p = 0.001). Compared with those with no mTBI, those in the 3 mTBI group manifested poorer baseline executive function (B = -0.149, p = 0.025) and attention scores (B = -0.085, p = 0.015). At baseline, those who had suffered four or more mTBIs demonstrated poorer attention (B = -0.135, p < 0.001), processing speed (B = -0.072, p = 0.009), and working memory (B = -0.052, p = 0.036), compared with those reporting no mTBI. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.
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Affiliation(s)
- Matthew J Lennon
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Tony Thayanandan
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Grant Rigney
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry, IoPPN, Kings College London, London, United Kingdom.,Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Peers PV, Punton SF, Murphy FC, Watson P, Bateman A, Duncan J, Astle DE, Hampshire A, Manly T. A randomized control trial of the effects of home-based online attention training and working memory training on cognition and everyday function in a community stroke sample. Neuropsychol Rehabil 2022; 32:2603-2627. [PMID: 34505555 PMCID: PMC7615301 DOI: 10.1080/09602011.2021.1972817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022]
Abstract
Cognitive difficulties are common following stroke and can have widespread impacts on everyday functioning. Technological advances offer the possibility of individualized cognitive training for patients at home, potentially providing a low-cost, low-intensity adjunct to rehabilitation services. Using this approach, we have previously demonstrated post-training improvements in attention and everyday functioning in fronto-parietal stroke patients. Here we examine whether these benefits are observed more broadly in a community stroke sample. Eighty patients were randomized to either 4 weeks of online adaptive attention training (SAT), working memory training (WMT) or waitlist (WL). Cognitive and everyday function measures were collected before and after the intervention, and after 3 months. During training, weekly measures of patients' subjective functioning were collected. The training was well received and compliance good. No differences in our primary end-point, spatial bias, or other cognitive functions were observed. However, on patient-reported outcomes, SAT participants showed greater levels of improvement in everyday functioning than WMT or WL participants. In line with our previous work, everyday functioning improvements were greatest for patients with spatial impairments and those who received SAT training. Whether attention training can be recommended for stroke survivors depends on whether cognitive test performance or everyday functioning is considered more relevant.
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Affiliation(s)
- Polly V. Peers
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sarah F. Punton
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Fionnuala C. Murphy
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Andrew Bateman
- Oliver Zangwill Centre, Cambridge Community Services NHS Trust, Ely, UK
- School of Health and Social Care, University of Essex, Colchester, UK
| | - John Duncan
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Duncan E. Astle
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Adam Hampshire
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Tom Manly
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Lyons H, Belli T, Blanch R, Hampshire A, Jensen O, Mitchell J, Rogers J, Seemungal B, Withnall R, Sinclair A. 167 mTBI Predict: a prospective biomarker study to predict outcomes in mild traumatic brain injury. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMild traumatic brain injury (mTBI) is common accounting for 1.4 million hospital visits annually in the UK. Although classified as mild it leads to disproportionate impact on future health. Many suffer long-term disability driven by post-traumatic headache, mood and visual disturbances, vestibular dys- function, post-traumatic stress disorder, cognitive impairment and inability to work. Biomarkers to predict these outcomes are an unmet need.MethodsWe will conduct a longitudinal, prospective cohort study over 8 years, recruiting 800 participants (military, civilian and sports injuries) with an acute diagnosis of mTBI. At onset, assessment of biomarkers will include brain imaging, cerebral physiology, blood and saliva, headache, mental health, vision, balance, and cognitive performance. We will evaluate the ability of biomarkers to predict long-term complications at 6, 12 and 24 months (and at 10 years plus though NHS digital data).DiscussionThis UK mTBI consortium aims to identify accurate, reproducible and clinically practical mul- timodal biomarkers in mTBI. Biomarkers would identify those with a good prognosis who could rapidly return to activity and those likely to suffer complications focussing prompt and targeted therapy. This programme of research aims to deliver a step change in patient care and bring much needed advances in mTBI management.
