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1.  Human cognitive ability is influenced by genetic variation in components of postsynaptic signalling complexes assembled by NMDA receptors and MAGUK proteins 
Translational Psychiatry  2014;4(1):e341-.
Differences in general cognitive ability (intelligence) account for approximately half of the variation in any large battery of cognitive tests and are predictive of important life events including health. Genome-wide analyses of common single-nucleotide polymorphisms indicate that they jointly tag between a quarter and a half of the variance in intelligence. However, no single polymorphism has been reliably associated with variation in intelligence. It remains possible that these many small effects might be aggregated in networks of functionally linked genes. Here, we tested a network of 1461 genes in the postsynaptic density and associated complexes for an enriched association with intelligence. These were ascertained in 3511 individuals (the Cognitive Ageing Genetics in England and Scotland (CAGES) consortium) phenotyped for general cognitive ability, fluid cognitive ability, crystallised cognitive ability, memory and speed of processing. By analysing the results of a genome wide association study (GWAS) using Gene Set Enrichment Analysis, a significant enrichment was found for fluid cognitive ability for the proteins found in the complexes of N-methyl-D-aspartate receptor complex; P=0.002. Replication was sought in two additional cohorts (N=670 and 2062). A meta-analytic P-value of 0.003 was found when these were combined with the CAGES consortium. The results suggest that genetic variation in the macromolecular machines formed by membrane-associated guanylate kinase (MAGUK) scaffold proteins and their interaction partners contributes to variation in intelligence.
doi:10.1038/tp.2013.114
PMCID: PMC3905224  PMID: 24399044
GWAS; intelligence; NMDA-RC; pathway analysis; synapse
2.  Influence of thickening of the inner skull table on intracranial volume measurement in older people 
Magnetic Resonance Imaging  2013;31(6):918-922.
Introduction
It is generally assumed that intracranial volume (ICV) remains constant after peaking in early adulthood. Thus ICV is used as a ‘proxy’ for original brain size when trying to estimate brain atrophy in older people in neuroimaging studies. However, physiological changes in the skull, such as thickening of the frontal inner table, are relatively common in older age and will reduce ICV. The potential influence that inner table skull thickening may have on ICV measurement in old age has yet to be investigated.
Methods
We selected 60 (31 males, 29 females) representative older adults aged 71.1–74.3 years from a community-dwelling ageing cohort, the Lothian Birth Cohort 1936. A semi-automatically derived current ICV measurement obtained from high resolution T1-weighted volume scans was compared to the estimated original ICV by excluding inner skull table thickening using expert manual image processing.
Results
Inner table skull thickening reduced ICV from an estimated original 1480.0 ml to a current 1409.1 ml, a median decrease of 7.3% (Z = − 6.334; p < 0.001), and this reduction was more prominent in women than men (median decrease 114.6 vs. 101.9 ml respectively). This led to potential significant underestimations of brain atrophy in this sample by 5.3% (p < 0.001) and obscured potential gender differences.
Conclusions
The effects of skull thickening are important to consider when conducting research in ageing, as they can obscure gender differences and result in underestimation of brain atrophy. Research into reliable methods of determining the estimated original ICV is required for research into brain ageing.
doi:10.1016/j.mri.2013.01.012
PMCID: PMC3682185  PMID: 23453763
Magnetic resonance imaging; Skull; Intracranial volume; Brain atrophy; Ageing
3.  IQ in late adolescence/early adulthood, risk factors in middle age and later all-cause mortality in men: the Vietnam Experience Study 
Objective
To examine the role of potential mediating factors in explaining the IQ–mortality relation.
Design, setting and participants
A total of 4316 male former Vietnam-era US army personnel with IQ test results at entry into the service in late adolescence/early adulthood in the 1960/1970s (mean age at entry 20.4 years) participated in a telephone survey and medical examination in middle age (mean age 38.3 years) in 1985–6. They were then followed up for mortality experience for 15 years.
