1
|
Fradera A, McLaren J, Gadon L, Cullen B, Evans J. Does the presence of chronic pain affect scores on cognitive screening tests/brief cognitive measures for dementia? A systematic review and meta-analysis. Clin Neuropsychol 2024:1-24. [PMID: 38369508 DOI: 10.1080/13854046.2024.2315739] [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: 08/21/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Cognitive screening tests can identify potential dementia by indicating a concerning level of cognitive impairment. The older populations for whom this is most relevant are more likely to experience chronic pain, which also impairs cognitive function, but pain's impact on cognitive screening tests specifically remains unknown. METHOD We conducted a systematic review and meta-analysis (SR/MA) following PRISMA guidelines evaluating cognitive screening scores in studies involving participants with chronic pain compared with a pain-free control group. Our question was whether the presence of chronic pain (self-reported or based on diagnosis) was associated with poorer performance on these screens, and to identify the heterogeneity across groups and screens. RESULTS The 51 studies identified yielded 62 effect size estimates. The pooled g was 0.76 (95% confidence interval 0.57 to 0.95). Heterogeneity was high for the full model (= 93.16%) with some reductions in sub-analyses. Around half of the studies were identified as being at a low risk of bias. There was no evidence of publication bias. CONCLUSIONS As a whole, this analysis suggests medium to large effect sizes on cognitive screen performance when people are living with chronic pain. We suggest that clinicians should consider the effect of chronic pain when cognitive screens are employed to investigate dementia. Further research could clarify the effect pain has on different screen sub-domains to aid their effective use with these populations.
Collapse
Affiliation(s)
- Alex Fradera
- School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Lisa Gadon
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Breda Cullen
- School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jonathan Evans
- School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
2
|
Gefen A, Alves P, Beeckman D, Cullen B, Lázaro‐Martínez JL, Lev‐Tov H, Santamaria N, Swanson T, Woo K, Söderström B, Svensby A, Malone M, Nygren E. Fluid handling by foam wound dressings: From engineering theory to advanced laboratory performance evaluations. Int Wound J 2024; 21:e14674. [PMID: 38353372 PMCID: PMC10865423 DOI: 10.1111/iwj.14674] [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: 10/22/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
This article describes the contemporary bioengineering theory and practice of evaluating the fluid handling performance of foam-based dressings, with focus on the important and clinically relevant engineering structure-function relationships and on advanced laboratory testing methods for pre-clinical quantitative assessments of this common type of wound dressings. The effects of key wound dressing material-related and treatment-related physical factors on the absorbency and overall fluid handling of foam-based dressings are thoroughly and quantitively analysed. Discussions include exudate viscosity and temperature, action of mechanical forces and the dressing microstructure and associated interactions. Based on this comprehensive review, we propose a newly developed testing method, experimental metrics and clinical benchmarks that are clinically relevant and can set the standard for robust fluid handling performance evaluations. The purpose of this evaluative framework is to translate the physical characteristics and performance determinants of a foam dressing into achievable best clinical outcomes. These guiding principles are key to distinguishing desirable properties of a dressing that contribute to optimal performance in clinical settings.
Collapse
Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Department of Mathematics and Statistics, Faculty of SciencesHasselt UniversityHasseltBelgium
| | - Paulo Alves
- Wounds Research Lab, Centre for Interdisciplinary Research in Health, Faculty of Nursing and Health SciencesUniversidade Católica PortuguesaPortoPortugal
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
| | | | | | - Hadar Lev‐Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Hospital Miller School of MedicineMiamiFloridaUSA
| | - Nick Santamaria
- School of Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | | | - Kevin Woo
- School of NursingQueen's UniversityKingstonOntarioCanada
| | - Bengt Söderström
- Wound Care Research and DevelopmentMölnlycke Health Care ABGothenburgSweden
| | - Anna Svensby
- Wound Care Research and DevelopmentMölnlycke Health Care ABGothenburgSweden
| | - Matthew Malone
- Research and Development, Bioactives and Wound Biology, Mölnlycke Health Care AB, Gothenburg, Sweden; and Infectious Diseases and Microbiology, School of MedicineWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Erik Nygren
- Wound Care Research and DevelopmentMölnlycke Health Care ABGothenburgSweden
| |
Collapse
|
3
|
van Dijk MT, Talati A, Kashyap P, Desai K, Kelsall NC, Gameroff MJ, Aw N, Abraham E, Cullen B, Cha J, Anacker C, Weissman MM, Posner J. Dentate Gyrus Microstructure Is Associated With Resilience After Exposure to Maternal Stress Across Two Human Cohorts. Biol Psychiatry 2024; 95:27-36. [PMID: 37393047 PMCID: PMC10755082 DOI: 10.1016/j.biopsych.2023.06.026] [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: 01/04/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Maternal stress (MS) is a well-documented risk factor for impaired emotional development in offspring. Rodent models implicate the dentate gyrus (DG) of the hippocampus in the effects of MS on offspring depressive-like behaviors, but mechanisms in humans remain unclear. Here, we tested whether MS was associated with depressive symptoms and DG micro- and macrostructural alterations in offspring across 2 independent cohorts. METHODS We analyzed DG diffusion tensor imaging-derived mean diffusivity (DG-MD) and volume in a three-generation family risk for depression study (TGS; n = 69, mean age = 35.0 years) and in the Adolescent Brain Cognitive Development (ABCD) Study (n = 5196, mean age = 9.9 years) using generalized estimating equation models and mediation analysis. MS was assessed by the Parenting Stress Index (TGS) and a measure compiled from the Adult Response Survey from the ABCD Study. The Patient Health Questionnaire-9 and rumination scales (TGS) and the Child Behavior Checklist (ABCD Study) measured offspring depressive symptoms at follow-up. The Schedule for Affective Disorders and Schizophrenia-Lifetime interview was used to assign depression diagnoses. RESULTS Across cohorts, MS was associated with future symptoms and higher DG-MD (indicating disrupted microstructure) in offspring. Higher DG-MD was associated with higher symptom scores measured 5 years (in the TGS) and 1 year (in the ABCD Study) after magnetic resonance imaging. In the ABCD Study, DG-MD was increased in high-MS offspring who had depressive symptoms at follow-up, but not in offspring who remained resilient or whose mother had low MS. CONCLUSIONS Converging results across 2 independent samples extend previous rodent studies and suggest a role for the DG in exposure to MS and offspring depression.
Collapse
Affiliation(s)
- Milenna T van Dijk
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
| | - Ardesheer Talati
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
| | - Pratik Kashyap
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Karan Desai
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Nora C Kelsall
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
| | - Marc J Gameroff
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
| | - Natalie Aw
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Eyal Abraham
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jiook Cha
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
| | - Christoph Anacker
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Division of Systems Neuroscience, New York State Psychiatric Institute, New York, New York; Columbia University Institute for Developmental Sciences, New York, New York
| | - Myrna M Weissman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York; Columbia University Institute for Developmental Sciences, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| |
Collapse
|
4
|
Gefen A, Alves P, Beeckman D, Cullen B, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K. How Should Clinical Wound Care and Management Translate to Effective Engineering Standard Testing Requirements from Foam Dressings? Mapping the Existing Gaps and Needs. Adv Wound Care (New Rochelle) 2024; 13:34-52. [PMID: 35216532 PMCID: PMC10654650 DOI: 10.1089/wound.2021.0173] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 11/16/2021] [Accepted: 02/20/2022] [Indexed: 02/07/2023] Open
Abstract
Significance: Wounds of all types remain one of the most important, expensive, and common medical problems, for example, up to approximately two-thirds of the work time of community nurses is spent on wound management. Many wounds are treated by means of dressings. The materials used in a dressing, their microarchitecture, and how they are composed and constructed form the basis for the laboratory and clinical performances of any advanced dressing. Recent Advances: The established structure/function principle in material science is reviewed and analyzed in this article in the context of wound dressings. This principle states that the microstructure determines the physical, mechanical, and fluid transport and handling properties, all of which are critically important for, and relevant to the, adequate performances of wound dressings. Critical Issues: According to the above principle, once the clinical requirements for wound care and management are defined for a given wound type and etiology, it should be theoretically possible to translate clinically relevant characteristics of dressings into physical test designs resulting specific metrics of materials, mechanical, and fluid transport and handling properties, all of which should be determined to meet the clinical objectives and be measurable through standardized bench testing. Future Directions: This multidisciplinary review article, written by an International Wound Dressing Technology Expert Panel, discusses the translation of clinical wound care and management into effective, basic engineering standard testing requirements from wound dressings with respect to material types, microarchitecture, and properties, to achieve the desirable performance in supporting healing and improving the quality of life of patients.
Collapse
Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Porto, Portugal
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University and Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden
| | | | | | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Hospital Miller School of Medicine, Miami, Florida, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Nick Santamaria
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Sharpe
- Podiatry Department, Salford Royal NHS Foundation Trust, Salford Care Organisation, Salford, United Kingdom
| | - Terry Swanson
- Nurse Practitioner, Warrnambool, Victoria, Australia
| | - Kevin Woo
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
5
|
Santamaria N, Woo K, Beeckman D, Alves P, Cullen B, Gefen A, Lázaro‐Martínez JL, Lev‐Tov H, Najafi B, Sharpe A, Swanson T. Clinical performance characteristics for bordered foam dressings in the treatment of complex wounds: An international wound dressing technology expert panel review. Int Wound J 2023; 20:3467-3473. [PMID: 37139846 PMCID: PMC10588323 DOI: 10.1111/iwj.14217] [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: 02/24/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
The aim of this article is to identify and describe clinical practice performance characteristics for bordered foam dressings in the treatment of complex wounds. Our recently published systematic review of outcomes and applied measurement instruments for the use of bordered foam dressings in complex wounds has led to us identifying a range of important clinical and patient-centred issues related to this dressing class. Specifically, here, we focus on an overview of performance criteria in the areas of application, adhesion, exudate management and debridement functions of bordered foam dressings. Our hope is that by highlighting the clinical performance criteria, future testing standards for wound dressings will more closely match our clinical expectations and, thereby, assist clinicians to make better wound treatment choices based on meaningful and clinically relevant dressing product performance standards. complex wounds, complex wound care, treatment, bordered foam dressings, dressing performance.
Collapse
Affiliation(s)
- Nick Santamaria
- School of Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Kevin Woo
- School of NursingQueen's UniversityKingstonOntarioCanada
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT)University Centre for Nursing and MidwiferyGhentBelgium
- Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Swedish Centre for Skin and Wound Research, Faculty of Health and Medicine, School of Health SciencesÖrebro UniversityÖrebroSweden
- Research Unit of Plastic Surgery, Department of Clinical ResearchFaculty of Health SciencesOdenseDenmark
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI)DublinIreland
| | - Paulo Alves
- Wounds Research Lab ‐ Centre for Interdisciplinary Research in HealthUniversidade Catolica PortuguesaPortugal
| | | | - Amit Gefen
- Department of Biomedical EngineeringFaculty of Engineering, Tel Aviv UniversityTel AvivIsrael
| | | | - Hadar Lev‐Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Hospital Miller School of MedicineMiamiFloridaUSA
| | - Bijan Najafi
- Michael E. DeBakey Department of Surgery, Baylor College of MedicineInterdisciplinary Consortium on Advanced Motion Performance (iCAMP)HoustonTexasUSA
| | - Andrew Sharpe
- Podiatry DepartmentSalford Royal NHS Foundation Trust, Salford Care OrganisationSalfordUK
| | | |
Collapse
|
6
|
Forsyth L, Aman A, Cullen B, Graham N, Lyall DM, Lyall LM, Pell JP, Ward J, Smith DJ, Strawbridge RJ. Genetic architecture of DCC and influence on psychological, psychiatric and cardiometabolic traits in multiple ancestry groups in UK Biobank. J Affect Disord 2023; 339:943-953. [PMID: 37487843 DOI: 10.1016/j.jad.2023.07.052] [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: 03/17/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND People with severe mental illness have a higher risk of cardiometabolic disease than the general population. Traditionally attributed to sociodemographic, behavioural factors and medication effects, recent genetic studies have provided evidence of shared biological mechanisms underlying mental illness and cardiometabolic disease. We aimed to determine whether signals in the DCC locus, implicated in psychiatric and cardiometabolic traits, were shared or distinct. METHODS In UK Biobank, we systematically assessed genetic variation in the DCC locus for association with metabolic, cardiovascular and psychiatric-related traits in unrelated "white British" participants (N = 402,837). Logistic or linear regression were applied assuming an additive genetic model and adjusting for age, sex, genotyping chip and population structure. Bonferroni correction for the number of independent variants was applied. Conditional analyses (including lead variants as covariates) and trans-ancestry analyses were used to investigate linkage disequilibrium between signals. RESULTS Significant associations were observed between DCC variants and smoking, anhedonia, body mass index (BMI), neuroticism and mood instability. Conditional analyses and linkage disequilibrium structure suggested signals for smoking and BMI were distinct from each other and the mood traits, whilst individual mood traits were inter-related in a complex manner. LIMITATIONS Restricting analyses in non-"white British" individuals to the phenotypes significant in the "white British" sample is not ideal, but the smaller samples sizes restricted the phenotypes possible to analyse. CONCLUSIONS Genetic variation in the DCC locus had distinct effects on BMI, smoking and mood traits, and therefore is unlikely to contribute to shared mechanisms underpinning mental and cardiometabolic traits.
