A Role-Needs Framework: Rethinking Support for Informal Caregivers for Alzheimer's Across the Global South and Global North.

OBJECTIVE: Caregivers play an essential role in supporting people with Alzheimer's disease globally. User-informed research is vital to developing trans-cultural guidelines for dementia support organisations. While coping strategies of caregivers are well researched, the 'coping-effectiveness' framework falls short of representing all caregiver needs. Our aim was to develop a robust and inclusive, globally applicable framework of caregiver-informed support needs. METHODS: In partnership with Alzheimer's Disease International and Roche, we conducted qualitative online semi-structured interviews with 34 family caregivers from the Global North (UK, US) and Global South (Brazil, South Africa) in the COVID-19 context. Participant-generated photographs helped encourage discussions of hidden contextual issues. Iterative inductive narrative analysis of interviews and photographs was carried out with input from global and national charity and industry sectors. RESULTS: We identified a framework of four cross-cultural caring approaches with implications for support: (1) Empathising, using emotion-focused strategies to develop strong expertise and coping skills, with time specific information, psychosocial and peer support needs. (2) Organising, using problem-focused strategies, with strong narratives of expertise and advocacy which benefited from early structured information and professional confirmation. (3) Non-identifying caregiving, where daily aspects of caring occurred without specialist knowledge and expertise, and caregivers sought assistance in managing disease-related support. (4) Reluctance, where struggling with unwanted caring responsibilities meant caregivers looked to professionals to carry out daily care. CONCLUSION: Our findings move beyond the 'coping-effectiveness' framework of support to suggest a novel 'role-needs' framework. Our approach supports inclusive ways of tailoring support to fit individual caregiver circumstances globally.

Mnemoscape: Supporting Older Adults' Event Memory Using Wearable Camera Photographs on an Immersive Interface.

BACKGROUND: Wearable camera photographs have been shown to be an effective memory aid in people with and without memory impairment. Most studies using wearable cameras as a memory aid have presented photographs on a computer monitor and used a written diary or no review as a comparison. In this pioneering study, we took a new and innovative approach to wearable camera photograph review that embeds the photographs within a virtual landscape. This approach may enhance these benefits by reinstating the original environmental context to increase participants' sense of re-experiencing the event. OBJECTIVE: We compare the traditional computer monitor presentation of wearable camera photographs and actively taken digital photographs with the presentation of wearable camera photographs in a new immersive interface that reinstates the spatiotemporal context. METHODS: Healthy older adults wore wearable or took digital photographs during a staged event. The next day and 2 weeks later, they viewed wearable camera photographs on a computer monitor or in context on an immersive interface, or digital photographs. RESULTS: Participants who viewed wearable camera photographs in either format recalled more details during photo viewing and subsequent free recall than participants who viewed digital photographs they had taken themselves. CONCLUSION: Wearable camera photographs are an effective support for event memory, regardless of whether they are presented in context in an experience-near format.

Remembering cultural experiences: lifespan distributions, richness and content of autobiographical memories of museum visits.

Little is known about our autobiographical memories for cultural events. This represents an opportunity for cultural institutions such as museums, as examination of visitor memories is one way in which they can seek to understand the long-term impact they may have on their visitors. This research applied a coding model developed from autobiographical memory theory to analysis of participants' memories for museum visits, considering the distribution of memories across the life span, types of memories and content. Differences between visitor groups (age, visit frequency) were also considered. Findings showed a strong recency effect in the life-span distribution, suggesting the importance of social sharing in memories of cultural experience. Analysis of content showed a hierarchy of information that was present in museum memories. Knowledge acquired during the event of the visit was important, as was contextualising information whereby visitors situated the memory within their autobiographical knowledge and chronology. Emotions and thoughts were also salient. Visitor differences had minimal impact on content, with the exception of some effects that were consistent with the literature on memory and ageing. This research develops understanding of autobiographical memories for cultural experiences and provides insight to museums, with practical implications in terms of understanding visitors' experiences.

Switching memory perspective.

