Sunday, January 24, 2021

Have women been missing out on chances to maintain cognitive reserve?


At present, the majority of people with late-onset Alzheimer's disease are women. While there are a variety of reasons why this may be the case, one possible factor is reduced opportunity to maintain cognitive reserve. (Although it has been defined in subtly different ways, cognitive reserve is essentially the maintenance of cognitive performance in the presence of brain pathology due to a "bank" of greater cognitive resources over the lifespan, such as formal education or an intellectually stimulating job). For example, some women may have (or have had) less cognitive reserve if they have left formal education earlier. 

A recent review paper has looked at this in depth. The authors highlight that much of the evidence that has been used to propose models of cognitive reserve has not looked at whether these models hold to the same extent for men and women, and so there may be underappreciated sex differences. Nonetheless, the authors did identify a number of studies that did grapple empirically with sex differences and cognitive reserve. (Although sex and gender are not the same thing, the authors noted that some studies referred to sex and others to gender, and sex differences may be conflated with gender roles; overall, it was unclear whether existing data would allow anyone to tease apart sex differences and gender differences).    

Focusing on education in particular, the authors found two longitudinal studies that indicated that more years of education led to reduced incidence/prevalence of Alzheimer's disease, and this effect did not differ between the sexes, although two other studies found that years of education were correlated with reduced Alzheimer's risk, but only for women. So it would seem the studies did agree that education reduced Alzheimer's risk for women, although the evidence was more equivocal for men (one might speculate that perhaps young males are more likely to enter more cognitively stimulating work if they leave school early, compared to young females, or at least this has been the case in the recent past). 

However, a cross-sectional study found that men with Alzheimer's disease had better performance on the MMSE than women of the same age with the same level of education, suggesting reserve was more beneficial for men (the authors of the review point out that this study did not assess neural pathology, so it may be the case that the women in this study had more advanced neural pathology than the men).   

Although I've briefly focused on education and women in particular above, it is likely that people from various disadvantaged groups have less opportunity to develop cognitive reserve over their lives. Internationally, there are substantial differences in the average number of years people spend in formal education, and although great progress has been made globally in closing the gender gap over the last century, the female:male ratio for years of schooling is still around 85% for Asia, Africa and the Pacifics. The full paper below looks in more detail at other factors that can help to maintain cognitive reserve:

Subramaniapillai, S., Almey, A., Rajah, M. N., & Einstein, G. (2020). Sex and gender differences in cognitive and brain reserve: Implications for Alzheimer’s disease in women. Frontiers in Neuroendocrinology, 100879.

 Related posts

Conference review: Reserve and resilience

If you like this post, follow me on Twitter: @ArchivePsych  

Friday, December 18, 2020

SOOTHE webinar: Learning about mental health from people with intellectual disabilities


This morning I attended the SOOTHE webinar Learning about mental health & well-being from people with intellectual disabilities. The SOOTHE project is working on mental health in people with intellectual disabilities, with the aim of developing an international community of practice. The webinar was bilingual, with some presenters speaking in Spanish but presenting slides in English. I found this quite refreshing, given usual Anglophone hegemony at events/in science globally.  

A key output of SOOTHE has been its E-quilt: an artistic means for expressing understanding of mental health. The quilt is still accepting submissions at this link. On the broader point of art, Professor Wolter Paans highlighted how artwork by people with ID can be included in an exhibition with an entry fee, underscoring the social value of the artwork.

Research in understanding mental health with people with ID was discussed. Some people with ID had quite biological understandings of mental health, even though they linked challenges to mental health with negative experiences in the past (feelings of rejection was often a theme, as well as not feeling heard/understood). There was a bidirectional effect; it seemed that participants not only gave their own viewpoint, but participation in the project broadened the participants' own understanding of mental health.

Beyond understanding mental health itself, the session went on to discuss innovations and ways of improving mental health. Among ideas discussed were relaxation/mindfulness workshops, musical spaces, use of technology, spaces to reduce stimuli, getting professional support to talk about difficult emotions, and enjoying meaningful activities in company of others. Social interactions as well as faith/religion were highlighted as helping to foster a sense of connectedness. Unsurprisingly, COVID-19 cropped up, with negative emotional impact of lockdown restrictions.

