探花直播 of Cambridge - Division of Anaesthesia

One in four patients in vegetative or minimally conscious state able to perform cognitive tasks, study finds

cjb250 — Wed, 14 Aug 2024 21:00:11 +0000

Severe brain injury can leave individuals unable to respond to commands physically, but in some cases they are still able to activate areas of the brain that would ordinarily play a role in movement. This phenomenon is known as 鈥榗ognitive motor dissociation鈥�.

To determine what proportion of patients in so-called 鈥榙isorders of consciousness鈥� experience this phenomenon 鈥� and help inform clinical practice 鈥� researchers across Europe and North America recruited a total of 353 adults with disorders of consciousness, including the largest cohort of 100 patients studied at Cambridge 探花直播 Hospitals NHS Foundation Trust.

Participants had mostly sustained brain injury from severe trauma, strokes or interrupted oxygen supply to the brain after heart attacks. Most were living in specialised long-term care facilities and a few were living at home with extensive care packages. 探花直播median time from injury for the whole group was about eight months.

Researchers assessed patterns of brain activation among these patients using functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). Subjects were asked to repeatedly imagine performing a motor activity (for example, 鈥渒eep wiggling your toes鈥�, 鈥渟winging your arm as if playing tennis鈥�, 鈥渨alking around your house from room to room鈥�) for periods of 15 to 30 seconds separated by equal periods of rest. To be able to follow such instructions requires not only the understanding of and response to a simple spoken command, but also more complex thought processes including paying attention and remembering the command.

探花直播results of the study are published today in the New England Journal of Medicine.

Dr Emmanuel Stamatakis from the Department of Clinical Neurosciences at the 探花直播 of Cambridge said: 鈥淲hen a patient has sustained a severe brain injury, there are very important, and often difficult, decisions to be made by doctors and family members about their care. It鈥檚 vitally important that we are able to understand the extent to which their cognitive processes are still functioning by utilising all available technology.鈥澛�

Among the 241 patients with a prolonged disorder of consciousness, who could not make any visible responses to bedside commands, one in four (25%) was able to perform cognitive tasks, producing the same patterns of brain activity recorded with EEG and/or fMRI that are seen in healthy subjects in response to the same instructions.

In the 112 patients who did demonstrate some motor responses to spoken commands at the bedside, 38% performed these complex cognitive tasks during fMRI or EEG. However, the majority of these patients (62%) did not demonstrate such brain activation. This counter-intuitive finding emphasises that the fMRI and EEG tasks require patients to have complex cognitive abilities such as short-term memory and sustained concentration, which are not required to the same extent for following bedside commands.

These findings are clinically very important for the assessment and management of the estimated 1,000 to 8,000 individuals in the UK in the vegetative state and 20,000 to 50,000 in a minimally conscious state. 探花直播detection of cognitive motor dissociation has been associated with more rapid recovery and better outcomes one year post injury, although the majority of such patients will remain significantly disabled, albeit with some making remarkable recoveries.

Dr Judith Allanson, Consultant in Neurorehabilitation, said: 鈥淎 quarter of the patients who have been diagnosed as in a vegetative or minimally conscious state after detailed behavioural assessments by experienced clinicians, have been found to be able to imagine carrying out complex activities when specifically asked to. This sobering fact suggests that some seemingly unconscious patients may be aware and possibly capable of significant participation in rehabilitation and communication with the support of appropriate technology.

鈥淛ust knowing that a patient has this ability to respond cognitively is a game changer in terms of the degree of engagement of caregivers and family members, referrals for specialist rehabilitation and best interest discussions about the continuation of life sustaining treatments.鈥�

探花直播researchers caution that care must be taken to ensure the findings are not misrepresented, pointing out, for example, that a negative fMRI/EEG result does not per se exclude cognitive motor dissociation as even some healthy volunteers do not show these responses.

Professor John Pickard, emeritus professorial Fellow of St Catharine's College, Cambridge, said: 鈥淥nly positive results 鈥� in other words, where patients are able to perform complex cognitive processes 鈥� should be used to inform management of patients, which will require meticulous follow up involving specialist rehabilitation services.鈥�

探花直播team is calling for a network of research platforms to be established in the UK to enable multicentre studies to examine mechanisms of recovery, develop easier methods of assessment than task-based fMRI/EEG, and to design novel interventions to enhance recovery including drugs, brain stimulation and brain-computer interfaces.

