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O'Donoghue MC, Blane J, Gillis G, Mitchell R, Lindsay K, Semple J, Pretorius PM, Griffanti L, Fossey J, Raymont V, Martos L, Mackay CE. Oxford brain health clinic: protocol and research database. BMJ Open 2023; 13:e067808. [PMID: 37541753 PMCID: PMC10407419 DOI: 10.1136/bmjopen-2022-067808] [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: 08/26/2022] [Accepted: 06/22/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Despite major advances in the field of neuroscience over the last three decades, the quality of assessments available to patients with memory problems in later life has barely changed. At the same time, a large proportion of dementia biomarker research is conducted in selected research samples that often poorly reflect the demographics of the population of patients who present to memory clinics. The Oxford Brain Health Clinic (BHC) is a newly developed clinical assessment service with embedded research in which all patients are offered high-quality clinical and research assessments, including MRI, as standard. METHODS AND ANALYSIS Here we describe the BHC protocol, including aligning our MRI scans with those collected in the UK Biobank. We evaluate rates of research consent for the first 108 patients (data collection ongoing) and the ability of typical psychiatry-led NHS memory-clinic patients to tolerate both clinical and research assessments. ETHICS AND DISSEMINATION Our ethics and consenting process enables patients to choose the level of research participation that suits them. This generates high rates of consent, enabling us to populate a research database with high-quality data that will be disseminated through a national platform (the Dementias Platform UK data portal).
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Affiliation(s)
- Melissa Clare O'Donoghue
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jasmine Blane
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Grace Gillis
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Karen Lindsay
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Juliet Semple
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Ludovica Griffanti
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Lola Martos
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Clare E Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Griffanti L, Gillis G, O'Donoghue MC, Blane J, Pretorius PM, Mitchell R, Aikin N, Lindsay K, Campbell J, Semple J, Alfaro-Almagro F, Smith SM, Miller KL, Martos L, Raymont V, Mackay CE. Adapting UK Biobank imaging for use in a routine memory clinic setting: The Oxford Brain Health Clinic. Neuroimage Clin 2022; 36:103273. [PMID: 36451375 PMCID: PMC9723313 DOI: 10.1016/j.nicl.2022.103273] [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] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
The Oxford Brain Health Clinic (BHC) is a joint clinical-research service that provides memory clinic patients and clinicians access to high-quality assessments not routinely available, including brain MRI aligned with the UK Biobank imaging study (UKB). In this work we present how we 1) adapted the UKB MRI acquisition protocol to be suitable for memory clinic patients, 2) modified the imaging analysis pipeline to extract measures that are in line with radiology reports and 3) explored the alignment of measures from BHC patients to the largest brain MRI study in the world (ultimately 100,000 participants). Adaptations of the UKB acquisition protocol for BHC patients include dividing the scan into core and optional sequences (i.e., additional imaging modalities) to improve patients' tolerance for the MRI assessment. We adapted the UKB structural MRI analysis pipeline to take into account the characteristics of a memory clinic population (e.g., high amount of white matter hyperintensities and hippocampal atrophy). We then compared the imaging derived phenotypes (IDPs) extracted from the structural scans to visual ratings from radiology reports, non-imaging factors (age, cognition) and to reference distributions derived from UKB data. Of the first 108 BHC attendees (August 2020-November 2021), 92.5 % completed the clinical scans, 88.0 % consented to use of data for research, and 43.5 % completed the additional research sequences, demonstrating that the protocol is well tolerated. The high rates of consent to research makes this a valuable real-world quality research dataset routinely captured in a clinical service. Modified tissue-type segmentation with lesion masking greatly improved grey matter volume estimation. CSF-masking marginally improved hippocampal segmentation. The IDPs were in line with radiology reports and showed significant associations with age and cognitive performance, in line with the literature. Due to the age difference between memory clinic patients of the BHC (age range 65-101 years, average 78.3 years) and UKB participants (44-82 years, average 64 years), additional scans on elderly healthy controls are needed to improve reference distributions. Current and future work aims to integrate automated quantitative measures in the radiology reports and evaluate their clinical utility.