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Hampshire A, Menon DK. Response to "Understanding chronic Covid-19". EClinicalMedicine 2022; 51:101551. [PMID: 35844769 PMCID: PMC9271170 DOI: 10.1016/j.eclinm.2022.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adam Hampshire
- Department of Brain Sciences, Imperial College London, UK
- Corresponding author at: UK DRI Care Research and Technology Centre, Department of Brain Sciences, 926, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ.
| | - David K. Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
- Cambridge University Hospitals National Health Service Foundation Trust, UK
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
- Corresponding author at: Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
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Singham T, Saunders R, Brooker H, Creese B, Aarsland D, Hampshire A, Ballard C, Corbett A, Desai R, Stott J. Are subtypes of affective symptoms differentially associated with change in cognition over time: A latent class analysis. J Affect Disord 2022; 309:437-445. [PMID: 35490883 DOI: 10.1016/j.jad.2022.04.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/14/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the absence of disease-modifying treatments, identifying potential psychosocial risk factors for dementia is paramount. Depression and anxiety have been identified as potential risk factors. Studies however have yielded mixed findings, lending possibility to the fact that potential constellations of co-occurring depression and anxiety symptoms may better explain the link between affective symptoms and cognitive decline. METHODS Data from participants (aged 50 and above) of the PROTECT study was used. Latent Class Analysis (LCA) was conducted on 21,684 participants with baseline anxiety and depression measures. Multiple linear regressions models, using a subset of these participants (N = 6136) who had complete cognition data at baseline and at 2-year follow-up, were conducted to assess for associations between class membership and longitudinal changes in cognition. RESULTS The LCA identified a 5-class solution: "No Symptoms", "Sleep", "Sleep and Worry", "Sleep and Anhedonia", and "Co-morbid Depression and Anxiety". Class membership was significantly associated with longitudinal change in cognition. Furthermore, this association differed across different cognitive measures. LIMITATIONS Limitations included significant attrition and a generally healthy sample which may impact generalisability. CONCLUSIONS Substantial heterogeneity in affective symptoms could explain previous inconsistent findings concerning the association between affective symptoms and cognition. Clinicians should not focus solely on total symptom scores on a single affective domain, but instead on the presence and patterns of symptoms (even if sub-clinical) on measures across multiple affective domains. Identifying particular subgroups that are at greater risk of poor cognitive outcomes may support targeted prevention work.
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Affiliation(s)
- Timothy Singham
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, UK
| | - Dag Aarsland
- Department of Old age Psychiatry, IoPPN, Kings College London, UK; Centre for Age-related research, Stavanger University Hospital, Stavanger, Norway
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, UK
| | - Roopal Desai
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
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Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Charlton RA, Happé F. Self-harm and Suicidality Experiences of Middle-Age and Older Adults With vs. Without High Autistic Traits. J Autism Dev Disord 2022:10.1007/s10803-022-05595-y. [PMID: 35616817 DOI: 10.1007/s10803-022-05595-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
Suicide has been identified as a leading cause of premature death in autistic populations. Elevated autistic traits have also been associated with higher rates of self-harm, suicidal ideation, and suicidal self-harm in the general population, but this has yet to be examined in older age. Using baseline cross-sectional data from the PROTECT study, middle-age and older adults with high autistic traits (n = 276) had significantly higher rates of suicidal ideation, deliberate self-harm, and suicidal self-harm than an age/sex-matched comparison group (n = 10,495). These differences represented a 5- to 6-fold increase in likelihood for self-harming and suicidality. These findings, which remained when controlling for depression symptoms, suggest that middle-age and older adults with high autistic traits may be particularly at risk of self-harm and suicidal behaviours.