Main results
In age-adjusted analyses, higher IQ scores were associated with reduced rates of total mortality (hazard ratio (HR)per SD increase in IQ 0.71; 95% CI 0.63 to 0.81). This relation did not appear to be heavily confounded by early socioeconomic position or ethnicity. The impact of adjusting for some potentially mediating risk indices measured in middle age on the IQ–mortality relation (marital status, alcohol consumption, systolic and diastolic blood pressure, pulse rate, blood glucose, body mass index, psychiatric and somatic illness at medical examination) was negligible (<10% attenuation in risk). Controlling for others (cigarette smoking, lung function) had a modest impact (10–17%). Education (0.79; 0.69 to 0.92), occupational prestige (0.77; 0.68 to 0.88) and income (0.86; 0.75 to 0.98) yielded the greatest attenuation in the IQ–mortality gradient (21–52%); after their collective adjustment, the IQ–mortality link was effectively eliminated (0.92; 0.79 to 1.07).
Conclusions
In this cohort, socioeconomic position in middle age might lie on the pathway linking earlier IQ with later mortality risk but might also partly act as a surrogate for cognitive ability.
doi:10.1136/jech.2007.064881
PMCID: PMC3650086  PMID: 18477751
4.  Assessing the Performance of Atlas-Based Prefrontal Brain Parcellation in an Ageing Cohort 
Journal of computer assisted tomography  2013;37(2):10.1097/RCT.0b013e31828004ea.
Objective
It is unclear whether atlas-based parcellation is suitable in ageing cohorts because age-related brain changes confound the performance of automatic methods. We assessed atlas-based parcellation of the prefrontal lobe in an ageing population using visual assessment, volumetric and spatial concordance.
Methods
We used atlas-based approach to parcellate brain MR images of 90 non-demented healthy adults, aged 72.7±0.7yrs and assed performance.
Results
Volumetric assessment showed that both single- and multi-atlas-based methods performed acceptably (Intraclass correlation coefficient, ICC:0.74 to 0.76). Spatial overlap measurements showed that multi- (Dice Coefficient, DC:0.84) offered an improvement over the single- (DC:0.75 to 0.78) atlas approach. Visual assessment also showed that multi-atlas outperformed single-atlas, and identified an additional post-processing step of CSF removal, enhancing concordance (ICC:0.86, DC:0.89).
Conclusions
Atlas-based parcellation performed reasonably well in the ageing population. Rigorous performance assessement aided method refinement, and emphasises the importance of age-matching and post-processing. Further work is required in more varied subjects.
doi:10.1097/RCT.0b013e31828004ea
PMCID: PMC3836171  PMID: 23493216
Prefrontal brain; multi-atlas; MRI; Ageing; skull thickening; brain atrophy
5.  Factors associated with symptoms of anxiety and depression in five cohorts of community-based older people: the HALCyon (Healthy Ageing across the Life Course) Programme 
Psychological medicine  2011;41(10):2057-2073.
Background
Symptoms of anxiety and depression are common in older people, but the relative importance of factors operating in early and later life in influencing risk is unclear, particularly in the case of anxiety.
Method
We used data from five cohorts in the Healthy Ageing across the Life Course (HALCyon) collaborative research programme : the Aberdeen Birth Cohort 1936, the Caerphilly Prospective Study, the Hertfordshire Ageing Study, the Hertfordshire Cohort Study and the Lothian Birth Cohort 1921. We used logistic regression to examine the relationship between factors from early and later life and risk of anxiety or depression, defined as scores of 8 or more on the subscales of the Hospital Anxiety and Depression Scale, and meta-analysis to obtain an overall estimate of the effect of each.
Results
Greater neuroticism, poorer cognitive or physical function, greater disability and taking more medications were associated in cross-sectional analyses with an increased overall likelihood of anxiety or depression. Associations between lower social class, either in childhood or currently, history of heart disease, stroke or diabetes and increased risk of anxiety or depression were attenuated and no longer statistically significant after adjustment for potential confounding or mediating variables. There was no association between birth weight and anxiety or depression in later life.
Conclusions
Anxiety and depression in later life are both strongly linked to personality, cognitive and physical function, disability and state of health, measured concurrently. Possible mechanisms that might underlie these associations are discussed.
doi:10.1017/S0033291711000195
PMCID: PMC3349051  PMID: 21349224
Anxiety; cohort studies; depression; elderly; life course
7.  Common SNPs explain some of the variation in the personality dimensions of neuroticism and extraversion 
Translational Psychiatry  2012;2(4):e102-.
