Oculomotor and inhibitory control in dyslexia

Previous research has suggested that people with dyslexia may have an impairment of inhibitory control. The oculomotor system is vulnerable to interference at various levels of the system, from high level cognitive control to peripheral neural pathways. Therefore, in this work we examined two forms of oculomotor inhibition and two forms of oculomotor interference at high and low levels of the control system. This study employed a prosaccade, antisaccade, and a recent distractor eye movement task (akin to a spatial negative priming) in order to explore high level cognitive control and the inhibition of a competing distractor. To explore low-level control we examined the frequency of microsaccades and post-saccade oscillations. The findings demonstrated that dyslexics have an impairment of volitional inhibitory control, reflected in the antisaccade task. In contrast, inhibitory control at the location of a competing distractor was equivalent in the dyslexic and non-dyslexic groups. There was no difference in the frequency of microsaccades between the two groups. However, the dyslexic group generated larger microsaccades prior to the target onset in the prosaccade and the antisaccade tasks.The groups did not differ in the frequency or in the morphology of the post-saccade oscillations. These findings reveal that the word reading and attentional difficulties of dyslexic readers cannot be attributed to an impairment in the inhibition of a visual distractor or interference from low-level oculomotor instability. We propose that the inhibitory impairment in dyslexia occurs at a higher cognitive level, perhaps in relation to the process of attentional disengagement

Dyslexia and substance use in a University Undergraduate Population

Background: A number of cognitive deficits are associated with dyslexia. However, only a limited amount of research has been performed exploring a putative link between dyslexia and substance use. As substance use is thought to involve a cognitive component, it is possible that the pattern of substance use would be different for dyslexic participants, when compared to nondyslexic controls. During the current study, a guiding hypothesis was that people with dyslexia would demonstrate less substance use than nondyslexic controls. Theories of memory activation, automaticity, and attentional bias in substance use suggest that cognitive components of substance use are important in the development and maintenance of continued substance use and it is thought that, at least some of these components, would be impaired in a dyslexic population. Objectives: If the cognitive deficits displayed by dyslexics somehow impair the development of cognitive components of substance use, substance use for dyslexic participants may be less pronounced. This paper therefore examines this hypothesis by comparing substance use within dyslexic and nondyslexic participants, from an undergraduate population. Methods: This was an exploratory questionnaire-based study. Dyslexic participants (n = 35) were compared to control participants (n = 62) on a series of questions designed to measure their substance use history. Results: The results provided preliminary evidence of a difference between dyslexic and nondyslexic substance use. Dyslexics reported a substance use history that was significantly lower than nondyslexic controls. Conclusions/Importance: These results are interpreted in terms of cognitive deficits within dyslexia and with reference to the cognitive model of substance use

Quality-of-life outcomes in older patients with early-stage rectal cancer receiving organ-preserving treatment with hypofractionated short-course radiotherapy followed by transanal endoscopic microsurgery (TREC): non-randomised registry of patients unsuitable for total mesorectal excision