探花直播research reported here was primarily funded by the James S. McDonnell Foundation. 探花直播work in Cambridge was supported by the National Institute for Health and Care Research UK, MRC, Smith鈥檚 Charity, Evelyn Trust, CLAHRC ARC fellowship and the Stephen Erskine Fellowship (Queens鈥� College).聽

Reference
Bodien, YG et al. Cognitive Motor Dissociation in Disorders of Consciousness. NEJM; 14 Aug 2024; DOI:聽10.1056/NEJMoa2400645

Adapted from a press release from Weill Cornell Medicine

Around one in four patients with severe brain injury who cannot move or speak 鈥� because they are in a prolonged coma, vegetative or minimally conscious state 鈥� is still able to perform complex mental tasks, a major international study has concluded in confirmation of much smaller previous studies.

When a patient has sustained a severe brain injury, there are very important, and often difficult, decisions to be made by doctors and family members about their care

Emmanuel Stamatakis

Witthaya Prasongsin (Getty Images)

Male patient in a hospital bed - stock image

Acknowledgements

探花直播multidisciplinary Cambridge Impaired Consciousness Research Group, led by Emeritus Professors John Pickard (Neurosurgery) & David Menon (Anaesthesia) and Drs Judith Allanson & Emmanuel A. Stamatakis (Lead, Cognition and Consciousness Imaging Group), started its research programme in 1997, partly in response to emerging concern over the misdiagnosis of the vegetative state. This pioneering work has only been possible by having access to the world class resources of the Wolfson Brain Imaging Centre, the NIHR/Wellcome Clinical Research Facility at Addenbrooke鈥檚 Hospital, the MRC Cognition and Brain Sciences Unit (Professors Barbara Wilson & Adrian Owen), the Royal Hospital for Neuro-disability (Putney) and the Central England Rehabilitation Unit (Royal Leamington Spa).

探花直播text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright 漏探花直播 of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways 鈥� on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Cambridge to lead new research platform to transform treatment of traumatic brain injury in the UK

cjb250 — Wed, 28 Jun 2023 00:00:22 +0000

Traumatic brain injury, or TBI, is a leading cause of death and disability in people under 40 in the UK and can cause a range of serious and lifelong health issues for people who survive, including dementia, epilepsy and poor mental health.

Until now, data collected by individual research projects investigating TBI has rarely been used outside the original study, even though it provides a potentially rich resource for understanding TBI and advancing its clinical care. This lack of coordinated use of data has slowed progress in treating and caring for people experiencing TBI.

To address this, the MRC, the National Institute for Health and Care Research (NIHR), the Ministry of Defence and Alzheimer鈥檚 Research UK are jointly funding this initiative to establish a UK-wide research platform, TBI-REPORTER, which will be led by the 探花直播 of Cambridge.

TBI-REPORTER will bring together leading experts from across the UK to enable research into TBI, including concussion, and across the lifespan from children to older ages. It will also support research in previously under studied populations, including prisoners, homeless people and victims of domestic violence.

To do this, TBI-REPORTER will collaborate with Health Data Research UK (HDR UK) and build on successes of wider NHS and population-based UK research, such as UK Biobank and Dementias Platform UK (DPUK), to bring together rich datasets from existing studies in TBI. It will also coordinate research data collection and clinical studies going forward, and all of this will be made available to UK and international researchers to accelerate research in TBI and its impact on lifelong health.

探花直播hope is that this will lead to more people being treated effectively as doctors are able to better predict how a certain injury is likely to affect a patient with TBI and offer them individualised care.

探花直播platform will also assist academic and industrial partners to develop better diagnostic tests and treatments for TBI. To facilitate this, the TBI-REPORTER platform will establish a network of research-ready NHS specialist neuroscience hospitals primed to trial innovative ways of diagnosing and treating TBI.

Brain injury survivor James Piercy said: 鈥淎s one of the estimated 1 million people living with the results of a traumatic brain injury, I welcome this new initiative which promises to improve diagnosis and treatment of TBI: the 鈥榟idden disability鈥�.鈥�

Project lead Professor David Menon, Head of the Division of Anaesthesia at the 探花直播 of Cambridge, said: 鈥淚t is a privilege to lead this ambitious platform, which brings together a breadth of experts and draws on the lived experience of TBI survivors and their families, to improve care of traumatic brain injury. We also believe that our work, in combination with that of international partners, will re-energise drug development in TBI and deliver new treatments for patients.鈥�

Secretary of State for Science, Innovation and Technology Chloe Smith said: 鈥淭raumatic brain injuries are a leading cause of death and disability in people under 40 in the UK and survivors often endure a lifetime of physical, emotional, and cognitive challenges.