The personality traits of neuroticism and extraversion are predictive of a number of social and behavioural outcomes and psychiatric disorders. Twin and family studies have reported moderate heritability estimates for both traits. Few associations have been reported between genetic variants and neuroticism/extraversion, but hardly any have been replicated. Moreover, the ones that have been replicated explain only a small proportion of the heritability (<∼2%). Using genome-wide single-nucleotide polymorphism (SNP) data from ∼12 000 unrelated individuals we estimated the proportion of phenotypic variance explained by variants in linkage disequilibrium with common SNPs as 0.06 (s.e.=0.03) for neuroticism and 0.12 (s.e.=0.03) for extraversion. In an additional series of analyses in a family-based sample, we show that while for both traits ∼45% of the phenotypic variance can be explained by pedigree data (that is, expected genetic similarity) one third of this can be explained by SNP data (that is, realized genetic similarity). A part of the so-called ‘missing heritability' has now been accounted for, but some of the reported heritability is still unexplained. Possible explanations for the remaining missing heritability are that: (i) rare variants that are not captured by common SNPs on current genotype platforms make a major contribution; and/ or (ii) the estimates of narrow sense heritability from twin and family studies are biased upwards, for example, by not properly accounting for nonadditive genetic factors and/or (common) environmental factors.
doi:10.1038/tp.2012.27
PMCID: PMC3337075  PMID: 22832902
complex traits; GCTA; genome-wide; polymorphisms; variance
8.  Does IQ predict total and cardiovascular disease mortality as strongly as other risk factors? Comparison of effect estimates using the Vietnam Experience Study 
Heart  2008;94(12):1541-1544.
Objective:
To compare the strength of the relation of two measurements of IQ and 11 established risk factors with total and cardiovascular disease (CVD) mortality.
Methods:
Cohort study of 4166 US male former army personnel with data on IQ test scores (in early adulthood and middle age), a range of established risk factors and 15-year mortality surveillance.
Results:
When CVD mortality (n = 61) was the outcome of interest, the relative index of inequality (RII: hazard ratio; 95% CI) for the most disadvantaged relative to the advantaged (in descending order of magnitude of the first six based on age-adjusted analyses) was: 6.58 (2.54 to 17.1) for family income; 5.55 (2.16 to 14.2) for total cholesterol; 5.12 (2.01 to 13.0) for body mass index; 4.70 (1.89 to 11.7) for IQ in middle age; 4.29 (1.70 to 10.8) for blood glucose and 4.08 (1.63 to 10.2) for high-density lipoprotein cholesterol (the RII for IQ in early adulthood was ranked tenth: 2.88; 1.19 to 6.97). In analyses featuring all deaths (n = 233), the RII for risk factors most strongly related to this outcome was 7.46 (4.54 to 12.3) for family income; 4.41 (2.77 to 7.03) for IQ in middle age; 4.02 (2.37 to 6.83) for smoking; 3.81 (2.35 to 6.17) for educational attainment; 3.40 (2.14 to 5.41) for pulse rate and 3.26 (2.06 to 5.15) for IQ in early adulthood. Multivariable adjustment led to marked attenuation of these relations, particularly those for IQ.
Conclusions:
Lower scores on measures of IQ at two time points were associated with CVD and, particularly, total mortality, at a level of magnitude greater than several other established risk factors.
doi:10.1136/hrt.2008.149567
PMCID: PMC2602751  PMID: 18801778
9.  Factors influencing tackle injuries in rugby union football 
OBJECTIVES: To assess the influence of selected aspects of lifestyle, personality, and other player related factors on injuries in the tackle. To describe the detailed circumstances in which these tackles occurred. METHODS: A prospective case-control study was undertaken in which the tackling and tackled players ("the cases") involved in a tackle injury were each matched with "control" players who held the same respective playing positions in the opposing teams. A total of 964 rugby matches involving 71 senior clubs drawn from all districts of the Scottish Rugby Union (SRU) were observed by nominated linkmen who administered self report questionnaires to the players identified as cases and controls. Information on lifestyle habits, match preparation, training, and coaching experience was obtained. A validated battery of psychological tests assessed players' trait anger and responses to anger and hostility. The circumstances of the tackles in which injury occurred were recorded by experienced SRU coaching staff in interviews with involved players after the match. RESULTS: A total of 71 tackle injury episodes with correct matching of cases and controls were studied. The following player related factors did not contribute significantly to tackle injuries: alcohol consumption before the match, feeling "below par" through minor illness, the extent of match preparation, previous coaching, or practising tackling. Injured and non- injured players in the tackle did not differ in their disposition toward, or expression of, anger or hostility. Some 85% of tackling players who were injured were three quarters, and 52% of injuries occurred when the tackle came in behind the tackled player or within his peripheral vision. Either the tackling or tackled player was sprinting or running in all of these injury episodes. One third of injuries occurred in differential speed tackles--that is, when one player was travelling much faster than the other at impact. The player with the lower momentum was injured in 80% of these cases. Forceful or crunching tackles resulting in injury mostly occurred head on or within the tackled player's side vision. CONCLUSIONS: Attention should be focused on high speed tackles going in behind the tackled player's line of vision. Comparative information on the circumstances of the vast majority of tackles in which no injury occurs is required before any changes are considered to reduce injuries in the tackle. 



