Helen Brooker - Academia.edu (original) (raw)

Papers by Helen Brooker

Additional file 2:. Additional Table 2 (.pdf) - Search strategies employed in reviewing conducted... more Additional file 2:. Additional Table 2 (.pdf) - Search strategies employed in reviewing conducted during development phase

International Psychogeriatrics, 2021

ABSTRACTObjectives:Evidence linking subjective concerns about cognition with poorer objective cog... more ABSTRACTObjectives:Evidence linking subjective concerns about cognition with poorer objective cognitive performance is limited by reliance on unidimensional measures of self-perceptions of aging (SPA). We used the awareness of age-related change (AARC) construct to assess self-perception of both positive and negative age-related changes (AARC gains and losses). We tested whether AARC has greater utility in linking self-perceptions to objective cognition compared to well-established measures of self-perceptions of cognition and aging. We examined the associations of AARC with objective cognition, several psychological variables, and engagement in cognitive training.Design:Cross-sectional observational study.Participants:The sample comprised 6056 cognitively healthy participants (mean [SD] age = 66.0 [7.0] years); divided into subgroups representing middle, early old, and advanced old age.Measurements:We used an online cognitive battery and measures of global AARC, AARC specific to th...

Psychology & Health, 2021

The version presented here may differ from the published version. If citing, you are advised to c... more The version presented here may differ from the published version. If citing, you are advised to consult the published version for pagination, volume/issue and date of publication

Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 2021

Background: The neuropsychiatric syndrome mild behavioral impairment (MBI) describes an at-risk s... more Background: The neuropsychiatric syndrome mild behavioral impairment (MBI) describes an at-risk state for dementia and may be a useful screening tool for sample enrichment. We hypothesized that stratifying a cognitively normal sample on MBI status would enhance the association between genetic risk for Alzheimer's disease (AD) and cognition. Methods: Data from 4458 participants over age 50 without dementia was analyzed. A cognitive composite score was constructed and the MBI Checklist was used to stratify those with MBI and those without. Polygenic scores for AD were generated using summary statistics from the IGAP study. Results: AD genetic risk was associated with worse cognition in the MBI group but not in the no MBI group (MBI: β =-0.09, 95% confidence interval:-0.13 to-0.03, P = 0.002, R 2 = 0.003). The strongest association was in those with more severe MBI aged ≥65. Conclusions: MBI is an important feature of aging; screening on MBI may be a useful sample enrichment strategy for clinical research.

International Psychogeriatrics, 2021

ABSTRACTObjectives:Older people describe positive and negative age-related changes, but we do not... more ABSTRACTObjectives:Older people describe positive and negative age-related changes, but we do not know much about what contributes to make them aware of these changes. We used content analysis to categorize participants’ written comments and explored the extent to which the identified categories mapped onto theoretical conceptualizations of influences on awareness of age-related change (AARC).Design:Cross-sectional observational study.Participants:The study sample comprised 609 UK individuals aged 50 years or over (mean (SD) age = 67.9 (7.6) years), enrolled in the PROTECT study.Measurements:Between January and March 2019, participants provided demographic information, completed a questionnaire assessing awareness of age-related change (AARC-10 SF), and responded to an open-ended question asking them to comment on their responses.Results:While some of the emerging categories were in line with the existing conceptual framework of AARC (e.g. experiencing negative changes and attitudes...

Behavioral Sleep Medicine, 2021

Background: Only one study has explored the associations of subjective sleep difficulties with se... more Background: Only one study has explored the associations of subjective sleep difficulties with self-perceptions of aging. It focused on a global indicator of self-perceptions of aging (subjective age) despite individuals reporting different experiences of aging in relation to different life domains. The concept of awareness of negative age-related change, capturing perceived losses across five domains (e.g., physical health, cognition), may be more appropriate when relating subjective sleep difficulties to self-perceptions of aging. We examined whether nine different indicators of subjective sleep difficulties predict levels of awareness of negative age-related change and subjective age, measured concurrently and one year later, while controlling for covariates (mood and daily function). Participants/Methods: We used data from the PROTECT cohort study; 4,482 UK residents (mean age = 66.1; SD = 6.9) completed measures of awareness of age-related change, subjective age, mood, daily function, and subjective sleep difficulties. Results: Based on linear regression analyses, poorer quality of sleep, lower alertness after awakening, satisfaction with sleep, depth of sleep, more frequent early awakening, difficulty falling asleep, more times awake during a night, fewer hours of sleep during the night and more hours of sleep during the day predicted higher awareness of negative age-related change at baseline and follow-up (p< .001). Associations were small in size. Associations between subjective sleep difficulties and subjective age were either negligible or statistically non-significant. Conclusions: Although subjective sleep difficulties are one of the many factors associated with awareness of negative age-related change, addressing sleep difficulties, alongside negative mood, and poor daily functioning, may promote a small additional increase in positive self-perceptions of aging.