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Affiliation(s)
- Gavin R Stewart
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Dag Aarsland
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Adam Hampshire
- Department of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Rebecca A Charlton
- Department of Psychology, Goldsmiths University of London, London, SE14 6NW, UK
| | - Francesca Happé
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
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Wolfova K, Creese B, Aarsland D, Ismail Z, Corbett A, Ballard C, Hampshire A, Cermakova P. Gender/Sex Differences in the Association of Mild Behavioral Impairment with Cognitive Aging. J Alzheimers Dis 2022; 88:345-355. [PMID: 35599483 DOI: 10.3233/jad-220040] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While the gender/sex differences in neuropsychiatric symptoms in dementia population are well described, gender/sex differences in mild behavioral impairment (MBI) in dementia-free populations and the relationship to cognitive performance and to subsequent cognitive decline have not been studied. OBJECTIVE We aimed to explore gender/sex differences in the association of MBI with the level of cognitive performance and its rate of decline in a dementia-free cohort. METHODS We studied 8,181 older adults enrolled in the online PROTECT UK Study. MBI was assessed using the MBI Checklist and cognition was measured by digit span, paired associate learning, spatial working memory, and verbal reasoning. Statistical analysis was conducted using linear regression models and linear mixed-effects models. RESULTS Out of 8,181 individuals (median age 63 years, 73% females), 11% of females and 14% of males had MBI syndrome. Females exhibited less often symptoms of decreased motivation (45% versus 36% in males), impulse dyscontrol (40% versus 44% in males; p = 0.001) and social inappropriateness (12% versus 15% ; p < 0.001), while they showed more often symptoms of emotional dysregulation (45% versus 36% ; p < 0.001). The associations of MBI domains with some measures of cognitive performance and decline were stronger in males than females, with the exception of the association of emotional dysregulation with the rate of cognitive decline in verbal reasoning, which was present exclusively in females. CONCLUSION MBI may influence cognition to a greater extent in males than in females. We propose that predictors and biomarkers of dementia should consider gender/sex as an effect modifier.
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Affiliation(s)
- Katrin Wolfova
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic.,Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Byron Creese
- University of Exeter Medical School, College of Medicine and Health, RD&E Hospital Wonford, Barrack Road, Exeter, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Zahinoor Ismail
- Departments of Psychiatry and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada.,University of Exeter Medical School, College of Medicine and Health, St Luke's Campus, University of Exeter, Exeter, UK
| | - Anne Corbett
- South Cloisters, College of Medicine & Health, St Luke's Campus, University of Exeter, Exeter, UK
| | - Clive Ballard
- University of Exeter Medical School, College of Medicine and Health, St Luke's Campus, University of Exeter, Exeter, UK
| | - Adam Hampshire
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Hampshire A, Chatfield DA, MPhil AM, Jolly A, Trender W, Hellyer PJ, Giovane MD, Newcombe VF, Outtrim JG, Warne B, Bhatti J, Pointon L, Elmer A, Sithole N, Bradley J, Kingston N, Sawcer SJ, Bullmore ET, Rowe JB, Menon DK. Multivariate profile and acute-phase correlates of cognitive deficits in a COVID-19 hospitalised cohort. EClinicalMedicine 2022; 47:101417. [PMID: 35505938 PMCID: PMC9048584 DOI: 10.1016/j.eclinm.2022.101417] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 02/02/2023] Open
Abstract
Background Preliminary evidence has highlighted a possible association between severe COVID-19 and persistent cognitive deficits. Further research is required to confirm this association, determine whether cognitive deficits relate to clinical features from the acute phase or to mental health status at the point of assessment, and quantify rate of recovery. Methods 46 individuals who received critical care for COVID-19 at Addenbrooke's hospital between 10th March 2020 and 31st July 2020 (16 mechanically ventilated) underwent detailed computerised cognitive assessment alongside scales measuring anxiety, depression and post-traumatic stress disorder under supervised conditions at a mean follow up of 6.0 (± 2.1) months following acute illness. Patient and matched control (N = 460) performances were transformed into standard deviation from expected scores, accounting for age and demographic factors using N = 66,008 normative datasets. Global accuracy and response time composites were calculated (G_SScore & G_RT). Linear modelling predicted composite score deficits from acute severity, mental-health status at assessment, and time from hospital admission. The pattern of deficits across tasks was qualitatively compared with normal age-related decline, and early-stage dementia. Findings COVID-19 survivors were less accurate (G_SScore=-0.53SDs) and slower (G_RT=+0.89SDs) in their responses than expected compared to their matched controls. Acute illness, but not chronic mental health, significantly predicted cognitive deviation from expected scores (G_SScore (p=0.0037) and G_RT (p = 0.0366)). The most prominent task associations with COVID-19 were for higher cognition and processing speed, which was qualitatively distinct from the profiles of normal ageing and dementia and similar in magnitude to the effects of ageing between 50 and 70 years of age. A trend towards reduced deficits with time from illness (r∼=0.15) did not reach statistical significance. Interpretation Cognitive deficits after severe COVID-19 relate most strongly to acute illness severity, persist long into the chronic phase, and recover slowly if at all, with a characteristic profile highlighting higher cognitive functions and processing speed. Funding This work was funded by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre (BRC), NIHR Cambridge Clinical Research Facility (BRC-1215-20014), the Addenbrooke's Charities Trust and NIHR COVID-19 BioResource RG9402. AH is funded by the UK Dementia Research Institute Care Research and Technology Centre and Imperial College London Biomedical Research Centre. ETB and DKM are supported by NIHR Senior Investigator awards. JBR is supported by the Wellcome Trust (220258) and Medical Research Council (SUAG/051 G101400). VFJN is funded by an Academy of Medical Sciences/ The Health Foundation Clinician Scientist Fellowship. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
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Affiliation(s)
- Adam Hampshire
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Doris A. Chatfield
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Anne Manktelow MPhil
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Amy Jolly
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | - William Trender
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Peter J. Hellyer
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Martina Del Giovane
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
| | | | - Joanne G. Outtrim
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Ben Warne
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Junaid Bhatti
- Department of Psychiatry, University of Cambridge, United Kingdom
| | - Linda Pointon
- Department of Psychiatry, University of Cambridge, United Kingdom
| | - Anne Elmer
- National Institute for Health Research Cambridge Clinical Research Facility, Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
| | - Nyarie Sithole
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Division of Infectious Diseases, Department of Medicine, University of Cambridge, United Kingdom
| | - John Bradley
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Department of Medicine, University of Cambridge, United Kingdom
- National Institute for Health Research Cambridge BioResource, United Kingdom
| | - Nathalie Kingston
- National Institute for Health Research COVID-19 BioResource, United Kingdom
| | - Stephen J. Sawcer
- Department of Clinical Neurosciences, and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - Edward T. Bullmore
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, United Kingdom
| | - James B. Rowe
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, United Kingdom
- Department of Clinical Neurosciences, and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | - David K. Menon
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Division of Anaesthesia, Department of Medicine, University of Cambridge
| | - the Cambridge NeuroCOVID Group, the NIHR COVID-19 BioResource, and Cambridge NIHR Clinical Research Facility
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, United Kingdom
- Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, United Kingdom
- National Institute for Health Research Cambridge Clinical Research Facility, Cambridge University Hospitals National Health Service Foundation Trust, United Kingdom
- Division of Infectious Diseases, Department of Medicine, University of Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, United Kingdom
- National Institute for Health Research Cambridge BioResource, United Kingdom
- Department of Clinical Neurosciences, and Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, United Kingdom
- Division of Anaesthesia, Department of Medicine, University of Cambridge
- National Institute for Health Research COVID-19 BioResource, United Kingdom
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Bourke NJ, Trender W, Hampshire A, Lai H, Demarchi C, David M, Hellyer P, Sharp DJ, Friedland D. Assessing prospective and retrospective metacognitive accuracy following traumatic brain injury remotely across cognitive domains. Neuropsychol Rehabil 2022; 33:574-591. [PMID: 35168480 DOI: 10.1080/09602011.2022.2034650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The ability to monitor one's behaviour is frequently impaired following TBI, impacting on patients' rehabilitation. Inaccuracies in judgement or self-reflection of one's performance provides a useful marker of metacognition. However, metacognition is rarely measured during routine neuropsychology assessments and how it varies across cognitive domains is unclear. A cohort of participants consisting of 111 TBI patients [mean age = 45.32(14.15), female = 29] and 84 controls [mean age = 31.51(12.27), female = 43] was studied. Participants completed cognitive assessments via a bespoke digital platform on their smartphones. Included in the assessment were a prospective evaluation of memory and attention, and retrospective confidence judgements of task performance. Metacognitive accuracy was calculated from the difference between confidence judgement of task performance and actual performance. Prospective judgment of attention and memory was correlated with task performance in these domains for controls but not patients. TBI patients had lower task performance in processing speed, executive functioning and working memory compared to controls, maintaining high confidence, resulting in overestimation of cognitive performance compared to controls. Additional judgments of task performance complement neuropsychological assessments with little additional time-cost. These results have important theoretical and practical implications for evaluation of metacognitive impairment in TBI patients and neurorehabilitation.