Collapse
Affiliation(s)
- Lewis Forsyth
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Alisha Aman
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Nicholas Graham
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Laura M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Joey Ward
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Daniel J Smith
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh E10 5HF, UK
| | - Rona J Strawbridge
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; Health Data Research, Glasgow G12 8RZ, UK; Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm 171 76, Sweden.
| |
Collapse
|
7
|
Ward J, Lyall LM, Cullen B, Strawbridge RJ, Zhu X, Stanciu I, Aman A, Niedzwiedz CL, Anderson J, Bailey MES, Lyall DM, Pell JP. Consistent effects of the genetics of happiness across the lifespan and ancestries in multiple cohorts. Sci Rep 2023; 13:17262. [PMID: 37828061 PMCID: PMC10570373 DOI: 10.1038/s41598-023-43193-9] [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: 02/23/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023] Open
Abstract
Happiness is a fundamental human affective trait, but its biological basis is not well understood. Using a novel approach, we construct LDpred-inf polygenic scores of a general happiness measure in 2 cohorts: the Adolescent Brain Cognitive Development (ABCD) cohort (N = 15,924, age range 9.23-11.8 years), the Add Health cohort (N = 9129, age range 24.5-34.7) to determine associations with several well-being and happiness measures. Additionally, we investigated associations between genetic scores for happiness and brain structure in ABCD (N = 9626, age range (8.9-11) and UK Biobank (N = 16,957, age range 45-83). We detected significant (p.FDR < 0.05) associations between higher genetic scores vs. several well-being measures (best r2 = 0.019) in children of multiple ancestries in ABCD and small yet significant correlations with a happiness measure in European participants in Add Health (r2 = 0.004). Additionally, we show significant associations between lower genetic scores for happiness with smaller structural brain phenotypes in a white British subsample of UK Biobank and a white sub-sample group of ABCD. We demonstrate that the genetic basis for general happiness level appears to have a consistent effect on happiness and wellbeing measures throughout the lifespan, across multiple ancestral backgrounds, and multiple brain structures.
Collapse
Affiliation(s)
- Joey Ward
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Laura M Lyall
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Rona J Strawbridge
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Health Data Research UK, Glasgow, UK
| | - Xingxing Zhu
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Ioana Stanciu
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Alisha Aman
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Claire L Niedzwiedz
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Jana Anderson
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Mark E S Bailey
- School of Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| |
Collapse
|
8
|
Campbell T, Cullen B. Estimating the effect of physical activity on cognitive function within the UK Biobank cohort. Int J Epidemiol 2023; 52:1592-1611. [PMID: 36749099 PMCID: PMC10555922 DOI: 10.1093/ije/dyad009] [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: 05/27/2022] [Accepted: 01/25/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Physical activity (PA) has been associated with benefits for cognitive function (CF), but previous estimates of the strength of this relationship may have been biased due to limitations in statistical modelling practices that are common among observational studies. We aimed to address this by using a rigorously constructed conceptual causal model to guide an empirical analysis estimating the effect of PA on CF in the UK Biobank cohort of middle-aged and older adults. METHODS This study analysed a subsample of 334 227 adults from the UK Biobank prospective cohort study. PA was measured subjectively by self-report and by device using accelerometry, and CF was measured using objective cognitive tests. Composite CF measures were derived to represent general and domain-specific performance. Effect coefficients were estimated using regression models, adjusting for a wide range of confounders specified by the assumed causal model, including genetic risk factors, and relevant health, sociodemographic and behavioural variables from across the lifespan. RESULTS Results indicated very small effect sizes (standardized mean difference estimates all <0.01) of inconsistent direction, for both cross-sectional and longitudinal analyses. CONCLUSIONS The expected protective effect of PA on CF was not observed. This may reflect selection bias within UK Biobank, or the relatively young age of the sample at follow-up.
Collapse
Affiliation(s)
- Thomas Campbell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- NHS Lanarkshire Neuropsychology Service, Monklands Hospital, Airdrie, UK
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
9
|
Ward J, Le NQ, Suryakant S, Brody JA, Amouyel P, Boland A, Bown R, Cullen B, Debette S, Deleuze JF, Emmerich J, Graham N, Germain M, Anderson JJ, Pell JP, Lyall DM, Lyall LM, Smith DJ, Wiggins KL, Soria JM, Souto JC, Morange PE, Smith NL, Trégouët DA, Sabater-Lleal M, Strawbridge RJ. Polygenic risk of major depressive disorder as a risk factor for venous thromboembolism. Blood Adv 2023; 7:5341-5350. [PMID: 37399490 PMCID: PMC10506044 DOI: 10.1182/bloodadvances.2023010562] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/17/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SCZ) are associated with an increased risk of cardiovascular diseases, including venous thromboembolism (VTE). The reasons for this are complex and include obesity, smoking, and use of hormones and psychotropic medications. Genetic studies have increasingly provided evidence of the shared genetic risk of psychiatric and cardiometabolic illnesses. This study aimed to determine whether a genetic predisposition to MDD, BD, or SCZ is associated with an increased risk of VTE. Genetic correlations using the largest genome-wide genetic meta-analyses summary statistics for MDD, BD, and SCZ (Psychiatric Genetics Consortium) and a recent genome-wide genetic meta-analysis of VTE (INVENT Consortium) demonstrated a positive association between VTE and MDD but not BD or SCZ. The same summary statistics were used to construct polygenic risk scores for MDD, BD, and SCZ in UK Biobank participants of self-reported White British ancestry. These were assessed for impact on self-reported VTE risk (10 786 cases, 285 124 controls), using logistic regression, in sex-specific and sex-combined analyses. We identified significant positive associations between polygenic risk for MDD and the risk of VTE in men, women, and sex-combined analyses, independent of the known risk factors. Secondary analyses demonstrated that this association was not driven by those with lifetime experience of mental illness. Meta-analyses of individual data from 6 additional independent cohorts replicated the sex-combined association. This report provides evidence for shared biological mechanisms leading to MDD and VTE and suggests that, in the absence of genetic data, a family history of MDD might be considered when assessing the risk of VTE.
Collapse
Affiliation(s)
- Joey Ward
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ngoc-Quynh Le
- Genomics of Complex Disease Unit, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Suryakant Suryakant
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Philippe Amouyel
- University of Lille, INSERM, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE-Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, Lille, France
| | - Anne Boland
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, Evry, France
- Laboratory of Excellence in Medical Genomics, GENMED, Evry, France
| | - Rosemary Bown
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Stéphanie Debette
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Jean-François Deleuze
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine, Evry, France
- Laboratory of Excellence in Medical Genomics, GENMED, Evry, France
- Centre d’Etude du Polymorphisme Humain, Fondation Jean Dausset, Paris, France
| | - Joseph Emmerich
- Department of Vascular Medicine, Paris Saint-Joseph Hospital Group, University of Paris, Paris, France
- UMR1153, INSERM CRESS, Paris, France
| | - Nicholas Graham
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Marine Germain
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Jana J. Anderson
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Donald M. Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Laura M. Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Laboratory of Excellence in Medical Genomics, GENMED, Evry, France
| | - Daniel J. Smith
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - José Manuel Soria
- Genomics of Complex Disease Unit, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Juan Carlos Souto
- Unitat d’Hemostàsia i Trombosi, Institut d’Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pierre-Emmanuel Morange
- Aix-Marseille University, INSERM, INRAE, Centre de Recherche en CardioVasculaire et Nutrition, Laboratory of Haematology, CRB Assistance Publique – Hôpitaux de Marseille, HemoVasc, Marseille, France
| | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle, WA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
- Department of Veterans Affairs Office of Research and Development, Seattle Epidemiologic Research and Information Center, Seattle, WA
| | - David-Alexandre Trégouët
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Maria Sabater-Lleal
- Genomics of Complex Disease Unit, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Rona J. Strawbridge
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Health Data Research UK, Glasgow, United Kingdom
| |
Collapse
|
10
|
Jamieson M, McClelland H, Goudie N, McFarlane J, Cullen B, Lennon M, Brewster S, Stanley B, McConnachie A, Evans J. AppReminders - a pilot feasibility randomized controlled trial of a memory aid app for people with acquired brain injury. Neuropsychol Rehabil 2023:1-37. [PMID: 37310032 DOI: 10.1080/09602011.2023.2220969] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Mobile phone reminding apps can be used by people with acquired brain injury (ABI) to compensate for memory impairments. This pilot feasibility trial aimed to establish the feasibility of a randomized controlled trial comparing reminder apps in an ABI community treatment setting. Adults with ABI and memory difficulty who completed the three-week baseline were randomized (n = 29) and allocated to Google Calendar or ApplTree app. Those who attended an intervention session (n = 21) watched a 30-minute video tutorial of the app then completed reminder setting assignments to ensure they could use the app. Guidance was given if needed from a clinician or researcher. Those who passed the app assignments (n = 19) completed a three-week follow up. Recruitment was lower than target (n = 50), retention rate was 65.5%, adherence rate was 73.7%. Qualitative feedback highlighted issues that may impact usability of reminding apps introduced within community brain injury rehabilitation. Feasibility results indicate a full trial would require 72 participants to demonstrate the minimally clinically important efficacy difference between apps, should a difference exist. Most participants (19 of 21) given an app could learn to use it with the short tutorial. Design features implemented in ApplTree have potential to improve the uptake and utility of reminding apps.
Collapse
Affiliation(s)
- Matthew Jamieson
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Human Computer Interaction, Department of Computing Science, University of Glasgow, Glasgow, UK
| | | | - Nicola Goudie
- Community Treatment Centre for Brain Injury, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jean McFarlane
- Acquired Brain Injury (ABI) Service, West Dunbartonshire HSPC, Dumbarton, UK
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marilyn Lennon
- Computer and Information Science, University of Strathclyde, Glasgow, UK
| | - Stephen Brewster
- Human Computer Interaction, Department of Computing Science, University of Glasgow, Glasgow, UK
| | - Bethany Stanley
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Jonathan Evans
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
11
|
Cullen B, Gameroff MJ, Ward J, Bailey MES, Lyall DM, Lyall LM, MacSweeney N, Murphy E, Sangha N, Shen X, Strawbridge RJ, van Dijk MT, Zhu X, Smith DJ, Talati A, Whalley HC, Cavanagh J, Weissman MM. Cognitive Function in People With Familial Risk of Depression. JAMA Psychiatry 2023; 80:610-620. [PMID: 37074691 PMCID: PMC10116387 DOI: 10.1001/jamapsychiatry.2023.0716] [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] [Received: 10/04/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023]
Abstract
Importance Cognitive impairment in depression is poorly understood. Family history of depression is a potentially useful risk marker for cognitive impairment, facilitating early identification and targeted intervention in those at highest risk, even if they do not themselves have depression. Several research cohorts have emerged recently that enable findings to be compared according to varying depths of family history phenotyping, in some cases also with genetic data, across the life span. Objective To investigate associations between familial risk of depression and cognitive performance in 4 independent cohorts with varied depth of assessment, using both family history and genetic risk measures. Design, Setting, and Participants This study used data from the Three Generations at High and Low Risk of Depression Followed Longitudinally (TGS) family study (data collected from 1982 to 2015) and 3 large population cohorts, including the Adolescent Brain Cognitive Development (ABCD) study (data collected from 2016 to 2021), National Longitudinal Study of Adolescent to Adult Health (Add Health; data collected from 1994 to 2018), and UK Biobank (data collected from 2006 to 2022). Children and adults with or without familial risk of depression were included. Cross-sectional analyses were conducted from March to June 2022. Exposures Family history (across 1 or 2 prior generations) and polygenic risk of depression. Main Outcomes and Measures Neurocognitive tests at follow-up. Regression models were adjusted for confounders and corrected for multiple comparisons. Results A total of 57 308 participants were studied, including 87 from TGS (42 [48%] female; mean [SD] age, 19.7 [6.6] years), 10 258 from ABCD (4899 [48%] female; mean [SD] age, 12.0 [0.7] years), 1064 from Add Health (584 [49%] female; mean [SD] age, 37.8 [1.9] years), and 45 899 from UK Biobank (23 605 [51%] female; mean [SD] age, 64.0 [7.7] years). In the younger cohorts (TGS, ABCD, and Add Health), family history of depression was primarily associated with lower performance in the memory domain, and there were indications that this may be partly associated with educational and socioeconomic factors. In the older UK Biobank cohort, there were associations with processing speed, attention, and executive function, with little evidence of education or socioeconomic influences. These associations were evident even in participants who had never been depressed themselves. Effect sizes between familial risk of depression and neurocognitive test performance were largest in TGS; the largest standardized mean differences in primary analyses were -0.55 (95% CI, -1.49 to 0.38) in TGS, -0.09 (95% CI, -0.15 to -0.03) in ABCD, -0.16 (95% CI, -0.31 to -0.01) in Add Health, and -0.10 (95% CI, -0.13 to -0.06) in UK Biobank. Results were generally similar in the polygenic risk score analyses. In UK Biobank, several tasks showed statistically significant associations in the polygenic risk score analysis that were not evident in the family history models. Conclusions and Relevance In this study, whether assessed by family history or genetic data, depression in prior generations was associated with lower cognitive performance in offspring. There are opportunities to generate hypotheses about how this arises through genetic and environmental determinants, moderators of brain development and brain aging, and potentially modifiable social and lifestyle factors across the life span.
