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Ko J, Furby H, Ma X, Long JD, Lu XY, Slowiejko D, Gandhy R. Clustering and prediction of disease progression trajectories in Huntington's disease: An analysis of Enroll-HD data using a machine learning approach. Front Neurol 2023; 13:1034269. [PMID: 36793800 PMCID: PMC9923354 DOI: 10.3389/fneur.2022.1034269] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/21/2022] [Indexed: 01/31/2023] Open
Abstract
Introduction Huntington's disease (HD) is a rare neurodegenerative disease characterized by cognitive, behavioral and motor symptoms that progressively worsen with time. Cognitive and behavioral signs of HD are generally present in the years prior to a diagnosis; however, manifest HD is typically assessed by genetic confirmation and/or the presence of unequivocal motor symptoms. Nevertheless, there is a large variation in symptom severity and rate of progression among individuals with HD. Methods In this retrospective study, longitudinal natural history of disease progression was modeled in individuals with manifest HD from the global, observational Enroll-HD study (NCT01574053). Unsupervised machine learning (k-means; km3d) was used to jointly model clinical and functional disease measures simultaneously over time, based on one-dimensional clustering concordance such that individuals with manifest HD (N = 4,961) were grouped into three clusters: rapid (Cluster A; 25.3%), moderate (Cluster B; 45.5%) and slow (Cluster C; 29.2%) progressors. Features that were considered predictive of disease trajectory were then identified using a supervised machine learning method (XGBoost). Results The cytosine adenine guanine-age product score (a product of age and polyglutamine repeat length) at enrollment was the top predicting feature for cluster assignment, followed by years since symptom onset, medical history of apathy, body mass index at enrollment and age at enrollment. Conclusions These results are useful for understanding factors that affect the global rate of decline in HD. Further work is needed to develop prognostic models of HD progression as these could help clinicians with individualized clinical care planning and disease management.
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Affiliation(s)
- Jinnie Ko
- Genentech Inc., South San Francisco, CA, United States,*Correspondence: Jinnie Ko ✉
| | - Hannah Furby
- Roche Products Ltd., Welwyn Garden City, United Kingdom
| | - Xiaoye Ma
- Genentech Inc., South San Francisco, CA, United States
| | - Jeffrey D. Long
- University of Iowa Health Care, Iowa City, IA, United States
| | - Xiao-Yu Lu
- Genentech Inc., South San Francisco, CA, United States
| | | | - Rita Gandhy
- Genentech Inc., South San Francisco, CA, United States
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2
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Furby H, Siadimas A, Rutten-Jacobs L, Rodrigues FB, Wild EJ. Natural History and Burden of Huntington's Disease in the UK: A Population-Based Cohort Study. Eur J Neurol 2022; 29:2249-2257. [PMID: 35514071 PMCID: PMC9542098 DOI: 10.1111/ene.15385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Huntington's disease (HD) is a rare neurodegenerative disease that presents with progressive psychological, cognitive and motor impairment. These diverse symptoms place a high burden on the patient, families and the healthcare systems they rely on. This study aimed to describe the epidemiology and clinical burden in individuals with HD compared with controls from the general population. METHODS This cohort study utilised data from general practitioner (GP) medical records to estimate the prevalence and incidence of HD between Jan 2000 and Dec 2018. A cohort of incident HD cases were matched 1:3 to controls from the general population, in whom common clinical diagnoses, medications and healthcare interventions were compared at the time of first recorded diagnosis and at a time close to death. Incidence rates of common diagnoses and mortality were compared with matched controls in the time following HD diagnosis. RESULTS Prevalence of HD increased between 2000 and 2018, whilst incidence remained stable. Prevalence of psychiatric diagnoses and symptomatic treatments were higher in HD cases than controls. A higher relative risk of psychotic disorders, depression, insomnia, dementia, weight loss, pneumonia and falls was observed in HD cases. Risk of death was >4 times higher in HD, with a median survival of ~12 years from first recorded diagnosis. CONCLUSIONS This study demonstrates the significant and progressive clinical burden in individuals up to 18 years after first recorded diagnosis.
