Information Processing Speed in Ageing: Is it task dependent?

Evidence indicates that information processing speed slows as age increases and disproportionately so with impaired cognition and various neurodegenerative diseases such as Alzheimer’s disease. The new DSM-5 criteria for neuro-cognitive disorders state that measuring information processing speed associated with attentional function should be included within dementia diagnosis. However, what is not clarified is that outcome variability can occur, in part, as a result of methodological factors i.e. type of attention-related test/ attentional function and by person-related factors such as sex and education. In addition, there appears to be a dichotomy between the types of tests used within research studies and clinical settings which should be addressed [Haworth et al, 2016].The aim of the research presented in this thesis was to investigate how using different tests of attentional function in similar groups of young and older adults may affect the outcome measure of information processing speed (RT) and its variability (IIV). Part of this aim was to determine whether the number of trials may influence performance i.e. RT, IIV and accuracy (number of errors). Another aim was to determine whether result outcome is affected similarly across tests by a variety of person-related factors i.e. sex, education, objective cognitive measures and particularly previously un-tested factors of subjective memory function and perceived test difficulty which may help determine whether subjective feelings are associated with slower and more variable information processing speed and may influence study outcome.The first study [Chapter 2] comprised of a visual search test commonly used in research as a sensitive measure of ageing upon RT and IIV and attentional shifting, yet not examined particularly in relation to subjective memory function and perceived test difficulty. Results indicated that information processing speed was significantly slowed in older compared to younger adults and attentional shifting was poorer in older adults. There was no relationship with subjective memory function whereas the influence of sex, education and perceived test difficulty were dependent on the condition and age.In the second, larger study including the Trail Making Test (TMT), Simple reaction time (RT) test, Choice RT test and Multi-Item Localization test (MILO) [Chapters 3- 5], the results indicated that in all tests older adults were significantly slower and more variable than young adults at group level. Person-related factors were influential depending on the test used. Subjective memory function and education were only influential within conditions of the MILO and perceived test difficulty influential in Trails B and Choice RT. Large effect sizes in visual search, MILO and the Choice RT suggested they were most sensitive to ageing effects. In conclusion, we speculate which attentional tests may be more useful in research and than those already used in clinical settings i.e. TMT and highlight the need to take into consideration different factors depending on the attentional test used so as not to misinterpret normal levels of information processing speed in ostensibly healthy aging

Lacking Pace but Not Precision: Age-Related Information Processing Changes in Response to a Dynamic Attentional Control Task

Age-related decline in information processing can have a substantial impact on activities such as driving. However, the assessment of these changes is often carried out using cognitive tasks that do not adequately represent the dynamic process of updating environmental stimuli. Equally, traditional tests are often static in their approach to task complexity, and do not assess difficulty within the bounds of an individual’s capability. To address these limitations, we used a more ecologically valid measure, the Swansea Test of Attentional Control (STAC), in which a threshold for information processing speed is established at a given level of accuracy. We aimed to delineate how older, compared to younger, adults varied in their performance of the task, while also assessing relationships between the task outcome and gender, general cognition (MoCA), perceived memory function (MFQ), cognitive reserve (NART), and aspects of mood (PHQ-9, GAD-7). The results indicate that older adults were significantly slower than younger adults but no less precise, irrespective of gender. Age was negatively correlated with the speed of task performance. Our measure of general cognition was positively correlated with the task speed threshold but not with age per se. Perceived memory function, cognitive reserve, and mood were not related to task performance. The findings indicate that while attentional control is less efficient in older adulthood, age alone is not a defining factor in relation to accuracy. In a real-life context, general cognitive function, in conjunction with dynamic measures such as STAC, may represent a far more effective strategy for assessing the complex executive functions underlying driving ability

What are patient perspectives in atypical and idiopathic Parkinson’s disease of the benefits and timing of ACP and palliative care input? A rapid review

Parkinson’s Disease (PD) is a progressive neurological condition affecting 145,000 people living in the UK. The disease trajectory is both unpredictable and highly variable with a re-cent review of patients dying with a diagnosis of idiopathic PD in Cardiff, (personal commu-nication) showed the time from diagnosis to death ranged from 2-23 years. The review also showed that fewer than 5% of patients had any documented advanced care planning (ACP) and only 8.5% had been referred to a palliative care service prior to being in their last days of life in hospital. This rapid review aims to examine the evidence on patient perception of these issues. The review findings will be used to identify patients perspectives on the benefit and timing of advanced care planning (ACP) and palliative care team involvement and subsequently a Cardiff and Vale University Health Board development project enhancing palliative care in advanced Parkinson’s Disease