Collapse
Affiliation(s)
- Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Marc J. Gameroff
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York
| | - Joey Ward
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Mark E. S. Bailey
- School of Molecular Biosciences, University of Glasgow, Glasgow, United Kingdom
| | - Donald M. Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Laura M. Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Niamh MacSweeney
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Eleanor Murphy
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York
| | - Natasha Sangha
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Xueyi Shen
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Rona J. Strawbridge
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Milenna T. van Dijk
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York
| | - Xingxing Zhu
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Daniel J. Smith
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Ardesheer Talati
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York
| | - Heather C. Whalley
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathan Cavanagh
- School of Infection and Immunity, University of Glasgow, Glasgow, United Kingdom
| | - Myrna M. Weissman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York
- Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
12
|
Lyall LM, Sangha N, Zhu X, Lyall DM, Ward J, Strawbridge RJ, Cullen B, Smith DJ. Subjective and objective sleep and circadian parameters as predictors of depression-related outcomes: A machine learning approach in UK Biobank. J Affect Disord 2023; 335:83-94. [PMID: 37156273 DOI: 10.1016/j.jad.2023.04.138] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/25/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Sleep and circadian disruption are associated with depression onset and severity, but it is unclear which features (e.g., sleep duration, chronotype) are important and whether they can identify individuals showing poorer outcomes. METHODS Within a subset of the UK Biobank with actigraphy and mental health data (n = 64,353), penalised regression identified the most useful of 51 sleep/rest-activity predictors of depression-related outcomes; including case-control (Major Depression (MD) vs. controls; postnatal depression vs. controls) and within-case comparisons (severe vs. moderate MD; early vs. later onset, atypical vs. typical symptoms; comorbid anxiety; suicidality). Best models (of lasso, ridge, and elastic net) were selected based on Area Under the Curve (AUC). RESULTS For MD vs. controls (n(MD) = 24,229; n(control) = 40,124), lasso AUC was 0.68, 95 % confidence interval (CI) 0.67-0.69. Discrimination was reasonable for atypical vs. typical symptoms (n(atypical) = 958; n(typical) = 18,722; ridge: AUC 0.74, 95 % CI 0.71-0.77) but poor for remaining models (AUCs 0.59-0.67). Key predictors across most models included: difficulty getting up, insomnia symptoms, snoring, actigraphy-measured daytime inactivity and lower morning activity (~8 am). In a distinct subset (n = 310,718), the number of these factors shown was associated with all depression outcomes. LIMITATIONS Analyses were cross-sectional and in middle-/older aged adults: comparison with longitudinal investigations and younger cohorts is necessary. DISCUSSION Sleep and circadian measures alone provided poor to moderate discrimination of depression outcomes, but several characteristics were identified that may be clinically useful. Future work should assess these features alongside broader sociodemographic, lifestyle and genetic features.
Collapse
Affiliation(s)
- Laura M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Natasha Sangha
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Xingxing Zhu
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joey Ward
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rona J Strawbridge
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Health Data Research, UK; Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
13
|
Rose AE, Cullen B, Crawford S, Evans JJ. A systematic review of mood and depression measures in people with severe cognitive and communication impairments following acquired brain injury. Clin Rehabil 2023; 37:679-700. [PMID: 36380679 PMCID: PMC10041571 DOI: 10.1177/02692155221139023] [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: 11/17/2022]
Abstract
AIM A systematic review to identify which mood and depression measures are valid for use with people with severe cognitive and communication impairments following severe acquired brain injury. METHOD A systematic search of Cochrane, Web of Science, Ovid, and EBSCOhost was performed in March 2020, July 2021, and September 2022. The search focused on self-report and observer-rated assessment tools used to assess mood, depression, and/or distress in those described as having a severe acquired brain injury. Psychometric properties were extracted using the Consensus-based standards for the selection of health measurement instruments (COSMIN) risk of bias checklist. Qualitative synthesis was performed on extracted patient data. RESULTS Nineteen papers detailing the psychometric properties of 25 measures were included, involving 2,914 participants. Nine papers provided details confirming the severity of participants' cognitive and communication impairments. The remaining papers described including severely injured participants but provided limited details so that precise level of severity could not be confirmed. Only one paper showed evidence of adequate psychometric properties and included those with severe cognitive impairments in a study of two observer-rated measures, the Stroke Aphasia Depression Questionnaire (10 items) and the Aphasia Depression Rating Scale. CONCLUSIONS Due to the exclusion of individuals with severe cognitive and communication consequences following brain injury, no studies using self-report measures showed adequate validity evidence to recommend their use in this population. A small study using two observer-rated scales included those with severe cognitive impairments and showed satisfactory evidence that these measures can be validly used with this population.
Collapse
Affiliation(s)
- Alexandra E Rose
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Psychology, 59386Royal Hospital for Neuro-disability, London, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Crawford
- Department of Psychology, 59386Royal Hospital for Neuro-disability, London, UK
| | - Jonathan J Evans
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
14
|
Raepsaet C, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K, Beeckman D. The development of a core outcome set for clinical effectiveness studies of bordered foam dressings in the treatment of complex wounds. J Tissue Viability 2023:S0965-206X(23)00046-3. [PMID: 37127485 DOI: 10.1016/j.jtv.2023.04.008] [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: 02/23/2023] [Revised: 04/05/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
AIM The aim of this project was to develop a core outcome set (COS) for clinical effectiveness studies of bordered foam dressings in the treatment of complex wounds. METHODS The research project followed the Core Outcome Measures in Effectiveness Trials (COMET) initiative and consisted of two phases. The first phase prepared the background and process, while the second phase had three steps: outcome list generation via systematic review and qualitative study, Delphi consensus study, and consensus meeting. The study has been registered in the Core Outcome Measures in Effectiveness Trials database. RESULTS The systematic review resulted in 82 outcomes and 20 additional outcomes were obtained during the interviews. After refinement, 111 panellists from 23 countries rated a list of 51 outcomes. In the following consensus meeting, six outcomes were prioritized to be included in the core outcome set. After the consensus meeting, a patient-reported outcome was added to the core outcome set. CONCLUSION The COS for evaluating the effectiveness of bordered foam dressings in treating complex wounds includes 7 outcomes: "ability to stay in place", "leakage", "pain", "dressing related periwound skin changes", "change in wound size over time", and "overall satisfaction". These identified outcomes are correlated with contemporary bioengineering testing and evaluation methods for dressing performance, which underpins the need for a close multidisciplinary collaboration to advance the field of wound dressings. The outcome 'overall satisfaction' reflects the impact of complex wounds and their treatment on a patient's daily life. The use of these outcomes is recommended to improve data synthesis and promote evidence-based practice. Future developments in COS development involve creating measurement instruments and relevant endpoints for these outcomes.
Collapse
Affiliation(s)
- Charlotte Raepsaet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Paulo Alves
- Wounds Research Lab - Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Porto, Portugal
| | | | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Hadar Lev-Tov
- University of Miami Hospital Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, FL, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nick Santamaria
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Sharpe
- Podiatry Department, Salford Royal NHS Foundation Trust, Salford Care Organisation, Salford, United Kingdom
| | | | - Kevin Woo
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, Faculty of Health and Medicine, School of Health Sciences, Örebro University, Örebro, Sweden; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| |
Collapse
|
15
|
Cullen B, Gefen A. The biological and physiological impact of the performance of wound dressings. Int Wound J 2023; 20:1292-1303. [PMID: 36110054 PMCID: PMC10031231 DOI: 10.1111/iwj.13960] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 08/03/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022] Open
Abstract
Chronic wounds affect millions globally and are a huge financial burden. Whilst there are many wound dressings commercially available to manage these wounds, the complexity of the repair process makes it difficult to select the right dressing for the right wound at the right time. Thus, in this narrative review, we have examined reasons why wounds fail to heal, summarised the pathophysiology of the chronic wound environment and provided an evidence-based, clinically-relevant compilation of the published literature relevant to dressing design and evaluation. This has highlighted the need for a deeper understanding of wound exudates, how exudates change throughout the healing process, and how they are impacted by different dressing materials. Studies assessing biochemical and biophysical changes in exudates throughout the healing process are extremely valuable in this regard, enhancing both our understanding of the wound healing process and the ability to assess dressing performance. In addition, this knowledge allows us to replicate various wound conditions in the laboratory, and develop clinically-relevant models for testing current and new dressings, therefore providing a more comprehensive understanding of how and when they should be used. This approach makes the use of dressings more effective, thereby improving outcomes, and reducing the economic burden of chronic wounds.
Collapse
Affiliation(s)
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
16
|
Aman A, Slob EAW, Ward J, Cullen B, Graham N, Lyall DM, Sattar N, Strawbridge RJ. Investigating the potential impact of PCSK9-inhibitors on mood disorders using eQTL-based Mendelian randomization. PLoS One 2022; 17:e0279381. [PMID: 36580462 PMCID: PMC9799310 DOI: 10.1371/journal.pone.0279381] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022] Open
Abstract
Prescription of PCSK9-inhibitors has increased in recent years but not much is known about its off-target effects. PCSK9-expression is evident in non-hepatic tissues, notably the brain, and genetic variation in the PCSK9 locus has recently been shown to be associated with mood disorder-related traits. We investigated whether PCSK9 inhibition, proxied by a genetic reduction in expression of PCSK9 mRNA, might have a causal adverse effect on mood disorder-related traits. We used genetic variants in the PCSK9 locus associated with reduced PCSK9 expression (eQTLs) in the European population from GTEx v8 and examined the effect on PCSK9 protein levels and three mood disorder-related traits (major depressive disorder, mood instability, and neuroticism), using summary statistics from the largest European ancestry genome-wide association studies. We conducted summary-based Mendelian randomization analyses to estimate the causal effects, and attempted replication using data from eQTLGen, Brain-eMETA, and the CAGE consortium. We found that genetically reduced PCSK9 gene-expression levels were significantly associated with reduced PCSK9 protein levels but not with increased risk of mood disorder-related traits. Further investigation of nearby genes demonstrated that reduced USP24 gene-expression levels was significantly associated with increased risk of mood instability (p-value range = 5.2x10-5-0.03), and neuroticism score (p-value range = 2.9x10-5-0.02), but not with PCSK9 protein levels. Our results suggest that genetic variation in this region acts on mood disorders through a PCSK9-independent pathway, and therefore PCSK9-inhibitors are unlikely to have an adverse impact on mood disorder-related traits.
Collapse
Affiliation(s)
- Alisha Aman
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Eric A. W. Slob
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus University Rotterdam Institute for Behaviour and Biology, Erasmus School of Economics, Rotterdam, The Netherlands
| | - Joey Ward
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Breda Cullen
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Nicholas Graham
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Donald M. Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Rona J. Strawbridge
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
17
|
Hay R, Cullen B, Graham N, Lyall DM, Aman A, Pell JP, Ward J, Smith DJ, Strawbridge RJ. Genetic analysis of the PCSK9 locus in psychological, psychiatric, metabolic and cardiovascular traits in UK Biobank. Eur J Hum Genet 2022; 30:1380-1390. [PMID: 35501368 PMCID: PMC9712543 DOI: 10.1038/s41431-022-01107-9] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/11/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
The association between severe mental illness (SMI) and cardiovascular and metabolic disease (CMD) is poorly understood. PCSK9 is expressed in systems critical to both SMI and CMD and influences lipid homeostasis and brain function. We systematically investigated relationships between genetic variation within the PCSK9 locus and risk for both CMD and SMI. UK Biobank recruited ~500,000 volunteers and assessed a wide range of SMI and CMD phenotypes. We used genetic data from white British ancestry individuals of UK Biobank. Genetic association analyses were conducted in PLINK, with statistical significance defined by the number of independent SNPs. Conditional analyses and linkage disequilibrium assessed the independence of SNPs and the presence of multiple signals. Two genetic risk scores of lipid-lowering alleles were calculated and used as proxies for putative lipid-lowering effects of PCSK9. PCSK9 variants were associated with central adiposity, venous thrombosis embolism, systolic blood pressure, mood instability, and neuroticism (all p < 1.16 × 10-4). No secondary signals were identified. Conditional analyses and high linkage disequilibrium (r2 = 0.98) indicated that mood instability and central obesity may share a genetic signal. Genetic risk scores suggested that the lipid-lowering effects of PCSK9 may be causal for greater mood instability and higher neuroticism. This is the first study to implicate the PCSK9 locus in mood-disorder symptoms and related traits, as well as the shared pathology of SMI and CMD. PCSK9 effects on mood may occur via lipid-lowering mechanisms. Further work is needed to understand whether repurposing PCSK9-targeting therapies might improve SMI symptoms and prevent CMD.
Collapse
Affiliation(s)
- Rachel Hay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicholas Graham
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alisha Aman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
- Health Data Research UK, Glasgow, UK.
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
| |
Collapse
|
18
|
Sangha N, Lyall L, Wyse C, Cullen B, Whalley HC, Smith DJ. The nosological status of unipolar mania and hypomania within UK Biobank according to objective and subjective measures of diurnal rest and activity. Bipolar Disord 2022; 24:726-738. [PMID: 35656588 PMCID: PMC9796466 DOI: 10.1111/bdi.13237] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is uncertainty whether unipolar mania is a discrete sub-type of bipolar disorder. Disrupted rest/activity rhythms are a key feature of bipolar disorder (BD) but have not been well characterised in unipolar mania/hypomania (UM). We compared subjective and objective rest/activity patterns, demographic and mental health outcomes across BD, UM and control groups. METHODS UK residents aged 37-73 years were recruited into UK Biobank from 2006 to 2010. BD, UM and control groups were identified via a mental health questionnaire. Demographic, mental health and subjective sleep outcomes were self-reported. Accelerometery data were available for a subset of participants, and objective measures of sleep and activity were derived. RESULTS A greater proportion of males met UM criteria, and more females were in the BD group. Both BD and UM groups had poor mental health outcomes vs. controls. Objectively measured activity differed between all three groups: UM had highest levels of activity and BD lowest. The UM group had shorter sleep duration compared to controls. Subjective rest/activity measures showed that both mood disorder groups (compared to controls) had later chronotype preference, more disturbed sleep and increased difficulty getting up in the morning. However, the UM group were more likely to report an early chronotype compared to BD and control groups. CONCLUSIONS BD and UM share features in common, but key differences support the proposition that UM may be a distinct and more clinically homogenous disorder. UM was characterised by a higher proportion of males, early chronotype, increased activity and shorter sleep duration.