BackgroundBy 2050 worldwide dementia prevalence is expected to triple, rising to 152 million. Aff... more BackgroundBy 2050 worldwide dementia prevalence is expected to triple, rising to 152 million. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the development of ‘Active Brains’: a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults, and key findings arising from this process.MethodsA theory-, evidence- and person-based approach to intervention development was undertaken. Scoping reviews and behavioural analysis contributed to intervention planning. Optimisation involved qualitative interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes.ResultsThe development process synthesised findings from planning and optimisation activities. Scoping reviews and qualitative interviews suggested that the same intervention content should be suitable for ...

Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 2020

Introduction: Sensitive neuropsychological tests are needed to improve power for clinical trials ... more Introduction: Sensitive neuropsychological tests are needed to improve power for clinical trials in early Alzheimer's disease (AD). Methods: To develop a neuropsychological composite (FLAME-Factors of Longitudinal Attention, Memory and Executive Function), we assessed, 10,714 participants over the age of 50 from PROTECT with validated computerized assessments for 2 years. A factorial analysis was completed to identify the key cognitive factors in all participants, and further analyses examined sensitivity to change in people with stage 2/3 early Alzheimer's disease (AD) according to the US Food and Drug Administration (FDA) framework. Results: The FLAME composite score (speed of attention, accuracy of attention, memory, and executive function) distinguished between normal cognition and stage 2/3 early AD at baseline, and was sensitive to cognitive and global/functional decline over 2 years, with the potential to improve power for clinical trials. Discussion: FLAME is sensitive to change, providing a straightforward approach to reduce sample size for RCTs in early AD. Conclusion: FLAME is a useful computerized neuropsychology composite with utility for clinical trials focusing on cognition.

Frontiers in Psychiatry, 2020

Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduc... more Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduced clinical contact suggested for this population. This has increased the need for remote memory clinics, we therefore review the literature, current practices and guidelines on organizing such remote memory clinics, focusing on assessment of cognition, function and other relevant measurements, proposing a novel pathway based on three levels of complexity: simple telephone or video-based interviews and testing using available tests (Level 1), digitized and validated methods based on standard pen-and-paper tests and scales (Level 2), and finally fully digitized cognitive batteries and remote measurement technologies (RMTs, Level 3). Pros and cons of these strategies are discussed. Remotely collected data negates the need for frail patients or carers to commute to clinic and offers valuable insights into progression over time, as well as treatment responses to therapeutic interventions, providing a more realistic and contextualized environment for data-collection. Notwithstanding several challenges related to internet access, computer skills, limited evidence base and regulatory and data protection issues, digital biomarkers collected remotely have significant potential for diagnosis and symptom management in older adults and we propose a framework and pathway for how technologies can be implemented to support remote memory clinics. These platforms are also well-placed for administration of digital cognitive training and other interventions. The individual, societal and public/private costs of COVID-19 are high and will continue to rise for some time but the challenges the pandemic has placed on memory services also provides an opportunity to embrace novel approaches. Remote memory clinics' financial, logistical, clinical and practical benefits have been highlighted by COVID-19, supporting their use to not only be maintained when social distancing legislation is lifted but to be devoted extra resources and attention to fully potentiate this valuable arm of clinical assessment and care.

Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 2020

Keith Andrew Wesnes died at the age of 69 at his home in Goring, in April. Keith was involved in ... more Keith Andrew Wesnes died at the age of 69 at his home in Goring, in April. Keith was involved in the fields of cognitive neuroscience, psychopharmacology, and drug development.