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Affiliation(s)
| | | | | | - Filipe B Rodrigues
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Edward J Wild
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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3
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Gavrielov-Yusim N, Barer Y, Martinec M, Siadimas A, Roumpanis S, Furby H, Goldshtein I, Jan A, Coloma PM. Huntington's Disease in Israel: A Population-Based Study Using 20 Years of Routinely-Collected Healthcare Data. J Huntingtons Dis 2021; 10:469-477. [PMID: 34602495 DOI: 10.3233/jhd-210500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Huntington's disease (HD) is a rare, genetic, neurodegenerative disease. Obtaining population-level data on epidemiology and disease management is challenging. OBJECTIVE To investigate the epidemiology, clinical manifestations, treatment, and healthcare utilization of patients with HD in Israel. METHODS Retrospective population-based cohort study, including 20 years of routinely collected data from Maccabi Healthcare Services, an insurer and healthcare provider for one-quarter of the Israeli population. RESULTS The study cohort included 109 adult patients (aged ≥18 years) diagnosed with HD, with mean age of 49.9 years and 56%females. The most common HD-related conditions were anxiety (40%), behavioral problems (34%), sleep disorders (21%), and falls (13%). Annual incidence rates for HD ranged from 0.17 to 1.34 per 100,000 from 2000 to 2018; the 2018 crude prevalence in adults was 4.36 per 100,000. Median survival from diagnosis was approximately 12 years (95%CI: 10.4-15.3). The most frequent symptomatic treatments were antidepressants (69%), antipsychotics (63%), and tetrabenazine (63%), the only drug approved for the treatment of HD chorea in Israel during the examined period. Patterns of healthcare utilization changed as disease duration increased, reflected by increased frequency of emergency department visits and home visits. CONCLUSION This retrospective population-based study provides insights into the prevalence, incidence, clinical profile, survival, and resource utilization of patients with HD in ethnically diverse Israel. The findings in this study are generally consistent with the international literature and demonstrate the value of routinely collected healthcare data as a complementary resource in HD research.
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Affiliation(s)
- Natalie Gavrielov-Yusim
- Product Development Personalized Health Care - Data Science, Roche Pharmaceuticals, Hod HaSharon, Israel
| | - Yael Barer
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Michael Martinec
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Athanasios Siadimas
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Spyros Roumpanis
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Hannah Furby
- Product Development Personalized Health Care - Data Science, Roche, Welwyn, UK
| | - Inbal Goldshtein
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asif Jan
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Preciosa M Coloma
- Product Development Personalized Health Care - Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Steventon JJ, Foster C, Furby H, Helme D, Wise RG, Murphy K. Hippocampal Blood Flow Is Increased After 20 min of Moderate-Intensity Exercise. Cereb Cortex 2021; 30:525-533. [PMID: 31216005 PMCID: PMC7703728 DOI: 10.1093/cercor/bhz104] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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] [Received: 01/24/2019] [Revised: 04/01/2019] [Accepted: 04/25/2019] [Indexed: 01/17/2023] Open
Abstract
Long-term exercise interventions have been shown to be a potent trigger for both neurogenesis and vascular plasticity. However, little is known about the underlying temporal dynamics and specifically when exercise-induced vascular adaptations first occur, which is vital for therapeutic applications. In this study, we investigated whether a single session of moderate-intensity exercise was sufficient to induce changes in the cerebral vasculature. We employed arterial spin labeling magnetic resonance imaging to measure global and regional cerebral blood flow (CBF) before and after 20 min of cycling. The blood vessels’ ability to dilate, measured by cerebrovascular reactivity (CVR) to CO2 inhalation, was measured at baseline and 25-min postexercise. Our data showed that CBF was selectively increased by 10–12% in the hippocampus 15, 40, and 60 min after exercise cessation, whereas CVR to CO2 was unchanged in all regions. The absence of a corresponding change in hippocampal CVR suggests that the immediate and transient hippocampal adaptations observed after exercise are not driven by a mechanical vascular change and more likely represents an adaptive metabolic change, providing a framework for exploring the therapeutic potential of exercise-induced plasticity (neural, vascular, or both) in clinical and aged populations.