The perspective in which memories were spontaneously recalled, field (original perspective) or observer (see oneself in the memory), was examined for both recent and remote memories. Recent memories were dominated by field perspective whilst remote memories were dominated by observer perspective. Further, field memories contained reliably more episodic detail than observer memories. After a 1-week interval, the same memories were recalled again but with a switched memory perspective. Switching from an observer to a field perspective did not reliably increase the amount of episodic details in a memory. Switching from field to observer perspective did, however, reliably reduce the number of episodic details. These findings suggest that memories may be represented in long-term memory with a fixed perspective, either field or observer, which can be temporarily altered sometimes changing the nature of a memory, i.e. how much detail remains accessible.

Remembering, imagining, false memories & personal meanings.

The Self-Memory System encompasses the working self, autobiographical memory and episodic memory. Specific autobiographical memories are patterns of activation over knowledge structures in autobiographical and episodic memory brought about by the activating effect of cues. The working self can elaborate cues based on the knowledge they initially activate and so control the construction of memories of the past and the future. It is proposed that such construction takes place in the remembering-imagining system - a window of highly accessible recent memories and simulations of near future events. How this malfunctions in various disorders is considered as are the implication of what we term the modern view of human memory for notions of memory accuracy. We show how all memories are to some degree false and that the main role of memories lies in generating personal meanings.

Biological stress regulation in female adolescents: a key role for confiding.

Attachment behaviors play a critical role in regulating emotion within the context of close relationships, and attachment theory is currently used to inform evidence-based practice in the areas of adolescent health and social care. This study investigated the association between female adolescents' interview-based attachment behaviors and two markers of hypothalamic-pituitary-adrenal axis activity: cortisol and dehydroepiandrosterone (DHEA). Unlike the classic stress hormone cortisol, there is very limited investigation of DHEA-a quintessential developmental hormone-in relation to attachment, especially in adolescents. Fifty-five healthy females mean age 14.36 (±2.41) years participated in the attachment style interview. A smaller cortisol awakening response was related to anxious attachment attitudes, including more fear of rejection, whereas greater morning basal DHEA secretion was only predicted by lower levels of reported confiding in one's mother. These attachment-hormone relationships may be developmental markers in females, as they were independent of menarche status. These findings highlight that the normative shifts occurring in attachment to caregivers around adolescence are reflected in adolescents' biological stress regulation. We discuss how studying these shifts can be informed by evolutionary-developmental theory.

No clear evidence of a difference between individuals who self-report an absence of auditory imagery and typical imagers on auditory imagery tasks.

Aphantasia is characterised by the inability to create mental images in one's mind. Studies investigating impairments in imagery typically focus on the visual domain. However, it is possible to generate many different forms of imagery including imagined auditory, kinesthetic, tactile, motor, taste and other experiences. Recent studies show that individuals with aphantasia report a lack of imagery in modalities, other than vision, including audition. However, to date, no research has examined whether these reductions in self-reported auditory imagery are associated with decrements in tasks that require auditory imagery. Understanding the extent to which visual and auditory imagery deficits co-occur can help to better characterise the core deficits of aphantasia and provide an alternative perspective on theoretical debates on the extent to which imagery draws on modality-specific or modality-general processes. In the current study, individuals that self-identified as being aphantasic and matched control participants with typical imagery performed two tasks: a musical pitch-based imagery and voice-based categorisation task. The majority of participants with aphantasia self-reported significant deficits in both auditory and visual imagery. However, we did not find a concomitant decrease in performance on tasks which require auditory imagery, either in the full sample or only when considering those participants that reported significant deficits in both domains. These findings are discussed in relation to the mechanisms that might obscure observation of imagery deficits in auditory imagery tasks in people that report reduced auditory imagery.

Hydrocephalus: A neuropsychological and theoretical primer.

Hydrocephalus is a common neurological condition, the hallmark feature of which is an excess in production, or accumulation, of cerebrospinal fluid in the ventricles. Although it is associated with diffuse damage to paraventricular brain areas, patients are broadly typified by a particular pattern of cognitive impairments that include deficits in working memory, attention, and spatial abilities. There have, however, been relatively few neuropsychological accounts of the condition. Moreover, theories of the relationship between aetiology and impairment appear to have emerged in isolation of each other, and proffer fundamentally different accounts. In this primer, we aim to provide a comprehensive and contemporary overview of hydrocephalus for the neuropsychologist, covering cognitive sequelae and theoretical interpretations of their origins. We review clinical and neuropsychological assays of cognitive profiles, along with the few studies that have addressed more integrative behaviours. In particular, we explore the distinction between congenital or early-onset hydrocephalus with a normal-pressure variant that can be acquired later in life. The relationship between these two populations is a singularly interesting one in neuropsychology since it can allow for the examination of typical and atypical developmental trajectories, and their interaction with chronic and acute impairment, within the same broad neurological condition. We reflect on the ramifications of this for our subject and suggest avenues for future research.