Background Older patients with early-stage rectal cancer are under-represented in clinical trials and, therefore, little high-quality data are available to guide treatment in this patient population. The TREC trial was a randomised, open-label feasibility study conducted at 21 centres across the UK that compared organ preservation through short-course radiotherapy (SCRT; 25 Gy in five fractions) plus transanal endoscopic microsurgery (TEM) with standard total mesorectal excision in adults with stage T1–2 rectal adenocarcinoma (maximum diameter ≤30 mm) and no lymph node involvement or metastasis. TREC incorporated a non-randomised registry offering organ preservation to patients who were considered unsuitable for total mesorectal excision by the local colorectal cancer multidisciplinary team. Organ preservation was achieved in 56 (92%) of 61 non-randomised registry patients with local recurrence-free survival of 91% (95% CI 84–99) at 3 years. Here, we report acute and long-term patient-reported outcomes from this non-randomised registry group. Methods Patients considered by the local colorectal cancer multidisciplinary team to be at high risk of complications from total mesorectal excision on the basis of frailty, comorbidities, and older age were included in a non-randomised registry to receive organ-preserving treatment. These patients were invited to complete questionnaires on patient-reported outcomes (the European Organisation for Research and Treatment of Cancer Quality of Life [EORTC-QLQ] questionnaire core module [QLQ-C30] and colorectal cancer module [QLQ-CR29], the Colorectal Functional Outcome [COREFO] questionnaire, and EuroQol-5 Dimensions-3 Level [EQ-5D-3L]) at baseline and at months 3, 6, 12, 24, and 36 postoperatively. To aid interpretation, data from patients in the non-randomised registry were compared with data from those patients in the TREC trial who had been randomly assigned to organ-preserving therapy, and an additional reference cohort of aged-matched controls from the UK general population. This study is registered with the ISRCTN registry, ISRCTN14422743, and is closed. Findings Between July 21, 2011, and July 15, 2015, 88 patients were enrolled onto the TREC study to undergo organ preservation, of whom 27 (31%) were randomly allocated to organ-preserving therapy and 61 (69%) were added to the non-randomised registry for organ-preserving therapy. Non-randomised patients were older than randomised patients (median age 74 years [IQR 67–80] vs 65 years [61–71]). Organ-preserving treatment was well tolerated among patients in the non-randomised registry, with mild worsening of fatigue; quality of life; physical, social, and role functioning; and bowel function 3 months postoperatively compared with baseline values. By 6–12 months, most scores had returned to baseline values, and were indistinguishable from data from the reference cohort. Only mild symptoms of faecal incontinence and urgency, equivalent to less than one episode per week, persisted at 36 months among patients in both groups. Interpretation The SCRT and TEM organ-preservation approach was well tolerated in older and frailer patients, showed good rates of organ preservation, and was associated with low rates of acute and long-term toxicity, with minimal effects on quality of life and functional status. Our findings support the adoption of this approach for patients considered to be at high risk from radical surgery. Funding Cancer Research UK

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

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

Alcohol usage predicts holistic perception:A novel method for exploring addiction

This paper is in closed access until 22nd Nov 2020.Holistic perception is a special form of automatic and experience dependent processing that prioritises objects of interest through the visual system. We therefore speculated that higher levels of alcohol consumption may be associated with enhanced holistic perception for alcohol cues. In our first experiment, we confirmed this hypothesis by showing that increasing regular alcohol usage was associated with greater holistic perception of alcohol, but not non-alcohol, cues. We replicated this finding in a second experiment, but confirmed drink-specific holistic perception for lager cues was not predicted by experience with that drink, but general alcohol usage. In our final experiment when alcohol images were absent from the task, higher levels of alcohol consumption predicted decreased holistic perception for non-rewarding cues. Alcohol use is therefore linked to inverse alterations in holistic perception for alcohol versus non-alcohol cues, with the latter’s effects context dependent. We hypothesise that such inverse relationships may be due to limited cortical resources becoming reutilised for alcohol cues at the expense of other stimuli. Future work will be required to determine holistic perception’s role in maintaining addiction, its predictive value in successful abstinence, and its relationship with characteristics of addiction such as cue reactivity, attentional biases and personality traits

Digital Traces of behaviour within addiction: Response to Griffiths (2017)

Griffiths’ (2017) response to the recent commentary piece by Ryding and Kaye (2017) on “Internet Addiction: A conceptual minefield” provided a useful critique and extension of some key issues. We take this opportunity to further build upon on one of these issues to provide some further insight into how the field of “internet addiction” (IA) or technological addictions more generally, may benefit from capitalising on behavioural data. As such, this response extends Griffiths’ (2007) points surrounding the efficacy of behavioural data previously used in studies on problematic gambling, to consider its merit for future research on IA or associated topics such as Internet Gaming Disorder (IGD) or “Smartphone addiction”. Within this, we highlight the challenges associated with utilising behavioural data but provide some practical solutions which may support researchers and practitioners in this field. These recent developments could, in turn, advance our understanding and potentially validate such concepts by establishing behavioural correlates, conditions and contexts. Indeed, corroborating behavioural metrics alongside self-report measures presents a key opportunity if scholars and practitioners are to move the field forward