Fulbourn Hospital

BackgroundSeizures are a common consequence of acute hemorrhagic stroke, which has a high morbidity and fatality rate. It is yet unknown how they relate to age, the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and discharge status.MethodsWe conducted a cross-sectional study of 75 patients (aged 16-92 years) with acute hemorrhagic stroke admitted to the Neuropsychiatry Department of Qena University Hospitals, a tertiary care center serving a large catchment area in Upper Egypt. Data were collected over six months, from September 2024 to February 2025. Neurological impairment was assessed using the NIHSS, and functional outcome was measured using the mRS at admission and discharge. Statistical comparisons included paired t-tests and Wilcoxon signed-rank tests. Associations between seizures, age, stroke severity, and outcomes were also analyzed.ResultsSeizures were not correlated with age. During hospitalization, a noteworthy mean improvement in NIHSS (+0.97; t = 10.70 and p < 0.0001; W = 21.50 and p < 0.0001) was noted, suggesting neurological recovery. On the other hand, mRS remained at a median 3 (t = -0.51 and p = 0.6113; W = 275 and p = 0.9173), indicating no discernible change. There was no discernible change in NIHSS or mRS among patients who were released on demand (n = 10). Ten out of the 12 in-hospital fatalities had seizures, and the majority had moderate-to-severe strokes (NIHSS ≥9; mRS ≥3). Patients with very severe strokes (NIHSS 16-17; mRS = 5) and no recovery experienced two non-seizure fatalities. Admission NIHSS (1-17) and mRS (1-5) showed a broad variety of stroke presentations and recovery trajectories.ConclusionThe baseline of stroke severity was the best indicator of a bad prognosis in acute hemorrhagic stroke, and seizure incidence was not age-dependent. Significant neurological recovery was recorded by NIHSS, but short-term functional improvement was not reflected by mRS. These results indicate that seizures are more common in fatal cases but secondary to the total load of strokes, underscoring the prognostic significance of baseline severity.

A preference for sooner-smaller over later-larger rewards, known as delay discounting, is a candidate transdiagnostic marker of waiting impulsivity and a research domain criterion. While abnormal discounting rates have been associated with many psychiatric diagnoses and abnormal brain structure, the underlying neuropsychological processes remain largely unknown. Here, we deconstruct delay discounting into choice and rate processes by testing different computational models and investigate their associations with white matter tracts. Patients with cocaine use disorder (CUD) (n = 107) and healthy participants (n = 81) completed the Monetary Choice Questionnaire. We computed their discounting rate using the well-known Kirby method, as well as logistic regression, single-subject Bayesian, and full hierarchical Bayesian models. In Bayesian models, we also included a choice sharpness parameter. Seventy patients with CUD and 69 healthy participants also underwent diffusion tensor imaging tractography to quantify streamlines that connect the executive control and valuation brain networks. Patients with CUD showed significantly higher discounting rates and lower choice sharpness, suggesting greater indifference in their choices. Importantly, the full Bayesian model had the greatest reliability for parameter recovery when compared to the Kirby and logistic regression methods. Using Bayesian estimates, we found that white matter streamlines that connect the executive control network with the nucleus accumbens predicted the discounting rate in healthy participants but not in patients with CUD. We demonstrated that measuring delay discounting and choice sharpness directly with a novel computational model explained impulsive discounting choices in patients with CUD better than standard hyperbolic discounting. Our findings highlight a distinct neuropsychological phenotype of impulsive discounting, which may be generalizable to other patient groups.

In our article, Cohen's d was calculated by dividing the fixed-effect estimate from linear mixedeffects models (LMMs) by the residual standard deviation.While this differs from the classical Cohen's d based on group means and pooled standard deviations, it is a commonly accepted approximation of effect size within the LMM framework 1-4 .This method accounts for the hierarchical structure of the data, including random effects, providing a semi-standardized effect size.We clarify this to ensure transparency and avoid misinterpretation.