Collapse
Affiliation(s)
- Natasha Sangha
- Mental Health and Wellbeing, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Laura Lyall
- Mental Health and Wellbeing, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Cathy Wyse
- Department of BiologyMaynooth UniversityKildareIreland
| | - Breda Cullen
- Mental Health and Wellbeing, Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Heather C. Whalley
- Centre for Clinical Brain Sciences, Division of PsychiatryUniversity of EdinburghEdinburghUK
| | - Daniel J. Smith
- Centre for Clinical Brain Sciences, Division of PsychiatryUniversity of EdinburghEdinburghUK
| |
Collapse
|
19
|
Van Hoye A, Regan C, Lane A, Cullen B, Vuillemin A, Woods C. Sport federation investment in health promotion: program implementation and viability. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.341] [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: 11/14/2022] Open
Abstract
Abstract
Background
Researchers have called for a better recognition of the potential of sports clubs for health promotion (HP), but less is known on the support provided by sports federation. The present study analyses the the implementation of the Gaelic Athletics Association (GAA) Healthy Club Project, to investigate its organization’s viability.
Methods
A single case study was realized, based on observation, document analysis and interviews, to document the viable system model.
Results
Results have identified a three-level structure, where 6 employees at national level support the work of 28 volunteer’s county health and well-being officers and 439 clubs implicated. Strengths of the organization are the identification of a single national referent for clubs or county, the learning process and openness to novelty, as well as the enhanced workforce through county implication as role model. Challenges are the financial and human resources provision, the ability to implicate county and club board and the training in HP of volunteers. Interlevel relationship are supported by the creation of a community of practice and the centralization of the project at national level, but hindered by a clear definition of county tasks. The strengths of the controlling system include a steering committee implicating partners completing each other and the proper use of evaluation to build evidence on the project, where challenges remains in wider collaboration within the GAA.
Conclusions
The present work has underlined key scaling up factors of the HCP implementation to support its viability, which could be learnt from other sports federation implementing HP interventions.
Key messages
• Sports federation have a key role to play to support sports clubs to promote health, by developing specific programs.
• Health Promotion development in sports clubs has similar scaling up implementation factor than other public health interventions.
Collapse
Affiliation(s)
- A Van Hoye
- Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - C Regan
- Community and Health Department, Gaelic Athletic Association , Dublin, Ireland
| | - A Lane
- Technological University of the Shannon SHE Research Group, , Athlone, Ireland
| | - B Cullen
- Innovation and Research , Sport Ireland, Dublin, Ireland
| | - A Vuillemin
- Université Côte d'Azur LAHMESS, , France, France
| | - C Woods
- Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| |
Collapse
|
20
|
Reynolds B, O'Connell S, Cullen B. Validation of the Distress Thermometer in Parkinson's disease. Prog Neurol Psychiatry 2022. [DOI: 10.1002/pnp.769] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bronagh Reynolds
- Dr Reynolds is a Clinical Psychologist, South Ayrshire Community Mental Health Team, NHS Ayrshire & Arran, UK
| | - Susan O'Connell
- Dr O'Connell is a Consultant Clinical Psychologist, Department of Neuropsychology, Institute of Neurosciences, NHS Greater Glasgow & Clyde, UK
| | - Breda Cullen
- Dr Cullen is a Senior Lecturer, School of Health and Wellbeing, University of Glasgow, UK
| |
Collapse
|
21
|
Raepsaet C, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K, Beeckman D. Study protocol for the development of a core outcome set (COS) for clinical effectiveness trials of bordered foam dressings in the treatment of complex wounds. J Tissue Viability 2022; 31:625-629. [DOI: 10.1016/j.jtv.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
|
22
|
Lyall DM, Quinn T, Lyall LM, Ward J, Anderson JJ, Smith DJ, Stewart W, Strawbridge RJ, Bailey MES, Cullen B. Quantifying bias in psychological and physical health in the UK Biobank imaging sub-sample. Brain Commun 2022; 4:fcac119. [PMID: 35651593 PMCID: PMC9150072 DOI: 10.1093/braincomms/fcac119] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/01/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022] Open
Abstract
UK Biobank is a prospective cohort study of around half-a-million general population participants, recruited between 2006 and 2010, with baseline studies at recruitment and multiple assessments since. From 2014 to date, magnetic resonance imaging (MRI) has been pursued in a participant sub-sample, with the aim to scan around n = 100k. This sub-sample is studied widely and therefore understanding its relative characteristics is important for future reports. We aimed to quantify psychological and physical health in the UK Biobank imaging sub-sample, compared with the rest of the cohort. We used t-tests and χ2 for continuous/categorical variables, respectively, to estimate average differences on a range of cognitive, mental and physical health phenotypes. We contrasted baseline values of participants who attended imaging (versus had not), and compared their values at the imaging visit versus baseline values of participants who were not scanned. We also tested the hypothesis that the associations of established risk factors with worse cognition would be underestimated in the (hypothesized) healthier imaging group compared with the full cohort. We tested these interactions using linear regression models. On a range of cognitive, mental health, cardiometabolic, inflammatory and neurological phenotypes, we found that 47 920 participants who were scanned by January 2021 showed consistent statistically significant 'healthy' bias compared with the ∼450 000 who were not scanned. These effect sizes were small to moderate based on Cohen's d/Cramer's V metrics (range = 0.02 to -0.21 for Townsend, the largest effect size). We found evidence of interaction, where stratified analysis demonstrated that associations of established cognitive risk factors were smaller in the imaging sub-sample compared with the full cohort. Of the ∼100 000 participants who ultimately will undergo MRI assessment within UK Biobank, the first ∼50 000 showed some 'healthy' bias on a range of metrics at baseline. Those differences largely remained at the subsequent (first) imaging visit, and we provide evidence that testing associations in the imaging sub-sample alone could lead to potential underestimation of exposure/outcome estimates.
Collapse
Affiliation(s)
- Donald M. Lyall
- Institute of Health and Wellbeing, University of
Glasgow, 1 Lilybank Gardens, Scotland G12 8RZ, UK
| | - Terry Quinn
- Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Scotland, UK
| | - Laura M. Lyall
- Institute of Health and Wellbeing, University of
Glasgow, 1 Lilybank Gardens, Scotland G12 8RZ, UK
| | - Joey Ward
- Institute of Health and Wellbeing, University of
Glasgow, 1 Lilybank Gardens, Scotland G12 8RZ, UK
| | - Jana J. Anderson
- Institute of Health and Wellbeing, University of
Glasgow, 1 Lilybank Gardens, Scotland G12 8RZ, UK
| | - Daniel J. Smith
- Division of Psychiatry, University of
Edinburgh, Edinburgh, Scotland, UK
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth
University Hospital, Scotland, UK
| | - Rona J. Strawbridge
- Institute of Health and Wellbeing, University of
Glasgow, 1 Lilybank Gardens, Scotland G12 8RZ, UK
- Cardiovascular Medicine Unit, Department of Medicine
Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mark E. S. Bailey
- School of Life Sciences, College of Medical,
Veterinary and Life Sciences, University of Glasgow, Glasgow,
Scotland, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of
Glasgow, 1 Lilybank Gardens, Scotland G12 8RZ, UK
| |
Collapse
|
23
|
Raepsaet C, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K, Beeckman D. Clinical research on the use of bordered foam dressings in the treatment of complex wounds: A systematic review of reported outcomes and applied measurement instruments. J Tissue Viability 2022; 31:514-522. [DOI: 10.1016/j.jtv.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
|
24
|
De Kock JH, Latham HA, Cowden RG, Cullen B, Narzisi K, Jerdan S, Munoz SA, Leslie SJ, Stamatis A, Eze J. Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial. JMIR Ment Health 2022; 9:e34002. [PMID: 35044927 PMCID: PMC8982650 DOI: 10.2196/34002] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time. OBJECTIVE This study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic. METHODS NHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6). RESULTS Retention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI -0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI -0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI -0.11 to 0.46), and mental well-being (vs MPS: Cohen d=-0.04, 95% CI -0.62 to -0.08; vs NHSWBP: Cohen d=-0.15, 95% CI -0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group. CONCLUSIONS Our analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments. TRIAL REGISTRATION ISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122.
Collapse
Affiliation(s)
- Johannes H De Kock
- Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, School of Health, University of the Highlands and Islands, Inverness, United Kingdom.,Department of Clinical Psychology, New Craigs Psychiatric Hospital, Inverness, United Kingdom
| | | | - Richard G Cowden
- Human Flourishing Program, Harvard University, Cambridge, MA, United States
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Katia Narzisi
- Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, School of Health, University of the Highlands and Islands, Inverness, United Kingdom
| | - Shaun Jerdan
- Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, School of Health, University of the Highlands and Islands, Inverness, United Kingdom
| | - Sarah-Anne Munoz
- Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, School of Health, University of the Highlands and Islands, Inverness, United Kingdom
| | - Stephen J Leslie
- Cardiac Unit, Raigmore Hospital, NHS Highland, Inverness, United Kingdom
| | - Andreas Stamatis
- Exercise and Nutrition Sciences, State University of New York, Plattsburgh, NY, United States
| | - Jude Eze
- Epidemiology Research Unit, Department of Veterinary and Animal Science, Northern Faculty, Scotland's Rural College, Inverness, United Kingdom
| |
Collapse
|
25
|
Jamieson M, Lennon M, Cullen B, Brewster S, Evans J. Supporting People with Acquired Brain Injury to Use a Reminding App; Narrow-deep vs. Broad-shallow User Interfaces. ACM Trans Access Comput 2022. [DOI: 10.1145/3501275] [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: 10/18/2022]
Abstract
People with memory impairments following an acquired brain injury stand to benefit from smartphone apps as memory aids. Due, in part, to usability issues they use smartphone-based reminding less than the general population. Evidence suggests this group may benefit from user interface (UI) designs with more screens with less information per screen (narrow-deep UI) rather than fewer screens with more information per screen (broad-shallow UI). This study compared the difference in speed, accuracy, guidance needed, and task load for 32 people with acquired brain injury when setting reminders using narrow-deep and broad-shallow UI. They were also given cognitive assessments (measuring selective attention, executive functioning, and overall executive and memory ability) and interviewed about their UI preference. There was a significant difference in accuracy; participants were less accurate (they made two more errors on average for every three reminders set) using a broad-shallow compared to narrow-deep UI. The reason for this difference was that participants omitted more information when using broad-shallow UI. There were no differences in speed, guidance required, and overall task-load. Participants with better selective attention and more experience with smartphones benefited the most from narrow-deep UI compared to broad-shallow UI. Most participants preferred one UI over the other. Those who preferred narrow-deep found it easier to use, that they missed less information and liked having one piece of information at a time. Those who preferred broad-shallow found it easier to review the information and felt less likely to lose track. The findings can inform that implementation of UI choices to make apps more accessible for those with cognitive impairments.
Collapse
Affiliation(s)
- Matthew Jamieson
- University of Glasgow College of Medical Veterinary and Life Sciences, Institute of Health and Wellbeing
| | | | - Breda Cullen
- University of Glasgow College of Medical Veterinary and Life Sciences, Institute of Health and Wellbeing
| | | | - Jonathan Evans
- University of Glasgow College of Medical Veterinary and Life Sciences, Institute of Health and Wellbeing
| |
Collapse
|
26
|
De Kock JH, Ann Latham H, Cowden RG, Cullen B, Narzisi K, Jerdan S, Muñoz SA, Leslie SJ, McNamara N, Boggon A, Humphry RW. The mental health of NHS staff during the COVID-19 pandemic: two-wave Scottish cohort study. BJPsych Open 2022; 8:e23. [PMID: 35043077 PMCID: PMC8755549 DOI: 10.1192/bjo.2021.1079] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/17/2021] [Revised: 11/01/2021] [Accepted: 12/06/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Health and social care workers (HSCWs) are at risk of experiencing adverse mental health outcomes (e.g. higher levels of anxiety and depression) because of the COVID-19 pandemic. This can have a detrimental effect on quality of care, the national response to the pandemic and its aftermath. AIMS A longitudinal design provided follow-up evidence on the mental health (changes in prevalence of disease over time) of NHS staff working at a remote health board in Scotland during the COVID-19 pandemic, and investigated the determinants of mental health outcomes over time. METHOD A two-wave longitudinal study was conducted from July to September 2020. Participants self-reported levels of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and mental well-being (Warwick-Edinburgh Mental Well-being Scale) at baseline and 1.5 months later. RESULTS The analytic sample of 169 participants, working in community (43%) and hospital (44%) settings, reported substantial levels of depression and anxiety, and low mental well-being at baseline (depression, 30.8%; anxiety, 20.1%; well-being, 31.9%). Although mental health remained mostly constant over time, the proportion of participants meeting the threshold for anxiety increased to 27.2% at follow-up. Multivariable modelling indicated that working with, and disruption because of, COVID-19 were associated with adverse mental health changes over time. CONCLUSIONS HSCWs working in a remote area with low COVID-19 prevalence reported substantial levels of anxiety and depression, similar to those working in areas with high COVID-19 prevalence. Efforts to support HSCW mental health must remain a priority, and should minimise the adverse effects of working with, and disruption caused by, the COVID-19 pandemic.
