̽��ֱ�� of Cambridge - David Menon

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’s Research UK are jointly funding this initiative to establish a UK-wide research platform, TBI-REPORTER, which will be led by the ̽��ֱ�� 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.

̽��ֱ��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.

̽��ֱ��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: “As 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 ‘hidden disability’.”

Project lead Professor David Menon, Head of the Division of Anaesthesia at the ̽��ֱ�� of Cambridge, said: “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. 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.”

Secretary of State for Science, Innovation and Technology Chloe Smith said: “Traumatic 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.

“This 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’s science sector is improving treatment and health outcomes for Britons across the country.”

Professor John Iredale, Executive Chair of the MRC, part of UKRI, added: “We 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’s 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.”

Dr Susan Kohlhaas, Director of Research at Alzheimer’s Research UK, said: “Over 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’s Research UK, we believe it is only by bringing people from different backgrounds together through collaborative approaches that we’ll begin to solve the major challenges in treatment and diagnosis of TBIs. ̽��ֱ��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.”

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 ̽��ֱ��. 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 £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

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Bicycle accident

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Traumatic brain injury ‘remains a major global health problem’ say experts

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

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

̽��ֱ��Commission documents traumatic brain injury (TBI) as a global public-health problem, which afflicts 55 million people worldwide, costs over US$400 billion (£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’s 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 ‘mild’, 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: “Traumatic brain injury remains a major global health problem, with substantial impact on patients, families and society. 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. Continued collaborative efforts are needed to continue to improve patient outcomes and reduce the societal impact of TBI.”

̽��ֱ��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 ‘mild’ TBI. In low- and middle-income countries, both pre-hospital and post-acute care are largely deficient.

̽��ֱ��Commission presents substantial advances in diagnostics and treatment approaches. Blood-based biomarkers perform as well – or perhaps even better – 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 ̽��ֱ�� Hospital and ̽��ֱ�� of Antwerp, Belgium, said: “Improving 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.”

Professor Geoffrey Manley from the ̽��ֱ�� of California, San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center, USA, said: “This 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”.

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

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – 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.

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

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

̽��ֱ��findings, published in the journal eClinicalMedicine, emerge from the NIHR COVID-19 BioResource. ̽��ֱ��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, ‘brain fog’, 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’s Hospital, part of Cambridge ̽��ֱ�� 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.

̽��ֱ��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 – and these deficits were still detectable when the patients were following up six months later. ̽��ֱ��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 ̽��ֱ�� of Cambridge, the study’s senior author, said: “Cognitive impairment is common to a wide range of neurological disorders, including dementia, and even routine ageing, but the patterns we saw – the cognitive 'fingerprint' of COVID-19 – was distinct from all of these.”

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 – depression, anxiety, post-traumatic stress, low motivation, fatigue, low mood, and disturbed sleep – the team found that acute illness severity was better at predicting the cognitive deficits.

̽��ֱ��patients’ 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: “We 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.”

There are several factors that could cause the cognitive deficits, say the researchers. 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’s 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’s first author, said: “Around 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.”

Professor Menon and Professor Ed Bullmore from Cambridge’s 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.

̽��ֱ��research was funded by the NIHR BioResource, NIHR Cambridge Biomedical Research Centre and the Addenbrooke’s Charitable Trust, with support from 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 ̽��ֱ�� of Cambridge and Imperial College London.

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

David Menon

RUBEN BONILLA GONZALO

Senior woman wearing face mask lying on hospital bed

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When Symptoms Don't Stop

jg533 — Fri, 22 Jan 2021 08:13:29 +0000

Treating those most severely affected by COVID-19 has necessarily taken priority during the pandemic. But could long COVID be the next wave of the crisis?

Nature’s epidural: Genetic variant may explain why some women don’t need pain relief during childbirth

cjb250 — Tue, 21 Jul 2020 15:00:21 +0000

Childbirth is widely recognised as a painful experience. However, every woman’s experience of labour and birth is unique, and the level of discomfort and pain experienced during labour varies substantially between women.

A collaboration between clinicians and scientists based at Addenbrooke’s Hospital, part of Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust (CUH), and the ̽��ֱ�� of Cambridge sought to investigate why some mothers report less pain during labour.

A group of women was recruited and characterised by the team led by Dr Michael Lee from the ̽��ֱ��’s Division of Anaesthesia. All the women had carried their first-born to full term and did not request any pain relief during an uncomplicated vaginal delivery. Dr Lee and colleagues carried out a number of tests on the women, including applying heat and pressure to their arms and getting them to plunge their hands into icy water.

Compared to a control group of women that experienced similar births, but were given pain relief, the test group showed higher pain thresholds for heat, cold and mechanical pressure, consistent with them not requesting pain relief during childbirth. ̽��ֱ��researchers found no differences in the emotional and cognitive abilities of either group, suggesting an intrinsic difference in their ability to detect pain.

