Centre for Clinical Neuropsychology Research

Paediatric neurocognitive interventions

Working memory training in children who have survived an acquired brain injury

Professor Anna Adlam

This stream of work is funded by the British Academy and Action Medical Research. We are conducting a multi-site (South West and East Anglia) randomised controlled trial to investigate the efficacy of computerised working memory training (working memory is the ability to store and manipulate information in mind over a brief period of time) with children (aged 8 – 16 years) who have survived a brain injury. We are interested in finding out whether children show training gains on measures of working memory (near transfer) immediately after training and after 6-months, and whether gains are also shown on measures of maths and literacy (far transfer), and other cognitive and psychosocial measures. If you would like to find out more about this study, or would like to take part, then please contact the research team (ccnr@exeter.ac.uk). Related to this stream of work, we are also conducting studies to investigate memory and attention in children with neurological vulnerability such as, children born prematurely, children with attention deficit hyperactivity disorder, and children with genetic risk factors.

Prospective memory training in adolescents who have survived an acquired brain injury

Professor Anna Adlam

Following our recent study (with Dr Rebecca Rous, Cambridge Cognition, in preparation for publication), we are conducting a repeated single case series to investigate whether adolescents who have survived a brain injury benefit from an intervention to improve executive function (e.g., problem-solving, planning, organisation skills) and prospective memory (the ability to keep goals and intended actions in mind). We are interested in finding out whether adolescents show improvements on a prospective memory task and the performance of ‘real world’ goals that they set themselves. This study will soon be recruiting adolescents in the South West. If you would like to find out more about this study, or would like to take part, then please contact the research team (ccnr@exeter.ac.uk). Related to this stream of work, we are working with colleagues in the USA to evaluate web-based interventions for executive function in adolescents who have survived a brain injury.

Neural correlates of neurocognitive interventions

Professor Anna Adlam and Dr Fraser Milton

We are interested in understanding the mechanisms underpinning neurocognitive interventions, particularly during development and following brain injury. This work involves neuroimaging techniques such as structural magnetic resonance imaging, functional magnetic resonance imaging, and diffusion tensor imaging.

Socioemotional processes, traumatic brain injury (TBI), and crime in youth

Criminal Justice System

Professor Huw Williams

Following on from our work showing the elevated levels of TBI in prisoners, and links to violence and recidivism, we have a range of projects exploring the symptoms of TBI, and problems in emotional control and understanding (Theory of Mind and Empathy)  in youth in custody and in the community offenders services. We are also working closely with the Offender Health Research Network, Youth Justice Board and Disabilities Trust to improve assessment and management of TBI in the Criminal Justice System.

Eating disorders neuroscience in youth

The Ravello Profile - neuropsychological assessment in eating disorders

Dr Ian Frampton, Professor Huw Williams, Professor Emeritus Bryan Lask, Marie-Claire Reville

This international collaborative research project aims to develop a standard neuropsychological assessment for research and clinical use in eating disorders. Participating centres from Europe, Scandinavia, North and South America have established a joint database to help us understand more about the neuropsychological consequences (and potential causes) of eating disorders. Generous funding by the Rosetree's Trust, Care UK, the Huntercombe Group, the Ellern Mede Centre for Eating Disorders and Helse Sør Øst, Norway has supported this project.

Functional neuroimaging in eating disorders

Dr Ian Frampton, Professor Huw Williams, Professor Emeritus Bryan Lask, Marie-Claire Reville

Our studies in this area are exploring how brain function is affected by starvation during the acute phase of eating disorders, and also testing our noradrenergic hypothesis (Nunn et al, 2012) that dysfunction of a neural network incorporating the insula cortex in the brain could be an underlying risk factor. With the support of Helse Sør Øst, Norway and colleagues from the Centre for Neuroimaging Sciences at the University of London, we have developed and tested a novel hypothesis using functional neuroimaging techniques. We are now developing our research into potential neuroscience-based treatments for eating disorders in collaboration with the Exeter MR Research Centre.

Neurocognitive processes, neurological disorders, and depression

Mood disorders in individuals with neurological conditions

Professor Anna Adlam, Dr Phil Yates, Dr David Llewellyn, & Professor Huw Williams

Acquired Brain Injury (ABI) can lead to major challenges in life and well being. We have shown how ABI can be linked to many mood disorders (e.g., leading to PTSD, rumination, and challenges in adaptive social identity). Building on our previous work, we are working with colleagues at the Mood Disorders Centre and the University of Exeter Medical School to understand the development and maintenance of mood disorders in individuals with neurological disorders (e.g., stroke, traumatic brain injury, dementia). We are also developing and evaluating targeted interventions.

Does working memory training reduce rumination and depression?

Professor Anna Adlam and Dr Henrietta Roberts

We have recently been awarded Wellcome Trust Seed Corn Funding to investigate whether working memory training reduced repetitive negative thought and symptoms of depression. The findings from this study will inform future research examining neurocognitive interventions in adults with dementia who experience depression.

Brief neurocognitive screening assessments in dementia

Brief cognitive assessment and diagnostic pathways for dementia

Dr David Llewellyn and Professor Anna Adlam

Identifying risk factors for neurocognitive decline

Dr David Llewellyn

Vitamin D and neurocognitive dysfunction

We are conducting an ancillary Study to the NHLBI-funded Cardiovascular Health Study (CHS) investigating vitamin D levels in relation to Alzheimer‘s disease, dementia and neuroimaging abnormalities (supported by the Alzheimer‘s Association, the NIHR Peninsula Collaboration for Leadership in Applied Health Research and Care [PenCLAHRC] and other funders). This follows on from our ealier work which established that low serum vitamin D levels increase the odds of cognitive impairment in older English and US adults, and increases the risk of cognitive decline in older Italian adults. Vitamin D supplementation offers an inexpensive and well tolerated way to increase vitamin D levels thus raising new possibilities for dementia prevention and treatment.

Metabolic dysfunction, lifestyle factors and dementia

It is now estimated that up to half of all cases of dementia could be prevented by targeting modifiable risk factors. This programme of work therefore investigates a range of potentially modifiable risk factors for dementia including parathyroid hormone levels, leptin, obesity, and alcohol consumption (supported by the NIHR PenCLAHRC, the Norman Family Charitable Trust and other funders). This includes a Health and Retirement Study (HRS) 2014 Experimental Module on alcohol consumption and drinking history.

Vascular aspects of cognitive impairment and dementia

We are currently investigating the vascular aspects of neurocognitive dysfunction in a range of clinical and population-based studies including the HRS (supported by the Mary Kinross Charitable Trust and other funders). For example we are currently conducting a systematic review and Monte Carlo simulation study incorporating quasi-experimental analyses to establish whether coronary artery bypass graft surgery (CABG) increases the long-term risk of cognitive decline or dementia.

Mild Traumatic Brain Injury/Sports concussion

Professor Huw Williams

Emergency care of Traumatic Brain Injury

We have identified key risk periods for TBI and what types and levels of injury and emotional factors (such as acute stress) influence outcome. This has led to a clinic in the Emergency Dept in which we work closely with A&E Consultants on testing patients within hours of mild trauma on computerised measures to identify those at risk of poor recovery.

Sports Related Concussion (SRC)

We work with a premiership rugby team and University of Exeter squads, on projects exploring potential changes in brain connectivity and functions after SRC. These projects are in collaboration with Prof Dave Sharp (Imperial College, London) and Dr Andrew Gardner (University of Newcastle, Australia). This will help us develop better systems for identifying athletes at risk of poor recovery, and potential for improved interventions.