Frontiers in Neurology, 2020

Background: The number of people with dementia is increasing, with huge challenges for society an... more Background: The number of people with dementia is increasing, with huge challenges for society and health-care systems. There are no disease-modifying therapies available. There is, therefore, an urgent need to identify strategies to reduce the risk of developing dementia. Anthocyanins are a class of compounds found in dark berries and fruits with some effects that might reduce the risk for cognitive decline and the development of dementia in older people. Aim: This phase II three-center, randomized, 24-week, placebo-controlled study, ongoing in Norway, aims to evaluate the safety, and efficacy of anthocyanins in modifying key dementia-related mechanisms and maintain cognitive functioning in older people at risk for dementia. Discussion: This study aims to demonstrate whether there are beneficial effects of purified anthocyanins on cognition and relevant biological functions in people at increased risk for dementia. Forthcoming results may contribute to further improvement of intervention strategies to prevent or delay the onset of dementia, including a potential decision to take anthocyanins toward phase III trials.

Background A questionnaire assessing awareness of positive and negative age-related changes (AARC... more Background A questionnaire assessing awareness of positive and negative age-related changes (AARC gains and losses) was developed in the US and Germany. We validated the short form of the measure (AARC-10 SF) and the cognitive functioning subscale from the 50-item version of the AARC (AARC-50) questionnaire in the UK population aged 50 and over. Methods Data from 14,797 participants in the PROTECT cohort were used to explore and confirm the psychometric properties of the AARC measures including: validity of the factor structure; reliability; measurement invariance across males and females and across individuals with and without a university degree; and convergent validity with measures of self-perception of aging and mental, physical, and cognitive health. We also explored the relationship between demographic variables and AARC. Results We confirmed the two-factor structure (gains and losses) of the AARC-10 SF and the AARC-50 cognitive functioning subscale. Both scales showed good r...

BACKGROUND: Mild Behavioral Impairment (MBI) is a neuropsychiatric syndrome describing later-life... more BACKGROUND: Mild Behavioral Impairment (MBI) is a neuropsychiatric syndrome describing later-life emergent apathy, mood/anxiety symptoms, impulse dyscontrol, social inappropriateness and psychosis that are not attributable to psychiatric diagnoses. MBI is an at-risk state for incident cognitive decline and dementia, and is associated with dementia biomarkers including amyloid beta; and neurofilament light. Thus, MBI may be an early clinical marker of neurodegenerative disease. In this study, we hypothesized that stratification by MBI in a cognitively normal sample would moderate the signal between Alzheimer disease (AD) genetic risk and cognition. METHODS: Genetic, cognitive and MBI data was available for 3,126 PROTECT study participants over 50 without dementia. A general cognitive composite score was constructed based on scores on paired associates learning, digit span, self-ordered search and verbal reasoning. MBI was assessed using the MBI Checklist. Polygenic scores for AD were...

International Journal of Geriatric Psychiatry, 2020

Background: Identifying predictors for general cognitive training (GCT) success in healthy older ... more Background: Identifying predictors for general cognitive training (GCT) success in healthy older adults has many potential uses, including aiding intervention and improving individual dementia risk prediction, which are of high importance in health care. However, the factors that predict training improvements and the temporal course of predictors (eg, do the same prognostic factors predict training success after a short training period, such as 6 weeks, as well as after a longer training period, such as 6 months?) are largely unknown. Methods: Data (N = 4,184 healthy older individuals) from two arms (GCT vs. control) of a three-arm randomized controlled trial were reanalyzed to investigate predictors of GCT success in five cognitive tasks (grammatical reasoning, spatial working memory, digit vigilance, paired association learning, and verbal learning) at three time points (after 6 weeks, 3 months, and 6 months of training). Possible investigated predictors were sociodemographic variables, depressive symptoms, number of training sessions, cognitive baseline values, and all interaction terms (group*predictor). Results: Being female was predictive for improvement in grammatical reasoning at 6 weeks in the GCT group, and lower cognitive baseline scores were predictive for improvement in spatial working memory and verbal learning at 6 months. Conclusion: Our data indicate that predictors seem to change over time; remarkably, lower baseline performance at study entry is only a significant predictor at 6 months training. Possible reasons for these results are discussed in relation to the compensation hypothesis.