A mixed-methods study to evaluate a patient-designed tool to reduce harm from cancer-associated thrombosis: The EMPOWER study

Introduction Venous thromboembolism (VTE) is a common and serious complication of systemic anticancer therapies. Delays in presentation increase risk of death or long-term morbidity. Background A patient charity developed an information video for patients receiving systemic anticancer therapy including what to do if they developed symptoms of VTE. This was introduced into clinical practice in a regional cancer center and its impact compared with a district general hospital where the video was not used. Methods A mixed-methods approach was used, comprising clinical audit data, patient surveys, and key informant interviews. The time between development of VTE symptoms and seeking medical evaluation was routinely recorded on patients attending a regional cancer-associated thrombosis service with systemic anticancer therapy–provoked VTE. The video was then embedded into clinical practice at the regional cancer center for 3 months. The primary outcome was the difference in time to presentation with VTE symptoms, between patients attending the regional cancer center and the district general hospital (which acted as control). Other outcomes included impact on radiology resources, patient knowledge, and perspectives of chemotherapy nurses. Results Addition of the video was associated with a lower mean time to presentation from 8.9 to 2.9 days (0.33 hazard ratio; 95% confidence interval, 4.5-7.4; P < .0001). This may reflect greater awareness of VTE, resulting in earlier clinical presentation when they developed attributable symptoms. Conclusion The video was associated with reduced delays in diagnosis of systemic anticancer therapy–associated VTE by 6 days, thereby reducing long-term complications

What is the evidence base for the assessment and management of cancer cachexia in adults with incurable pancreatic cancer? A rapid review

Cancer associated cachexia is a multifactorial disorder characterised by weight loss, and specifically the loss of muscle mass (with or without adipose tissue loss). It is distinct from malnutrition or starvation in that its effects may be partially, but not fully, reversed through nutritional support alone. It is associated with changes in muscle strength and results in progressive functional decline, treatment associated complications, worsening quality of life and cancer-related mortality. These cumulative effects are particularly relevant in pancreatic cancer, for which the majority of patients present with incurable disease and in which the rates of cancer cachexia are very high. Despite the well documented symptomatic and functional burdens - and associated implications for anticancer treatment receipt - there is very little structured assessment of cachexia by cancer Multidisciplinary Teams (MDT) and limited evidence on optimal interventions. International consensus driven guidelines have provided strong recommendations on a multidisciplinary and multimodal interventional approach to the assessment of cachexia and of the assessment and management of nutrition in cancer, whilst acknowledging that the levels of evidence for specific components is often moderate or low. The consensus guide-line on definition of cancer cachexia encourages assessment based on four domains: Storage (body composition, BMI, degree and rate of weight loss), Intake (nutritional assessment; symptom assessment for anorexia, nausea), Potential (evidence of catabolism e.g. CRP) and Performance. The rationale for this review is to examine the evidence base for the assessment and management of cancer cachexia specifically in pancreatic cancer where treatment intent is non-curative

Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the evidence base for early palliative care interventions, including referral to specialist palliative care services for improving outcomes in people diagnosed with a primary brain tumour and their carers

Support needs and barriers to accessing support:Baseline results of a mixed-methods national survey of people bereaved during the COVID-19 pandemic

BACKGROUND: The COVID-19 pandemic is a mass bereavement event which has profoundly disrupted grief experiences. Understanding support needs and access to support among people bereaved at this time is crucial to ensuring appropriate bereavement support infrastructure. AIM: To investigate grief experiences, support needs and use of formal and informal bereavement support among people bereaved during the pandemic. DESIGN: Baseline results from a longitudinal survey. Support needs and experiences of accessing support are reported using descriptive statistics and thematic analysis of free-text data. SETTING/PARTICIPANTS: 711 adults bereaved in the UK between March and December 2020, recruited via media, social media, national associations and community/charitable organisations. RESULTS: High-level needs for emotional support were identified. Most participants had not sought support from bereavement services (59%, n = 422) or their General-Practitioner (60%, n = 428). Of participants who had sought such support, over half experienced difficulties accessing bereavement services (56%, n = 149)/General-Practitioner support (52%, n = 135). About 51% reported high/severe vulnerability in grief; among these, 74% were not accessing bereavement or mental-health services. Barriers included limited availability, lack of appropriate support, discomfort asking for help and not knowing how to access services. About 39% (n = 279) experienced difficulties getting support from family/friends, including relational challenges, little face-to-face contact and disrupted collective mourning. The perceived uniqueness of pandemic bereavement and wider societal strains exacerbated their isolation. CONCLUSIONS: People bereaved during the pandemic have high levels of support needs alongside difficulties accessing support. We recommend increased provision and tailoring of bereavement services, improved information on support options and social/educational initiatives to bolster informal support and ameliorate isolation