鈥淭his funding will bring together leading experts and support studies into the long-term consequences of traumatic brain injuries, allowing researchers to identify patterns and develop tailored treatments, with the potential of saving and massively improving the lives of those with such injuries. It is yet another example of how the UK鈥檚 science sector is improving treatment and health outcomes for Britons across the country.鈥�

Professor John Iredale, Executive Chair of the MRC, part of UKRI, added: 鈥淲e recognise the devastating impacts traumatic brain injury can have for its survivors and those who care for them, and are determined to improve the status quo. This award will capitalise on the UK鈥檚 unique scientific strengths to see research into TBI accelerated on a scale not seen before. This will lead to the discoveries we need to give survivors of TBI all around the world a much more hopeful future.鈥�

Dr Susan Kohlhaas, Director of Research at Alzheimer鈥檚 Research UK, said: 鈥淥ver a million people in the UK are living with long-term symptoms of a traumatic brain injury, and evidence suggests that exposure to such an injury can increase dementia risk. At Alzheimer鈥檚 Research UK, we believe it is only by bringing people from different backgrounds together through collaborative approaches that we鈥檒l begin to solve the major challenges in treatment and diagnosis of TBIs. 探花直播TBI-REPORTER programme will be fundamental in improving our understanding of how brain injury contributes to dementia risk so we can prevent dementia in the future.鈥�

TBI-REPORTER represents a collaboration of leading institutions from across the UK, and will be coordinated by the Universities of Cambridge, Glasgow and Sheffield, Imperial College London, and Swansea 探花直播. It also includes close engagement with the public, patients, and their families through the United Kingdom Acquired Brain Injury Forum (UKABIF).

Cambridge is to lead a 拢9.5m research platform that aims to transform the way survivors of traumatic brain injury are diagnosed and treated in the UK, the Medical Research Council (MRC) announced today.

It is a privilege to lead this ambitious platform, which brings together a breadth of experts and draws on the lived experience of TBI survivors and their families, to improve care of traumatic brain injury

David Menon

GlauchauCity

Bicycle accident

探花直播text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright 漏探花直播 of Cambridge and licensors/contributors as identified.聽 All rights reserved. We make our image and video content available in a number of ways 鈥� as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

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Public Domain

Almost half of people with concussion still show symptoms of brain injury six months later

cjb250 — Tue, 25 Apr 2023 23:00:34 +0000

Mild traumatic brain injury 鈥� concussion 鈥� results from a blow or jolt to the head. It can occur as a result of a fall, a sports injury or from a cycling accident or car crash, for example. But despite being labelled 鈥榤ild鈥�, it is commonly linked with persistent symptoms and incomplete recovery. Such symptoms include depression, cognitive impairment, headaches, and fatigue.

While some clinicians in recent studies predict that nine out of 10 individuals who experience concussion will have a full recovery after six months, evidence is emerging that only a half achieve a full recovery. This means that a significant proportion of patients may not receive adequate post-injury care.

Predicting which patients will have a fast recovery and who will take longer to recover is challenging, however. At present, patients with suspected concussion will typically receive a brain scan 鈥� either a CT scan or an MRI scan, both of which look for structural problems, such as inflammation or bruising 鈥� yet even if these scans show no obvious structural damage, a patient鈥檚 symptoms may still persist.

Dr Emmanuel Stamatakis from the Department of Clinical Neurosciences and Division of Anaesthesia at the 探花直播 of Cambridge said: 鈥淲orldwide, we鈥檙e seeing an increase in the number of cases of mild traumatic brain injury, particularly from falls in our ageing population and rising numbers of road traffic collisions in low- and middle-income countries.

鈥淎t present, we have no clear way of working out which of these patients will have a speedy recovery and which will take longer, and the combination of over-optimistic and imprecise prognoses means that some patients risk not receiving adequate care for their symptoms.鈥�

Dr Stamatakis and colleagues studied fMRI brain scans 鈥� that is, functional MRI scans, which look at how different areas of the brain coordinate with each other 鈥� taken from 108 patients with mild traumatic brain injury and compared them with scans from 76 healthy volunteers. Patients were also assessed for ongoing symptoms.

探花直播patients and volunteers had been recruited to CENTER-TBI, a large European research project which aims to improve the care for patients with traumatic brain injury, co-chaired by Professor David Menon (head of the division of Anaesthesia) and funded by the European Union.

In results published today in Brain, the team found that just under half (45%) were still showing symptoms resulting from their brain injury, with the most common being fatigue, poor concentration and headaches.

探花直播researchers found that these patients had abnormalities in a region of the brain known as the thalamus, which integrates all sensory information and relays this information around the brain. Counter-intuitively, concussion was associated with increased connectivity between the thalamus and the rest of the brain 鈥� in other words, the thalamus was trying to communicate more as a result of the injury 鈥� and the greater this connectivity, the poorer the prognosis for the patient.