Alzheimer's & Dementia, 2018

Alzheimer's & Dementia, 2019

burned were recorded on the Fitbit device, with participants blinded to activity levels. Particip... more burned were recorded on the Fitbit device, with participants blinded to activity levels. Participants also completed the Perceived Stress Scale (PSS) and the Geriatric Depression Scale (GDS). Results: Adjusting for demographics (age, sex, and education), greater average daily steps (b1⁄4 -0.0008, p1⁄40.02), distance (b1⁄4 -1.15, p1⁄40.001), and calories (b1⁄4 -0.01, p1⁄40.001) were associated with lower perceived stress, but not depressive symptoms (GDS ps>0.30). The relationship between Fitbit measures and perceived stress remained significant even after adjusting for BMI, heart rate, and systolic blood pressure (ps<0.01). Engaging in <7100 daily steps was associated with 2.2 increased odds of being categorized as “high stress” (upper 50%ile of sample). Conclusions: Our data provide support for the relationship between a range of daily movement metrics (step count, distance traveled, calories burned) and levels of perceived stress. The Fitbit actigraph’s step counting feature may be a potential intervention for encouraging increased movement in older adults, with the aim of decreasing experiences of psychological stress and promoting brain health. These findings are compelling due to their incorporation of all movement, rather than merely traditional high-intensity exercise. Further research should aim to disentangle the contributions of non-exercise movement versus deliberate exercise to the maintenance of psychological health in older adults.

Alzheimer's & Dementia, 2019

Alzheimer's & Dementia, 2017

2% females). ANCOVAs were conducted on the various test measures, fixed terms were fitted for the... more 2% females). ANCOVAs were conducted on the various test measures, fixed terms were fitted for the IADL response (2 levels), the number of sessions completed and the interaction between the two. Gender, age and education were fitted as covariates. The volunteers who reported needing some help (CogTrack TM n¼784; PROTECT n¼857) were on average just over 3 years older than those who did not, and performed more poorly on every measure. The analysis revealed that this was significant on one or more measures from each task (p<0.0001), with no interactions with the number of sessions completed. The Cohen's d effect sizes of the impairments were greatest on the CogTrack TM tests of attention, exceeding the 0.2 threshold for small effects. Conclusions: These results indicate that core aspects of cognitive function are significantly poorer in subjects who report needing help with the 7 instrumental activities of daily living assessed in this study.

Objectives: In this large population study we set out to examine the profile of Mild Behavioral I... more Objectives: In this large population study we set out to examine the profile of Mild Behavioral Impairment using the Mild Behavioral Impairment Checklist (MBI-C), and determine its factor structure when employed as a self-report and informant rated tool.Design: Population based cohort study. Setting: Online testing via the PROTECT study (http://www.protectstudy.org.uk)Participants: 5,742 participant-informant dyads.Measurements: Both participants and informants completed the MBI-C. The factor structure of the MBI-C was evaluated by exploratory factor analysis (EFA).Results: The most common MBI-C items as rated by self-report and informants related to affective dysregulation (mood/anxiety symptoms), being present in 34% and 38% of the sample respectively. The least common were items relating to abnormal thoughts and perception (psychotic symptoms) (present in 3 and 6% of the sample respectively). There were only weak correlations between self-report and informant-rated MBI-C response...

International journal of geriatric psychiatry, Jan 27, 2018

Depressive disorder is commonly associated with impaired cognitive function; however, it is uncle... more Depressive disorder is commonly associated with impaired cognitive function; however, it is unclear whether the age of onset of the first episode of depression, current depression severity, or historical severity of depressive episodes are associated with cognitive performance. This study examined baseline cross-sectional data from the ongoing online PROTECT study. A total of 7344 participants, 50 years or older, with a history of depression and no diagnosis of dementia were divided into three groups according to age of onset of their first depressive episode: early-onset, midlife-onset, and late-onset. Performance on measures of visuospatial episodic memory, executive function, verbal working, and visual working memory were evaluated. Demographic and clinical characteristics such as age, education, and severity of symptoms during their worst previous depressive episode and current depression severity were included in multivariate regression models. The late-onset depression group s...