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Affiliation(s)
- Ludovica Griffanti
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom.
| | - Grace Gillis
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - M Clare O'Donoghue
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Jasmine Blane
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Pieter M Pretorius
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | | | - Nicola Aikin
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Karen Lindsay
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jon Campbell
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Juliet Semple
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Fidel Alfaro-Almagro
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Stephen M Smith
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Karla L Miller
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Lola Martos
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Clare E Mackay
- Department of Psychiatry, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
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Blane J, ClareO'Donoghue M, Craig E, Clarke L, Raymont V, Mackay C, Martos L. Patient attitudes towards remote memory clinic assessment. Alzheimers Dement 2022; 17 Suppl 11:e053742. [PMID: 34971057 DOI: 10.1002/alz.053742] [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: 11/07/2022]
Abstract
BACKGROUND Due to demand on UK memory clinic services, most patients have limited consultant interaction before diagnosis/discharge. Technology offers an opportunity for remote assessment, from telephone/video-based consultations to fully digitised cognitive assessments with potential to track disease progression. Whilst many acute services utilise remote assessment, there are perceived barriers in memory clinic populations. However, COVID-19 and related national restrictions may have altered patients' attitudes towards and experience with remote assessment tools. We aimed to investigate attitudes including confidence and perceived challenges towards remote assessment as well as access and experience with technology amongst Oxfordshire memory clinic patients. METHOD Between June and September 2020, all patients awaiting initial memory clinic assessment were asked to participate in a standardised semi-quantitative survey as part of an Oxford Health NHS Foundation Trust service evaluation. Designed with service-user input, questions aimed to capture availability, experience and confidence using technology and patients' comfort with assessment, diagnosis and future care discussions being conducted remotely, as well as any concerns or comments. RESULT Amongst 73 respondents (average age=79.1 years), access to technology was high; 82% reported telephone access and 58% to a laptop, tablet, smartphone or combination of the three. 17% reported previous use of web-based video conferencing tools, and although confidence using these tools was 7%, this increased with written instruction or relative assistance. Similarly, whilst under half of the respondents felt comfortable with assessments, diagnosis or future care discussions occurring remotely, this increased to approximately two thirds with relative presence (67%, 69% and 66%, respectively). Qualitative analysis of patient's comments regarding remote assessment also revealed concerns over wait times/urgent need for assessment. However, 62% preferred to wait for an in-person visit, rather than an immediate remote appointment. CONCLUSION This survey demonstrates availability of technology in this population but a disparity in willingness to engage in remote assessment. Consequently, there is a need to diverge from one-size-fits-all models to a tiered approach that helps facilitate individual choice based on the availability/confidence with technology and level of relative support. The Oxford Brain Health Centre, an integrated clinical-research service, provides an opportunity to research this tiered approach in clinical practice.