PMCID: PMC1756133  PMID: 10027056
10.  Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome 
Thorax  1997;52(2):114-119.
BACKGROUND: Continuous positive airway pressure (CPAP) is an effective treatment in patients with moderate and severe sleep apnoea/hypopnoea syndrome (SAHS), but the minimum illness severity at which patients obtain benefit from CPAP is unclear. A study was therefore undertaken to investigate whether CPAP improves symptoms and daytime function in patients with mild SAHS. METHODS: Sixteen consecutively recruited patients with mild SAHS (5.0-14.9 apnoeas + hypopnoeas per hour slept and two or more symptoms of SAHS) participated in a prospective placebo controlled randomised crossover trial to assess the effects of CPAP on symptoms and daytime function. Patients spent four weeks on placebo and four weeks on CPAP, undergoing assessments of sleepiness, symptoms, cognitive performance, and well being on the last day of each treatment. Data from the placebo and CPAP assessments were compared. RESULTS: The mean (SE) objective effective use of CPAP was 2.8 (0.7) hours per night. Significant improvements in symptom score (-1.7 (0.5), p < 0.01), mental flexibility (-14 (5) seconds, p = 0.02), and depression rating (-1.6 (0.8), p = 0.03) on CPAP were observed. However, no significant differences in subjective or objective sleepiness were found. Ten of the 16 patients preferred CPAP and opted to continue with this treatment, although this proportion was non- significant (p > 0.4). The eight patients with best CPAP use showed an additional CPAP related improvement in quality of life (-4.4 (1.8), p = 0.03). Those who complied better with CPAP therapy also had a higher average microarousal frequency (p < 0.01) and apnoea+hypopnoea index (p = 0.02) than the poorer compliers. CONCLUSIONS: The results of this study provide evidence for improvements in symptoms and daytime function for patients with mild SAHS treated with CPAP. 



PMCID: PMC1758499  PMID: 9059469
11.  Hostility and the heart. 
BMJ : British Medical Journal  1997;315(7105):379-380.
PMCID: PMC2127292  PMID: 9277594
13.  Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance. 
Thorax  1991;46(8):569-573.
Most patients with asthma waken with nocturnal asthma from time to time. To assess morbidity in patients with nocturnal asthma nocturnal sleep quality, daytime sleepiness, and daytime cognitive performance were measured prospectively in 12 patients with nocturnal asthma (median age 43 years) and 12 age and intellect matched normal subjects. The median (range) percentage overnight fall in peak expiratory flow rate (PEF) was 22 (15 to 50) in the patients with nocturnal asthma and 4 (-4 to 7) in the normal subjects. The patients with asthma had poorer average scores for subjective sleep quality than the normal subjects (median paired difference 1.1 (95% confidence limits 0.1, 2.3)). Objective overnight sleep quality was also worse in the asthmatic patients, who spent more time awake at night (median difference 51 (95% CL 8.1, 74) minutes), had a longer sleep onset latency (12 (10, 30) minutes), and tended to have less stage 4 (deep) sleep (-33 (-58, 4) minutes). Daytime cognitive performance was worse in the patients with nocturnal asthma, who took a longer time to complete the trail making tests (median difference 62 (22, 75) seconds) and achieved a lower score on the paced serial addition tests (-10 (-24, -3)). Mean daytime sleep latency did not differ significantly between the two groups (2 (-3, 7) minutes). It is concluded that hospital outpatients with stable nocturnal asthma have impaired sleep quality and daytime cognitive performance even when having their usual maintenance asthma treatment.
PMCID: PMC463276  PMID: 1926025
14.  Is there a bidirectional relationship between depressive symptoms and cognitive ability in older people? A prospective study using the English Longitudinal Study of Ageing 
Psychological Medicine  2012;42(10):2057-2069.