Rebecca Woodrow, a PhD student in the Department of Clinical Neuroscience and Hughes Hall, Cambridge, said: 鈥淒espite there being no obvious structural damage to the brain in routine scans, we saw clear evidence that the thalamus 鈥� the brain鈥檚 relay system 鈥� was hyperconnected. We might interpret this as the thalamus trying to over-compensate for any anticipated damage, and this appears to be at the root of some of the long-lasting symptoms that patients experience.鈥�

By studying additional data from positron emission tomography聽(PET) scans, which can measure regional chemical composition of body tissues, the researchers were able to make associations with key neurotransmitters depending on which long-term symptoms a patient displayed. For example, patients experiencing cognitive problems such as memory difficulties showed increased connectivity between the thalamus and areas of the brain rich in the neurotransmitter noradrenaline; patients experiencing emotional symptoms, such as depression or irritability, showed greater connectivity with areas of the brain rich in serotonin.

Dr Stamatakis, who is also Stephen Erskine Fellow at Queens' College, Cambridge, added: 鈥淲e know that there already drugs that target these brain chemicals so our findings offer hope that in future, not only might we be able to predict a patient鈥檚 prognosis, but we may also be able to offer a treatment targeting their particular symptoms.鈥�

Reference
Woodrow, RE et al. Acute thalamic connectivity precedes chronic postconcussive symptoms in mild traumatic brain injury. Brain; 26 April 2023; DOI: 10.1093/brain/awad056

Even mild concussion can cause long-lasting effects to the brain, according to researchers at the 探花直播 of Cambridge. Using data from a Europe-wide study, the team has shown that for almost a half of all people who receive a knock to the head, there are changes in how regions of the brain communicate with each other, potentially causing long term symptoms such as fatigue and cognitive impairment.

探花直播combination of over-optimistic and imprecise prognoses means that some patients risk not receiving adequate care for their symptoms

Emmanuel Stamatakis

AleksandarGeorgiev (Getty Images)

Female Still In Shock After Getting Hit By Car With Motorcycle

探花直播text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright 漏探花直播 of Cambridge and licensors/contributors as identified.聽 All rights reserved. We make our image and video content available in a number of ways 鈥� as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Traumatic brain injury 鈥榬emains a major global health problem鈥� say experts

Anonymous — Fri, 30 Sep 2022 00:14:20 +0000

探花直播report 鈥� the 2022 Lancet Neurology Commission 鈥� has been produced by world-leading experts, including co-lead author Professor David Menon from the Division of Anaesthesia at the 探花直播 of Cambridge.

探花直播Commission documents traumatic brain injury (TBI) as a global public-health problem, which afflicts 55 million people worldwide, costs over US$400 billion (拢350 billion) per year, and is a leading cause of injury-related death and disability.

TBI is not only an acute condition but also a chronic disease with long-term consequences, including an increased risk of late-onset neurodegeneration, such as Parkinson鈥檚 disease and dementia. Road traffic incidents and falls are the main causes, but while in low- and middle-income countries, road traffic accidents account for almost three times the number of TBIs as falls, in high-income countries falls cause twice the number of TBIs compared to road traffic accidents. These data have clear consequences for prevention.

Over 90% of TBIs are categorized as 鈥榤ild鈥�, but over half of such patients do not fully recover by six months after injury. Improving outcome in these patients would be a huge public health benefit. A multidimensional approach to outcome assessment is advocated, including a focus on mental health and post-traumatic stress disorder. Outcome after TBI is poorer in females compared with males, but reasons for this are not clear.

Professor Menon said: 鈥淭raumatic brain injury remains a major global health problem, with substantial impact on patients, families and society.聽 Over the last decade, large international collaborations have provided important information to improve understanding and care of TBI.聽 However, significant problems remain, especially in low and middle income countries.聽 Continued collaborative efforts are needed to continue to improve patient outcomes and reduce the societal impact of TBI.鈥�

探花直播Commission identified substantial disparities in care, including lower treatment intensity for patients injured by low-energy mechanisms, deficiencies in access to rehabilitation and insufficient follow-up in patients with 鈥榤ild鈥� TBI. In low- and middle-income countries, both pre-hospital and post-acute care are largely deficient.

探花直播Commission presents substantial advances in diagnostics and treatment approaches. Blood-based biomarkers perform as well 鈥� or perhaps even better 鈥� than clinical decision rules for selecting patients with mild TBI for CT scanning, and can thus help reduce unnecessary radiation risks. They also have prognostic value for outcome. Genomic analyses suggests that 26% of outcome variance in TBI might be heritable, emphasizing the relevance of host response, which is modifiable. Advanced monitoring of the brain in patients with severe injuries in the intensive care setting provides better insight into derangements of brain function and metabolism, providing a basis for individualizing management to the needs of a patient. These advances have, however, not yet led to improved outcome. Mortality in patients with moderate to severe injuries appears to have decreased, but a greater number of survivors may have substantial disability.