Additional file 2:. Additional Table 2 (.pdf) - Search strategies employed in reviewing conducted... more Additional file 2:. Additional Table 2 (.pdf) - Search strategies employed in reviewing conducted during development phase

International Psychogeriatrics, 2021

ABSTRACTObjectives:Evidence linking subjective concerns about cognition with poorer objective cog... more ABSTRACTObjectives:Evidence linking subjective concerns about cognition with poorer objective cognitive performance is limited by reliance on unidimensional measures of self-perceptions of aging (SPA). We used the awareness of age-related change (AARC) construct to assess self-perception of both positive and negative age-related changes (AARC gains and losses). We tested whether AARC has greater utility in linking self-perceptions to objective cognition compared to well-established measures of self-perceptions of cognition and aging. We examined the associations of AARC with objective cognition, several psychological variables, and engagement in cognitive training.Design:Cross-sectional observational study.Participants:The sample comprised 6056 cognitively healthy participants (mean [SD] age = 66.0 [7.0] years); divided into subgroups representing middle, early old, and advanced old age.Measurements:We used an online cognitive battery and measures of global AARC, AARC specific to th...

Psychology & Health, 2021

The version presented here may differ from the published version. If citing, you are advised to c... more The version presented here may differ from the published version. If citing, you are advised to consult the published version for pagination, volume/issue and date of publication

Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 2021

Background: The neuropsychiatric syndrome mild behavioral impairment (MBI) describes an at-risk s... more Background: The neuropsychiatric syndrome mild behavioral impairment (MBI) describes an at-risk state for dementia and may be a useful screening tool for sample enrichment. We hypothesized that stratifying a cognitively normal sample on MBI status would enhance the association between genetic risk for Alzheimer's disease (AD) and cognition. Methods: Data from 4458 participants over age 50 without dementia was analyzed. A cognitive composite score was constructed and the MBI Checklist was used to stratify those with MBI and those without. Polygenic scores for AD were generated using summary statistics from the IGAP study. Results: AD genetic risk was associated with worse cognition in the MBI group but not in the no MBI group (MBI: β =-0.09, 95% confidence interval:-0.13 to-0.03, P = 0.002, R 2 = 0.003). The strongest association was in those with more severe MBI aged ≥65. Conclusions: MBI is an important feature of aging; screening on MBI may be a useful sample enrichment strategy for clinical research.

International Psychogeriatrics, 2021

ABSTRACTObjectives:Older people describe positive and negative age-related changes, but we do not... more ABSTRACTObjectives:Older people describe positive and negative age-related changes, but we do not know much about what contributes to make them aware of these changes. We used content analysis to categorize participants’ written comments and explored the extent to which the identified categories mapped onto theoretical conceptualizations of influences on awareness of age-related change (AARC).Design:Cross-sectional observational study.Participants:The study sample comprised 609 UK individuals aged 50 years or over (mean (SD) age = 67.9 (7.6) years), enrolled in the PROTECT study.Measurements:Between January and March 2019, participants provided demographic information, completed a questionnaire assessing awareness of age-related change (AARC-10 SF), and responded to an open-ended question asking them to comment on their responses.Results:While some of the emerging categories were in line with the existing conceptual framework of AARC (e.g. experiencing negative changes and attitudes...

Behavioral Sleep Medicine, 2021

Background: Only one study has explored the associations of subjective sleep difficulties with se... more Background: Only one study has explored the associations of subjective sleep difficulties with self-perceptions of aging. It focused on a global indicator of self-perceptions of aging (subjective age) despite individuals reporting different experiences of aging in relation to different life domains. The concept of awareness of negative age-related change, capturing perceived losses across five domains (e.g., physical health, cognition), may be more appropriate when relating subjective sleep difficulties to self-perceptions of aging. We examined whether nine different indicators of subjective sleep difficulties predict levels of awareness of negative age-related change and subjective age, measured concurrently and one year later, while controlling for covariates (mood and daily function). Participants/Methods: We used data from the PROTECT cohort study; 4,482 UK residents (mean age = 66.1; SD = 6.9) completed measures of awareness of age-related change, subjective age, mood, daily function, and subjective sleep difficulties. Results: Based on linear regression analyses, poorer quality of sleep, lower alertness after awakening, satisfaction with sleep, depth of sleep, more frequent early awakening, difficulty falling asleep, more times awake during a night, fewer hours of sleep during the night and more hours of sleep during the day predicted higher awareness of negative age-related change at baseline and follow-up (p< .001). Associations were small in size. Associations between subjective sleep difficulties and subjective age were either negligible or statistically non-significant. Conclusions: Although subjective sleep difficulties are one of the many factors associated with awareness of negative age-related change, addressing sleep difficulties, alongside negative mood, and poor daily functioning, may promote a small additional increase in positive self-perceptions of aging.