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Affiliation(s)
- J J Steventon
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK.,School of Physics and Astronomy, The Parade, Cardiff University, Cardiff, CF24 3AA, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
| | - C Foster
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
| | - H Furby
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK.,Institute of Neurology, University College London, London, WC1B 5EH, UK
| | - D Helme
- Department of Anaesthetics and Intensive Care Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - R G Wise
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
| | - K Murphy
- School of Physics and Astronomy, The Parade, Cardiff University, Cardiff, CF24 3AA, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
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Rodrigues FB, Byrne LM, Tortelli R, Johnson EB, Wijeratne PA, Arridge M, De Vita E, Ghazaleh N, Houghton R, Furby H, Alexander DC, Tabrizi SJ, Schobel S, Scahill RI, Heslegrave A, Zetterberg H, Wild EJ. Mutant huntingtin and neurofilament light have distinct longitudinal dynamics in Huntington's disease. Sci Transl Med 2020; 12:eabc2888. [PMID: 33328328 PMCID: PMC7611886 DOI: 10.1126/scitranslmed.abc2888] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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: 04/20/2020] [Accepted: 09/04/2020] [Indexed: 07/26/2023]
Abstract
The longitudinal dynamics of the most promising biofluid biomarker candidates for Huntington's disease (HD)-mutant huntingtin (mHTT) and neurofilament light (NfL)-are incompletely defined. Characterizing changes in these candidates during disease progression could increase our understanding of disease pathophysiology and help the identification of effective therapies. In an 80-participant cohort over 24 months, mHTT in cerebrospinal fluid (CSF), as well as NfL in CSF and blood, had distinct longitudinal trajectories in HD mutation carriers compared with controls. Baseline analyte values predicted clinical disease status, subsequent clinical progression, and brain atrophy, better than did the rate of change in analytes. Overall, NfL was a stronger monitoring and prognostic biomarker for HD than mHTT. Nonetheless, mHTT has prognostic value and might be a valuable pharmacodynamic marker for huntingtin-lowering trials.
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Affiliation(s)
- Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, UK
| | - Lauren M Byrne
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, UK
| | - Rosanna Tortelli
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, UK
| | - Eileanoir B Johnson
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, UK
| | - Peter A Wijeratne
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK
| | - Marzena Arridge
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Enrico De Vita
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Naghmeh Ghazaleh
- PD Personalised Healthcare, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Richard Houghton
- PD Personalised Healthcare, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Hannah Furby
- PD Personalised Healthcare, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK
| | - Sarah J Tabrizi
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, UK
- UK Dementia Research Institute at UCL, London WC1E 6BT, UK
| | - Scott Schobel
- Product Development Neuroscience, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Rachael I Scahill
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, UK
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, London WC1E 6BT, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London WC1E 6BT, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, 431 80 Mölndal, Sweden
| | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London WC1B 5EH, UK.
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Steventon JJ, Furby H, Ralph J, O'Callaghan P, Rosser AE, Wise RG, Busse M, Murphy K. Altered cerebrovascular response to acute exercise in patients with Huntington's disease. Brain Commun 2020; 2:fcaa044. [PMID: 32566927 PMCID: PMC7293798 DOI: 10.1093/braincomms/fcaa044] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 01/20/2023] Open
Abstract
The objective of this study was to determine whether a single session of exercise was sufficient to induce cerebral adaptations in individuals with Huntington’s disease and to explore the time dynamics of any acute cerebrovascular response. In this case–control study, we employed arterial-spin labelling MRI in 19 Huntington’s disease gene-positive participants (32–65 years, 13 males) and 19 controls (29–63 years, 10 males) matched for age, gender, body mass index and self-reported activity levels, to measure global and regional perfusion in response to 20 min of moderate-intensity cycling. Cerebral perfusion was measured at baseline and 15, 40 and 60 min after exercise cessation. Relative to baseline, we found that cerebral perfusion increased in patients with Huntington’s disease yet was unchanged in control participants in the precentral gyrus (P = 0.016), middle frontal gyrus (P = 0.046) and hippocampus (P = 0.048) 40 min after exercise cessation (+15 to +32.5% change in Huntington’s disease participants, −7.7 to 0.8% change in controls). The length of the disease‐causing trinucleotide repeat expansion in the huntingtin gene predicted the change in the precentral gyrus (P = 0.03) and the intensity of the exercise intervention predicted hippocampal perfusion change in Huntington’s disease participants (P < 0.001). In both groups, exercise increased hippocampal blood flow 60 min after exercise cessation (P = 0.039). These findings demonstrate the utility of acute exercise as a clinically sensitive experimental paradigm to modulate the cerebrovasculature. Twenty minutes of aerobic exercise induced transient cerebrovascular adaptations in the hippocampus and cortex selectively in Huntington’s disease participants and likely represents latent neuropathology not evident at rest.