Diurnal patterns of salivary cortisol and DHEA in adolescent anorexia nervosa.

Although there is well-documented evidence for hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis function in anorexia nervosa (AN), there has been little research into secretory patterns of salivary cortisol and dehydroepiandrosterone (DHEA) in this condition. The cortisol awakening response (CAR), a prominent and discrete feature of the cortisol cycle, has not been extensively explored in adolescent AN. Saliva samples were collected at awakening, 30 min and 12 h post-awakening on two consecutive weekdays from eight female adolescents with clinically diagnosed AN and 41 healthy control (HC) age-matched females. Adolescent AN patients had greater salivary cortisol and DHEA concentrations than HC girls at all points. Increased hormone secretion was unrelated to body mass index. However, despite hypersecretion of both hormones, the circadian pattern including the CAR paralleled that of the HC group. Findings from this preliminary study confirm dysregulation of HPA axis function in adolescent AN as evidenced by hypersecretion of both cortisol and DHEA, which share the common secretagogue adrenocorticotropic hormone. However, the parallel diurnal profiles for AN and HC participants, including the CAR, may indicate hypersecretion per se rather than differential regulation of the diurnal pattern of these two adrenal steroids in AN.

Only minimal differences between individuals with congenital aphantasia and those with typical imagery on neuropsychological tasks that involve imagery.

Aphantasia describes the experience of individuals who self-report a lack of voluntary visual imagery. It is not yet known whether individuals with aphantasia show deficits in cognitive and neuropsychological tasks thought to relate to aspects of visual imagery, including Spatial Span, One Touch Stocking of Cambridge, Pattern Recognition Memory, Verbal Recognition Memory and Mental Rotation. Twenty individuals with congenital aphantasia (VVIQ < 25) were identified and matched on measures of age and IQ to twenty individuals with typical imagery (VVIQ > 35). A group difference was found in the One Touch Stocking of Cambridge task for response time, but not accuracy, when the number of imagined moves that participants had to hold in their heads to complete the task increased. Similarly, a group difference in response time was apparent in the mental rotation task, but only in the subgroup of aphantasic participants who reported a severe deficit in visual imagery (VVIQ score of 16). These results suggest that the cognitive profile of people without imagery does not greatly differ from those with typical imagery when examined by group. In addition, the severity of aphantasia (and VVIQ criterion) may be an important factor to consider when investigating differences in imagery experience. Overall, this study raises questions about whether or not aphantasia represents a difference in cognitive function or in conscious experience.

Anxious attachment style and salivary cortisol dysregulation in healthy female children and adolescents.

BACKGROUND: Attachment style has been linked with basal cortisol secretion in healthy adult women. We investigated whether dysregulation in basal cortisol secretion may be evident in younger healthy females. METHODS: Sixty healthy females aged 9-18 years (mean 14.16, SD ± 2.63 years) participated in the Attachment Style Interview (ASI). Eight saliva samples, synchronised to awakening, were collected per day on two consecutive weekdays to examine the cortisol awakening response (CAR) and the subsequent diurnal decline. RESULTS: Participants exhibiting an anxious attachment style had higher cortisol levels on awakening, in contrast to those who were securely attached. The anxious insecure group also showed an attenuated CAR compared to all other participants. Attachment style groups did not differ in cortisol secretion over the remainder of the day. CONCLUSIONS: These findings indicate that the same pattern of cortisol dysregulation associated with disorder in adulthood manifests as a function of anxious (but not avoidant) insecure attachment style in females during healthy childhood and adolescence.

Using SenseCam with an amnesic patient: accessing inaccessible everyday memories.

Forgetting is a normal and everyday occurrence that may sometimes reflect a complete loss of the mnemonic record or a failure to encode it in the first place. However, on many occasions with the help of cues we can eventually or suddenly recall a memory that seemed to be lost, thus highlighting the probability that many instances of "forgetting" may in fact reflect inaccessibility rather than true loss. We report here on our amnesic patient CR who presents an extreme example of this normal everyday forgetting. For 4 weeks, CR recorded regular personal autobiographical events both on a SenseCam (henceforth SC) and in a written diary form. Subjective and objective aspects of recall were measured each weekend both without any cues and then with either a SC or diary cue. We show that the SC enabled CR to recall significantly more detailed episodic memories than reading the diary and importantly we observed that the qualitative nature of these memories was different. We comment on the considerable potential of SC for therapeutic purposes.

