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IntroductionDespite major advances in the field of neuroscience over the last three decades, the quality of assessments available to patients with memory problems in later life has barely changed. At the same time, a large proportion of dementia biomarker research is conducted in selected research samples that often poorly reflect the demographics of the population of patients who present to memory clinics. The Oxford Brain Health Clinic (BHC) is a newly developed clinical assessment service with embedded research in which all patients are offered high-quality clinical and research assessments, including MRI, as standard.Methods and analysisHere we describe the BHC protocol, including aligning our MRI scans with those collected in the UK Biobank. We evaluate rates of research consent for the first 108 patients (data collection ongoing) and the ability of typical psychiatry-led NHS memory-clinic patients to tolerate both clinical and research assessments.Ethics and disseminationOur ethics and consenting process enables patients to choose the level of research participation that suits them. This generates high rates of consent, enabling us to populate a research database with high-quality data that will be disseminated through a national platform (the Dementias Platform UK data portal).

Background Despite a proliferation of computerised and remote monitoring assessments offering opportunities to provide valuable data to researchers and clinicians, there are significant concerns about feasibility of such tools within a clinical population. A patient‐centred design is essential to ensure these tools are effective and well tolerated by a memory clinic population, whilst producing high quality data. Our aim was to integrate Patient and Public Involvement (PPI) systematically in the development of a remote monitoring study for patients of the Oxford Brain Health Clinic (OBHC; O'Donoghue et al., 2023). Method A comprehensive approach was taken to engage people living with dementia and mild cognitive impairment, their relatives, as well as volunteers interested in dementia research. This was achieved through a workshop and survey to explore the relevance of the research and potential assessments, by user‐testing methods to refine study design, by co‐producing the study aims and documents with a lay member, and through regular consultations with a PPI panel to review progress and practical considerations (Table 1). Result PPI activities were instrumental in shaping the research, with two key themes emerging: relevance of outcome measures and choice. The need for clear, relevant, prognostic information was stressed, alongside high‐priority outcome measures such as daily activity, memory, relationships, and care needs. Contributors highlighted the importance of choice in the types of assessments, the means of participation, and to what extent there should be relative involvement. Contributors suggested improvements to digital tasks including increasing device compatibility and the need for analogue alternatives. This resulted in a study design which maximises patient/relative choice while collecting data relating to high‐priority outcome measures. This study design was found by our PPI consultants to be generally acceptable and feasible. Conclusion By integrating PPI, we have created a patient‐centred remote monitoring study that is reflective of the needs and preferences of patients and their relatives. Although embedding PPI requires time and resources, it is invaluable for studies involving digital assessments within clinical populations and significantly shaped this research, challenged existing assumptions, and led to more acceptable outcomes, which should ultimately result in greater inclusion.

Despite a proliferation of computerised and remote monitoring assessments offering opportunities to provide valuable data to researchers and clinicians, there are significant concerns about feasibility of such tools within a clinical population. A patient-centred design is essential to ensure these tools are effective and well tolerated by a memory clinic population, whilst producing high quality data. Our aim was to integrate Patient and Public Involvement (PPI) systematically in the development of a remote monitoring study for patients of the Oxford Brain Health Clinic (OBHC; O'Donoghue et al., 2023). A comprehensive approach was taken to engage people living with dementia and mild cognitive impairment, their relatives, as well as volunteers interested in dementia research. This was achieved through a workshop and survey to explore the relevance of the research and potential assessments, by user-testing methods to refine study design, by co-producing the study aims and documents with a lay member, and through regular consultations with a PPI panel to review progress and practical considerations (Table 1). PPI activities were instrumental in shaping the research, with two key themes emerging: relevance of outcome measures and choice. The need for clear, relevant, prognostic information was stressed, alongside high-priority outcome measures such as daily activity, memory, relationships, and care needs. Contributors highlighted the importance of choice in the types of assessments, the means of participation, and to what extent there should be relative involvement. Contributors suggested improvements to digital tasks including increasing device compatibility and the need for analogue alternatives. This resulted in a study design which maximises patient/relative choice while collecting data relating to high-priority outcome measures. This study design was found by our PPI consultants to be generally acceptable and feasible. By integrating PPI, we have created a patient-centred remote monitoring study that is reflective of the needs and preferences of patients and their relatives. Although embedding PPI requires time and resources, it is invaluable for studies involving digital assessments within clinical populations and significantly shaped this research, challenged existing assumptions, and led to more acceptable outcomes, which should ultimately result in greater inclusion.