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Affiliation(s)
- Jessica J Steventon
- Cardiff University Brain Research Imaging Centre, School of Physics and Astronomy, Cardiff University, Cardiff CF24 4HQ, UK.,Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff CF24 4HQ, UK
| | - Hannah Furby
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff CF24 4HQ, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff CF24 4HQ, UK
| | - James Ralph
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff CF24 4HQ, UK
| | - Peter O'Callaghan
- Cardiology Department, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - Anne E Rosser
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff CF24 4HQ, UK.,Cardiff Brain Repair Group, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - Richard G Wise
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff CF24 4HQ, UK
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre, School of Physics and Astronomy, Cardiff University, Cardiff CF24 4HQ, UK
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7
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Yhnell E, Furby H, Lowe RS, Brookes-Howell LC, Drew CJG, Playle R, Watson G, Metzler-Baddeley C, Rosser AE, Busse ME. A randomised feasibility study of computerised cognitive training as a therapeutic intervention for people with Huntington's disease (CogTrainHD). Pilot Feasibility Stud 2020; 6:88. [PMID: 32577299 PMCID: PMC7304172 DOI: 10.1186/s40814-020-00623-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is associated with a range of cognitive deficits including problems with executive function. In the absence of a disease modifying treatment, cognitive training has been proposed as a means of slowing cognitive decline; however, the impact of cognitive training in HD patient populations remains unclear. The CogTrainHD study assessed the feasibility and acceptability of home-based computerised executive function training, for people impacted by HD. METHODS Thirty HD gene carriers were recruited and randomised to either executive function training or non-intervention control groups. Participants allocated to the intervention group were asked to complete executive function training three times a week for 30 min for 12 weeks in their own homes. Semi-structured interviews were conducted with participants and friends, family or carers, to determine their views on the study. RESULTS 26 out of 30 participants completed the baseline assessments and were subsequently randomised: 13 to the control group and 13 to the intervention group. 23 of the 30 participants were retained until study completion: 10/13 in the intervention group and 13/13 in the control group. 4/10 participants fully adhered to the executive function training. All participants in the control group 13/13 completed the study as intended. Interview data suggested several key facilitators including participant determination, motivation, incorporation of the intervention into routine and support from friends and family members. Practical limitations, including lack of time, difficulty and frustration in completing the intervention, were identified as barriers to study completion. CONCLUSIONS The CogTrainHD feasibility study provides important evidence regarding the feasibility and acceptability of a home-based cognitive training intervention for people with HD. Variable adherence to the cognitive training implies that the intervention is not feasible to all participants in its current form. The study has highlighted important aspects in relation to both the study and intervention design that require consideration, and these include the design of games in the executive function training software, logistical considerations such as lack of time, the limited time participants had to complete the intervention and the number of study visits required. Further studies are necessary before computerised executive function training can be recommended routinely for people with HD. TRIAL REGISTRATION ClinicalTrials.gov, Registry number NCT02990676.