Recent clinical trials on slowing dementia progression have led to renewed focus on finding safer, more effective treatments. One approach to identify plausible candidates is to assess whether existing medications for other conditions may affect dementia risk. We conducted a systematic review to identify studies adopting a data-driven approach to investigate the association between a wide range of prescribed medications and dementia risk. We included 14 studies using administrative or medical records data for more than 130 million individuals and 1 million dementia cases. Despite inconsistencies in identifying specific drugs that may modify Alzheimer's or dementia risk, some themes emerged for drug classes with biological plausibility. Antimicrobials, vaccinations, and anti-inflammatories were associated with reduced risk, while diabetes drugs, vitamins and supplements, and antipsychotics were associated with increased risk. We found conflicting evidence for antihypertensives and antidepressants. Drug repurposing for use in dementia is an urgent priority. Our findings offer a basis for prioritizing candidates and exploring underlying mechanisms. ·We present a systematic review of studies reporting association between drugs prescribed for other conditions and risk of dementia including 139 million people and 1 million cases of dementia.·Our work supports some previously reported associations, for example, showing decreased risk of dementia with drugs to treat inflammatory disease and increased risk with antipsychotic treatment.·Antimicrobial treatment was perhaps more surprisingly associated with decreased risk, supportive of recent increased interest in this potential therapeutic avenue.·Our work should help prioritize drugs for entry into adaptive platform trials in Alzheimer's disease and will serve as a useful resource for those investigating drugs or classes of drugs and risk of dementia.

PurposeCamouflaging, or the use of strategies by autistic people to minimize the visibility of their autistic traits in social situations, is associated with stress, autistic burnout, depression, and suicidality among autistic adults. However, little is known about how autistic children and adolescents experience camouflaging, limiting our understanding of its onset and development. The present study filled this knowledge gap by examining camouflaging behaviour among autistic children and adolescents using a photo-elicitation approach. MethodsEight autistic children and adolescents aged 10–14 years (M = 11.88, SD = 1.89) attended an orientation session and were given two to three weeks to take photographs on the topic of camouflaging. Individual interviews were conducted with each participant about their photos. Inductive thematic analysis and an interpretive engagement framework were used to identify major themes within participant interviews and images. ResultsQualitative analysis identified 12 themes reflecting motivations to camouflage (as a response to negative social experiences, as a learned habit), contexts of camouflaging (e.g., the audience), strategies and behaviours used to camouflage (suppressing autistic stimming behaviour, hiding the self), and perceived consequences of camouflaging (internal conflict, stress, needing time to recharge). ConclusionResults highlight that autistic children and adolescents as young as 10 years old engage in camouflaging behaviour which can be pervasive and automatic, and that this can be a stressful, confusing, and energetically draining experience. Better understanding of the development and experience of camouflaging in childhood can inform prevention of mental health concerns in adulthood.

AimsTo review the current level of compliance with CPFT (Cambridge & Peterborough Foundation Trust) guidelines by inpatients prescribed anti-psychotics at George Mackenzie House (GMH) low-secure unit and likewise, with NHFT (Northamptonshire Foundation Trust) guidelines by inmates prescribed anti-psychotics at HMP Whitemoor's Fens Unit.To identify any differences or similarities in compliance rates between both sites.To identify any possible areas of difficulty in ensuring full compliance with said guidelines and suggest possible solutions.MethodsA retrospective design was used, in which the electronic and hardcopy patient records of service users at both sites, covering a specified time-frame (2nd Dec 2021- 2nd Dec 2022) were screened. Data collected from eligible users included demographic information, names of anti-psychotics used and results of each individual's screening profile measured against the respective Trust's guidelines.ResultsThe demographic profiles of eligible service users at both sites were largely similar.17 out of 18 services users from GMH and 23 out of 50 service users from the Fens Unit were found eligible for the audit.The majority of eligible service users at both sites (88-100%) were compliant with measurement of relevant laboratory markers, as per Trust guidelines.However, at both sites, there were notable omissions in monitoring of certain physical parameters, especially waist circumference (100% omission in both sites) and ECG monitoring ( 60% omission in prison,14% in GMH), which is important given the significant comorbidity of cardiovascular risk factors amongst service users at both sites.ConclusionWe noted disproportionate compliance in the monitoring of different physical health parameters. While laboratory tests were on the whole, satisfactorily monitored, there were gaps in other clinical measurements like waist circumference and ECG recordings. We postulate several reasons for this discrepancy, including:A possible lack of awareness about the importance of measuring parameters like waist circumference, which also indicates a lack of familiarity with Trust guidelines.A lack of time/inconvenience in ensuring adequate recording of clinical parametersInadequate reminders to conduct relevant physical health checks.We suggest possible solutions to ensure 100% compliance: for example, creating a teaching session for staff and service users on pertinent topics, like metabolic syndrome or creating electronic aids to remind staff when physical measurements are due.This audit also engendered further questions on appropriateness of anti-psychotic prescription and importance of educating service users about physical complications of anti-psychotic use. These could be the focus of future audits.