Background Despite a proliferation of computerised and remote monitoring assessments offering opportunities to provide valuable data to researchers and clinicians, there are significant concerns about feasibility of such tools within a clinical population. A patient‐centred design is essential to ensure these tools are effective and well tolerated by a memory clinic population, whilst producing high quality data. Our aim was to integrate Patient and Public Involvement (PPI) systematically in the development of a remote monitoring study for patients of the Oxford Brain Health Clinic (OBHC; O'Donoghue et al., 2023). Method A comprehensive approach was taken to engage people living with dementia and mild cognitive impairment, their relatives, as well as volunteers interested in dementia research. This was achieved through a workshop and survey to explore the relevance of the research and potential assessments, by user‐testing methods to refine study design, by co‐producing the study aims and documents with a lay member, and through regular consultations with a PPI panel to review progress and practical considerations (Table 1). Result PPI activities were instrumental in shaping the research, with two key themes emerging: relevance of outcome measures and choice. The need for clear, relevant, prognostic information was stressed, alongside high‐priority outcome measures such as daily activity, memory, relationships, and care needs. Contributors highlighted the importance of choice in the types of assessments, the means of participation, and to what extent there should be relative involvement. Contributors suggested improvements to digital tasks including increasing device compatibility and the need for analogue alternatives. This resulted in a study design which maximises patient/relative choice while collecting data relating to high‐priority outcome measures. This study design was found by our PPI consultants to be generally acceptable and feasible. Conclusion By integrating PPI, we have created a patient‐centred remote monitoring study that is reflective of the needs and preferences of patients and their relatives. Although embedding PPI requires time and resources, it is invaluable for studies involving digital assessments within clinical populations and significantly shaped this research, challenged existing assumptions, and led to more acceptable outcomes, which should ultimately result in greater inclusion.

Despite a proliferation of computerised and remote monitoring assessments offering opportunities to provide valuable data to researchers and clinicians, there are significant concerns about feasibility of such tools within a clinical population. A patient-centred design is essential to ensure these tools are effective and well tolerated by a memory clinic population, whilst producing high quality data. Our aim was to integrate Patient and Public Involvement (PPI) systematically in the development of a remote monitoring study for patients of the Oxford Brain Health Clinic (OBHC; O'Donoghue et al., 2023). A comprehensive approach was taken to engage people living with dementia and mild cognitive impairment, their relatives, as well as volunteers interested in dementia research. This was achieved through a workshop and survey to explore the relevance of the research and potential assessments, by user-testing methods to refine study design, by co-producing the study aims and documents with a lay member, and through regular consultations with a PPI panel to review progress and practical considerations (Table 1). PPI activities were instrumental in shaping the research, with two key themes emerging: relevance of outcome measures and choice. The need for clear, relevant, prognostic information was stressed, alongside high-priority outcome measures such as daily activity, memory, relationships, and care needs. Contributors highlighted the importance of choice in the types of assessments, the means of participation, and to what extent there should be relative involvement. Contributors suggested improvements to digital tasks including increasing device compatibility and the need for analogue alternatives. This resulted in a study design which maximises patient/relative choice while collecting data relating to high-priority outcome measures. This study design was found by our PPI consultants to be generally acceptable and feasible. By integrating PPI, we have created a patient-centred remote monitoring study that is reflective of the needs and preferences of patients and their relatives. Although embedding PPI requires time and resources, it is invaluable for studies involving digital assessments within clinical populations and significantly shaped this research, challenged existing assumptions, and led to more acceptable outcomes, which should ultimately result in greater inclusion.

Background The Oxford Brain Health Clinic (OBHC) has assessed over 300 NHS memory clinic patients with a magnetic resonance imaging (MRI) protocol aligned with the UK Biobank. We also acquired the same data from over 100 healthy volunteers (HV) of a similar age range. This work explores multimodal patterns of imaging‐derived phenotypes (IDPs) across diagnostic groups in a real‐world memory clinic setting. Method Scans from 342 OBHC patients and 107 HV (demographics in Table 1) were processed with an integrated quality control‐analysis pipeline optimised for memory clinic use (Gillis et al., medRxiv, 2024). Subsequent diagnoses were extracted from electronic healthcare records and categorised as follows: dementia (ICD10 codes F00, F01, F02, F03), mild cognitive impairment (MCI ‐ F06.7), and no dementia‐related diagnoses (NDRD, including F10, F31, F32, F41). We performed ordinal regression analyses to test associations of IDPs with diagnoses, controlling for age, sex, head size, and applying hierarchical FDR correction. Result IDPs from all 6 MRI modalities significantly differed across groups (Figure 1). Pairwise post‐hoc analyses revealed that healthy volunteers and dementia patients also significantly differed across all modalities (Figure 2A). In addition to structural changes, MCI patients had significantly higher cortical mean diffusivity, lower white matter integrity, and lower cerebral blood flow compared to HV (Figure 2B). Dementia patients had smaller volumes, localised increases in mean diffusivity, and more white matter hyperintensities (WMHs) than MCI patients (Figure 2C). Memory clinic patients who received no formal dementia‐related diagnosis did not have significantly different brain volumes compared to HV, but the left hippocampal mean diffusivity was significantly higher (Figure 2D). Conclusion Thanks to the comprehensive multimodal MRI assessment offered in the OBHC, we observed distinct patterns of changes across the dementia spectrum. While structural IDPs may still provide best sensitivity, non‐conventional MRI may give further insights on mechanisms of neurodegeneration. Microstructural and perfusion changes may precede the formation of overt WMH lesions, supporting the possibility of diffusion MRI and perfusion imaging as early signatures alongside structural imaging. Increased mean diffusivity in the left hippocampus in NDRD might explain memory problems that led to the referral to memory clinic.