Emeritus Professor Andrew Maas from the Antwerp 探花直播 Hospital and 探花直播 of Antwerp, Belgium, said: 鈥淚mproving care pathways and removing current disparities in care for patients with TBI will require close collaboration between policymakers, clinicians and researchers, with input from patients and patient representatives.鈥�

Professor Geoffrey Manley from the 探花直播 of California, San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center, USA, said: 鈥淭his Commission represents true team science, involving over 300 authors and contributors from around the globe working closely with the team at Lancet Neurology. Much of the data reported come from large-scale collaborative studies, illustrating the strength of longer-term observational research. There can be no doubt that multidisciplinary international collaboration is the way forward鈥�.

Reference
Lancet Neurology Commission. Lancet Neurology; 30 Sept 2022; DOI: 10.1016/S1474-4422(22)00309-X

Adapted from a press release from SMC Media.

A new report highlights the advances and challenges in prevention, clinical care, and research in traumatic brain injury, a leading cause of injury-related death and disability worldwide.

Over the last decade, large international collaborations have provided important information to improve understanding and care of TBI. However, significant problems remain, especially in low and middle income countries

David Menon

Tashi-Delek (Getty Images)

Firefighters At A Car Accident Scene

探花直播text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright 漏探花直播 of Cambridge and licensors/contributors as identified.聽 All rights reserved. We make our image and video content available in a number of ways 鈥� as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Cognitive impairment from severe COVID-19 equivalent to 20 years of ageing, study finds

cjb250 — Tue, 03 May 2022 07:00:18 +0000

探花直播findings, published in the journal eClinicalMedicine, emerge from the NIHR COVID-19 BioResource. 探花直播results of the study suggest the effects are still detectable more than six months after the acute illness, and that any recovery is at best gradual.

There is growing evidence that COVID-19 can cause lasting cognitive and mental health problems, with recovered patients reporting symptoms including fatigue, 鈥榖rain fog鈥�, problems recalling words, sleep disturbances, anxiety and even post-traumatic stress disorder (PTSD) months after infection. In the UK, a study found that around one in seven individuals surveyed reported having symptoms that included cognitive difficulties 12 weeks after a positive COVID-19 test.

While even mild cases can lead to persistent cognitive symptoms, between a third and three-quarters of hospitalised patients report still suffering cognitive symptoms three to six months later.

To explore this link in greater detail, researchers analysed data from 46 individuals who received in-hospital care, on the ward or intensive care unit, for COVID-19 at Addenbrooke鈥檚 Hospital, part of Cambridge 探花直播 Hospitals NHS Foundation Trust. 16 patients were put on mechanical ventilation during their stay in hospital. All the patients were admitted between March and July 2020 and were recruited to the NIHR COVID-19 BioResource.

探花直播individuals underwent detailed computerised cognitive tests an average of six months after their acute illness using the Cognitron platform, which measures different aspects of mental faculties such as memory, attention and reasoning. Scales measuring anxiety, depression and post-traumatic stress disorder were also assessed. Their data were compared against matched controls.

This is the first time that such rigorous assessment and comparison has been carried out in relation to the after effects of severe COVID-19.

COVID-19 survivors were less accurate and with slower response times than the matched control population 鈥� and these deficits were still detectable when the patients were following up six months later. 探花直播effects were strongest for those who required mechanical ventilation. By comparing the patients to 66,008 members of the general public, the researchers estimate that the magnitude of cognitive loss is similar on average to that sustained with 20 years ageing, between 50 and 70 years of age, and that this is equivalent to losing 10 IQ points.

Survivors scored particularly poorly on tasks such as verbal analogical reasoning, a finding that supports the commonly-reported problem of difficulty finding words. They also showed slower processing speeds, which aligns with previous observations post COVID-19 of decreased brain glucose consumption within the frontoparietal network of the brain, responsible for attention, complex problem-solving and working memory, among other functions.

Professor David Menon from the Division of Anaesthesia at the 探花直播 of Cambridge, the study鈥檚 senior author, said: 鈥淐ognitive impairment is common to a wide range of neurological disorders, including dementia, and even routine ageing, but the patterns we saw 鈥� the cognitive 'fingerprint' of COVID-19 鈥� was distinct from all of these.鈥�

While it is now well established that people who have recovered from severe COVID-19 illness can have a broad spectrum of symptoms of poor mental health 鈥� depression, anxiety, post-traumatic stress, low motivation, fatigue, low mood, and disturbed sleep 鈥� the team found that acute illness severity was better at predicting the cognitive deficits.

探花直播patients鈥� scores and reaction times began to improve over time, but the researchers say that any recovery in cognitive faculties was at best gradual and likely to be influenced by a number of factors including illness severity and its neurological or psychological impacts.