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Affiliation(s)
- Jasmine Blane
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - M ClareO'Donoghue
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Emma Craig
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Laura Clarke
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa Raymont
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | | | - Lola Martos
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
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O'Donoghue MC, Blane J, Mitchell R, Aikin N, Lindsay K, Campbell J, Semple J, Raymont V, Martos L, Mackay C. Embedding dementia research in clinical practice: Progress of the Oxford Brain Health Centre. Alzheimers Dement 2021. [DOI: 10.1002/alz.049778] [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: 11/07/2022]
Affiliation(s)
- M Clare O'Donoghue
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Jasmine Blane
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Robert Mitchell
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Nicola Aikin
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Karen Lindsay
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Jon Campbell
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Juliet Semple
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Vanessa Raymont
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Lola Martos
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
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Griffanti L, Clare O'Donoghue M, Blane J, Mitchell R, Aikin N, Lindsay K, Campbell J, Semple J, Nobis L, Raymont V, Martos L, Mackay C. Translating magnetic resonance imaging research in clinical practice for dementia: The Oxford Brain Health Centre. Alzheimers Dement 2021. [DOI: 10.1002/alz.051016] [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)
| | - M. Clare O'Donoghue
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Jasmine Blane
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Robert Mitchell
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Nicola Aikin
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Karen Lindsay
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Jon Campbell
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Juliet Semple
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Lisa Nobis
- University of Oxford Oxford United Kingdom
| | - Vanessa Raymont
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Lola Martos
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
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Marsh LC, Leach RM, Blane J, Daly K, Barrett NA, Slack A, Kopelman MD. Long-term cognitive and psychiatric outcomes of acute respiratory distress syndrome managed with Extracorporeal Membrane Oxygenation. Respir Med 2021; 183:106419. [PMID: 33957436 DOI: 10.1016/j.rmed.2021.106419] [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] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cognitive dysfunction is often reported in patients who have experienced acute respiratory distress syndrome (ARDS). Extra Corporeal Membrane Oxygenation (ECMO) therapy is increasingly used to manage ARDS patients in ICU, transforming survival rates. However, few studies have examined cognitive outcomes. METHODS We examined self-reported cognitive complaints, psychiatric outcomes and neuropsychological test performance in survivors of severe hypoxaemia managed with VV-ECMO, at 18-24 month follow-up, compared with a group of healthy controls. RESULTS Over 70% of ECMO-treated patients (N = 46) complained of difficulty in at least one aspect of cognition on self-report measures (study 1). However, a much lower frequency of cognitive impairment was found on formal neuropsychological testing (study 2). Mean neuropsychological test scores of the ECMO group (N = 24) did not significantly differ from healthy controls (N = 23) after controlling for depression. Less than 30% of ECMO-treated patients showed impairments in anterograde memory, and deficits on general IQ or executive function were seen in <17% of patients. However, we observed high levels of self-reported anxiety and depression in the ECMO-treated patients. CONCLUSIONS Cognitive outcomes in ECMO-treated patients were generally good, with preserved neuropsychological function in the majority of patients, despite severe hypoxaemia and high rates of self-reported difficulties. However, we saw high levels of mental health symptoms in these patients, highlighting a need for psychological support.
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Affiliation(s)
- L C Marsh
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - R M Leach
- Pulmonary and Critical Care Medicine, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - J Blane
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - K Daly
- Pulmonary and Critical Care Medicine, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - N A Barrett
- Pulmonary and Critical Care Medicine, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - A Slack
- Pulmonary and Critical Care Medicine, Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - M D Kopelman
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
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Lancaster C, Koychev I, Blane J, Chinner A, Wolters L, Hinds C. Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk. JMIR Mhealth Uhealth 2020; 8:e16142. [PMID: 32238339 PMCID: PMC7163418 DOI: 10.2196/16142] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 09/05/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022] Open
Abstract
Background By enabling frequent, sensitive, and economic remote assessment, smartphones will facilitate the detection of early cognitive decline at scale. Previous studies have sustained participant engagement with remote cognitive assessment over a week; extending this to a period of 1 month clearly provides a greater opportunity for measurement. However, as study durations are increased, the need to understand how participant burden and scientific value might be optimally balanced also increases. Objective This study explored the little but often approach to assessment employed by the Mezurio app when prompting participants to interact every day for over a month. Specifically, this study aimed to understand whether this extended duration of remote study is feasible, and which factors promote sustained participant engagement over such periods. Methods A total of 35 adults (aged 40-59 years) with no diagnosis of cognitive impairment were prompted to interact with the Mezurio smartphone app platform for up to 36 days, completing short, daily episodic memory tasks in addition to optional executive function and language tests. A subset (n=20) of participants completed semistructured interviews focused on their experience of using the app. Results Participants complied with 80% of the daily learning tasks scheduled for subsequent tests of episodic memory, with 88% of participants still actively engaged by the final task. A thematic analysis of the participants’ experiences highlighted schedule flexibility, a clear user interface, and performance feedback as important considerations for engagement with remote digital assessment. Conclusions Despite the extended study duration, participants demonstrated high compliance with the schedule of daily learning tasks and were extremely positive about their experiences. Long durations of remote digital interaction are therefore definitely feasible but only when careful attention is paid to the design of the users’ experience.