BackgroundPrevious studies on the association between pain and cognitive decline or impairment have yielded mixed results, while studies from low- and middle-income countries (LMICs) or specifically on mild cognitive impairment (MCI) are scarce. Thus, we investigated the association between pain and MCI in LMICs and quantified the extent to which perceived stress, sleep/energy problems, and mobility limitations explain the pain/MCI relationship.MethodsData analysis of cross-sectional data from six LMICs from the Study on Global Ageing and Adult Health (SAGE) were performed. MCI was based on the National Institute on Aging-Alzheimer's Association criteria. "Overall in the last 30 days, how much of bodily aches or pain did you have?” was the question utilized to assess pain. Associations were examined by multivariable logistic regression analysis and meta-analysis.ResultsData on 32,715 individuals aged 50 years and over were analysed [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, compared to no pain, mild, moderate, and severe/extreme pain were dose-dependently associated with 1.36 (95% CI = 1.18–1.55), 2.15 (95% CI = 1.77–2.62), and 3.01 (95% CI = 2.36–3.85) times higher odds for MCI, respectively. Mediation analysis showed that perceived stress, sleep/energy problems, and mobility limitations explained 10.4%, 30.6%, and 51.5% of the association between severe/extreme pain and MCI.ConclusionsAmong middle-aged to older adults from six LMICs, pain was associated with MCI dose-dependently, and sleep problems and mobility limitations were identified as potential mediators. These findings raise the possibility of pain as a modifiable risk factor for developing MCI.

Background and ObjectivesInformal care is the primary source of support for older adults with cognitive impairment, yet is less available to those who live alone. We examined trends in the prevalence of physical disability and social support among older adults with cognitive impairment living alone in the United States.Research Design and MethodsWe analyzed 10 waves of data from the U.S. Health and Retirement Survey spanning 2000–2018. Eligible people were those aged ≥65, having cognitive impairment, and living alone. Physical disability and social support were measured via basic and instrumental activities of daily living (BADLs, IADLs). We estimated linear temporal trends for binary/integer outcomes via logistic/Poisson regression, respectively.ResultsA total of 20 070 participants were included. Among those reporting BADL/IADL disability, the proportion unsupported for BADLs decreased significantly over time (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97–0.99), and the proportion unsupported for IADLs increased (OR = 1.02, CI 1.01–1.04). Among those receiving IADL support, the number of unmet IADL support needs increased significantly over time (relative risk [RR] 1.04, CI 1.03–1.05). No gender disparities were found for these trends. Over time, Black respondents had a relatively increasing trend of being BADL-unsupported (OR = 1.03, CI 1.0–1.05) and Hispanic and Black respondents had a relatively increasing trend in the number of unmet BADL needs (RR = 1.02, CI 1.00–1.03; RR = 1.01, CI 1.00–1.02, respectively), compared to the corresponding trends in White respondents.Discussion and ImplicationsAmong lone-dwelling U.S. older adults with cognitive impairment, fewer people received IADL support over time, and the extent of unmet IADL support needs increased. Racial/ethnic disparities were seen both in the prevalence of reported BADL/IADL disability and unmet BADL/IADL support needs; some but not all were compatible with a reduction in disparity over time. This evidence could prompt interventions to reduce disparities and unmet support needs.

IntroductionThis study investigates family carers experiences of inpatient mental health care for people with dementia. A mental health inpatient admission for a person with dementia is usually considered when a person is distressed and this distress leads to behaviours that are assessed to be risky for the person or others.MethodsParticipants included seven family carers whose relative with dementia had been cared for within a mental health ward in the United Kingdom UK within the last 5 years. Interviews were used to explore the circumstances that led to the admission, expectations of mental health care, and perceptions of care during the admission and support received by family carers.ResultsParticipants described their distress at the time of admission and how the process of admission sometimes added to their distress. Carers often felt excluded from their relatives care in hospital and many felt a loss of their rights. Participants felt that the mental health admission had a negative impact on their relative with dementia. Mental health law and legislation was difficult to navigate and carers were concerned about how much knowledge and understanding of dementia staff have.DiscussionFindings suggest that family carers may benefit from targeted support during their relatives admission. Mental health wards could do more to recognise the expertise in care and knowledge of the person with dementia of family carers and involve them in planning care. More research is needed to explore the experiences and outcomes of people with dementia during such admissions.