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Affiliation(s)
- N J Bourke
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - W Trender
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - A Hampshire
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - H Lai
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - C Demarchi
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - M David
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - P Hellyer
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - D J Sharp
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - D Friedland
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
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Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Charlton RA, Happé F. Traumatic life experiences and post-traumatic stress symptoms in middle-aged and older adults with and without autistic traits. Int J Geriatr Psychiatry 2022; 37. [PMID: 34994472 DOI: 10.1002/gps.5669] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/18/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Research with younger adults has begun to explore associations between autism/autistic traits and vulnerability to Post Traumatic Stress Disorder (PTSD). Large scale studies and/or examination of age-effects have not been conducted. METHODS Adults aged 50 years+ from the PROTECT study (n = 20,220) completed items about current and childhood socio-communicative difficulties characteristic of autism. Approximately 1% (n = 251) endorsed high autistic traits, henceforth the Autism Spectrum Traits (AST) group. Differences between the AST and an age-and sex-matched "Comparison Older Adults" (COA; n = 9179) group were explored for lifetime traumatic experiences and current symptoms of PTSD, depression, and anxiety. RESULTS Almost 30% of the AST group, compared to less than 8% of the COA, reported severe trauma in childhood/adulthood, including emotional, physical or sexual abuse. Elevated current PTSD symptoms were reported by AST compared to COA. An interaction was observed between autistic traits and trauma severity; the effect of level of trauma on PTSD symptoms was significantly greater for AST versus COA participants. This interaction remained significant when controlling for current depression and anxiety symptoms. CONCLUSIONS The findings suggest that high autistic traits may increase the likelihood of experiencing trauma across the lifespan, and the impact of severe trauma on PTSD symptoms. Older adults with high (vs. low) autistic traits may be at greater risk of experiencing PTSD symptoms in latter life. Future research should test whether the pattern of results is similar for diagnosed autistic adults.
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Affiliation(s)
- Gavin R Stewart
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Hampshire
- Department of Medicine, Imperial College London, London, UK
| | | | - Francesca Happé
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Hampshire A, Trender W, Grant JE, Mirza MB, Moran R, Hellyer PJ, Chamberlain SR. Item-level analysis of mental health symptom trajectories during the COVID-19 pandemic in the UK: Associations with age, sex and pre-existing psychiatric conditions. Compr Psychiatry 2022; 114:152298. [PMID: 35123177 PMCID: PMC8801903 DOI: 10.1016/j.comppsych.2022.152298] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/22/2021] [Accepted: 01/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is widespread concern regarding how the COVID-19 pandemic has affected mental health. Emerging meta-analyses suggest that the impact on anxiety/depression may have been transient, but much of the included literature has major methodological limitations. Addressing this topic rigorously requires longitudinal data of sufficient scope and scale, controlling for contextual variables, with baseline data immediately pre-pandemic. AIMS To analyse self-report of symptom frequency from two largely UK-based longitudinal cohorts: Cohort 1 (N = 10,475, two time-points: winter pre-pandemic to UK first winter resurgence), and Cohort 2 (N = 10,391, two time-points, peak first wave to UK first winter resurgence). METHOD Multinomial logistic regression applied at the item level identified sub-populations with greater probability of change in mental health symptoms. Permutation analyses characterised changes in symptom frequency distributions. Cross group differences in symptom stability were evaluated via entropy of response transitions. RESULTS Anxiety was the most affected aspect of mental health. The profiles of change in mood symptoms was less favourable for females and older adults. Those with pre-existing psychiatric diagnoses showed substantially higher probability of very frequent symptoms pre-pandemic and elevated risk of transitioning to the highest levels of symptoms during the pandemic. Elevated mental health symptoms were evident across intra-COVID timepoints in Cohort 2. CONCLUSIONS These findings suggest that mental health has been negatively affected by the pandemic, including in a sustained fashion beyond the first UK lockdown into the first winter resurgence. Women, and older adults, were more affected relative to their own baselines. Those with diagnoses of psychiatric conditions were more likely to experience transition to the highest levels of symptom frequency.