The self-defining period in autobiographical memory: Evidence from a long-running radio show.

This study is the first to demonstrate that a self-defining period (SP) for personally relevant music emerges spontaneously in a public naturalistic setting. While previous research has demonstrated that people tend to have better memory and preference for songs from their teenage years, the theoretical relevance of these studies has been limited by their reliance on forced-choice methodology and a confinement to contemporary popular Western music. Here, we examine the record choices of famous guests (n = 80; mean age = 61.6 years) interviewed for Desert Island Discs, a long-running popular radio programme on BBC Radio 4. Half of all choices were shown to have been most important between the ages of 10 and 30 years, and the most popular reason for their relevance was the song's link to memories of a person, period, or place. We suggest that music is a defining feature of the SP, intrinsically connected to the developing self.

The cortisol awakening response predicts a same-day index of executive function in healthy young adults.

The cortisol awakening response (CAR) is associated with various aspects of cognition, including executive function, in older adult and clinical samples. However, the association between these variables in the healthy functioning population is not well understood due to the limited number of appropriately controlled studies. This study explored the association between the CAR and a set shifting index of executive function in 55 (44 females) healthy participants aged 20.2 ± 3.0 years. Notoriously, assessment of the CAR from self-collected saliva samples within the domestic setting is subject to sample timing error, so electronic monitoring of both awakening and sampling times were employed. Participants attended the laboratory in the afternoon of CAR assessment for testing on the Attention Switching Task of the CANTAB neuropsychological testing battery. A positive association was found between CAR magnitude and attention-switching performance in the afternoon of the same day. This was independent of known relevant CAR covariates, but only evident in CAR data collected without delay exceeding 8 min post-awakening. These findings offer insight into a potential role for the CAR in modulating cognitive functions associated with the pre-frontal cortex.

Silent cerebral infarction and cognitive function following TAVI: an observational two-centre UK comparison of the first-generation CoreValve and second-generation Lotus valve.

OBJECTIVE: To compare the incidence of silent cerebral infarction and impact on cognitive function following transcatheter aortic valve implantation (TAVI) with the first-generation CoreValve (Medtronic, Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston Scientific, Natick Massachusetts, USA). DESIGN: A prospective observational study comprising a 1.5 T cerebral MRI scan, performed preoperatively and immediately following TAVI, and neurocognitive assessments performed at baseline, 30 days and 1 year follow-up. SETTING: University hospitals of Leeds and Leicester, UK. PATIENTS: 66 (80.6±8.0 years, 47% male) patients with high-risk severe symptomatic aortic stenosis recruited between April 2012 and May 2015. MAIN OUTCOME MEASURES: Incidence of new cerebral microinfarction and objective decline in neurocognitive performance. RESULTS: All underwent cerebral MRI at baseline and immediately following TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments at baseline, 30 days and 1 year. There was a significantly greater incidence of new cerebral microinfarction observed following the Lotus TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean volume of infarcted cerebral tissue per patient was equivalent following the two prostheses (p=0.166). More patients suffered new anterior (14 (48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%), p=0.005) lesions following Lotus. Lotus was associated with a decline in verbal memory and psychomotor speed at 30 days. However, performance longitudinally at 1 year was preserved in all neurocognitive domains. CONCLUSIONS: There was a higher incidence of silent cerebral microinfarction and a greater number of lesions per patient following Lotus compared with CoreValve. However, there was no objective decline in neurocognitive function discernible at 1 year following TAVI with either prosthesis.

Informant Personality Is Associated With Ratings of Memory Problems in Older Adults.

Memory complaints are a key diagnostic criterion for dementia and mild cognitive impairment. Rating scales can be used to capture information about individuals' memory problems from informants such as family members. However, problems with scale reliability suggest that individual differences influence the ratings informants provide. This project tested whether informants' neuroticism was associated with their ratings of an older adult's memory. In an online study, 293 volunteers completed a Five-Factor Personality Questionnaire and used 2 memory questionnaires to provide ratings of memory problems in an older individual they knew well. Rater neuroticism correlated positively with estimates of memory problems: More neurotic informants provided higher estimates of memory difficulties in the person they were rating. A second study replicated this finding with 786 volunteers and another widely used memory measure, the AD8. In both studies, exploratory analyses suggested the effect size was large enough to impact on clinical practice.