“It is unusual for women to not request gas and air, or epidural for pain relief during labour, particularly when delivering for the first time,” said Dr Lee, joint first author. “When we tested these women, it was clear their pain threshold was generally much higher than it was for other women.”

Next, senior co-author, Professor Geoff Woods, and his colleagues at the Cambridge Institute for Medical Research sequenced the genetic code of both groups of women and found that those in the test group had a higher-than-expected prevalence of a rare variant of the gene KCNG4. It’s estimated that one approximately 1 in 100 women carry this variant.

KCNG4 provides the code for the production of a protein that forms part of a ‘gate’, controlling the electric signal that flows along our nerve cells. As the joint first author Dr Van Lu showed, sensitivity of this gatekeeper to electric signals that had the ability to open the gate and turn nerves on was reduced by the rare variant.

This was confirmed in a study involving mice led by Dr Ewan St. John Smith from the Department of Pharmacology, who showed that the threshold at which the ‘defective’ gates open, and hence the nerve cell switches ‘on’, is higher – which may explain why women with this rare gene variant experience less pain during childbirth.

Dr St. John Smith, senior co-author, explained: “ ̽��ֱ��genetic variant that we found in women who feel less pain during childbirth leads to a ‘defect’ in the formation of the switch on the nerve cells. In fact, this defect acts like a natural epidural. It means it takes a much greater signal – in other words, stronger contractions during labour – to switch it on. This makes it less likely that pain signals can reach the brain.”

“Not only have we identified a genetic variant in a new player underlying different pain sensitivities,” added senior co-author Professor Frank Reimann, “but we hope this can open avenues to the development of new drugs to manage pain.”

“This approach of studying individuals who show unexpected extremes of pain experience also may find wider application in other contexts, helping us understand how we experience pain and develop new drugs to treat it,” said Professor David Menon, senior co-author.

̽��ֱ��research was support by the Addenbrooke’s Charitable Trust, the National Institute for Health Research Cambridge Biomedical Research Centre, Wellcome, Rosetrees Trust and the BBSRC.

Reference
Lee, M.C. et al (2020). Human labour pain is influenced by the voltage-gated potassium channel Kv6.4 subunit. Cell Reports; 21 July 2020; DOI: 10.1016/j.celrep.2020.107941

Women who do not need pain relief during childbirth may be carriers of a key genetic variant that acts a natural epidural, say scientists at the ̽��ֱ�� of Cambridge. In a study published today in the journal Cell Reports, the researchers explain how the variant limits the ability of nerve cells to send pain signals to the brain.

This [variant] acts like a natural epidural. It means it takes a much greater signal – in other words, stronger contractions during labour – to switch it on. This makes it less likely that pain signals can reach the brain

Ewan St. John Smith

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Mother and newborn baby

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AI successfully used to identify different types of brain injuries

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

̽��ֱ��researchers, from the ̽��ֱ�� 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 ̽��ֱ��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.

“CT is an incredibly important diagnostic tool, but it’s rarely used quantitatively,” said co-senior author Professor David Menon, from Cambridge’s Department of Medicine. “Often, 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.”

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.

“Detailed assessment of a CT scan with annotations can take hours, especially in patients with more severe injuries,” said co-first author Dr Virginia Newcombe, also from Cambridge’s Department of Medicine. “We 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.”

̽��ֱ��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.

̽��ֱ��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.

“This tool will allow us to answer research questions we couldn’t answer before,” said Newcombe. “We want to use it on large datasets to understand how much imaging can tell us about the prognosis of patients.”

“We 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,” 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. ̽��ֱ��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.

̽��ֱ��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.

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

Reference:
Miguel Monteiro et al. ‘Multi-class semantic segmentation and quantification of traumatic brain injury lesions on head CT using deep learning: an algorithm development and multicentre validation study.’ ̽��ֱ��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’t answer before

Virginia Newcombe

Yes

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

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

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

̽��ֱ��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). ̽��ֱ��authors set out clinical and research priorities with 12 key messages and recommendations to reduce the global burden of TBI.

̽��ֱ��enormous and rising health and socioeconomic burden posed by TBI demands urgent action from health-care professionals and policy makers. About half the world’s 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.

̽��ֱ��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.

“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,” says Professor Menon. “We are not doing enough to prevent and manage such injuries, which is why we calling on policymakers, funders and healthcare professionals to take action.”

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.

̽��ֱ��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’s 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.

̽��ֱ��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—a precision-medicine approach.

̽��ֱ��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 ̽��ֱ��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

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Running on autopilot: scientists find important new role for ‘daydreaming’ network

cjb250 — Mon, 23 Oct 2017 19:00:43 +0000

When we are performing tasks, specific regions of the brain become more active – for example, if we are moving, the motor cortex is engaged, while if we are looking at a picture, the visual cortex will be active. But what happens when we are apparently doing nothing?