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Affiliation(s)
- Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK.
| | - William Trender
- Department of Brain Sciences, Imperial College London, London, UK
| | - Jon E Grant
- Department of Psychiatry, University of Chicago, Chicago, USA
| | - M Berk Mirza
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosalyn Moran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter J Hellyer
- Department of Brain Sciences, Imperial College London, London, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK
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Zhao S, Shibata K, Hellyer PJ, Trender W, Manohar S, Hampshire A, Husain M. Rapid vigilance and episodic memory decrements in COVID-19 survivors. Brain Commun 2022; 4:fcab295. [PMID: 35128398 PMCID: PMC8807287 DOI: 10.1093/braincomms/fcab295] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022] Open
Abstract
Recent studies indicate that COVID-19 infection can lead to serious neurological consequences in a small percentage of individuals. However, in the months following acute illness, many more suffer from fatigue, low motivation, disturbed mood, poor sleep and cognitive symptoms, colloquially referred to as 'brain fog'. But what about individuals who had asymptomatic to moderate COVID-19 and reported no concerns after recovering from COVID-19? Here, we examined a wide range of cognitive functions critical for daily life (including sustained attention, memory, motor control, planning, semantic reasoning, mental rotation and spatial-visual attention) in people who had previously suffered from COVID-19 but were not significantly different from a control group on self-reported fatigue, forgetfulness, sleep abnormality, motivation, depression, anxiety and personality profile. Reassuringly, COVID-19 survivors performed well in most abilities tested, including working memory, executive function, planning and mental rotation. However, they displayed significantly worse episodic memory (up to 6 months post-infection) and greater decline in vigilance with time on task (for up to 9 months). Overall, the results show that specific chronic cognitive changes following COVID-19 are evident on objective testing even amongst those who do not report a greater symptom burden. Importantly, in the sample tested here, these were not significantly different from normal after 6-9 months, demonstrating evidence of recovery over time.
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Affiliation(s)
- Sijia Zhao
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3PH, UK
| | - Kengo Shibata
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Peter J. Hellyer
- Department of Brain Sciences, Imperial College London, 926, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - William Trender
- Department of Brain Sciences, Imperial College London, 926, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Sanjay Manohar
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3PH, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, 926, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3PH, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
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Turner S, Sabatini S, Brooker H, Corbett A, Hampshire A. Self-Perceptions of Aging Among Dementia Caregivers: Evidence from the UK Protect Study. Innov Aging 2021. [PMCID: PMC8680653 DOI: 10.1093/geroni/igab046.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Contact with older adults impact the perceptions people have towards their own aging self (Jarrott & Savla, 2015) and how they prepare for their own age-related change (Kornadt et al., 2015). Caregivers have close, intimate contact with older adults, yet no research explores how that contact may impact caregivers’ perceptions of their own aging. In this exploratory study, we compare perceptions of one’s own aging between current and previous formal caregivers, non-formal caregivers, and never-caregivers. We utilized data from 1978 informal caregivers, 247 formal caregivers, and 5586 never-caregivers of the 2019 wave of the UK Protect Study. We conducted ANCOVA tests to compare global levels of Awareness of Age-Related Change (AARC) gains and losses, AARC gains and losses specific to cognition, attitudes towards one’s own aging, and felt age across the three subgroups of participants with different caregiving roles. Omnibus results suggested that there were significant group differences (p<.05) in global levels of AARC gains and losses, AARC gains specific to cognition, and attitudes towards one’s own aging (p<.05) for female, but not male, caregivers. However, effect sizes were either small or negligible. Therefore, despite frequent contact with older adults, dementia caregivers may not have better or worse self-perceptions of aging than non-caregivers. Such findings may be reflective of intergenerational ambivalence, and future work should consider how the nature of the caregiving situation (i.e. relationship quality, intensity of the care, caregiver burden) shapes caregivers’ perceptions of their own aging, especially over time as caregivers navigate their own aging processes.
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Affiliation(s)
- Shelbie Turner
- Oregon State University, Oregon State University, Oregon, United States
| | | | - Helen Brooker
- Exeter, University of Exeter, England, United Kingdom
| | - Anne Corbett
- University of Exeter, University of Exeter Medical School, England, United Kingdom
| | - Adam Hampshire
- Imperial College London, London, England, United Kingdom
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