Recovery from adolescent anorexia nervosa and associations with diurnal patterns of salivary stress hormones: a case report.

In the neurodevelopment of adolescent anorexia nervosa (AN), dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is proposed to be a central component. Furthermore, a therapeutic milieu focusing on affect regulation can contribute much to treatment, given the emotional processing difficulties associated with this disorder. Studies of HPA axis function following such specialist treatments for adolescent AN, however, are rare. This study describes the diurnal pattern of HPA axis activation, including the cortisol awakening response (CAR), in a 16-year-old female diagnosed with AN both during illness and at clinical recovery following milieu therapy with a focus on affect regulation. Specialised single-case study statistics were used to assess whether the patient's data were significantly different from the healthy "norm" at illness and recovery. During illness, her measure of affective problems was outside of the normal range and cortisol and DHEA secretory profiles were significantly elevated across the diurnal period. However, at recovery both her affective state and HPA axis function became comparable to healthy controls. This case study suggests that salivary markers of HPA axis function can be feasibly incorporated into the clinical regime within a specialist adolescent AN residential service and could be used by clinicians to monitor prognosis and interventions.

The cortisol awakening response is related to executive function in older age.

Changes in the cortisol awakening response (CAR) have been reportedly associated with older age and may reflect changes in cognitive performance. However methodological issues around adherence, in regard to careful timing of the CAR, suggest caution in drawing firm conclusions. More investigation is also needed regarding which cognitive domains may be most relevant. Executive Function (EF) is linked strongly to functioning of the frontal cortex, itself linked to cortisol secretion via regulation of the Hypothalamic Adrenocortical Axis. In this study, cortisol profiles, cognitive performance and adherence were carefully assessed in a sample of 50 older participants, aged 60-91 years (mean=74 years). Key aspects of EF were assessed using Form B of the standard Trail-making Test controlling for time taken to complete the simpler Trail-A form of the test. Strong associations between CAR profiles and EF were evident. Cortisol measures significantly predictive of superior EF-related performance in a regression analysis were: earlier peaking and greater magnitude of the CAR. Together these measures explained fully a quarter of all the variance in test performance (R(2)=0.25; F=7.90; df=2,47; p<.001). Cognitive tests of declarative memory, often linked to hippocampal functioning, were not associated with CAR profiles. We conclude that in a population of healthy older adults aspects of the CAR may be strongly, and perhaps with some degree of specificity, associated with that domain of cognitive functioning, EF, which seems to depend crucially on the integrity of frontal cortex circuitry.

Functional MRI/event-related potential study of sensory consonance and dissonance in musicians and nonmusicians.

Pleasurability of individual chords, known as sensory consonance, is widely regarded as physiologically determined and has been shown to be associated with differential activity in the auditory cortex and in several other regions. Here, we present results obtained contrasting isolated four-note chords classified as consonant or dissonant in tonal music. Using event-related functional MRI, consonant chords were found to elicit a larger haemodynamic response in the inferior and middle frontal gyri, premotor cortex and inferior parietal lobule. The effect was right lateralized for nonmusicians and less asymmetric for musicians. Using event-related potentials, the degree of sensory consonance was found to modulate the amplitude of the P1 in both groups and of the N2 in musicians only.

FMRI/ERP of musical syntax: comparison of melodies and unstructured note sequences.

To date, the neural correlates of musical syntax processing have been investigated mainly by means of paradigms in which isolated chords are made incongruent with the harmonic context. Here, we present results obtained contrasting unfamiliar one-part piano melodies with unstructured note sequences, comparable in pitch and rhythm but devoid of any syntactic structure. This paradigm indexes a superset of the cognitive functions involved in processing of harmonic rules. Using functional magnetic resonance imaging, differential activation of a bilateral cortical network comprising the inferior frontal gyrus, superior temporal gyrus and premotor cortex was found. Using event-related potentials, the N2 evoked by each note in melodies was found to have longer latency and a more frontal distribution than that evoked in unstructured sequences.