Background
Cross-sectional surveys of older people commonly find associations between higher levels of depressive symptoms and poorer cognitive performance, but the direction of effect is unclear. We examined whether there was a bidirectional relationship between depressive symptoms and general cognitive ability in non-demented older people, and explored the role of physical health, smoking, exercise, social class and education as potential confounders of this association and as possible determinants of the rate of change of cognitive decline and depressive symptoms.
Method
The English Longitudinal Study of Ageing consists of people aged 50 years and over. Cognitive function and self-reported depressive symptoms were measured in 2002–2003, 2004–2005, 2006–2007 and 2008–2009. We fitted linear piecewise models with fixed knot positions to allow different slopes for different age groups. Analyses are based on 8611 people.
Results
Mean cognitive function declined with age; there was no trend in the trajectory of depressive symptoms. Better cognitive function was associated with less depression up to the age of 80 years. Greater depression was associated with a slightly faster rate of cognitive decline but only in people aged 60–80 years. There were no consistent associations across age groups between sex, smoking, education, social class, exercise or number of chronic physical illnesses and the rate of change of cognitive decline or depressive symptoms.
Conclusions
In this longitudinal study of older people, there was no consistent evidence that being more depressed led to an acceleration in cognitive decline and no support for the hypothesis that there might be reciprocal dynamic influences between cognitive ability and depressive symptoms.
doi:10.1017/S0033291712000402
PMCID: PMC3435872  PMID: 23206378
Ageing; cognition; cognitive decline; depressive symptoms
17.  Daytime sleepiness, cognitive performance and mood after continuous positive airway pressure for the sleep apnoea/hypopnoea syndrome. 
Thorax  1993;48(9):911-914.
BACKGROUND--Patients with the sleep apnoea/hypopnoea syndrome often receive continuous positive airway pressure to improve their symptoms and daytime performance, yet objective evidence of the effect of this treatment on cognitive performance is lacking. METHODS--A prospective parallel group study was performed comparing the change in objective daytime sleepiness as assessed by multiple sleep latency, cognitive function, and mood in 21 patients (mean (SE) number of apnoeas and hypopnoeas/hour 57 (6)) who received continuous positive airway pressure for three months and 16 patients (49(6) apnoeas and hypopnoeas/hour) who received conservative treatment for a similar period. RESULTS--Both groups showed significant within group changes in cognitive function between baseline and three months, but when comparisons were made between groups the only significant difference was a greater improvement in multiple sleep latency with continuous positive airway pressure. However, the improvement in sleep latency with continuous positive airway pressure was relatively small (3.5 (0.5) to 5.6 (0.7) min). The group treated with continuous positive airway pressure was divided into those who complied well with treatment (> 4.5 hours/night) and those who did not. Those who complied well (n = 14) showed significant improvement in mean sleep latency and also in depression score compared with the controls but no greater improvement in cognitive function. CONCLUSION--This study confirms significant improvements in objective sleepiness and mood with continuous positive airway pressure, but shows no evidence of major improvements in cognitive function.
PMCID: PMC464776  PMID: 8236074
18.  Survey of perceived stress and work demands of consultant doctors. 
OBJECTIVES: The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants. METHODS: A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout. RESULTS: Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS. CONCLUSION: These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers.
PMCID: PMC1128453  PMID: 8664957
19.  Functional dysphonia. 
BMJ : British Medical Journal  1995;311(7012):1039-1040.
PMCID: PMC2551359  PMID: 7580648
23.  Effects of sleep disruption on cognitive performance and mood in medical house officers. 
Twelve medical house officers were tested on a battery of memory, concentration, and work related tasks after three conditions: a night spent off duty; a night spent on call; and a night spent admitting emergency cases. Short term recall, but not digit span, concentration, or work related abilities, was impaired after a night of emergency admissions. A night spent on call had no effect on cognitive performance. Self reported mood scores showed that house officers were more deactivated (indicating a lack of vigour and drive) after nights of emergency admissions but not after nights on call. Significant between subject differences were found for five of the eight cognitive tests. Though loss of sleep and long hours of work have an effect on memory and mood, the individual differences among doctors are the main source of the variance in performance of tasks.
PMCID: PMC1248664  PMID: 3122881
25.  Dementia and Mrs Thatcher. 
PMCID: PMC1419190  PMID: 3936580

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