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Affiliation(s)
- Emma Yhnell
- Neuroscience and Mental Health Research Institute, Cardiff University (NMHRI), 3rd Floor, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
- Cardiff University School of Biosciences, The Sir Martin Evans Building, Museum Avenue, Cardiff, CF10 3AX UK
| | - Hannah Furby
- School of Psychology, Cardiff University Brain Research Imaging Centre (CUBRIC), Maindy Road, Cardiff University, Cardiff, CF24 4HQ UK
| | - Rachel S. Lowe
- Centre for Trials Research (CTR), Cardiff University, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Lucy C. Brookes-Howell
- Centre for Trials Research (CTR), Cardiff University, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Cheney J. G. Drew
- Centre for Trials Research (CTR), Cardiff University, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rebecca Playle
- Centre for Trials Research (CTR), Cardiff University, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Gareth Watson
- Centre for Trials Research (CTR), Cardiff University, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Claudia Metzler-Baddeley
- School of Psychology, Cardiff University Brain Research Imaging Centre (CUBRIC), Maindy Road, Cardiff University, Cardiff, CF24 4HQ UK
| | - Anne E. Rosser
- Neuroscience and Mental Health Research Institute, Cardiff University (NMHRI), 3rd Floor, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
- Cardiff University Brain Repair Group, Life Sciences Building, Museum Avenue, Cardiff, CF10 3AX UK
| | - Monica E. Busse
- Centre for Trials Research (CTR), Cardiff University, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS UK
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Quarrell OWJ, Nance MA, Nopoulos P, Reilmann R, Oosterloo M, Tabrizi SJ, Furby H, Saft C, Roos RAC, Squitieri F, Landwehrmeyer GB, Burgunder JM. Defining pediatric huntington disease: Time to abandon the term Juvenile Huntington Disease? Mov Disord 2019; 34:584-585. [PMID: 30788860 DOI: 10.1002/mds.27640] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Oliver W J Quarrell
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Martha A Nance
- Struthers Parkinson's Center, Minneapolis, Minnesota, USA
| | - Peg Nopoulos
- Departments of Psychiatry, Pediatrics, & Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ralf Reilmann
- George-Huntington-Institute & Department of Radiology, University of Muenster, Muenster, Germany
- Department for Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Mayke Oosterloo
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sarah J Tabrizi
- Department of Neurodegenerative Disease, University College London Institute of Neurology, University College London, London, UK
| | - Hannah Furby
- Department of Neurodegenerative Disease, University College London Institute of Neurology, University College London, London, UK
| | - Carsten Saft
- Department of Neurology, Huntington Centre NRW, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center Neurology, Leiden, The Netherlands
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione Instituto Di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | | | - Jean-Marc Burgunder
- Swiss HD Center, Neurozentrum Siloah and Department of Neurology, University of Bern, Bern, Switzerland
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Furby H, Ralph J, Rosser AE, O’Callaghan P, Murphy K, Wise RG, Steventon JJ. E08 Cerebral blood flow is associated with disease severity and cognitive defecits in pre/early huntington’s disease. Imaging 2018. [DOI: 10.1136/jnnp-2018-ehdn.102] [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] [Indexed: 11/04/2022] Open
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10
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Furby H, Yhnell E, Mazzaschi F, Mole J, Busse M, Rosser AE, Metzler-Baddeley C. E06 Using 3T MRI to explore myelin break-down in pre-symptomatic huntington’s disease. Imaging 2018. [DOI: 10.1136/jnnp-2018-ehdn.100] [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] [Indexed: 11/03/2022] Open
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11
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Steventon JJ, Collett J, Furby H, Hamana K, Foster C, O'Callaghan P, Dennis A, Armstrong R, Németh AH, Rosser AE, Murphy K, Quinn L, Busse M, Dawes H. Alterations in the metabolic and cardiorespiratory response to exercise in Huntington's Disease. Parkinsonism Relat Disord 2018; 54:56-61. [PMID: 29705557 DOI: 10.1016/j.parkreldis.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data suggests that an altered metabolic and cardiorespiratory exercise response may affect exercise performance in individuals with Huntington's disease (HD). There is no clear exploration of the response in individuals at different stages of the disease or in relation to genetic markers. This study aimed to examine the exercise response and recovery of HD participants, and the relationship to genetic and clinical markers. METHOD HD gene-positive participants (n = 31; 9 pre-manifest; 22 manifest HD) and a healthy control group (n = 29) performed an incremental exercise test until exhaustion. Performance, cardiorespiratory, metabolic and perceptual responses to exercise were determined from a maximal cycle ergometer test throughout the exercise test and during a recovery period. RESULTS During sub-maximal exercise, metabolic (lactate levels, oxygen uptake) and cardiorespiratory markers (heart rate) were elevated in HD participants compared to controls. Lactate elevation was specific to pre-manifest HD participants. Work capacity was reduced in both pre-manifest and manifest HD participants with tests terminated with no difference in metabolic, perceptual or cardiorespiratory markers. Submaximal oxygen uptake was correlated with motor score, whilst peak measures were unrelated to genetic or clinical markers. Heart rate recovery was attenuated in pre-manifest and manifest HD participants. CONCLUSIONS Our findings confirm metabolic and cardiorespiratory deficits reduce exercise performance and affect recovery from an early stage in HD, with submaximal deficits related to phenotypic expression. Exercise capacity appears to be limited by an altered movement economy, thus clinicians should consider an altered exercise response and recovery may affect prescription in HD.