Collapse
Affiliation(s)
- Johannes H De Kock
- Institute for Health Research and Innovation, University of the Highlands and Islands; and Department of Clinical Psychology, New Craigs Psychiatric Hospital, NHS Highland, UK
| | | | - Richard G Cowden
- Institute for Quantitative Social Science, Harvard University, USA
| | - Breda Cullen
- Institute of Health & Wellbeing, University of Glasgow, UK
| | - Katia Narzisi
- Institute for Health Research and Innovation, University of the Highlands and Islands, UK
| | - Shaun Jerdan
- Institute for Health Research and Innovation, University of the Highlands and Islands, UK
| | - Sarah-Anne Muñoz
- Institute for Health Research and Innovation, University of the Highlands and Islands, UK
| | - Stephen J Leslie
- Institute for Health Research and Innovation, University of the Highlands and Islands; and Cardiac Unit, Raigmore Hospital, NHS Highland, UK
| | - Neil McNamara
- Department of Psychiatry, New Craigs Psychiatric Hospital, NHS Highland, UK
| | - Adam Boggon
- University College London Medical School, Royal Free Hospital, UK
| | | |
Collapse
|
27
|
Zhu X, Ward J, Cullen B, Lyall DM, Strawbridge RJ, Lyall LM, Smith DJ. Phenotypic and genetic associations between anhedonia and brain structure in UK Biobank. Transl Psychiatry 2021; 11:395. [PMID: 34282121 PMCID: PMC8289859 DOI: 10.1038/s41398-021-01522-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023] Open
Abstract
Anhedonia is a core symptom of multiple psychiatric disorders and has been associated with alterations in brain structure. Genome-wide association studies suggest that anhedonia is heritable, with a polygenic architecture, but few studies have explored the association between genetic loading for anhedonia-indexed by polygenic risk scores for anhedonia (PRS-anhedonia)-and structural brain imaging phenotypes. Here, we investigated how anhedonia and PRS-anhedonia were associated with brain structure within the UK Biobank cohort. Brain measures (including total grey/white matter volumes, subcortical volumes, cortical thickness (CT) and white matter integrity) were analysed using linear mixed models in relation to anhedonia and PRS-anhedonia in 19,592 participants (9225 males; mean age = 62.6 years, SD = 7.44). We found that state anhedonia was significantly associated with reduced total grey matter volume (GMV); increased total white matter volume (WMV); smaller volumes in thalamus and nucleus accumbens; reduced CT within the paracentral cortex, the opercular part of inferior frontal gyrus, precentral cortex, insula and rostral anterior cingulate cortex; and poorer integrity of many white matter tracts. PRS-anhedonia was associated with reduced total GMV; increased total WMV; reduced white matter integrity; and reduced CT within the parahippocampal cortex, superior temporal gyrus and insula. Overall, both state anhedonia and PRS-anhedonia were associated with individual differences in multiple brain structures, including within reward-related circuits. These associations may represent vulnerability markers for psychopathology relevant to a range of psychiatric disorders.
Collapse
Affiliation(s)
- Xingxing Zhu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Health Data Research (HDR), Glasgow, UK
| | - Laura M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, UK
| |
Collapse
|
28
|
Chan CP, Arnold AD, Howard JP, Shun-Shin MJ, Maclean E, Cullen B, Chow J, Lim PB, Ng FS, Linton NWF, Peters NS, Schilling RJ, Kanagaratnam P, Francis DP, Whinnett ZI. Explanation-visualised deep learning model for accessory pathway localisation using 12-lead electrocardiography. Europace 2021. [DOI: 10.1093/europace/euab116.510] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation Imperial Centre of Research Excellence
Background/Introduction
ECG algorithms for identifying accessory pathway (AP) locations are inaccurate and difficult to use. Human expert interpretation is poorly reproducible. Artificial intelligence (AI) techniques such as machine learning can improve accuracy in classification tasks by eschewing theory-driven predictions. More reproducible and accurate AP localisation could shorten procedure time and personalise ablation consent.
Purpose
We developed a neural network to perform AP localisation using 12-lead ECGs. Its decision-making process was analysed to enable explainability of the neural network.
Methods
A convolutional neural network was trained on raw, digital, intra-procedural 12-lead ECGs of patients with manifest APs who underwent successful ablation. ECGs were labelled with AP locations as left-sided, septal or right-sided using procedure reports, fluoroscopy and electro-anatomical maps. Accuracy of the neural network was assessed via 4-fold cross-validation and was compared to the Arruda algorithm. Five cardiologists were also assessed for their accuracy in determining locations in sub-groups of cases. The neural network was retrospectively analysed to identify areas of ECGs most influential to its predictions using importance mapping.
Results
In 156 cases, accuracy of the neural network (92.9%) was significantly higher than the Arruda algorithm (76.9%; p < 0.0001) and all five cardiologists (37.5% to 65.9%; p = 0.0001 to 0.0290). Importance mapping demonstrated that the QRS complexes of leads aVL and V1 were perceived as most influential, indicating interrogation of the lateral and anterior-posterior axes respectively.
The figure shows (A) architecture of the neural network, (B) accuracy of the neural network, Arruda algorithm and five cardiologists, (*, p = 0.05 – 0.01; **, p = 0.01 – 0.001; ***, p = 0.001 - 0.0001; ****, p < 0.0001; as compared to the neural network) and (C) example importance maps for 12-lead ECGs of left-sided, septal and right-sided APs (in order from left to right), with darker regions corresponding to greater relative importance.
Conclusion
AI ECG interpretation allows accurate, reproducible prediction of AP locations, superior to conventional algorithms and human interpretation. Although AI decision-making is thought of as a ‘black box’, explanation visualisation techniques such as importance mapping allow humans to understand aspects of how a neural network make decisions. A prospectively validated neural network could be integrated into clinical practice to improve pre-procedural AP localisation. Abstract Figure. Summary of results
Collapse
Affiliation(s)
- CP Chan
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - AD Arnold
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - JP Howard
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - MJ Shun-Shin
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - E Maclean
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - B Cullen
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - J Chow
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - PB Lim
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - FS Ng
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - NWF Linton
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - NS Peters
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - RJ Schilling
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kanagaratnam
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - DP Francis
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - ZI Whinnett
- National Heart and Lung Institute Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
29
|
Bogie J, Fleming M, Cullen B, Mackay D, Pell JP. Using graphic modelling to identify modifiable mediators of the association between area-based deprivation at birth and offspring unemployment. PLoS One 2021; 16:e0249258. [PMID: 33788869 PMCID: PMC8011734 DOI: 10.1371/journal.pone.0249258] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Deprivation can perpetuate across generations; however, the causative pathways are not well understood. Directed acyclic graphs (DAG) with mediation analysis can help elucidate and quantify complex pathways in order to identify modifiable factors at which to target interventions. METHODS AND FINDINGS We linked ten Scotland-wide databases (six health and four education) to produce a cohort of 217,226 pupils who attended Scottish schools between 2009 and 2013. The DAG comprised 23 potential mediators of the association between area deprivation at birth and subsequent offspring 'not in education, employment or training' status, covering maternal, antenatal, perinatal and child health, school engagement, and educational factors. Analyses were performed using modified g-computation. Deprivation at birth was associated with a 7.3% increase in offspring 'not in education, employment or training'. The principal mediators of this association were smoking during pregnancy (natural indirect effect of 0·016, 95% CI 0·013, 0·019) and school absences (natural indirect effect of 0·021, 95% CI 0·018, 0·024), explaining 22% and 30% of the total effect respectively. The proportion of the association potentially eliminated by addressing these factors was 19% (controlled direct effect when set to non-smoker 0·058; 95% CI 0·053, 0·063) for smoking during pregnancy and 38% (controlled direct effect when set to no absences 0·043; 95% CI 0·037, 0·049) for school absences. CONCLUSIONS Combining a DAG with mediation analysis helped disentangle a complex public health problem and quantified the modifiable factors of maternal smoking and school absence that could be targeted for intervention. This study also demonstrates the general utility of DAGs in understanding complex public health problems.
Collapse
Affiliation(s)
- James Bogie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Breda Cullen
- Institute of Health and Wellbeing, Academic Centre, Gartnavel Royal Hospital, Glasgow, United Kingdom
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
30
|
Mawdsley E, Reynolds B, Cullen B. A systematic review of the effectiveness of machine learning for predicting psychosocial outcomes in acquired brain injury: Which algorithms are used and why? J Neuropsychol 2021; 15:319-339. [PMID: 33780595 DOI: 10.1111/jnp.12244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/14/2020] [Revised: 03/01/2021] [Indexed: 01/29/2023]
Abstract
Clinicians working in the field of acquired brain injury (ABI, an injury to the brain sustained after birth) are challenged to develop suitable care pathways for an individual client's needs. Being able to predict psychosocial outcomes after ABI would enable clinicians and service providers to make advance decisions and better tailor care plans. Machine learning (ML, a predictive method from the field of artificial intelligence) is increasingly used for predicting ABI outcomes. This review aimed to examine the efficacy of using ML to make psychosocial predictions in ABI, evaluate the methodological quality of studies, and understand researchers' rationale for their choice of ML algorithms. Nine studies were reviewed from five databases, predicting a range of psychosocial outcomes from stroke, traumatic brain injury, and concussion. Eleven types of ML were employed with a total of 75 ML models. Every model was evaluated as having high risk of bias, unable to provide adequate evidence for predictive performance due to poor methodological quality. Overall, there was limited rationale for the choice of ML algorithms and poor evaluation of the methodological limitations by study authors. Considerations for overcoming methodological shortcomings are discussed, along with suggestions for assessing the suitability of data and suitability of ML algorithms for different ABI research questions.
Collapse
Affiliation(s)
- Emma Mawdsley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, UK.,NHS Greater Glasgow and Clyde, UK
| | - Bronagh Reynolds
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, UK.,NHS Ayrshire and Arran, UK
| | - Breda Cullen
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, UK
| |
Collapse
|
31
|
Abstract
Background Systemic inflammation has been linked with mood disorder and cognitive impairment. The extent of this relationship remains uncertain, with the effects of serum inflammatory biomarkers compared to genetic predisposition toward inflammation yet to be clearly established. Methods We investigated the magnitude of associations between C-reactive protein (CRP) measures, lifetime history of bipolar disorder or major depression, and cognitive function (reaction time and visuospatial memory) in 84,268 UK Biobank participants. CRP was measured in serum and a polygenic risk score for CRP was calculated, based on a published genome-wide association study. Multiple regression models adjusted for sociodemographic and clinical confounders. Results Increased serum CRP was significantly associated with mood disorder history (Kruskal–Wallis H = 196.06, p < 0.001, η2 = 0.002) but increased polygenic risk for CRP was not (F = 0.668, p = 0.648, η2 < 0.001). Compared to the lowest quintile, the highest serum CRP quintile was significantly associated with both negative and positive differences in cognitive performance (fully adjusted models: reaction time B = −0.030, 95% CI = −0.052, −0.008; visuospatial memory B = 0.066, 95% CI = 0.042, 0.089). More severe mood disorder categories were significantly associated with worse cognitive performance and this was not moderated by serum or genetic CRP level. Conclusions In this large cohort study, we found that measured inflammation was associated with mood disorder history, but genetic predisposition to inflammation was not. The association between mood disorder and worse cognitive performance was very small and did not vary by CRP level. The inconsistent relationship between CRP measures and cognitive performance warrants further study.
Collapse
Affiliation(s)
- David C Milton
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Emilia Ward
- School of Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.,Health Data Research UK, University of Glasgow, Glasgow, Scotland.,Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| |
Collapse
|
32
|
Strawbridge RJ, Johnston KJA, Bailey MES, Baldassarre D, Cullen B, Eriksson P, deFaire U, Ferguson A, Gigante B, Giral P, Graham N, Hamsten A, Humphries SE, Kurl S, Lyall DM, Lyall LM, Pell JP, Pirro M, Savonen K, Smit AJ, Tremoli E, Tomainen TP, Veglia F, Ward J, Sennblad B, Smith DJ. The overlap of genetic susceptibility to schizophrenia and cardiometabolic disease can be used to identify metabolically different groups of individuals. Sci Rep 2021; 11:632. [PMID: 33436761 PMCID: PMC7804422 DOI: 10.1038/s41598-020-79964-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022] Open
Abstract
Understanding why individuals with severe mental illness (Schizophrenia, Bipolar Disorder and Major Depressive Disorder) have increased risk of cardiometabolic disease (including obesity, type 2 diabetes and cardiovascular disease), and identifying those at highest risk of cardiometabolic disease are important priority areas for researchers. For individuals with European ancestry we explored whether genetic variation could identify sub-groups with different metabolic profiles. Loci associated with schizophrenia, bipolar disorder and major depressive disorder from previous genome-wide association studies and loci that were also implicated in cardiometabolic processes and diseases were selected. In the IMPROVE study (a high cardiovascular risk sample) and UK Biobank (general population sample) multidimensional scaling was applied to genetic variants implicated in both psychiatric and cardiometabolic disorders. Visual inspection of the resulting plots used to identify distinct clusters. Differences between these clusters were assessed using chi-squared and Kruskall-Wallis tests. In IMPROVE, genetic loci associated with both schizophrenia and cardiometabolic disease (but not bipolar disorder or major depressive disorder) identified three groups of individuals with distinct metabolic profiles. This grouping was replicated within UK Biobank, with somewhat less distinction between metabolic profiles. This work focused on individuals of European ancestry and is unlikely to apply to more genetically diverse populations. Overall, this study provides proof of concept that common biology underlying mental and physical illness may help to stratify subsets of individuals with different cardiometabolic profiles.