Background Multimorbidity across the lifespan, especially during critical age windows, is associated with increased dementia risk. In this study, we sought to characterise the accumulation of long‐term conditions (LTCs) in a real‐world memory clinic population at the Oxford Brain Health Clinic (OBHC). We contextualise these prevalences with comparison to UK Biobank (UKB). Method By 2025, medical histories extracted from primary care records were available on the OBHC Research Database for 190 NHS memory clinic patients. 50 LTCs or categories of LTCs were prioritised during extraction and grouped according to body system (Figure 1), recording the first time each diagnosis was made. To align with previous comorbidity lists (Patel et al., medRxiv, 2024), some conditions were merged (e.g., cancers, types of arthritis), and others were extracted from free‐text (e.g., anaemia, macular degeneration, osteoporosis, prostate, sleep disorders, hyperlipidaemia), resulting in a list of 31 LTCs for comparison. In line with the OBHC cohort, UKB participants younger than or deceased before age 65 were excluded. A supplementary comparison was performed including only those with a dementia diagnosis, excluding those from UKB who were diagnosed before age 65; only pre‐dementia LTCs were considered. Result On average, OBHC patients had 4 comorbid diagnoses before attending their memory clinic appointment; osteoarthritis and hypertension were most common, with a relative prevalence of 46.8% and 43.7%, respectively (Figure 1). In early adulthood, psychiatric conditions were most prevalent in OBHC patients, but cardiovascular conditions accumulated most rapidly across midlife to become the most prevalent (Figure 2). Of the 10 most prevalent LTCs in the OBHC, arthritis, depression, and IBS were more prevalent than in UKB (Figure 3A). OBHC dementia patients had significantly lower prevalences of hypertension, cardiovascular disease, and anaemia than UKB dementia patients (Figure 3B). Conclusion Although the rankings of conditions between cohorts were largely similar, we found potentially important differences in the prevalence of LTCs between a large population cohort and a real‐world patient sample. Ascertaining comparable data across research and clinical cohorts is a harmonisation challenge that needs to be met so the impact of multimorbidity on brain health can inform the development of personalised interventions.

Background The Oxford Brain Health Clinic (OBHC) was launched in August 2020 to provide enhanced assessments for memory clinic patients including MRI, advanced cognitive and lifestyle assessments, and optional research assessments. This study evaluates the impact of the OBHC pathway on psychiatrists' diagnostic confidence and the perceived usefulness of each assessment compared to a standard memory clinic (MC) pathway, to inform future refinement and NHS adoption. Method We retrospectively selected 100 cases from the South Oxford memory clinic (50 OBHC, 50 MC) seen between August 2021 and August 2022. Anonymised records, including assessments, diagnoses, and management plans, were extracted and reviewed. Six psychiatrists rated their diagnostic confidence (0 = no confidence, 10 = no doubt) and the usefulness of each assessment using a five‐point Likert scale (range from 1 = not useful at all to 5 = extremely useful). Each case was randomly assigned to two raters. Descriptive analysis was conducted for confidence and usefulness scores. Mann‐Whitney U tests were used to compare diagnostic confidence between pathways, and multiple linear regression was applied to adjust for the influence of patients' cognitive status. Results In the OBHC pathway, 48% of cases had dementia, 24% had mild cognitive impairment (MCI), and 28% had no memory disorder related diagnosis, compared to 74%, 16%, and 10% respectively in the MC pathway. Mean diagnostic confidence was high in both pathways (OBHC:8.58 ± 1.2; MC:8.38 ± 1.2). Regression analysis indicated that the OBHC pathway resulted in higher diagnostic confidence (β = ‐0.521, p = 0.067) compared to the MC pathway, although the result was not statistically significant. Assessments rated as useful (scores > 3) in the OBHC pathway included MRI, ACE‐III, observations, and informant interviews, while the MC pathway prioritised clinical interviews, relative discussions, CT, and MoCA. Conclusions The OBHC pathway demonstrates diagnostic confidence equal to or greater than that of standard memory clinics and offers all patients research engagement opportunities. Some assessments within the OBHC pathway address dementia risk factors, potentially enhancing management and research initiatives despite their limited immediate diagnostic utility. These results support the further refinement of the OBHC pathway within the NHS.