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Affiliation(s)
- J J Steventon
- School of Physics and Astronomy, Cardiff University, UK; NMHRI, School of Medicine, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK.
| | - J Collett
- Centre for Movement, Occupation and Rehabilitation Sciences, OxINMAHR, Oxford Brookes University, Oxford, UK; Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - H Furby
- NMHRI, School of Medicine, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK
| | - K Hamana
- School of Healthcare Sciences, Cardiff University, UK
| | - C Foster
- CUBRIC, School of Psychology, Cardiff University, UK
| | - P O'Callaghan
- Cardiology Department, University Hospital of Wales, Cardiff, UK
| | - A Dennis
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, OX3 9DU, UK
| | - R Armstrong
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A E Rosser
- IPMCN, School of Medicine, Cardiff University, UK
| | - K Murphy
- School of Physics and Astronomy, Cardiff University, UK; CUBRIC, School of Psychology, Cardiff University, UK
| | - L Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, USA
| | - M Busse
- Centre for Trials Research, Cardiff University, UK
| | - H Dawes
- Centre for Movement, Occupation and Rehabilitation Sciences, OxINMAHR, Oxford Brookes University, Oxford, UK; Department of Clinical Neurology, University of Oxford, Oxford, UK
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12
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Yhnell E, Furby H, Breen RS, Brookes-Howell LC, Drew CJG, Playle R, Watson G, Metzler-Baddeley C, Rosser AE, Busse ME. Exploring computerised cognitive training as a therapeutic intervention for people with Huntington's disease (CogTrainHD): protocol for a randomised feasibility study. Pilot Feasibility Stud 2018; 4:45. [PMID: 29445514 PMCID: PMC5801672 DOI: 10.1186/s40814-018-0237-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/16/2017] [Accepted: 01/18/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cognitive impairments, especially deficits of executive function, have been well documented as a core and early feature in Huntington's disease (HD). Cognitive impairments represent considerable burden and can be devastating for people and families affected by HD. Computerised cognitive training interventions that focus on improving executive function present a possible non-pharmacological treatment option. We propose to determine the feasibility, acceptability, and appropriate outcome measures for use in a randomised controlled feasibility study. METHODS/DESIGN Participants will be randomised into either a computerised cognitive training group or a control group. Those randomised to the training group will be asked to complete a cognitive training intervention based on the HappyNeuron Pro software tasks of executive function, for a minimum of 30 min, three times a week for the 12-week study duration. Participants in the control group will not receive computerised cognitive training but will receive a similar degree of social interaction via equivalent study and home visits. We will explore quantitative outcome measures, including measures of cognitive performance, motor function, questionnaires and semi-structured interviews, as well as magnetic resonance imaging (MRI) measures in a subset of participants. Feasibility will be determined through assessment of recruitment, retention, adherence and acceptability of the intervention. DISCUSSION The results of this study will provide crucial guidance and information regarding the feasibility of conducting a randomised controlled study into computerised cognitive training in HD. This study is crucial for the development of larger definitive randomised controlled trials which are powered to determine efficacy and for the development of future cognitive training programmes for people affected by HD. TRIAL REGISTRATION The study is registered on clinicaltrials.gov and has the unique identifier NCT02990676.