Professor Menon added: 鈥淲e followed some patients up as late as ten months after their acute infection, so were able to see a very slow improvement. While this was not statistically significant, it is at least heading in the right direction, but it is very possible that some of these individuals will never fully recover.鈥�

There are several factors that could cause the cognitive deficits, say the researchers.聽Direct viral infection is possible, but unlikely to be a major cause; instead, it is more likely that a combination of factors contribute, including inadequate oxygen or blood supply to the brain, blockage of large or small blood vessels due to clotting, and microscopic bleeds. However, emerging evidence suggests that the most important mechanism may be damage caused by the body鈥檚 own inflammatory response and immune system.

While this study looked at hospitalised cases, the team say that even those patients not sick enough to be admitted may also have tell-tale signs of mild impairment.

Professor Adam Hampshire from the Department of Brain Sciences at Imperial College London, the study鈥檚 first author, said: 鈥淎round 40,000 people have been through intensive care with COVID-19 in England alone and many more will have been very sick, but not admitted to hospital. This means there is a large number of people out there still experiencing problems with cognition many months later. We urgently need to look at what can be done to help these people.鈥�

Professor Menon and Professor Ed Bullmore from Cambridge鈥檚 Department of Psychiatry are co-leading working groups as part of the COVID-19 Clinical Neuroscience Study (COVID-CNS) that aim to identify biomarkers that relate to neurological impairments as a result of COVID-19, and the neuroimaging changes that are associated with these.

探花直播research was funded by the NIHR BioResource, NIHR Cambridge Biomedical Research Centre and the Addenbrooke鈥檚 Charitable Trust, with support from聽the NIHR Cambridge Clinical Research Facility.

Reference
Hampshire, A et al. Multivariate profile and acute-phase correlates of cognitive deficits in a COVID-19 hospitalised cohort. eClinicalMedicine; 28 Apr 2022; DOI: 10.1016/j.eclinm.2022.101417

Cognitive impairment as a result of severe COVID-19 is similar to that sustained between 50 and 70 years of age and is the equivalent to losing 10 IQ points, say a team of scientists from the 探花直播 of Cambridge and Imperial College London.

Cognitive impairment is common to a wide range of neurological disorders, but the patterns we saw 鈥� the cognitive 'fingerprint' of COVID-19 鈥� was distinct from all of these

David Menon

RUBEN BONILLA GONZALO

Senior woman wearing face mask lying on hospital bed

Yes

AI successfully used to identify different types of brain injuries

sc604 — Thu, 14 May 2020 23:42:42 +0000

探花直播researchers, from the 探花直播 of Cambridge and Imperial College London, have clinically validated and tested the AI on large sets of CT scans and found that it was successfully able to detect, segment, quantify and differentiate different types of brain lesions.

Their results, reported in 探花直播Lancet Digital Health, could be useful in large-scale research studies, for developing more personalised treatments for head injuries and, with further validation, could be useful in certain clinical scenarios, such as those where radiological expertise is at a premium.

Head injury is a huge public health burden around the world and affects up to 60 million people each year. It is the leading cause of mortality in young adults. When a patient has had a head injury, they are usually sent for a CT scan to check for blood in or around the brain, and to help determine whether surgery is required.

鈥淐T is an incredibly important diagnostic tool, but it鈥檚 rarely used quantitatively,鈥� said co-senior author Professor David Menon, from Cambridge鈥檚 Department of Medicine. 鈥淥ften, much of the rich information available in a CT scan is missed, and as researchers, we know that the type, volume and location of a lesion on the brain are important to patient outcomes.鈥�

Different types of blood in or around the brain can lead to different patient outcomes, and radiologists will often make estimates in order to determine the best course of treatment.

鈥淒etailed assessment of a CT scan with annotations can take hours, especially in patients with more severe injuries,鈥� said co-first author Dr Virginia Newcombe, also from Cambridge鈥檚 Department of Medicine. 鈥淲e wanted to design and develop a tool that could automatically identify and quantify the different types of brain lesions so that we could use it in research and explore its possible use in a hospital setting.鈥�

探花直播researchers developed a machine learning tool based on an artificial neural network. They trained the tool on more than 600 different CT scans, showing brain lesions of different sizes and types. They then validated the tool on an existing large dataset of CT scans.

探花直播AI was able to classify individual parts of each image and tell whether it was normal or not. This could be useful for future studies in how head injuries progress, since the AI may be more consistent than a human at detecting subtle changes over time.

鈥淭his tool will allow us to answer research questions we couldn鈥檛 answer before,鈥� said Newcombe. 鈥淲e want to use it on large datasets to understand how much imaging can tell us about the prognosis of patients.鈥�

鈥淲e hope it will help us identify which lesions get larger and progress, and understand why they progress so that we can develop more personalised treatment for patients in future,鈥� said Menon.