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Affiliation(s)
- Claire Lancaster
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jasmine Blane
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Amy Chinner
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Leona Wolters
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Chris Hinds
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Lancaster C, Koychev I, Blane J, Chinner A, Chatham C, Taylor K, Hinds C. Gallery Game: Smartphone-based assessment of long-term memory in adults at risk of Alzheimer's disease. J Clin Exp Neuropsychol 2020; 42:329-343. [PMID: 31973659 DOI: 10.1080/13803395.2020.1714551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Gallery Game, deployed within the Mezurio smartphone app, targets the processes of episodic memory hypothesized to be first vulnerable to neurofibrillary tau-related degeneration in Alzheimer's Disease, prioritizing both perirhinal and entorhinal cortex/hippocampal demands.Methods: Thirty-five healthy adults (aged 40-59 years), biased toward those at elevated familial risk of dementia, completed daily Gallery Game tasks for a month. Assessments consisted of cross-modal paired-associate learning, with subsequent tests of recognition and free recall following delays ranging from one to 13 days.Results: Retention intervals of at least three days were needed to evidence significant forgetting at both recognition and paired-associate recall test. The association between Gallery Game outcomes and established in-clinic memory assessments were small but numerically in the anticipated direction. In addition, there was preliminary support for utilizing the perirhinal-dependent pattern of semantic false alarms during object recognition as a marker of early impairment.Conclusions: These results support the need for tests of longer-term memory to sensitively record behavioral differences in adults with no diagnosis of cognitive impairment. Aggregate behavioral outcomes promote Gallery Game's utility as a digital assessment of episodic memory, aligning with established theoretical models of object memory and showing small yet uniform associations with existing in-clinic tests. Initial support for the discriminatory value of perirhinal-targeted outcomes justifies ongoing large-sample validation against traditional biomarkers of Alzheimer's disease.
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Affiliation(s)
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jasmine Blane
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amy Chinner
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Kirsten Taylor
- Roche Innovation Centre, F.Hoffmann-La Roche Ltd., Basel, Switzerland.,Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Chris Hinds
- Big Data Institute, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
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Atreya A, Lancaster CL, Koychev IG, Chinner A, Blane J, Chatham C, Taylor KI, Hinds C. P4-605: STORY TIME: COMPUTATIONAL ANALYSIS OF RAW-SPEECH TO AID THE DETECTION OF PRECLINICAL ALZHEIMER'S DISEASE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.08.153] [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: 10/25/2022]
Affiliation(s)
| | | | | | | | | | | | - Kirsten I. Taylor
- Roche Pharmaceuticals; Basel Switzerland
- University of Basel; Basel Switzerland
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Lancaster CL, Seslija M, Koychev IG, Chinner A, Blane J, Chatham C, Taylor KI, Hinds C. P4-604: SMARTPHONE-BASED ASSESSMENT OF EXECUTIVE FUNCTION: ANALYSING MOTOR-RESPONSE TRAJECTORIES TO ENHANCE THE DETECTION OF PRECLINICAL COGNITIVE IMPAIRMENT. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.08.152] [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: 11/17/2022]
Affiliation(s)
| | | | | | | | | | | | - Kirsten I. Taylor
- Roche Pharmaceuticals; Basel Switzerland
- University of Basel; Basel Switzerland
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Chinner A, Blane J, Lancaster C, Hinds C, Koychev I. Digital technologies for the assessment of cognition: a clinical review. Evid Based Ment Health 2018; 21:67-71. [PMID: 29678927 PMCID: PMC10270380 DOI: 10.1136/eb-2018-102890] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 12/21/2022]
Abstract
Dementia is the most widespread form of neurodegenerative disorder and is associated with an immense societal and personal cost. Prevalence of this disorder is projected to triple worldwide by 2050 leading to an urgent need to make advances in the efficiency of both its care and therapy research. Digital technologies are a rapidly advancing field that provide a previously unavailable opportunity to alleviate challenges faced by clinicians and researchers working in this area. This clinical review aimed to summarise currently available evidence on digital technologies that can be used to monitor cognition. We identified a range of pervasive digital systems, such as smartphones, smartwatches and smart homes, to assess and assist elderly demented, prodromal and preclinical populations. Generally, the studies reported good level of agreement between the digital measures and the constructs they aimed to measure. However, most of the systems are still only in the initial stages of development with limited data on acceptability in patients. Although it is clear that the use of digital technology to monitor and support the cognitive domains affected by dementia is a promising area of development, additional research validating the efficacy, utility and cost-effectiveness of these systems in patient populations is needed.