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Affiliation(s)
- Emma Yhnell
- Neuroscience and Mental Health Research Institute, Cardiff University, 3rd Floor, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ Wales UK
| | - Hannah Furby
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Road, Cardiff, CF24 4HQ Wales UK
| | - Rachel S. Breen
- Centre for Trials Research (CTR), Cardiff University, 4th and 7th Floors, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS Wales UK
| | - Lucy C. Brookes-Howell
- Centre for Trials Research (CTR), Cardiff University, 4th and 7th Floors, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS Wales UK
| | - Cheney J. G. Drew
- Centre for Trials Research (CTR), Cardiff University, 4th and 7th Floors, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS Wales UK
| | - Rebecca Playle
- Centre for Trials Research (CTR), Cardiff University, 4th and 7th Floors, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS Wales UK
| | - Gareth Watson
- Centre for Trials Research (CTR), Cardiff University, 4th and 7th Floors, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS Wales UK
| | - Claudia Metzler-Baddeley
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Road, Cardiff, CF24 4HQ Wales UK
| | - Anne E. Rosser
- Neuroscience and Mental Health Research Institute, Cardiff University, 3rd Floor, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ Wales UK
| | - Monica E. Busse
- Centre for Trials Research (CTR), Cardiff University, 4th and 7th Floors, Neuadd Meironnydd, Heath Park, Cardiff, CF14 4YS Wales UK
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13
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Davies JR, Humby T, Dwyer DM, Garfield AS, Furby H, Wilkinson LS, Wells T, Isles AR. Calorie seeking, but not hedonic response, contributes to hyperphagia in a mouse model for Prader-Willi syndrome. Eur J Neurosci 2015; 42:2105-13. [PMID: 26040449 PMCID: PMC4949663 DOI: 10.1111/ejn.12972] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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] [Received: 01/19/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 12/25/2022]
Abstract
Prader–Willi syndrome (PWS) is a neurodevelopmental disorder caused by deletion or inactivation of paternally expressed imprinted genes on human chromosome 15q11‐q13, the most recognised feature of which is hyperphagia. This is thought to arise as a consequence of abnormalities in both the physiological drive for food and the rewarding properties of food. Although a number of mouse models for PWS exist, the underlying variables dictating maladaptive feeding remain unknown. Here, feeding behaviour in a mouse model in which the imprinting centre (IC) of the syntenic PWS interval has been deleted (PWSICdel mice) is characterised. It is demonstrated that PWSICdel mice show hyperghrelinaemia and increased consumption of food both following overnight fasting and when made more palatable with sucrose. However, hyperphagia in PWSICdel mice was not accompanied by any changes in reactivity to the hedonic properties of palatable food (sucrose or saccharin), as measured by lick‐cluster size. Nevertheless, overall consumption by PWSICdel mice for non‐caloric saccharin in the licking test was significantly reduced. Combined with converging findings from a continuous reinforcement schedule, these data indicate that PWSICdel mice show a marked heightened sensitivity to the calorific value of food. Overall, these data indicate that any impact of the rewarding properties of food on the hyperphagia seen in PWSICdel mice is driven primarily by calorie content and is unlikely to involve hedonic processes. This has important implications for understanding the neural systems underlying the feeding phenotype of PWS and the contribution of imprinted genes to abnormal feeding behaviour more generally.
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Affiliation(s)
- Jennifer R Davies
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.,School of Medicine, Cardiff University, Cardiff, UK
| | - Trevor Humby
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.,School of Psychology, Cardiff University, Cardiff, UK
| | - Dominic M Dwyer
- School of Psychology, Cardiff University, Cardiff, UK.,School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | | | - Hannah Furby
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.,School of Medicine, Cardiff University, Cardiff, UK.,School of Biosciences, Cardiff University, Cardiff, UK
| | - Lawrence S Wilkinson
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.,School of Medicine, Cardiff University, Cardiff, UK.,School of Psychology, Cardiff University, Cardiff, UK
| | - Timothy Wells
- School of Biosciences, Cardiff University, Cardiff, UK
| | - Anthony R Isles
- Behavioural Genetics Group, MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.,School of Medicine, Cardiff University, Cardiff, UK
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14
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Stone JM, Pepper F, Fam J, Furby H, Hughes E, Morgan C, Howes OD. Glutamate, N-acetyl aspartate and psychotic symptoms in chronic ketamine users. Psychopharmacology (Berl) 2014; 231:2107-16. [PMID: 24264567 DOI: 10.1007/s00213-013-3354-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 11/04/2013] [Indexed: 01/21/2023]
Abstract
RATIONALE Ketamine, a non-competitive NMDA receptor antagonist, induces acute effects resembling the positive, negative and cognitive symptoms of schizophrenia. Chronic use has been suggested to lead to persistent schizophrenia-like neurobiological changes. OBJECTIVES This study aims to test the hypothesis that chronic ketamine users have changes in brain neurochemistry and increased subthreshold psychotic symptoms compared to matched poly-drug users. METHODS Fifteen ketamine users and 13 poly-drug users were included in the study. Psychopathology was assessed using the Comprehensive Assessment of At-Risk Mental State. Creatine-scaled glutamate (Glu/Cr), glutamate + glutamine (Glu + Gln/Cr) and N-acetyl aspartate (NAA/Cr) were measured in three brain regions-anterior cingulate, left thalamus and left medial temporal cortex using proton magnetic resonance spectroscopy. RESULTS Chronic ketamine users had higher levels of subthreshold psychotic symptoms (p < 0.005, Cohen's d = 1.48) and lower thalamic NAA/Cr (p < 0.01, d = 1.17) compared to non-users. There were no differences in medial temporal cortex or anterior cingulate NAA/Cr or in Glu/Cr or Glu + Gln/Cr in any brain region between the two groups. In chronic ketamine users, CAARMS severity of abnormal perceptions was directly correlated with anterior cingulate Glu/Cr (p < 0.05, r = 0.61-uncorrected), but NAA/Cr was not related to any measures of psychopathology. CONCLUSIONS The finding of lower thalamic NAA/Cr in chronic ketamine users may be secondary to the effects of ketamine use compared to other drugs of abuse and resembles previous reports in individuals at genetic or clinical risk of schizophrenia.
