The contribution of the central executive to visuo-spatial bootstrapping in younger adults, older adults and patients with mild cognitive impairment.

Background. Recent studies on verbal immediate serial recall (Darling & Havelka, 2010; Darling et al., 2012, 2014; Allen et al., 2015) show evidence of the integration of information from verbal and visuo-spatial short term memory with long-term memory representations. This so-called 'visuo-spatial bootstrapping‘ (VSB) pattern, in which verbal serial recall is improved when the information is arranged in a familiar spatially distributed pattern, such as a telephone keypad, is consistent with the existence within working memory of an episodic buffer. Objective. The general purpose was to investigate the structure of working memory, and in particular the relationship between verbal and visuo-spatial working memory. Specifically, this thesis aimed to determine the contribution of the central executive and the implications of the VSB paradigm in younger and older adults and patients with Mild Cognitive Impairment (MCI). Materials and Methods. The first study explored the role of the central executive. The VSB task with digit sequences, visually presented both in single and in a typical keypad display, was administered under conditions of verbal and central executive load. In the second study VSB was investigated in older and younger adults using three conditions: single digit display, typical and random keypad. In the third study, examining performance in VSB in a typical elderly sample compared with people with MCI. Each participant was assessed with a neuropsychological battery of tests and the VSB task composed by single digit and typical keypad display. Results and Conclusion. Central executive load demonstrated to have a negative effect on digit recall performance without affecting the bootstrapping effect. VSB does not need to recruit executive resources. No difference was observed in the bootstrapping pattern as a consequence of age and cognitive difficulties and the beneficial impact of additional visual information was comparable for MCI, older and younger participants.sub_psunpub2300_ethesesunpu

Is it time to change the way we detect Alzheimer’s disease and monitor its progression? Towards affordable and theory-driven approaches from cognitive neurosciences

A large proportion of people suffering from Alzheimer’s disease (AD) worldwide are not receiving a timely diagnosis. The tools currently used to detect AD and monitor its progression are not sensitive to the preclinical stages and lack specificity for correctdiagnosis. Available biomarkers show acceptable levels of sensitivity but remain littlespecific and not accessible to everyone. We embrace the view that enhancing cognitive assessment of AD should be a research priority. This Perspective paper focuses on issues which, to our view, have been preventing cognitive tests from meeting outstanding needs in the early of detection, monitoring, and treatment development of AD dementia.We first outline the limitations of current diagnostic procedures both theoretically and practically. We then provide a rationale for theory-driven cognitive approaches which would allow mapping assessment tools to specific neuropathological stages of the neurodegenerative course of AD. Finally, we propose research strategies that would help test a hypothesis which, though launched five years ago, remains untested.That is: “Which memory system is impaired first in Alzheimer’s disease?

Maximising impactful and locally relevant mental health research::Ethical considerations

Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection.  Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.</ns4:p

Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings:Ethical considerations

Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection.  Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect

Functional assessment of cognitively impaired older adults : are we asking the right questions?

Background: Recent attention has turned to the development of preventative treatments for Alzheimer’s disease (AD) by targeting the early stages of impairment. However, current neuropsychological and functional assessments are not ideally suited to identify early deviations from healthy ageing (HA). The Details of Functions of Everyday Life (DoFEL; Parra & Kaplan, 2019) is a theory-driven scale that incorporates cognitive constructs sensitive to the preclinical stages of dementia (memory binding). DoFEL can help assess the extent to which instrumental functions of daily living are supported by such cognitive abilities and if so, whether by asking the right questions through such a scale we could unveil subtle and still undetected impairments. We predict this would increase the sensitivity of scales to detect older adults with cognitive impairment who are at a high risk of dementia.   Methods: Twenty-five MCI and 21 HA controls (ACE-R score ≥ 88) (Mioshi et al., 2006) underwent an extensive baseline neuropsychological assessment followed by yearly follow-up assessments. The DoFEL is an informant-based neuropsychological assessment that measures a range of functional abilities which rely on different forms of binding functions. This measure includes 82 statements subdivided into 7 functional domains that comprehensively assess different aspects of daily living. Higher DoFEL score indicate greater impairment.   Results: Five key findings from this study were: (1) The total DoFEL score differentiates MCI from HA U=406.00, p=0.002. Higher scores were detected in individuals with MCI (Mdn= 0.41, Mean rank= 29.24) than in the HA (Mdn= 0.35, Mean rank= 16.67). (2) Individuals with MCI showed domain-specific impairments on DoFEL such as Objects and People, Technology and Communication, Work and Social Life. (3) Relative to HA, MCI patients presented with impaired functional abilities that rely on relational (i.e., forming associations, p=0.001) and conjunctive (i.e., forming object identity, p=0.004). (4) DoFEL scores correlate with (r= -0.62, p=0.000), and predicts cognitive performance on the ACE-R (β= -128.68, t(44)= -6.97, p=0.000).   Conclusion: DoFEL can detect differences between individuals with MCI and HA in overall and specific functional abilities seemingly supported by binding functions and therefore may be a useful tool to identify individuals at risk of developing AD

Mental health Gap Action Programme Intervention Guide (mhGAP-IG) for child and adolescent Mental Health in Low- and Middle-Income Countries (LMIC):A systematic review

BACKGROUND: The Mental Health Gap Action Programme (mhGAP) supports engagement of non-specialists in mental health services in Low- and Middle-Income countries. Given this aim, assessment of the effectiveness of approaches under its remit is warranted. AIMS: We evaluated mhGAP approaches relating to child and adolescent mental health, focusing on provider / child outcomes, and barriers / facilitators of implementation. METHODS: Thirteen databases were searched for reviews and primary research on mhGAP roll out for child and adolescent mental health. RESULTS: Twelve studies were reviewed. Provider-level outcomes were restricted to knowledge gains, with limited evidence of other effects. Child-level outcomes included improved access to care, enhanced functioning and socio-emotional well-being. Organisational factors, clients and providers? attitudes and expectations, and transcultural considerations were barriers. CONCLUSIONS: Further attention to the practical and methodological aspects of implementation of evaluation may improve the quality of evidence of the effectiveness of approaches under its remit