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Affiliation(s)
- Amy Chinner
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Jasmine Blane
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | | | - Chris Hinds
- Big Data Institute, University of Oxford, Oxford, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Molajo AO, Bowes RJ, Fananapazir L, Slaven Y, Wilkinson K, Blane J, Bennett DH. Comparison of vitreous carbon and elgiloy transvenous ventricular pacing leads. Pacing Clin Electrophysiol 1985; 8:261-5. [PMID: 2580288 DOI: 10.1111/j.1540-8159.1985.tb05758.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In a randomized prospective study of 150 patients, we compared two porous-tipped, finned leads, one with a vitreous carbon tip (surface area = 12 mm2) and the other with an Elgiloy tip (surface area = 8 mm2). We assessed the acute and chronic stimulation thresholds and the ease of implantation of the two leads. The acute current thresholds for the vitreous carbon and Elgiloy-tipped leads were 1.7 +/- 0.5 (+/- SD) mA vs. 1.1 +/- 0.4 mA (0.25 ms pulse width), 1.3 +/- 0.5 mA vs. 0.9 +/- 0.3 mA (0.5 ms), and 1.0 +/- 0.3 mA vs. 0.8 +/- 0.3 mA (0.75 ms), respectively (P less than 0.0005). Impedance at implantation was 473 +/- 121 ohms and 716 +/- 285 ohms (P less than 0.0005) for the carbon-tipped and Elgiloy-tipped leads, respectively. The R-wave amplitudes were 10.2 +/- 5.1 volts and 6.8 +/- 3.0 volts, respectively (P less than 0.0005). Both leads were easy to implant and showed low stable chronic thresholds from 3 weeks after implantation, at which time the stimulation threshold was 1.9 +/- 1.0 volts vs. 1.5 +/- 0.6 volts with the implanted voltage-variable generators and 1.8 +/- 0.8 mA vs. 1.6 +/- 0.6 mA with the implanted current-variable generators. Reoperation for displacement was required for two of the 87 (2.3%) carbon-tipped and 2 of the 67 (3.2%) Elgiloy-tipped leads. There was no exit block nor any other lead-related complication. We conclude that both leads have similar and satisfactory performance.
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Fananapazir L, Martin TS, Martin V, Slaven Y, Wilkinson K, Blane J, Bennett DH. Experience with 407 transvenous, finned pacing leads with a sintered porous-surfaced electrode. Pacing Clin Electrophysiol 1984; 7:132-5. [PMID: 6199758 DOI: 10.1111/j.1540-8159.1984.tb04870.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Experience with 407 transvenous ventricular finned pacing leads with a sintered porous-surfaced electrode is reported. A low complication rate was encountered: 97% of patients were free from lead-related complications. Four patients (1%) required re-operation: two for lead displacement, one for failure to sense spontaneous ventricular activity and one for exit block. A further patient developed exit block which resolved spontaneously. The vast majority of patients had low chronic stimulation thresholds; for example at six months after implantation, the mean threshold for a group of pacemakers with a pulse duration of 0.5 ms was 1.4 +/- 0.7 V and for another group with a pulse duration of 0.8 ms it was 1.9 +/- 0.7 mA. However, six patients developed a transient high stimulation threshold during the month after implantation, and a high threshold developed in another patient at five months and persisted. Mean acute stimulation and sensing thresholds were satisfactory: 0.7 +/- 0.2 V at 0.5 ms pulse duration and 7.6 +/- 2.4 mV, respectively.
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