Collapse
Affiliation(s)
- Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK. .,Health Data Research, London, UK. .,Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
| | - Keira J A Johnston
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.,Deanery of Molecular, Genetic and Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK.,School of Life Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Mark E S Bailey
- School of Life Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Damiano Baldassarre
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy.,Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Per Eriksson
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Ulf deFaire
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Amy Ferguson
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruna Gigante
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Philippe Giral
- Service Endocrinologie-Metabolisme, Groupe Hôpitalier Pitie-Salpetriere, Unités de Prévention Cardiovasculaire, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Nicholas Graham
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Anders Hamsten
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Institute Cardiovascular Science, University College London, London, UK
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Laura M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Matteo Pirro
- Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
| | - Kai Savonen
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Andries J Smit
- Department of Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | | | - Tomi-Pekka Tomainen
- Public Health and Clinical Nutrition, Department of Medicine, University of Eastern Finland, Kupiou, Finland
| | | | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Bengt Sennblad
- Department of Cell and Molecular Biology, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| |
Collapse
|
33
|
Morris J, Leung SSY, Bailey ME, Cullen B, Ferguson A, Graham N, Johnston KJA, Lyall DM, Lyall LM, Ward J, Smith DJ, Strawbridge RJ. Exploring the Role of Contactins across Psychological, Psychiatric and Cardiometabolic Traits within UK Biobank. Genes (Basel) 2020; 11:E1326. [PMID: 33182605 PMCID: PMC7697406 DOI: 10.3390/genes11111326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 12/17/2022] Open
Abstract
Individuals with severe mental illness have an increased risk of cardiometabolic diseases compared to the general population. Shared risk factors and medication effects explain part of this excess risk; however, there is growing evidence to suggest that shared biology (including genetic variation) is likely to contribute to comorbidity between mental and physical illness. Contactins are a family of genes involved in development of the nervous system and implicated, though genome-wide association studies, in a wide range of psychological, psychiatric and cardiometabolic conditions. Contactins are plausible candidates for shared pathology between mental and physical health. We used data from UK Biobank to systematically assess how genetic variation in contactin genes was associated with a wide range of psychological, psychiatric and cardiometabolic conditions. We also investigated whether associations for cardiometabolic and psychological traits represented the same or distinct signals and how the genetic variation might influence the measured traits. We identified: A novel genetic association between variation in CNTN1 and current smoking; two independent signals in CNTN4 for BMI; and demonstrated that associations between CNTN5 and neuroticism were distinct from those between CNTN5 and blood pressure/HbA1c. There was no evidence that the contactin genes contributed to shared aetiology between physical and mental illness.
Collapse
Affiliation(s)
- Julia Morris
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Soddy Sau Yu Leung
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Mark E.S. Bailey
- School of Life Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Amy Ferguson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Nicholas Graham
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Keira J. A. Johnston
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
- School of Life Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
- Deanery of Molecular, Genetic and Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Donald M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Laura M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Daniel J. Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Rona J. Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
- Health Data Research UK, Glasgow G12 8RZ, UK
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden
| |
Collapse
|
34
|
Moreton FC, Cullen B, Dickie DA, Lopez Gonzalez R, Santosh C, Delles C, Muir KW. Brain imaging factors associated with progression of subcortical hyperintensities in CADASIL over 2-year follow-up. Eur J Neurol 2020; 28:220-228. [PMID: 32931073 DOI: 10.1111/ene.14534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/03/2020] [Revised: 08/03/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Mutations in the NOTCH3 gene cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a cerebral small vessel disease manifesting with stroke, migraine and dementia in adults. The disease displays significant phenotypic variability that is incompletely explained. Early abnormalities in vascular function have been shown in animal models. We postulated that studying changes in vascular function may offer insights into disease progression. METHODS Twenty-two subjects with CADASIL [50% female, 50 (±11) years] from 19 pedigrees were included in a longitudinal multimodality study using brain magnetic resonance imaging (MRI), clinical measures, neuropsychology and measures of peripheral vascular function. MRI studies included measurement of structural brain changes, cerebral blood flow (CBF) and cerebrovascular reactivity by arterial spin labelling and a CO2 respiratory challenge. RESULTS Over 2 years, new stroke or transient ischaemic attack (TIA) occurred in five (23%) subjects and new significant disability in one (5%). There were significant increases in number of lacunes, subcortical hyperintensity volume and microbleeds, and a decrease in brain volume. CBF declined by 3.2 (±4.5) ml/100 g/min over 2 years. CBF and carotid-femoral pulse wave velocity at baseline predicted change in subcortical hyperintensity volume at follow-up. Carotid intima-media thickness and age predicted brain atrophy. Baseline CBF was lower in subjects who showed a decline in attention and working memory. CONCLUSIONS Cerebral blood flow predicts radiological progression of hyperintensities and thus is a potential biomarker of disease progression in CADASIL. Over 2 years, there were changes in several relevant imaging biomarkers (CBF, brain volume, lacunes, microbleeds and hyperintensity volume). Future studies in CADASIL should consider assessment of CBF as prognostic factor.
Collapse
Affiliation(s)
- F C Moreton
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK
| | - B Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D A Dickie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - R Lopez Gonzalez
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK.,Department of Clinical Physics and Bioengineering, Glasgow Royal Infirmary, Glasgow, UK
| | - C Santosh
- Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - K W Muir
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK
| |
Collapse
|
35
|
Jamieson M, Cullen B, Lennon M, Brewster S, Evans J. Designing ApplTree: usable scheduling software for people with cognitive impairments. Disabil Rehabil Assist Technol 2020; 17:338-348. [PMID: 32633592 DOI: 10.1080/17483107.2020.1785560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/23/2022]
Abstract
BACKGROUND Smartphone reminding applications can help overcome memory difficulties experienced by people with acquired brain injury (ABI). Cognitive difficulties with memory and attention make entering reminders into a device, and remembering to set reminders, challenging for this group. ApplTree is a reminding app with features that aim to address challenges. One app feature was push notifications (asking "Do you need to set any reminders?") to support people to initiate use of the app to set reminders. Another app feature was a customisable user interface design to support attention and short term memory during reminder setting. METHODS In a mixed-methods user study, five people with self or other reported memory impairment following ABI used ApplTree for at least 4 months. They received push notifications for at least 2 months and no push notifications for at least 2 months. Monthly participant interviews provided insight into user interface preference, app use, and push notification acceptability. RESULTS Receiving four Push notifications per day doubled number of daily reminders set and four of the five participants found receiving them to be acceptable. This long-term field study uncovered issues relevant for clinicians and designers, including insights into the potential benefits of different user interface designs, the impact of family members on app use, and the importance of perceived need influencing use and acceptance. CONCLUSIONS Feedback provided insight into future considerations when designing reminding apps and using them in neuropsychological rehabilitation. This work highlights the benefit of user-led research into accessible design and use of assistive technologies.IMPLICATIONS FOR REHABILITATION"Unsolicited" push prompts are an easy to implement feature of reminding technology that is useful and acceptable for people with ABI in community rehabilitation.Observations provide insights about how people with ABI make use of reminding apps over time. This can inform those designing apps or providing reminding technology as part of neuropsychological rehabilitation.Participants differed on their preference of the two user-interface designs available in ApplTree. This highlights an area for future research because currently available reminding apps have a broad-shallow design which may not always be appropriate for people with ABI.
Collapse
Affiliation(s)
- Matthew Jamieson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.,Human Computer Interaction, Department of Computing Science, University of Glasgow, Scotland
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Marilyn Lennon
- Computer and Information Science, University of Strathclyde, Glasgow, Scotland
| | - Stephen Brewster
- Human Computer Interaction, Department of Computing Science, University of Glasgow, Scotland
| | - Jonathan Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| |
Collapse
|
36
|
Smith CR, Cullen B, Sheridan MP, Cavanagh J, Grosset KA, Grosset DG. Cognitive impairment in Parkinson's disease is multifactorial: A neuropsychological study. Acta Neurol Scand 2020; 141:500-508. [PMID: 32002988 DOI: 10.1111/ane.13226] [Citation(s) in RCA: 8] [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] [Received: 10/08/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Parkinson's disease, mild cognitive impairment and dementia are associated with α-synuclein deposition and spread. However, coexistent Alzheimer's disease and cerebrovascular disease are common at autopsy, and may affect cognition. Our objective was to map cognitive impairment in Parkinson's disease to these different causes using clinical assessment. METHODS Neuropsychological testing was performed in a cross-sectional sample of cognitively impaired patients with Parkinson's disease. The pattern of deficits in varying cognitive domains was mapped to the presentations that typify different diseases. Data were analysed by an expert multidisciplinary panel, referencing diagnostic criteria, to reach a consensus diagnosis for the cognitive dysfunction. RESULTS There were 45 participants with Parkinson's disease and cognitive impairment, 73.3% male, mean age 69.1 years (SD 8.3). Twenty-seven (60.0%) had mild cognitive impairment, and 18 had dementia (40.0%). Cognitive impairment was primarily attributable to Lewy body disease alone in 19 of 45 patients (42.2%), to Lewy body disease plus Alzheimer's in 14 of 45 (31.1%), to Lewy body plus cerebrovascular disease in 6 of 45 (13.3%), and to Lewy body plus Alzheimer's and cerebrovascular disease in 1 of 45 (2.2%). The cognitive decline was not primarily Lewy-related in 5 of 45 patients (11.1%); in 4 of 45 (8.9%), it was primarily attributable to Alzheimer's disease, and 1 of 45 (2.2%) had behavioural-variant frontotemporal dementia. CONCLUSION Neuropsychological testing identifies distinct patterns of cognitive impairment in Parkinson's disease that provide clear pointers to comorbid disease processes, the most common being Alzheimer's disease. This approach may prove useful in clinical practice and has implications for clinical trials that target α-synuclein.
Collapse
Affiliation(s)
- Callum R. Smith
- Department of Neurology NHS Greater Glasgow and Clyde Glasgow UK
| | - Breda Cullen
- Institute of Health and Wellbeing University of Glasgow Glasgow UK
| | | | | | | | | |
Collapse
|
37
|
Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Smith DJ, Sudlow C, Ward J, Zammit S, Hotopf M. Mental health in UK Biobank - development, implementation and results from an online questionnaire completed by 157 366 participants: a reanalysis. BJPsych Open 2020; 6:e18. [PMID: 32026800 PMCID: PMC7176892 DOI: 10.1192/bjo.2019.100] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [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] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential. AIMS Describe the development, implementation and results of this questionnaire. METHOD An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use. RESULTS A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45-82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation. CONCLUSIONS The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Collapse
Affiliation(s)
- Katrina A S Davis
- Researcher, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, UK
| | - Jonathan R I Coleman
- Lecturer in Statistical Genetics, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, UK
| | - Mark Adams
- Data Scientist, Division of Psychiatry, University of Edinburgh, UK
| | - Naomi Allen
- Professor, University of Oxford; and Chief Scientist, UK Biobank, Nuffield Department of Population Health, University of Oxford Big Data Institute, UK
| | - Gerome Breen
- Professor of Psychiatric Genetics, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, UK
| | - Breda Cullen
- Senior Lecturer, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Chris Dickens
- Professor of Psychological Medicine, Institute of Health Research, University of Exeter Medical School, University of Exeter, UK
| | - Elaine Fox
- Professor of Psychology and Affective Neuroscience, Department of Experimental Psychology, University of Oxford, UK
| | - Nick Graham
- Clinical Lecturer in General Psychiatry, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Jo Holliday
- Senior Research Facilitator, University of Oxford; and UK Biobank: UK Biobank, Nuffield Department of Population Health, University of Oxford Big Data Institute, UK
| | - Louise M Howard
- NIHR Research Professor in Women's Mental Health and NIHR Senior Investigator, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ann John
- Professor of Public Health and Psychiatry and Consultant Public Health Medicine, Population Data Science, Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea University; and Public Health Wales NHS Trust, UK
| | - William Lee
- Consultant Liaison Psychiatrist and Honorary Clinical Senior Lecturer, Devon Partnership NHS Trust; and University of Exeter Medical School, University of Exeter, UK
| | - Rose McCabe
- Professor of Clinical Communication, School of Health Sciences, City, University of London, UK
| | - Andrew McIntosh
- Professor of Biological Psychiatry, Division of Psychiatry, University of Edinburgh, UK
| | - Robert Pearsall
- Consultant Psychiatrist and Honorary Clinical Senior Lecturer in Psychiatry, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Daniel J Smith
- Lecturer in Psychiatry, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Cathie Sudlow
- Director of the British Heart Foundation Data Science Centre, BHF Data Science Centre; Former Chief Scientist, UK Biobank; and Chair of Neurology and Clinical Epidemiology, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Joey Ward
- Researcher, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Stan Zammit
- Professor of Psychiatric Epidemiology, Centre for Academic Mental Health, University of Bristol; and Institute of Psychological Medicine and Clinical Neurosciences, University of Cardiff, Cardiff University School of Medicine, UK
| | - Matthew Hotopf
- Director, National Institute of Health Research Biomedical Research Centre at the Maudsley; Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, UK
| |
Collapse
|
38
|
Smith CR, Cavanagh J, Sheridan M, Grosset KA, Cullen B, Grosset DG. Factor structure of the Montreal Cognitive Assessment in Parkinson disease. Int J Geriatr Psychiatry 2020; 35:188-194. [PMID: 31736141 DOI: 10.1002/gps.5234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/07/2019] [Accepted: 11/07/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The Montreal Cognitive Assessment (MoCA) is a common tool for screening mild cognitive impairment (MCI) and dementia. Studies in multiple clinical groups provide evidence for various factor structures mapping to different cognitive domains. We tested the factor structure of the MoCA in a large cohort of early Parkinson disease (PD). MATERIALS AND METHODS Complete MoCA data were available from an observational cohort study for 1738 patients with recent-onset PD (64.6% male, mean age 67.6, SD 9.2). Confirmatory factor analysis (CFA) was applied to test previously defined two-factor, six-factor, and three-factor models in the full sample and in a subgroup with possible cognitive impairment (MoCA < 26). Secondary analysis used exploratory factor analysis (EFA; principal factors with oblique rotation). RESULTS The mean MoCA score was 25.3 (SD 3.4, range 10-30). Fit statistics in the six-factor model (χ2 /df 17.77, root mean square error of approximation [RMSEA] 0.10, comparative fit index [CFI] 0.74, Tucker-Lewis index [TLI] 0.69, standardised root mean square residual [SRMR] 0.07) indicated poorer fit than did previous studies. Findings were similar in the two-factor and three-factor models. EFA suggested an alternative six-factor solution (short-term recall, visuospatial-executive, attention/working memory, verbal-executive, orientation, and expressive language), although CFA did not support the validity of the new model. CONCLUSIONS The factor structure of the MoCA in early PD was not consistent with that of previous research. This may reflect higher cognitive performance and differing demographics in our sample. The results do not support a clear, clinically relevant factor structure in an early PD group, suggesting that the MoCA should be followed with detailed assessment to obtain domain-specific cognitive profiles.