BackgroundBy 2050 worldwide dementia prevalence is expected to triple, rising to 152 million. Aff... more BackgroundBy 2050 worldwide dementia prevalence is expected to triple, rising to 152 million. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the development of ‘Active Brains’: a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults, and key findings arising from this process.MethodsA theory-, evidence- and person-based approach to intervention development was undertaken. Scoping reviews and behavioural analysis contributed to intervention planning. Optimisation involved qualitative interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes.ResultsThe development process synthesised findings from planning and optimisation activities. Scoping reviews and qualitative interviews suggested that the same intervention content should be suitable for ...

Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 2020

Introduction: Sensitive neuropsychological tests are needed to improve power for clinical trials ... more Introduction: Sensitive neuropsychological tests are needed to improve power for clinical trials in early Alzheimer's disease (AD). Methods: To develop a neuropsychological composite (FLAME-Factors of Longitudinal Attention, Memory and Executive Function), we assessed, 10,714 participants over the age of 50 from PROTECT with validated computerized assessments for 2 years. A factorial analysis was completed to identify the key cognitive factors in all participants, and further analyses examined sensitivity to change in people with stage 2/3 early Alzheimer's disease (AD) according to the US Food and Drug Administration (FDA) framework. Results: The FLAME composite score (speed of attention, accuracy of attention, memory, and executive function) distinguished between normal cognition and stage 2/3 early AD at baseline, and was sensitive to cognitive and global/functional decline over 2 years, with the potential to improve power for clinical trials. Discussion: FLAME is sensitive to change, providing a straightforward approach to reduce sample size for RCTs in early AD. Conclusion: FLAME is a useful computerized neuropsychology composite with utility for clinical trials focusing on cognition.

Frontiers in Psychiatry, 2020

Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduc... more Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduced clinical contact suggested for this population. This has increased the need for remote memory clinics, we therefore review the literature, current practices and guidelines on organizing such remote memory clinics, focusing on assessment of cognition, function and other relevant measurements, proposing a novel pathway based on three levels of complexity: simple telephone or video-based interviews and testing using available tests (Level 1), digitized and validated methods based on standard pen-and-paper tests and scales (Level 2), and finally fully digitized cognitive batteries and remote measurement technologies (RMTs, Level 3). Pros and cons of these strategies are discussed. Remotely collected data negates the need for frail patients or carers to commute to clinic and offers valuable insights into progression over time, as well as treatment responses to therapeutic interventions, providing a more realistic and contextualized environment for data-collection. Notwithstanding several challenges related to internet access, computer skills, limited evidence base and regulatory and data protection issues, digital biomarkers collected remotely have significant potential for diagnosis and symptom management in older adults and we propose a framework and pathway for how technologies can be implemented to support remote memory clinics. These platforms are also well-placed for administration of digital cognitive training and other interventions. The individual, societal and public/private costs of COVID-19 are high and will continue to rise for some time but the challenges the pandemic has placed on memory services also provides an opportunity to embrace novel approaches. Remote memory clinics' financial, logistical, clinical and practical benefits have been highlighted by COVID-19, supporting their use to not only be maintained when social distancing legislation is lifted but to be devoted extra resources and attention to fully potentiate this valuable arm of clinical assessment and care.

Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 2020

Keith Andrew Wesnes died at the age of 69 at his home in Goring, in April. Keith was involved in ... more Keith Andrew Wesnes died at the age of 69 at his home in Goring, in April. Keith was involved in the fields of cognitive neuroscience, psychopharmacology, and drug development.