Pablo Alvarez discussed a Learnovate approach: going from ideas to implementable solutions, using storyboards to workshop how ideas might be implemented (e.g. physical activity, social interactions, music activities). The project involved working though how to make music available and accessible online, and how to share it. The team developed a prototype app, then had a Q & A session to feedback on user experience with the app, which can be used to create agenda for daily activities. When I say "team", it should be noted that there was a consistent focus on co-creation with people who will be using app. 

In a final discussion, one panelist sounded an optimistic note of how people are increasingly understanding that we're all on a continuum of mental health. COVID-19 was described as a natural experiment no one asked for, meaning that people in general have no choice but to use technology if they wish to communicate with others. The participation of people with ID in the process was highlighted, so there's an ongoing need for the information generated by the project to be available in an accessible way for people with ID, and that people with ID might be able to recruit others and become mental health advocates.

 Related posts

COVID-19: Impact on people ageing with intellectual disability

If you like this post, follow me on Twitter: @ArchivePsych  

Sunday, December 13, 2020

The Impact of COVID-19 on People Ageing with an Intellectual Disability in Ireland


The Irish Longitudinal Study on Ageing (IDS-TILDA) has been studying ageing in people with intellectual disability (ID) for over a decade. Now in its fourth wave, a number of its research activities had to be paused due to the COVID-19 pandemic and associated lockdown. However, the IDS-TILDA team has taken the opportunity to study the impact of COVID-19 on participants in this longitudinal study. To mark the release of the report of the findings of this research, an online launch was held on 3rd December 2020, International Day of Disabled Persons.

Attendees were welcomed by Professor Mary McCarron, Principal Investigator of IDS-TILDA. Minister Anne Rabbitte, TD, Minister of State with Responsibility for Disability, gave a speech highlighting the context and main findings of the study, and praising the work of the IDS-TILDA team, those people with ID who have taken part in the study, and those who have supported them during this pandemic. Minister Rabbitte acknowledged that the pandemic and associated lockdown have been difficult for all of us, but it has often been even more challenging for people with ID, who can be more vulnerable, and often have less autonomy than the general population.

Professor McCarron then presented key findings from the COVID-19 survey. The COVID-19 survey had a response rate of 96% from the IDS-TILDA cohort, meaning this survey was representative of the population with ID in Ireland. A majority of participants were tested for COVID-19, with many being tested multiple times. Of those who did test positive or had symptoms, a clear majority had a plan in place to manage self-isolation. Key sources of stress and anxiety were being unable to do one’s usual activities, not seeing friends/family, loneliness and isolation. At the same time, many participants reported there had been some positive aspects to the lockdown, such as trying new activities or using technology to communicate with relatives and friends. Most importantly, there were no reported deaths due to COVID-19 in the IDS-TILDA population.

Following this summary of the results, broadcaster Olivia O’Leary led a panel discussion with a variety of stakeholders, exploring different perspectives on the pandemic and lockdown. Participants on the panel highlighting how best practice was implemented for people with ID in Ireland included Professor Sean Kennelly (Consultant Physician in Geriatric and Stroke Medicine, Tallaght University Hospital), Dr Alison Hartnett (Acting CEO, National Federation of Voluntary Service Providers), Dr Kathleen MacLellan (Assistant Secretary, Social Care Division, Department of Health), and Lisa Lavelle (Director of Nursing, Daughters of Charity Disability Support Service). From an international perspective, Professor Chris Hatton (Manchester Metropolitan University) praised the work of services in Ireland in protecting people with ID, and the research of IDS-TILDA, saying he hoped similar research (conducted at a more localised level) in the UK would be published soon. Professor Philip McCallion, Co-Investigator of IDS-TILDA, highlighted the heterogeneity of experiences across the United States, given the size of the country, but drew particular attention to the deep impact of COVID-19 in the North-East of the USA, where he works at Temple University, Pennsylvania. Mei Lin Yap, a PPI contributor and steering committee member with IDS-TILDA, spoke of her lived experience of the lockdown, and of the importance of social contacts during the lockdown.  

Following final comments from Professor McCarron, the launch closed with the original song “We’re in this together” by Sunbeam House Services. The song and its accompanying video, made by the service users, was a great way to finish the launch and underscore the importance of solidarity with each other at this time.    