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Affiliation(s)
- James M Stone
- Department of Experimental Medicine, Imperial College London, London, UK,
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15
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Morgan CJA, Dodds CM, Furby H, Pepper F, Fam J, Freeman TP, Hughes E, Doeller C, King J, Howes O, Stone JM. Long-Term Heavy Ketamine Use is Associated with Spatial Memory Impairment and Altered Hippocampal Activation. Front Psychiatry 2014; 5:149. [PMID: 25538631 PMCID: PMC4255515 DOI: 10.3389/fpsyt.2014.00149] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [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: 09/01/2014] [Accepted: 10/12/2014] [Indexed: 11/13/2022] Open
Abstract
Ketamine, a non-competitive N-methyl-d-aspartate receptor antagonist, is rising in popularity as a drug of abuse. Preliminary evidence suggests that chronic, heavy ketamine use may have profound effects on spatial memory but the mechanism of these deficits is as yet unclear. This study aimed to examine the neural mechanism by which heavy ketamine use impairs spatial memory processing. In a sample of 11 frequent ketamine users and 15 poly-drug controls, matched for IQ, age, years in education. We used fMRI utilizing an ROI approach to examine the neural activity of three regions known to support successful navigation; the hippocampus, parahippocampal gyrus, and the caudate nucleus during a virtual reality task of spatial memory. Frequent ketamine users displayed spatial memory deficits, accompanied by and related to, reduced activation in both the right hippocampus and left parahippocampal gyrus during navigation from memory, and in the left caudate during memory updating, compared to controls. Ketamine users also exhibited schizotypal and dissociative symptoms that were related to hippocampal activation. Impairments in spatial memory observed in ketamine users are related to changes in medial temporal lobe activation. Disrupted medial temporal lobe function may be a consequence of chronic ketamine abuse and may relate to schizophrenia-like symptomatology observed in ketamine users.
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Affiliation(s)
- Celia J A Morgan
- Centre for Clinical Psychopharmacology, University of Exeter , Exeter , UK ; Clinical Psychopharmacology Unit UCL, University College London , London , UK
| | - Chris M Dodds
- Centre for Clinical Psychopharmacology, University of Exeter , Exeter , UK
| | - Hannah Furby
- Neuroimaging Sciences, Cardiff University , Cardiff , UK
| | - Fiona Pepper
- Institute of Psychiatry, Kings College London , London , UK
| | - Johnson Fam
- Department of Experimental Medicine, Imperial College London , London , UK
| | - Tom P Freeman
- Clinical Psychopharmacology Unit UCL, University College London , London , UK
| | - Emer Hughes
- Department of Experimental Medicine, Imperial College London , London , UK
| | - Christian Doeller
- Donders Institute for Brain, Cognition and Behaviour , Nijmegen , Netherlands
| | - John King
- Clinical Psychopharmacology Unit UCL, University College London , London , UK
| | - Oliver Howes
- Department of Experimental Medicine, Imperial College London , London , UK
| | - James M Stone
- Institute of Psychiatry, Kings College London , London , UK ; Department of Experimental Medicine, Imperial College London , London , UK
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