Frontiers in Neurology, 2020

Background: The number of people with dementia is increasing, with huge challenges for society an... more Background: The number of people with dementia is increasing, with huge challenges for society and health-care systems. There are no disease-modifying therapies available. There is, therefore, an urgent need to identify strategies to reduce the risk of developing dementia. Anthocyanins are a class of compounds found in dark berries and fruits with some effects that might reduce the risk for cognitive decline and the development of dementia in older people. Aim: This phase II three-center, randomized, 24-week, placebo-controlled study, ongoing in Norway, aims to evaluate the safety, and efficacy of anthocyanins in modifying key dementia-related mechanisms and maintain cognitive functioning in older people at risk for dementia. Discussion: This study aims to demonstrate whether there are beneficial effects of purified anthocyanins on cognition and relevant biological functions in people at increased risk for dementia. Forthcoming results may contribute to further improvement of intervention strategies to prevent or delay the onset of dementia, including a potential decision to take anthocyanins toward phase III trials.

Background A questionnaire assessing awareness of positive and negative age-related changes (AARC... more Background A questionnaire assessing awareness of positive and negative age-related changes (AARC gains and losses) was developed in the US and Germany. We validated the short form of the measure (AARC-10 SF) and the cognitive functioning subscale from the 50-item version of the AARC (AARC-50) questionnaire in the UK population aged 50 and over. Methods Data from 14,797 participants in the PROTECT cohort were used to explore and confirm the psychometric properties of the AARC measures including: validity of the factor structure; reliability; measurement invariance across males and females and across individuals with and without a university degree; and convergent validity with measures of self-perception of aging and mental, physical, and cognitive health. We also explored the relationship between demographic variables and AARC. Results We confirmed the two-factor structure (gains and losses) of the AARC-10 SF and the AARC-50 cognitive functioning subscale. Both scales showed good r...

BACKGROUND: Mild Behavioral Impairment (MBI) is a neuropsychiatric syndrome describing later-life... more BACKGROUND: Mild Behavioral Impairment (MBI) is a neuropsychiatric syndrome describing later-life emergent apathy, mood/anxiety symptoms, impulse dyscontrol, social inappropriateness and psychosis that are not attributable to psychiatric diagnoses. MBI is an at-risk state for incident cognitive decline and dementia, and is associated with dementia biomarkers including amyloid beta; and neurofilament light. Thus, MBI may be an early clinical marker of neurodegenerative disease. In this study, we hypothesized that stratification by MBI in a cognitively normal sample would moderate the signal between Alzheimer disease (AD) genetic risk and cognition. METHODS: Genetic, cognitive and MBI data was available for 3,126 PROTECT study participants over 50 without dementia. A general cognitive composite score was constructed based on scores on paired associates learning, digit span, self-ordered search and verbal reasoning. MBI was assessed using the MBI Checklist. Polygenic scores for AD were...

International Journal of Geriatric Psychiatry, 2020

Background: Identifying predictors for general cognitive training (GCT) success in healthy older ... more Background: Identifying predictors for general cognitive training (GCT) success in healthy older adults has many potential uses, including aiding intervention and improving individual dementia risk prediction, which are of high importance in health care. However, the factors that predict training improvements and the temporal course of predictors (eg, do the same prognostic factors predict training success after a short training period, such as 6 weeks, as well as after a longer training period, such as 6 months?) are largely unknown. Methods: Data (N = 4,184 healthy older individuals) from two arms (GCT vs. control) of a three-arm randomized controlled trial were reanalyzed to investigate predictors of GCT success in five cognitive tasks (grammatical reasoning, spatial working memory, digit vigilance, paired association learning, and verbal learning) at three time points (after 6 weeks, 3 months, and 6 months of training). Possible investigated predictors were sociodemographic variables, depressive symptoms, number of training sessions, cognitive baseline values, and all interaction terms (group*predictor). Results: Being female was predictive for improvement in grammatical reasoning at 6 weeks in the GCT group, and lower cognitive baseline scores were predictive for improvement in spatial working memory and verbal learning at 6 months. Conclusion: Our data indicate that predictors seem to change over time; remarkably, lower baseline performance at study entry is only a significant predictor at 6 months training. Possible reasons for these results are discussed in relation to the compensation hypothesis.