Collapse
Affiliation(s)
- Callum R Smith
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Jonathan Cavanagh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matthew Sheridan
- Division of Old Age Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald G Grosset
- Department of Neurology, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
39
|
Gabriel A, Barrett C, Cullen B, Hodges D, Lee W, Snyder R, Speyrer M, Suski M, Dick S, Thomason HA, Treadwell T. Infection and Inflammation in the Wound Environment: Addressing Issues of Delayed Wound Healing With Advanced Wound Dressings. Wounds 2020; 32:S1-S17. [PMID: 31876510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Impaired wound healing is estimated to affect about 2% of the US population, and a major goal of health care providers (HCPs) is to better understand delayed healing so they can effectively choose advanced wound dressings to manage these wounds. However, there are estimated to be more than 3000 dressing options available, making dressing selection an overwhelming burden. An expert panel of 7 HCPs experienced in diverse medical disciplines and 3 scientists convened to discuss the use of 2 families of dressings (silver-oxysalt [AgOx] dressings and oxidized regenerated cellulose/collagen [ORC/C] dressings) and delayed wound healing. Before the meeting, panelists reviewed 16 articles concerning the dressings, and 2 scientists presented on the topics of infection and inflammation in the wound environment, along with providing information about the dressing families, during the meeting. In addition, each HCP presented specific cases in which they had applied AgOx or ORC/C dressings and described how the dressing was used to manage stalled healing. After the meeting, the panelists and another HCP who was unable to attend the panel meeting provided insight and feedback for this publication, which provides an overview of the meeting. A major theme of this panel discussion was the need for a fundamental change in how HCPs approach wound care, especially for nonhealing wounds and underlying issues of infection and inflammation in the wound environment. Ultimately, the panel developed a decision-tree model for risk-stratifying patients based on their potential to have or develop these 2 underlying issues, followed by deciding on treatment options based on the status of infection and inflammation in the wound.
Collapse
Affiliation(s)
| | | | | | | | - Wayne Lee
- Hill Country Orthopedic Surgery and Sports Medicine, San Antonio, TX
| | | | - Marcus Speyrer
- The Wound Treatment Center, LLC, Opelousas General Health System, Opelousas, LA
| | | | - Sonya Dick
- KCI, an Acelity Company, San Antonio, TX and Knutsford, UK; University of Kentucky College of Medicine, Lexington, KY
| | - Helen A Thomason
- KCI, an Acelity Company, San Antonio, TX and Knutsford, UK; The University of Manchester, Manchester, UK
| | - Terry Treadwell
- Institute for Advanced Wound Care, Baptist Medical Center South, Montgomery, AL
| |
Collapse
|
40
|
Strawbridge RJ, Ward J, Bailey MES, Cullen B, Ferguson A, Graham N, Johnston KJA, Lyall LM, Pearsall R, Pell J, Shaw RJ, Tank R, Lyall DM, Smith DJ. Carotid Intima-Media Thickness: Novel Loci, Sex-Specific Effects, and Genetic Correlations With Obesity and Glucometabolic Traits in UK Biobank. Arterioscler Thromb Vasc Biol 2019; 40:446-461. [PMID: 31801372 PMCID: PMC6975521 DOI: 10.1161/atvbaha.119.313226] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Supplemental Digital Content is available in the text. Objective: Atherosclerosis is the underlying cause of most cardiovascular disease, but mechanisms underlying atherosclerosis are incompletely understood. Ultrasound measurement of the carotid intima-media thickness (cIMT) can be used to measure vascular remodeling, which is indicative of atherosclerosis. Genome-wide association studies have identified many genetic loci associated with cIMT, but heterogeneity of measurements collected by many small cohorts have been a major limitation in these efforts. Here, we conducted genome-wide association analyses in UKB (UK Biobank; N=22 179), the largest single study with consistent cIMT measurements. Approach and Results: We used BOLT-LMM software to run linear regression of cIMT in UKB, adjusted for age, sex, and genotyping chip. In white British participants, we identified 5 novel loci associated with cIMT and replicated most previously reported loci. In the first sex-specific analyses of cIMT, we identified a locus on chromosome 5, associated with cIMT in women only and highlight VCAN as a good candidate gene at this locus. Genetic correlations with body mass index and glucometabolic traits were also observed. Two loci influenced risk of ischemic heart disease. ConclusionS: These findings replicate previously reported associations, highlight novel biology, and provide new directions for investigating the sex differences observed in cardiovascular disease presentation and progression.
Collapse
Affiliation(s)
- Rona J Strawbridge
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Joey Ward
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Mark E S Bailey
- School of Life Sciences, College of Medical, Veterinary and Life Sciences (M.E.S.B., K.J.A.J.), University of Glasgow, United Kingdom
| | - Breda Cullen
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Amy Ferguson
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Nicholas Graham
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Keira J A Johnston
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom.,School of Life Sciences, College of Medical, Veterinary and Life Sciences (M.E.S.B., K.J.A.J.), University of Glasgow, United Kingdom.,Division of Psychiatry, College of Medicine, University of Edinburgh, United Kingdom (K.J.A.J.)
| | - Laura M Lyall
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Robert Pearsall
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Jill Pell
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Richard J Shaw
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom.,Health Data Research United Kingdom (R.J.S.).,Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (R.J.S.)
| | - Rachana Tank
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Donald M Lyall
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| | - Daniel J Smith
- From the Institute of Health and Wellbeing (R.J.S., J.W., B.C., A.F., N.G., K.J.A.J., L.M.L., R.P., J.P., R.J.S., R.T., D.M.L., D.J.S.), University of Glasgow, United Kingdom
| |
Collapse
|
41
|
Ward J, Lyall LM, Bethlehem RAI, Ferguson A, Strawbridge RJ, Lyall DM, Cullen B, Graham N, Johnston KJA, Bailey MES, Murray GK, Smith DJ. Novel genome-wide associations for anhedonia, genetic correlation with psychiatric disorders, and polygenic association with brain structure. Transl Psychiatry 2019; 9:327. [PMID: 31797917 PMCID: PMC6892870 DOI: 10.1038/s41398-019-0635-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/18/2019] [Accepted: 10/20/2019] [Indexed: 12/20/2022] Open
Abstract
Anhedonia is a core symptom of several psychiatric disorders but its biological underpinnings are poorly understood. We performed a genome-wide association study of state anhedonia in 375,275 UK Biobank participants and assessed for genetic correlation between anhedonia and neuropsychiatric conditions (major depressive disorder, schizophrenia, bipolar disorder, obsessive compulsive disorder and Parkinson's Disease). We then used a polygenic risk score approach to test for association between genetic loading for anhedonia and both brain structure and brain function. This included: magnetic resonance imaging (MRI) assessments of total grey matter volume, white matter volume, cerebrospinal fluid volume, and 15 cortical/subcortical regions of interest; diffusion tensor imaging (DTI) measures of white matter tract integrity; and functional MRI activity during an emotion processing task. We identified 11 novel loci associated at genome-wide significance with anhedonia, with a SNP heritability estimate (h2SNP) of 5.6%. Strong positive genetic correlations were found between anhedonia and major depressive disorder, schizophrenia and bipolar disorder; but not with obsessive compulsive disorder or Parkinson's Disease. Polygenic risk for anhedonia was associated with poorer brain white matter integrity, smaller total grey matter volume, and smaller volumes of brain regions linked to reward and pleasure processing, including orbito-frontal cortex. In summary, the identification of novel anhedonia-associated loci substantially expands our current understanding of the biological basis of state anhedonia and genetic correlations with several psychiatric disorders confirm the utility of this phenotype as a transdiagnostic marker of vulnerability to mental illness. We also provide the first evidence that genetic risk for state anhedonia influences brain structure, including in regions associated with reward and pleasure processing.
Collapse
Affiliation(s)
- Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Amy Ferguson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicholas Graham
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Mark E S Bailey
- School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| |
Collapse
|
42
|
Cullen B, Smith DJ, Deary IJ, Pell JP, Keyes KM, Evans JJ. Understanding cognitive impairment in mood disorders: mediation analyses in the UK Biobank cohort. Br J Psychiatry 2019; 215:683-690. [PMID: 31412972 PMCID: PMC7825642 DOI: 10.1192/bjp.2019.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cognitive impairment is strongly linked with persistent disability in people with mood disorders, but the factors that explain cognitive impairment in this population are unclear. AIMS To estimate the total effect of (a) bipolar disorder and (b) major depression on cognitive function, and the magnitude of the effect that is explained by potentially modifiable intermediate factors. METHOD Cross-sectional study using baseline data from the UK Biobank cohort. Participants were categorised as having bipolar disorder (n = 2709), major depression (n = 50 975) or no mood disorder (n = 102 931 and n = 105 284). The outcomes were computerised tests of reasoning, reaction time and memory. The potential mediators were cardiometabolic disease and psychotropic medication. Analyses were informed by graphical methods and controlled for confounding using regression, propensity score-based methods and G-computation. RESULTS Group differences of small magnitude were found on a visuospatial memory test. Z-score differences for the bipolar disorder group were in the range -0.23 to -0.17 (95% CI -0.39 to -0.03) across different estimation methods, and for the major depression group they were approximately -0.07 (95% CI -0.10 to -0.03). One-quarter of the effect was mediated via psychotropic medication in the bipolar disorder group (-0.05; 95% CI -0.09 to -0.01). No evidence was found for mediation via cardiometabolic disease. CONCLUSIONS In a large community-based sample in middle to early old age, bipolar disorder and depression were associated with lower visuospatial memory performance, in part potentially due to psychotropic medication use. Mood disorders and their treatments will have increasing importance for population cognitive health as the proportion of older adults continues to grow. DECLARATION OF INTEREST I.J.D. is a UK Biobank participant. J.P.P. is a member of the UK Biobank Steering Committee.
Collapse
|
43
|
Smith C, Malek N, Grosset K, Cullen B, Gentleman S, Grosset DG. Neuropathology of dementia in patients with Parkinson's disease: a systematic review of autopsy studies. J Neurol Neurosurg Psychiatry 2019; 90:1234-1243. [PMID: 31444276 DOI: 10.1136/jnnp-2019-321111] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 04/30/2019] [Revised: 07/15/2019] [Accepted: 08/14/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dementia is a common, debilitating feature of late Parkinson's disease (PD). PD dementia (PDD) is associated with α-synuclein propagation, but coexistent Alzheimer's disease (AD) pathology may coexist. Other pathologies (cerebrovascular, transactive response DNA-binding protein 43 (TDP-43)) may also influence cognition. We aimed to describe the neuropathology underlying dementia in PD. METHODS Systematic review of autopsy studies published in English involving PD cases with dementia. Comparison groups included PD without dementia, AD, dementia with Lewy bodies (DLB) and healthy controls. RESULTS 44 reports involving 2002 cases, 57.2% with dementia, met inclusion criteria. While limbic and neocortical α-synuclein pathology had the strongest association with dementia, between a fifth and a third of all PD cases in the largest studies had comorbid AD. In PD cases with dementia, tau pathology was moderate or severe in around a third, and amyloid-β pathology was moderate or severe in over half. Amyloid-β was associated with a more rapid cognitive decline and earlier mortality, and in the striatum, distinguished PDD from DLB. Positive correlations between multiple measures of α-synuclein, tau and amyloid-β were found. Cerebrovascular and TDP-43 pathologies did not generally contribute to dementia in PD. TDP-43 and amyloid angiopathy correlated with coexistent Alzheimer pathology. CONCLUSIONS While significant α-synuclein pathology is the main substrate of dementia in PD, coexistent pathologies are common. In particular, tau and amyloid-β pathologies independently contribute to the development and pattern of cognitive decline in PD. Their presence should be assessed in future clinical trials where dementia is a key outcome measure. TRIAL REGISTRATION NUMBER CRD42018088691.