Background The Oxford Brain Health Clinic (OBHC) has assessed over 300 NHS memory clinic patients with a magnetic resonance imaging (MRI) protocol aligned with the UK Biobank. We also acquired the same data from over 100 healthy volunteers (HV) of a similar age range. This work explores multimodal patterns of imaging‐derived phenotypes (IDPs) across diagnostic groups in a real‐world memory clinic setting. Method Scans from 342 OBHC patients and 107 HV (demographics in Table 1) were processed with an integrated quality control‐analysis pipeline optimised for memory clinic use (Gillis et al., medRxiv, 2024). Subsequent diagnoses were extracted from electronic healthcare records and categorised as follows: dementia (ICD10 codes F00, F01, F02, F03), mild cognitive impairment (MCI ‐ F06.7), and no dementia‐related diagnoses (NDRD, including F10, F31, F32, F41). We performed ordinal regression analyses to test associations of IDPs with diagnoses, controlling for age, sex, head size, and applying hierarchical FDR correction. Result IDPs from all 6 MRI modalities significantly differed across groups (Figure 1). Pairwise post‐hoc analyses revealed that healthy volunteers and dementia patients also significantly differed across all modalities (Figure 2A). In addition to structural changes, MCI patients had significantly higher cortical mean diffusivity, lower white matter integrity, and lower cerebral blood flow compared to HV (Figure 2B). Dementia patients had smaller volumes, localised increases in mean diffusivity, and more white matter hyperintensities (WMHs) than MCI patients (Figure 2C). Memory clinic patients who received no formal dementia‐related diagnosis did not have significantly different brain volumes compared to HV, but the left hippocampal mean diffusivity was significantly higher (Figure 2D). Conclusion Thanks to the comprehensive multimodal MRI assessment offered in the OBHC, we observed distinct patterns of changes across the dementia spectrum. While structural IDPs may still provide best sensitivity, non‐conventional MRI may give further insights on mechanisms of neurodegeneration. Microstructural and perfusion changes may precede the formation of overt WMH lesions, supporting the possibility of diffusion MRI and perfusion imaging as early signatures alongside structural imaging. Increased mean diffusivity in the left hippocampus in NDRD might explain memory problems that led to the referral to memory clinic.

The Oxford Brain Health Clinic (OBHC) was launched in August 2020 to provide enhanced assessments for memory clinic patients including MRI, advanced cognitive and lifestyle assessments, and optional research assessments. This study evaluates the impact of the OBHC pathway on psychiatrists' diagnostic confidence and the perceived usefulness of each assessment compared to a standard memory clinic (MC) pathway, to inform future refinement and NHS adoption. We retrospectively selected 100 cases from the South Oxford memory clinic (50 OBHC, 50 MC) seen between August 2021 and August 2022. Anonymised records, including assessments, diagnoses, and management plans, were extracted and reviewed. Six psychiatrists rated their diagnostic confidence (0 = no confidence, 10 = no doubt) and the usefulness of each assessment using a five-point Likert scale (range from 1 = not useful at all to 5 = extremely useful). Each case was randomly assigned to two raters. Descriptive analysis was conducted for confidence and usefulness scores. Mann-Whitney U tests were used to compare diagnostic confidence between pathways, and multiple linear regression was applied to adjust for the influence of patients' cognitive status. In the OBHC pathway, 48% of cases had dementia, 24% had mild cognitive impairment (MCI), and 28% had no memory disorder related diagnosis, compared to 74%, 16%, and 10% respectively in the MC pathway. Mean diagnostic confidence was high in both pathways (OBHC:8.58 ± 1.2; MC:8.38 ± 1.2). Regression analysis indicated that the OBHC pathway resulted in higher diagnostic confidence (β = -0.521, p = 0.067) compared to the MC pathway, although the result was not statistically significant. Assessments rated as useful (scores > 3) in the OBHC pathway included MRI, ACE-III, observations, and informant interviews, while the MC pathway prioritised clinical interviews, relative discussions, CT, and MoCA. The OBHC pathway demonstrates diagnostic confidence equal to or greater than that of standard memory clinics and offers all patients research engagement opportunities. Some assessments within the OBHC pathway address dementia risk factors, potentially enhancing management and research initiatives despite their limited immediate diagnostic utility. These results support the further refinement of the OBHC pathway within the NHS.