Parental perspectives on the grief and support needs of children and young people bereaved during the COVID-19 pandemic: Qualitative findings from a national survey

Background During the COVID-19 pandemic, many children and young people have experienced the death of close family members, whilst also facing unprecedented disruption to their lives. This study aimed to investigate the experiences and support needs of bereaved children and young people from the perspective of their parents and guardians. Methods We analysed cross-sectional qualitative free-text data from a survey of adults bereaved in the UK during the pandemic. Participants were recruited via media, social media, national associations and community/charitable organisations. Thematic analysis was conducted on free text data collected from parent/guardian participants in response to a survey question on the bereavement experiences and support needs of their children. Results Free-text data from 104 parent/guardian participants was included. Three main themes were identified: the pandemic-related challenges and struggles experienced by children and young people; family support and coping; and support from schools and services. Pandemic-challenges include the impacts of being separated from the relative prior to their death, isolation from peers and other family members, and disruption to daily routines and wider support networks. Examples were given of effective family coping and communication, but also of difficulties relating to parental grief and children’s existing mental health problems. Schools and bereavement organisations’ provision of specialist support was valued, but there was evidence of unmet need, with some participants reporting a lack of access to specialist grief or mental health support. Conclusion Children and young people have faced additional strains and challenges associated with pandemic bereavement. We recommend resources and initiatives that facilitate supportive communication within family and school settings, adequate resourcing of school and community-based specialist bereavement/mental health services, and increased information and signposting to the support that is available

Factors associated with higher levels of grief and support needs among people bereaved during the pandemic: results from a national online survey

We identified factors associated with higher levels of grief and support needs among 711 people bereaved during the COVID-19 pandemic in the UK (deaths 16 March 2020-2 January 2021). An online survey assessed grief using the Adult Attitude to Grief (AAG) scale, which calculates an overall index of vulnerability (IOV) (range 0-36), and practical and emotional support needs in 13 domains. Participants’ mean age was 49.5 (SD 12.9); 628 (88.6%) female. Mean age of deceased 72.2 (SD 16.1). 311 (43.8%) deaths were from confirmed/suspected COVID-19. High overall levels of grief and support needs were observed; 28.2% exhibited severe vulnerability (IOV ≥ 24). Grief and support needs were higher for close relationships with the deceased (versus more distant) and reported social isolation and loneliness (P < 0.001), and lower with age of deceased above 40-50. Other associated factors were place of death and health professional support post-death (P < 0.05

Parents’ accounts of the grief experiences and support needs of children and young people bereaved during the COVID-19 pandemic: results from a UK-wide online survey.

Introduction Many children and young people have experienced the death of close family members during the Covid-19 pandemic, whilst also facing unprecedented disruption to their daily routines and support networks. Aims This study investigated their bereavement experiences and support needs as described by their parents/guardians. Method We disseminated a UK-wide online survey through social media platforms and community/charitable organisations, capturing the grief experiences of adults bereaved during the pandemic. Parent/guardian free-text responses (N=106) to a question on their child(ren)’s support needs were analysed thematically. Results Three main themes were identified: the pandemic-related challenges and struggles experienced by children and young people; family support and coping; and support from schools and services. Pandemic specific challenges include the impacts of not being able to be with the relative prior to their death, isolation from peers and other family members, and disruption to daily routines and wider support networks. Examples were given of effective coping and grief-related communication within families, but some parents also described difficulties relating to their own grief and children’s pre-existing mental health problems. The important role of schools and bereavement organisations in providing specialist support was valued, but there was evidence of unmet need and difficulties accessing bereavement and mental health support. Conclusion Children and young people have faced additional strains and challenges associated with pandemic bereavement, with some requiring specialist bereavement or mental health support. Impact This study provides insight into how children and young people experienced the death of a close family member during the pandemic. We recommend initiatives that facilitate open communication within family, peer and school settings, adequate resourcing of school and community-based specialist services, and increased information and signposting to support