While the researchers are currently planning to use the AI for research only, they say with proper validation, it could also be used in certain clinical scenarios, such as in resource-limited areas where there are few radiologists.

In addition, the researchers say that it could have a potential use in emergency rooms, helping get patients home sooner. Of all the patients who have a head injury, only between 10 and 15% have a lesion that can be seen on a CT scan. 探花直播AI could help identify these patients who need further treatment, so those without a brain lesion can be sent home, although any clinical use of the tool would need to be thoroughly validated.

探花直播ability to analyse large datasets automatically will also enable the researchers to solve important clinical research questions that have previously been difficult to answer, including the determination of relevant features for prognosis which in turn may help target therapies.

探花直播research was supported in part by the European Union, the European Research Council, the Engineering and Physical Sciences Research Council, Academy of Medical Sciences/ 探花直播Health Foundation, and the National Institute for Health Research.

Reference:
Miguel Monteiro et al. 鈥�Multi-class semantic segmentation and quantification of traumatic brain injury lesions on head CT using deep learning: an algorithm development and multicentre validation study.鈥� 探花直播Lancet Digital Health (2020). DOI: 10.1016/S2589-7500(20)30085-6

Researchers have developed an AI algorithm that can detect and identify different types of brain injuries.

This tool will allow us to answer research questions we couldn鈥檛 answer before

Virginia Newcombe

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Intensive care units in England could run out of beds within two weeks, study finds

cjb250 — Tue, 24 Mar 2020 13:32:31 +0000

Since emerging in November 2019, there have been over 267,000 confirmed cases of COVID-19 coronavirus and over 11,200 deaths (WHO figures 22 March). While COVID-19 generally causes mild symptoms, some patients may develop severe lung inflammation. This may be severe enough to require intensive care for advanced, invasive mechanical ventilation (鈥榣ife support鈥�).

Mechanical ventilation is a specialised procedure that can only be provided on an intensive care unit. 探花直播number of intensive care beds is limited and the equipment and specialist staffing required makes it difficult to create more ICU beds easily/quickly. In Northern Italy, which has been particularly severely affected, the large volumes of patients has overwhelmed ICU capacity.

鈥淚f mechanical ventilation cannot be provided to patients who need it, they will die,鈥� says Dr Ari Ercole from the Division of Anaesthesia at the 探花直播 of Cambridge. 鈥淚CU capacity is a crucial concern as additional capacity takes time to create both in terms of staffing and equipment.鈥�

Dr Ercole and colleagues from Cambridge鈥檚 Division of Anaesthesia and Department of Computer Science and Technology have built a real-time computer model to try and make the earliest possible predictions of ICU demand in England. Their aim is to give an early warning of when or whether capacity will become critical and give as much advanced notice as possible to help build capacity.

Because of the urgent implications of the model鈥檚 results, the team has made its study available online early. 探花直播research has not been peer-reviewed. All source code has been made freely-available online.

探花直播team used COVID-19 diagnoses from England as reported by Public Health England and matched to NHS commissioning regions as its source data to obtain information on daily cases. They have assumed that the daily incidence of COVID-19 can be modelled as an exponential growth, in line with what has been observed in Italy. 聽探花直播most up-to-date information suggests the median length of time spent in an ICU is eight days.

探花直播Cambridge model predicts that ICU demand in England could rise to levels which are impossible to supply with the current beds available very quickly 鈥� as early as within two weeks in some regions and with London at particular risk.

鈥淚f our assumptions are correct, ICU capacity may be complete overwhelmed very quickly in England,鈥� added Dr Ercole, who is also a Fellow in Clinical Medicine at Magdalene College. 鈥淎 large increase in ICU capacity is required extremely urgently if we are to be able to treat patients with life-threatening COVID-19 in the near future.鈥�

探花直播model makes a number of assumptions about the outbreak which may limit its accuracy, but is based on the best available data at the earliest time.

探花直播team used data published by Public Health England. While the researchers acknowledge this data does not recognise all cases within the wider population, it is likely to include the vast majority of severe cases, on which the models specifically focus. Changes over time in World Health Organization case definitions and in surveillance strategies may also overestimate ICU admission rates as milder cases were not identified initially and would artificially inflate the forecast numbers.

They have forecast the percentage of聽COVID-19 bed requirements in isolation. In reality, all ICUs will need to continue to provide 鈥榖usiness as usual鈥� care for other types of patients. Since UK bed occupancy is typically greater than 80% and may frequently exceed 100%, the researchers say it is clearly not the case that all open beds can simply be re-allocated for COVID-19 patients.

They have also assumed that all adult critical care beds can be used for level 3 or mechanically ventilated ICU patients, which may not be possible; some specialist ICUs may not be able to reconfigure at all.

