Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist)

Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.</p

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Autonomic influences on cognitive performance at a population level

THESIS 10817The principle aims of this doctoral investigation were to provide new insights into the relationship between cardiovascular disease (CVD) and cognitive performance, by investigating the function of the autonomic nervous system (ANS) in a population sample of older adults with varying degrees of cognitive function

Delusional infestation in healthcare professionals: Outcomes from a multi‐centre case series

Abstract Delusional infestation (DI) describes an unwavering fixed belief of infestation with pathogens, despite a lack of medical evidence supporting this. Effective management of DI with antipsychotics is made challenging by the fixed belief that the condition is an infestation or infection rather than a mental illness. A case series of individuals diagnosed with DI included 11% who were healthcare professionals (HCPs). We sought to characterise a cohort of HCPs who presented with DI in the UK. The case notes of HCPs diagnosed with DI at specialist clinics between 2015 and 2019 were reviewed. Demographic and clinical data were obtained. Twelve HCPs were identified out of a total of 381 individuals diagnosed with DI. Median age was 52.5 (IQR = 14.5) years. 75% (n = 9) were women. Ten individuals had primary DI, whilst two had secondary DI (one to recreational drug use, one to depression). Four individuals (33%) engaged with antipsychotic treatment. Two responded well, both had secondary DI. Of the two individuals with primary DI who engaged, one did not respond to antipsychotic medication and the other was unable to tolerate two antipsychotic drugs. In Primary DI (n = 10), the rate of adherence was lower at 20% (n = 2). In DI, high engagement and adherence rates to treatment have been reported in specialist centres. Improvement has been reported as high as 70%–75%. This indicates that a large proportion of individuals who adhere to treatment appear to derive benefit. In this series, engagement with treatment by HCPs with primary DI was low at 20%, and improvement was only achieved in individuals with secondary DI. Mental illness‐related stigma, feelings of distress and difficulty forming therapeutic relationships with a professional peer are significant challenges. Developing rapport is key to treatment success in DI. In HCPs this may be suboptimal due to these negative feelings, resulting in lower engagement. A diagnosis of DI in a HCP may raise concerns regarding fitness to practise. An assessment of the impact of DI and the potential to interfere with professional duties warrants consideration. We highlight the occurrence of DI in HCPs, and the apparent lower engagement with treatment in this cohort

AF is associated with self-reported syncope and falls in a general population cohort

syncope is an important, but underestimated clinical problem in older persons. It is often overlooked in clinical practice or mistaken for falls. Atrial fibrillation (AF) is the most common cardiac arrhythmia, but little evidence exists regarding the association between AF, falls and syncope in the general population. cross-sectional analyses within a population sample of people aged 50+, taken from The Irish Longitudinal Study on Ageing. Ten-minute electrocardiogram recordings (n = 4,885) were analysed to detect AF. Syncope (self-reported faints or blackouts) and falls in the past year, co-morbidities, health measures and medications were gathered through computer-aided personal interviews. Multivariable logistic regression was performed to study associations between AF, falls and syncope. mean age was 62 years (range: 50-91), 54% were female. Prevalence of AF was 3%, increasing to 8% in participants aged 75+. Of participants, 5% (n = 223) reported syncope and 20% (n = 972) reported falls. After adjustment for confounders, AF was significantly associated with faints and blackouts (odds ratio (OR) 2.0 [95% confidence interval (CI) 1.0-3.9]). After stratification by age category, we found that this association was strongest and only significant in participants aged 50-64 years (OR 4.4 [1.5-12.6]). Stratified for age group, AF was significantly associated with falls in participants aged 65-74 years (OR 2.0 [1.0-4.1]). adults aged 50+ with self-reported syncope and adults aged 65-74 years with falls are twice as likely to have AF at physical examination. These associations are independent of stroke, cardiovascular and psychotropic drugs and other confounders. Further longitudinal studies are needed to explore this association and potential causality furthe