You can download the report at this link.

Related posts

Researcher profile

If you like this post, follow me on Twitter: @ArchivePsych

Tuesday, October 27, 2020

Writing workshop: "Novel Problems" with Niamh Campbell

I recently attended "Novel Problems" at the Irish Writers Centre The course was conducted entirely online, given the pandemic. The course is run by Niamh Campbell, whose debut novel This Happy has been getting very positive reviews. I had previously attended Fundamentals of Fiction, which combined a didactic aspect with workshopping of work, whereas Novel Problems focused more heavily on workshopping throughout. 

The quality of writing at Novel Problems was very high, and some of the participants were progressing quite well in the publishing game; one person in particular had already secured an agent, and their novel was in the process of being sent to publishing houses. Whereas the participants at Fundamentals worked in a mix of genres, the pieces workshopped on this course tended to be  more grounded in realism (in contrast, my current work combines the surreal, hyperreality and magic realism, so I felt like somewhat of a black sheep in this regard). During some of the discussions I realised that I would have benefitted from reading through the circulated extracts a few times; a lot of subtleties of people's work can go over one's head at a first read.

For the last week, we spent some time talking about an interesting article by Zadie Smith which led to much discussion around issues of identity, and authenticity in writing. I think this discussion was very pertinent for many of the writers in the group, whose work had a semi-autobiographical quality. My current work in progress is a totally fictional piece that is not based on anyone I know, but the article by Zadie Smith does make a fair point that the writer's personality will come through in their writing (regardless of how outlandish their story might be). 

This course is geared towards writers who have been working on a novel for some time, but I wouldn't write it off if you're starting on something, as long as you're passionate about it. If the course is running again, it's a great chance to get feedback from other motivated writers. 

Related posts

Insider's guide to publishing: Dublin International Literature Festival
Notes on writing process
Workshop: fundamentals of fiction

If you like this post, follow me on Twitter: @ArchivePsych

Monday, October 19, 2020

The distracted muse: generating new ideas when performing a separate task


There are many distractions on offer when one is undertaking a creative task. I write fiction, but do so on a laptop connected to the internet, and research into some aspect of life I want to include in a novel can quickly lead down a rabbit hole of interesting Wikipedia articles. 

new paper in Creativity Research Journal looks at the possible effects of distraction on creative thinking. In contrast to the usual story of distraction spoiling the creative person's work, the idea presented here is that, by occupying attentional resources that could otherwise inhibit possible ideas, more creative ideas may emerge.  

The author assessed divergent thinking (generating different ideas/multiple possible solutions to a problem) using an Alternate Uses Task. Participants were provided with the names of everyday items and asked to come up with different ways of using them (so, if you see an iron, you could take the water out of it to water a plant, leave the iron out to make it look like you do more housework than you really do etc. etc.). Participants also had to complete a simple task which involved pressing coloured buttons in response to coloured boxes appearing on a screen. Sometimes (the dual-task condition) they had to complete the two tasks at the same time.

The results indicated that participants' scores on the alternate uses task increased in the dual task condition, compared to when they did the alternate uses task by itself. This was the case for originality (i.e. how unique the ideas were), fluency (i.e. how many ideas were produced), flexibility (i.e. how many broader categories of ideas were produced), and elaboration (i.e. how developed the ideas were). I would have expected originality to increase in the dual task condition, as unusual ideas become less inhibited, but was quite surprised to see overall fluency increase, given that the dual task might have made it more effort to produce a given number of ideas.

There is a history of different explanations offered as to why one can come up with better ideas while working on a different task to the creative endeavour. One possible explanation is opportunistic assimilation, where an idea from a different field can influence another project where you're stuck for ideas. However, I don't think such assimilation could be demonstrated in a short-term study of this nature, where the rather basic dual task would be unlikely to provoke many ideas.       

 This research looked at divergent thinking over a short period of time. Collins himself notes that divergent thinking is not equivalent to creativity.  Longer creative works will often take longer periods of focused concentration. Doing a line edit on a novel is probably best done without distractions (so unplug your internet!). The experimental scenario was set up in such a way that the participant would be encouraged to keep working at the creative task at the same time as the distracting dual task (rather than just disappearing down the Bermuda triangle of Wikipedia and leaving the Word doc with the novel closed). Nonetheless, this article suggests that giving your full and undivided attention to a task when generating new ideas might not be all it's cracked up to be.