In 2001, scientists at the Washington ̽��ֱ�� School of Medicine found that a collection of brain regions appeared to be more active during such states of rest. This network was named the ‘default mode network’ (DMN). While it has since been linked to, among other things, daydreaming, thinking about the past, planning for the future, and creativity, its precise function is unclear.

Abnormal activity in the DMN has been linked to an array of disorders including Alzheimer’s disease, schizophrenia, attention-deficit/hyperactivity disorder (ADHD) and disorders of consciousness. However, scientists have been unable to show a definitive role in human cognition.

Now, in research published today in the Proceedings of National Academy of Sciences, scientists at the ̽��ֱ�� of Cambridge have shown that the DMN plays an important role in allowing us to switch to ‘autopilot’ once we are familiar with a task.

In the study, 28 volunteers took part in a task while lying inside a magnetic resonance imaging (MRI) scanner. Functional MRI (fMRI) measures changes in brain oxygen levels as a proxy for neural activity.

In the task, participants were shown four cards and asked to match a target card (for example, two red diamonds) to one of these cards. There were three possible rules – matching by colour, shape or number. Volunteers were not told the rule, but rather had to work it out for themselves through trial and error.

̽��ֱ��most interesting differences in brain activity occurred when comparing the two stages of the task – acquisition (where the participants were learning the rules by trial and error) and application (where the participants had learned the rule and were now applying it). During the acquisition stage, the dorsal attention network, which has been associated with the processing of attention-demanding information, was more active. However, in the application stage, where participants utilised learned rules from memory, the DMN was more active.

Crucially, during the application stage, the stronger the relationship between activity in the DMN and in regions of the brain associated with memory, such as the hippocampus, the faster and more accurately the volunteer was able to perform the task. This suggested that during the application stage, the participants could efficiently respond to the task using the rule from memory.

“Rather than waiting passively for things to happen to us, we are constantly trying to predict the environment around us,” says Dr Deniz Vatansever, who carried out the study as part of his PhD at the ̽��ֱ�� of Cambridge and who is now based at the ̽��ֱ�� of York.

“Our evidence suggests it is the default mode network that enables us do this. It is essentially like an autopilot that helps us make fast decisions when we know what the rules of the environment are. So for example, when you’re driving to work in the morning along a familiar route, the default mode network will be active, enabling us to perform our task without having to invest lots of time and energy into every decision.”

“ ̽��ֱ��old way of interpreting what’s happening in these tasks was that because we know the rules, we can daydream about what we’re going to have for dinner later and the DMN kicks in,” adds senior author Dr Emmanuel Stamatakis from the Division of Anaesthesia at the ̽��ֱ�� Of Cambridge. “In fact, we showed that the DMN is not a bystander in these tasks: it plays an integral role in helping us perform them.”

This new study supports an idea expounded upon by Daniel Kahneman, Nobel Memorial Prize in Economics laureate 2002, in his book Thinking, Fast and Slow, that there are two systems that help us make decisions: a rational system that helps us reach calculated decisions, and a fast system that allows us to make intuitive decisions – the new research suggests this latter system may be linked with the DMN.

̽��ֱ��researchers believe their findings have relevance to brain injury, particularly following traumatic brain injury, where problems with memory and impulsivity can substantially compromise social reintegration. They say the findings may also have relevance for mental health disorders, such as addiction, depression and obsessive compulsive disorder, where particular thought patterns drive repeated behaviours, and the mechanisms of anaesthetic agents and other drugs on the brain.

This research was carried out in the general context of understanding conscious processing in the human brain. ̽��ֱ��Division of Anaesthesia, headed by Professor David Menon, NIHR Senior Investigator, has a programme of research aiming to further elucidate the neural basis of consciousness and cognition in health and disease.

̽��ֱ��research was supported by the Yousef Jameel Academic Program, ̽��ֱ��Stephen Erskine Fellowship from Queens’ College Cambridge, and the NIHR Cambridge Biomedical Resource Centre.

Reference
Vatansever, D, Menon, DK, Stamatakis, EA. Default Mode Contributions to Automated Information Processing. PNAS; 23 Oct 2017; DOI: 10.1073/pnas.1710521114

A brain network previously associated with daydreaming has been found to play an important role in allowing us to perform tasks on autopilot. Scientists at the ̽��ֱ�� of Cambridge showed that far from being just ‘background activity’, the so-called ‘default mode network’ may be essential to helping us perform routine tasks.

̽��ֱ��default mode network is essentially like an autopilot that helps us make fast decisions when we know what the rules of the environment are

Deniz Vatansever

Erik Starck

Driving a car

̽��ֱ��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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