Alzheimer's & Dementia, 2018

Alzheimer's & Dementia, 2019

burned were recorded on the Fitbit device, with participants blinded to activity levels. Particip... more burned were recorded on the Fitbit device, with participants blinded to activity levels. Participants also completed the Perceived Stress Scale (PSS) and the Geriatric Depression Scale (GDS). Results: Adjusting for demographics (age, sex, and education), greater average daily steps (b1⁄4 -0.0008, p1⁄40.02), distance (b1⁄4 -1.15, p1⁄40.001), and calories (b1⁄4 -0.01, p1⁄40.001) were associated with lower perceived stress, but not depressive symptoms (GDS ps>0.30). The relationship between Fitbit measures and perceived stress remained significant even after adjusting for BMI, heart rate, and systolic blood pressure (ps<0.01). Engaging in <7100 daily steps was associated with 2.2 increased odds of being categorized as “high stress” (upper 50%ile of sample). Conclusions: Our data provide support for the relationship between a range of daily movement metrics (step count, distance traveled, calories burned) and levels of perceived stress. The Fitbit actigraph’s step counting feature may be a potential intervention for encouraging increased movement in older adults, with the aim of decreasing experiences of psychological stress and promoting brain health. These findings are compelling due to their incorporation of all movement, rather than merely traditional high-intensity exercise. Further research should aim to disentangle the contributions of non-exercise movement versus deliberate exercise to the maintenance of psychological health in older adults.

Alzheimer's & Dementia, 2019

Alzheimer's & Dementia, 2017

2% females). ANCOVAs were conducted on the various test measures, fixed terms were fitted for the... more 2% females). ANCOVAs were conducted on the various test measures, fixed terms were fitted for the IADL response (2 levels), the number of sessions completed and the interaction between the two. Gender, age and education were fitted as covariates. The volunteers who reported needing some help (CogTrack TM n¼784; PROTECT n¼857) were on average just over 3 years older than those who did not, and performed more poorly on every measure. The analysis revealed that this was significant on one or more measures from each task (p<0.0001), with no interactions with the number of sessions completed. The Cohen's d effect sizes of the impairments were greatest on the CogTrack TM tests of attention, exceeding the 0.2 threshold for small effects. Conclusions: These results indicate that core aspects of cognitive function are significantly poorer in subjects who report needing help with the 7 instrumental activities of daily living assessed in this study.

Objectives: In this large population study we set out to examine the profile of Mild Behavioral I... more Objectives: In this large population study we set out to examine the profile of Mild Behavioral Impairment using the Mild Behavioral Impairment Checklist (MBI-C), and determine its factor structure when employed as a self-report and informant rated tool.Design: Population based cohort study. Setting: Online testing via the PROTECT study (http://www.protectstudy.org.uk)Participants: 5,742 participant-informant dyads.Measurements: Both participants and informants completed the MBI-C. The factor structure of the MBI-C was evaluated by exploratory factor analysis (EFA).Results: The most common MBI-C items as rated by self-report and informants related to affective dysregulation (mood/anxiety symptoms), being present in 34% and 38% of the sample respectively. The least common were items relating to abnormal thoughts and perception (psychotic symptoms) (present in 3 and 6% of the sample respectively). There were only weak correlations between self-report and informant-rated MBI-C response...

International journal of geriatric psychiatry, Jan 27, 2018

Depressive disorder is commonly associated with impaired cognitive function; however, it is uncle... more Depressive disorder is commonly associated with impaired cognitive function; however, it is unclear whether the age of onset of the first episode of depression, current depression severity, or historical severity of depressive episodes are associated with cognitive performance. This study examined baseline cross-sectional data from the ongoing online PROTECT study. A total of 7344 participants, 50 years or older, with a history of depression and no diagnosis of dementia were divided into three groups according to age of onset of their first depressive episode: early-onset, midlife-onset, and late-onset. Performance on measures of visuospatial episodic memory, executive function, verbal working, and visual working memory were evaluated. Demographic and clinical characteristics such as age, education, and severity of symptoms during their worst previous depressive episode and current depression severity were included in multivariate regression models. The late-onset depression group s...