Collins, M. J. D. A. (2020). A Distracted Muse: The Positive Effect of Dual-Task Distraction on Creative Potential. Creativity Research Journal, doi: 10.1080/10400419.2020.1816066. 

Related posts

Creativity and two modes of thought

But is it creative?

Stress and creativity

If you like this post, follow me on Twitter: @ArchivePsych

Monday, September 28, 2020

Memory clinic for people with intellectual disability


It was great to see Trinity College Dublin's news page cover a recent webinar from the National Intellectual Disability Memory Service at Tallaght Hospital. In addition to Professors Mary McCarron and Seán Kennelly, who established the service, the webinar had the special guest speaker Dr Juan Fortea, who spoke of some of the intersectional aspects of health inequities for people ID, as well as highlighting his work with the Down Alzheimer Barcelona Neuroimaging Initiative and international consortia. He mentioned that there appears to be more funding for research on this topic in the United States, although the incidence of Down Syndrome is higher in Europe. He also spoke about the value of research in enhancing quality of life for people with Down Syndrome, and highlighted that barriers to participation in research could well be considered a form of discrimination against people with Down Syndrome.    

The National Intellectual Disability Memory Service will work in assessment, diagnosis, post-diagnostic support, and research. Assessing any patient for dementia is complicated, but this is particularly true in the context of intellectual disability, where physicians cannot assume a typical baseline level of cognitive performance or independence in daily living. The onset of dementia is younger on average in people with ID, so the potential to capture baseline cognitive performance and independence at a younger age (e.g. mid-thirties) will allow for a clearer picture of any decline. Professor Seán Kennelly highlighted the importance of appropriate disclosure of diagnosis, as well as how post-diagnostic support should take into account lifestyle factors such as sleep and physical activity.   

The National Intellectual Disability Memory Service aims to develop satellite clinics across Ireland, so patients from around the country will not necessarily have to travel to Tallaght in Dublin for assessment. Professor Mary McCarron also underlined the value of telemedicine in helping to address equity of access, particularly in this time of the COVID-19 pandemic. A recent guide to memory clinics highlighted that there were no memory clinics for the general population in the Northwest of Ireland, despite this region having the highest prevalence of dementia, and to the best of my knowledge there is no national memory clinic for the general population. Notwithstanding that general memory clinics will see a higher number of patients, the NIDMS is clearly setting a very high standard in this arena.

The webinar is available at the NIMDS webpage: 

Related posts

Detecting dementia in people with ID

If you like this post, follow me on Twitter: @ArchivePsych

Thursday, September 17, 2020

Irish Research Staff Association: meeting with Minister Simon Harris

I recently became Chair of the Irish Research Staff Association (IrishRSA), which represents research staff across the island of Ireland. My colleague Dr Rosarii Griffin and I had the chance to meet with Minister Simon Harris and his team at the Department of Further & Higher Education, Research, Innovation & Science.

The meeting was very constructive, covering various topics affecting Irish research staff, with the precarity of researcher careers being a key issue underpinning the discussion. We discussed  researcher representation on decision making bodies, and the need for researchers to be consulted on the content of the national Researcher Career Framework.

Another key point was the importance of collating reliable data on researcher numbers & career trajectories, which is required to inform policy with regard to research careers.

We also discussed future research policy, Horizon Europe, impacts of Brexit, UNESCO commitments and full-cost extensions to projects interrupted by COVID-19. We look forward to continued consultation with the Minister on these topics and to supporting the Irish HEI research performing sector.

The IrishRSA consists of members from TCD, UCC, UCD, NUIG, MU and RCSI but actively welcomes research staff from all HEIs across the island of Ireland to contact us and join the association (

Many thanks to Minister’s office for the photograph. Left to right: Dr Rosarii Griffin (UCC, Treasurer of Irish RSA), Minister Simon Harris (Minister for Further and Higher Education, Research, Innovation and Science), Dr Andrew P. Allen (TCD, Chair of Irish RSA)

If you like this post, follow me on Twitter: @ArchivePsych