Listen to Dr Ercole on the Naked Scientists podcast.

Reference
Deasy, J et al. Forecasting Ultra-early Intensive Care Strain from COVID-19 in England.聽DOI:聽10.1101/2020.03.19.20039057

How you can support Cambridge's COVID-19 research effort

Donate to support COVID-19 research at Cambridge

Intensive care unit (ICU) occupancy is likely to increase dramatically over the next few weeks, suggests research published by a team at the 探花直播 of Cambridge. Their work suggests that if the current exponential growth of COVID-19 infections continues, then within two weeks, five out of seven commissioning regions in England will have more critically ill COVID-19 patients than can be accommodated with ICU beds normally available.聽

ICU capacity is a crucial concern as additional capacity takes time to create both in terms of staffing and equipment

Ari Ercole

Calleamanecer (WikiCommons)

Clinicians in Intensive Care Unit

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Cambridge expert jointly leads international push to reduce global burden of traumatic brain injury

cjb250 — Tue, 07 Nov 2017 00:53:24 +0000

探花直播Commission has been co-led by Professor David Menon from the Division of Anaesthesia at the 探花直播 of Cambridge together with Professor Andrew Maas from Antwerp 探花直播 Hospital and 探花直播 of Antwerp, Belgium.

探花直播Commission is being launched today at the European Parliament and targets policy makers, funders, and patient organisations, as well as health-care professionals. It combines the expertise of over 300 international clinicians and researchers, many of whom are part of the International Initiative for Traumatic Brain Injury Research (InTBIR). 探花直播authors set out clinical and research priorities with 12 key messages and recommendations to reduce the global burden of TBI.

探花直播enormous and rising health and socioeconomic burden posed by TBI demands urgent action from health-care professionals and policy makers. About half the world鈥檚 population will suffer a TBI over their lifetime. TBI is estimated to affect 50 million people every year. It is the leading cause of mortality in young adults and a major cause of disability across all ages. It also substantially increases the risk of late-life dementia.

探花直播care and consequences of TBI cost the global economy US$400 billion annually. Given an estimated gross world product of about $74 trillion, this means that about $1 in every $200 of annual global output is spent on the costs or consequences of TBI.

鈥淭raumatic brain injury affects huge numbers of people worldwide, with potentially serious consequences for their health and wellbeing and a major economic burden on already stretched health services,鈥� says Professor Menon. 鈥淲e are not doing enough to prevent and manage such injuries, which is why we calling on policymakers, funders and healthcare professionals to take action.鈥�

Increasing industrialisation and motor vehicle use are causing increases in TBI due to traffic incidents in low-income and middle-income countries, which disproportionately affect the young. In high-income countries, incidence of TBI is highest and increasing in the elderly due to falls. Expectations of unfavourable outcomes in the elderly can lead to treatments being withheld or prematurely withdrawn, with resulting poorer outcomes reinforcing therapeutic nihilism in the management of these patients. However, with appropriate care good results can be obtained.

More recently, substantial interest has focused on the health impact of sports-related concussion and its long-term effects. It is now recognised that repetitive injuries carry increased risks and that TBI should not be seen as an event, but as a process, often with lifelong consequences.

探花直播Commission reports that understanding of TBI and care of patients is hampered by inconsistent epidemiological data, poor integration of systems of care, and substantial disparities in access to care. Furthermore, current medical management is inappropriately based on a one-size-fits-all approach. Inadequate attention to the condition鈥檚 heterogeneity at presentation and outcome might also be a substantial contributor to the failure of clinical trials of promising new therapies. Crucially, even when additional evidence is generated to improve management, the integration of such evidence into clinical guidelines and routine clinical care is slow. Most importantly, many cases of TBI are preventable, but well recognised measures to prevent the disease are not universally mandated in law or they are poorly implemented in practice.

探花直播authors set out priorities and recommendations to address the varied challenges in understanding, prevention, and care of TBI, and seek to identify strategies to better characterise TBI, increase prognostic accuracy, and match treatments to patients鈥攁 precision-medicine approach.

探花直播Commission also promotes use of new tools for clinical evidence generation and implementation, so that research outputs are more generalisable and can be more rapidly integrated into clinical care. Moreover, it highlights the importance of international collaboration of funding agencies and researchers to provide a global response to reduce the individual and societal burden of TBI.

Substantial reductions in the global burden of traumatic brain injury (TBI) could be achieved with improved policies for prevention, new directions for clinical care, and novel approaches to research, according to 探花直播Lancet Neurology Commission on TBI.

Traumatic brain injury affects huge numbers of people worldwide, with potentially serious consequences for their health and wellbeing and a major economic burden on already stretched health services

David Menon

Ross Goodman

Car crash rescue 3

探花直播text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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