Collapse
Affiliation(s)
- Callum Smith
- Department of Neurology, Institute of Neurosciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Naveed Malek
- Department of Neurology, Ipswich Hospital NHS Trust, Ipswich, UK
| | - Katherine Grosset
- Department of Neurology, Institute of Neurosciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Steve Gentleman
- Neuropathology Unit, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurosciences, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
44
|
Davis KAS, Cullen B, Adams M, Brailean A, Breen G, Coleman JRI, Dregan A, Gaspar HA, Hübel C, Lee W, McIntosh AM, Nolan J, Pearsall R, Hotopf M. Indicators of mental disorders in UK Biobank-A comparison of approaches. Int J Methods Psychiatr Res 2019; 28:e1796. [PMID: 31397039 PMCID: PMC6877131 DOI: 10.1002/mpr.1796] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/04/2019] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES For many research cohorts, it is not practical to provide a "gold-standard" mental health diagnosis. It is therefore important for mental health research that potential alternative measures for ascertaining mental disorder status are understood. METHODS Data from UK Biobank in those participants who had completed the online Mental Health Questionnaire (n = 157,363) were used to compare the classification of mental disorder by four methods: symptom-based outcome (self-complete based on diagnostic interviews), self-reported diagnosis, hospital data linkage, and self-report medication. RESULTS Participants self-reporting any psychiatric diagnosis had elevated risk of any symptom-based outcome. Cohen's κ between self-reported diagnosis and symptom-based outcome was 0.46 for depression, 0.28 for bipolar affective disorder, and 0.24 for anxiety. There were small numbers of participants uniquely identified by hospital data linkage and medication. CONCLUSION Our results confirm that ascertainment of mental disorder diagnosis in large cohorts such as UK Biobank is complex. There may not be one method of classification that is right for all circumstances, but an informed and transparent use of outcome measure(s) to suit each research question will maximise the potential of UK Biobank and other resources for mental health research.
Collapse
Affiliation(s)
- Katrina A S Davis
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Breda Cullen
- Mental Health and Wellbeing, The Academic Centre, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Mark Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Anamaria Brailean
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Gerome Breen
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jonathan R I Coleman
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandru Dregan
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Héléna A Gaspar
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Christopher Hübel
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - William Lee
- Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK.,Devon Partnership NHS Trust, Psychological Medicine, Exeter, UKUK Biobank, Office of the UKB Chief Scientist, Edinburgh, UK
| | | | - John Nolan
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK.,Office of the UKB Chief Scientist, UK Biobank, Edinburgh, UK
| | - Robert Pearsall
- Mental Health and Wellbeing, The Academic Centre, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Matthew Hotopf
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
45
|
Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Smith DJ, Sudlow C, Ward J, Zammit S, Hotopf M. Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants - RETRACTED. BJPsych Open 2019; 5:e56. [PMID: 31530304 PMCID: PMC6611070 DOI: 10.1192/bjo.2019.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
46
|
Lyall LM, Cullen B, Lyall DM, Leighton SP, Siebert S, Smith DJ, Cavanagh J. The associations between self-reported depression, self-reported chronic inflammatory conditions and cognitive abilities in UK Biobank. Eur Psychiatry 2019; 60:63-70. [PMID: 31158611 PMCID: PMC6669333 DOI: 10.1016/j.eurpsy.2019.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background Depression and chronic inflammatory medical conditions have been linked to impaired cognitive ability. However despite frequent comorbidity, their combined association with cognitive ability has rarely been examined. Methods This study examined associations between self-reported depression and chronic inflammatory diseases and their interaction with cognitive performance in 456,748 participants of the UK Biobank, adjusting for sociodemographic and lifestyle factors. Numbers with available data ranged from 94,899 to 453,208 depending on the cognitive test. Results Self-reported depression was associated with poorer performance compared to controls in several cognitive tests (fully adjusted models, reaction time: B = 6.08, 95% CI = 5.09, 7.07; pairs matching: incidence rate ratio = 1.02, 95% CI = 1.02, 1.03; Trail Making Test B: B = 1.37, 95% CI = 0.88, 1.87; Digit Symbol Substitution Test (DSST): B = −0.35, 95% CI = −0.44, −0.27). Self-reported chronic inflammatory conditions were associated with slower reaction time (B = 3.79, 95% CI = 2.81, 4.78) and lower DSST scores (B = −0.21, 95% CI = −0.30, −0.13). No interaction effects were observed. Discussion In this large, population-based study we provide evidence of lower cognitive performance in both depression and a comprehensive category of chronic inflammatory conditions. Results are consistent with additive effects of both types of disorder on cognitive ability. Clinicians should be aware of such effects, particularly as cognitive impairment is linked to poorer disease outcomes and quality of life.
Collapse
Affiliation(s)
- Laura M Lyall
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.
| | - Breda Cullen
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Donald M Lyall
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Samuel P Leighton
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, G12 8TA, UK
| | - Daniel J Smith
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Jonathan Cavanagh
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| |
Collapse
|
47
|
Jamieson M, Jack R, O’Neill B, Cullen B, Lennon M, Brewster S, Evans J. Technology to encourage meaningful activities following brain injury. Disabil Rehabil Assist Technol 2019; 15:453-466. [DOI: 10.1080/17483107.2019.1594402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Matthew Jamieson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel Jack
- Acquired Brain Injury Team, West Dunbartonshire, Scotland
| | - Brian O’Neill
- The Disabilities Trust, Graham Anderson House, Glasgow, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marilyn Lennon
- Department of Computing Science, University of Strathclyde, Glasgow, UK
| | - Stephen Brewster
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jonathan Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
48
|
Baylan S, Haig C, MacDonald M, Stiles C, Easto J, Thomson M, Cullen B, Quinn TJ, Stott D, Mercer SW, Broomfield NM, Murray H, Evans JJ. Measuring the effects of listening for leisure on outcome after stroke (MELLO): A pilot randomized controlled trial of mindful music listening. Int J Stroke 2019; 15:149-158. [PMID: 30940047 PMCID: PMC7045280 DOI: 10.1177/1747493019841250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Cognitive deficits and low mood are common post-stroke. Music listening is
suggested to have beneficial effects on cognition, while mindfulness may
improve mood. Combining these approaches may enhance cognitive recovery and
improve mood early post-stroke. Aims To assess the feasibility and acceptability of a novel mindful music
listening intervention. Methods A parallel group randomized controlled feasibility trial with ischemic stroke
patients, comparing three groups; mindful music listening, music listening
and audiobook listening (control group), eight weeks intervention.
Feasibility was measured using adherence to protocol and questionnaires.
Cognition (including measures of verbal memory and attention) and mood
(Hospital Anxiety and Depression Scale) were assessed at baseline, end of
intervention and at six-months post-stroke. Results Seventy-two participants were randomized to mindful music listening
(n = 23), music listening (n = 24), or
audiobook listening (n = 25). Feasibility and acceptability
measures were encouraging: 94% fully consistent with protocol; 68.1%
completing ≥6/8 treatment visits; 80–107% listening adherence; 83% retention
to six-month endpoint. Treatment effect sizes for cognition at six month
follow-up ranged from d = 0.00 ([−0.64,0.64], music alone), d = 0.31,
([0.36,0.97], mindful music) for list learning; to d = 0.58 ([0.06,1.11],
music alone), d = 0.51 ([−0.07,1.09], mindful music) for immediate story
recall; and d = 0.67 ([0.12,1.22], music alone), d = 0.77
([0.16,1.38]mindful music) for attentional switching compared to audiobooks.
No signal of change was seen for mood. A definitive study would require 306
participants to detect a clinically substantial difference in improvement
(z-score difference = 0.66, p = 0.017, 80% power) in verbal
memory (delayed story recall). Conclusions Mindful music listening is feasible and acceptable post-stroke. Music
listening interventions appear to be a promising approach to improving
recovery from stroke.
Collapse
Affiliation(s)
- Satu Baylan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Maxine MacDonald
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ciara Stiles
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Stroke Psychology Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jake Easto
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Stroke Psychology Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Meigan Thomson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stewart W Mercer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Usher institute of population health sciences and informatics, University of Edinburgh, Edinburgh, UK
| | - Niall M Broomfield
- Stroke Psychology Service, NHS Greater Glasgow and Clyde, Glasgow, UK.,Norwich Medical School, University of East Anglia, England, UK
| | - Heather Murray
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Jonathan J Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
49
|
Strawbridge RJ, Ward J, Ferguson A, Graham N, Shaw RJ, Cullen B, Pearsall R, Lyall LM, Johnston KJA, Niedzwiedz CL, Pell JP, Mackay D, Martin JL, Lyall DM, Bailey MES, Smith DJ. Identification of novel genome-wide associations for suicidality in UK Biobank, genetic correlation with psychiatric disorders and polygenic association with completed suicide. EBioMedicine 2019; 41:517-525. [PMID: 30745170 PMCID: PMC6442001 DOI: 10.1016/j.ebiom.2019.02.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Suicide is a major issue for global public health. Suicidality describes a broad spectrum of thoughts and behaviours, some of which are common in the general population. Although suicide results from a complex interaction of multiple social and psychological factors, predisposition to suicidality is at least partly genetic. METHODS Ordinal genome-wide association study of suicidality in the UK Biobank cohort comparing: 'no suicidality' controls (N = 83,557); 'thoughts that life was not worth living' (N = 21,063); 'ever contemplated self-harm' (N = 13,038); 'act of deliberate self-harm in the past' (N = 2498); and 'previous suicide attempt' (N = 2666). OUTCOMES We identified three novel genome-wide significant loci for suicidality (on chromosomes nine, 11 and 13) and moderate-to-strong genetic correlations between suicidality and a range of psychiatric disorders, most notably depression (rg 0·81). INTERPRETATION These findings provide new information about genetic variants relating to increased risk of suicidal thoughts and behaviours. Future work should assess the extent to which polygenic risk scores for suicidality, in combination with non-genetic risk factors, may be useful for stratified approaches to suicide prevention at a population level. FUND: UKRI Innovation-HDR-UK Fellowship (MR/S003061/1). MRC Mental Health Data Pathfinder Award (MC_PC_17217). MRC Doctoral Training Programme Studentship at the University of Glasgow (MR/K501335/1). MRC Doctoral Training Programme Studentship at the Universities of Glasgow and Edinburgh. UKRI Innovation Fellowship (MR/R024774/1).
Collapse
Affiliation(s)
- Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Amy Ferguson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicholas Graham
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard J Shaw
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Pearsall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Keira J A Johnston
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Division of Psychiatry, College of Medicine, University of Edinburgh, UK; School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark E S Bailey
- School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| |
Collapse
|
50
|
Strawbridge RJ, Ward J, Lyall LM, Tunbridge EM, Cullen B, Graham N, Ferguson A, Johnston KJA, Lyall DM, Mackay D, Cavanagh J, Howard DM, Adams MJ, Deary I, Escott-Price V, O'Donovan M, McIntosh AM, Bailey MES, Pell JP, Harrison PJ, Smith DJ. Genetics of self-reported risk-taking behaviour, trans-ethnic consistency and relevance to brain gene expression. Transl Psychiatry 2018; 8:178. [PMID: 30181555 PMCID: PMC6123450 DOI: 10.1038/s41398-018-0236-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 12/25/2022] Open
Abstract
Risk-taking behaviour is an important component of several psychiatric disorders, including attention-deficit hyperactivity disorder, schizophrenia and bipolar disorder. Previously, two genetic loci have been associated with self-reported risk taking and significant genetic overlap with psychiatric disorders was identified within a subsample of UK Biobank. Using the white British participants of the full UK Biobank cohort (n = 83,677 risk takers versus 244,662 controls) for our primary analysis, we conducted a genome-wide association study of self-reported risk-taking behaviour. In secondary analyses, we assessed sex-specific effects, trans-ethnic heterogeneity and genetic overlap with psychiatric traits. We also investigated the impact of risk-taking-associated SNPs on both gene expression and structural brain imaging. We identified 10 independent loci for risk-taking behaviour, of which eight were novel and two replicated previous findings. In addition, we found two further sex-specific risk-taking loci. There were strong positive genetic correlations between risk-taking and attention-deficit hyperactivity disorder, bipolar disorder and schizophrenia. Index genetic variants demonstrated effects generally consistent with the discovery analysis in individuals of non-British White, South Asian, African-Caribbean or mixed ethnicity. Polygenic risk scores comprising alleles associated with increased risk taking were associated with lower white matter integrity. Genotype-specific expression pattern analyses highlighted DPYSL5, CGREF1 and C15orf59 as plausible candidate genes. Overall, our findings substantially advance our understanding of the biology of risk-taking behaviour, including the possibility of sex-specific contributions, and reveal consistency across ethnicities. We further highlight several putative novel candidate genes, which may mediate these genetic effects.
Collapse
Affiliation(s)
- Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elizabeth M Tunbridge
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicholas Graham
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Amy Ferguson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Keira J A Johnston
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Division of Psychiatry, College of Medicine, University of Edinburgh, Edinburgh, UK
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jonathan Cavanagh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David M Howard
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Mark J Adams
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Ian Deary
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | | | - Michael O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Mark E S Bailey
- School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|