Association of Increase in White Matter Hyperintensity Volume With Rate of Hippocampal Atrophy in a Population-Based Study of Aging.

Background And Objectives: Higher white matter hyperintensity volume (WMHV) is associated with hippocampal atrophy, cognitive decline, and dementia; however, it is unknown whether continually increasing WMHV is related to hippocampal atrophy. The aim of this study was to determine whether higher WMHV change rate (WMHVR) is related to higher hippocampal atrophy rate (HAR); this relationship is dependent on cardiovascular risk factors (CVRFs), Alzheimer disease (AD) pathology, and genetic risk; and this relationship is mediated by neuroaxonal degradation.

Methods: Participants from Insight46, a substudy of the 1946 British Birth Cohort, underwent combined [F]florbetapir PET/MRI scans at University College London approximately 2.

Insights from fifteen years of real-world development, testing and implementation of youth digital mental health interventions.

This paper reviews the current evidence and synthesizes fifteen years of real-world development, testing, and implementation of digital mental health interventions (DMHIs) for young people. Drawing on the work of Orygen Digital, we outline the evolution of interventions including the Moderated Online Social Therapy (MOST) platform, the Mello app, and a suite of virtual reality-based therapies; all developed to meet the complex clinical, developmental, and service needs of youth aged 12 to 25. We identify ten key challenges and opportunities encountered in designing, developing and implementing these DMHIs: (1) meaningful co-design; (2) sustained user engagement; (3) personalization and transdiagnostic targeting; (4) optimizing intensities of human support; (5) leveraging peer support and social networking; (6) embedding DMHIs in clinical services; (7) blending digital and face-to-face care; (8) building data infrastructure and learning health systems; (9) developing sustainable and scalable business models; and (10) preparing DMHIs for large language models.

Associations between night/shift working and late-life brain health.

Sleep and circadian disturbances are associated with increased dementia risk. The mechanism remains poorly understood. We aimed to examine the relationship between night/shift working at age 31 and biomarkers of late-life brain health and to estimate the extent to which these relationships are mediated by unhealthy lifestyle behaviours.

Staff expectations for the implementation of digital remote monitoring in services for people with psychosis: A qualitative study using normalisation process theory.

Background: Digital remote monitoring (DRM) utilises devices such as smartphones and wearables to remotely collect health-related data, providing insights into the mental health of individuals with psychosis. This data can be shared with mental health services to aid clinical assessment. DRM has been found to effectively identify early signs of psychosis relapse, enabling clinicians to intervene earlier and improve outcomes for service users.

Executive Dysfunction and Disability in SPMS: Predictive Value of the Frontal Assessment Battery in the UCLH MS-STAT2 Cohort.

Introduction: Cognitive impairment is common in secondary progressive multiple sclerosis (SPMS), with executive dysfunction disproportionately so. The frontal assessment battery (FAB) is a bedside test assessing executive function. This study explores the distribution of FAB scores in a large SPMS cohort and their associations with disability.

Evidence-Based Approaches to Quality Improvement: A Narrative Review of Integrating Bayesian Adaptive Trials Into Health Services.

Rationale: Quality improvement (QI) in health service programmes aims to make small, incremental changes to increase reach and efficiency. Simple, low-risk programmatic changes can improve services, particularly when supported by robust evidence. However, in health service contexts, there is tension between the need for swift decision-making and the high research standards for conducting methodologically rigorous trials.

Ultra-fast MRI for dementia diagnosis and treatment eligibility: A prospective study.

Introduction: Magnetic resonance imaging (MRI) is crucial for dementia diagnosis and a pre-requisite for amyloid-lowering therapies in Alzheimer's disease. Despite guidelines, many patients never undergo MRI due to limited scanner availability. Shorter scan times would reduce costs and patient burden.

The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality.

The expanding domain of digital mental health is transitioning beyond traditional telehealth to incorporate smartphone apps, virtual reality, and generative artificial intelligence, including large language models. While industry setbacks and methodological critiques have highlighted gaps in evidence and challenges in scaling these technologies, emerging solutions rooted in co-design, rigorous evaluation, and implementation science offer promising pathways forward. This paper underscores the dual necessity of advancing the scientific foundations of digital mental health and increasing its real-world applicability through five themes.

Mental Health Professionals' Perspectives on Digital Remote Monitoring in Services for People with Psychosis.

Background And Hypothesis: Digital remote monitoring (DRM) captures service users' health-related data remotely using devices such as smartphones and wearables. Data can be analyzed using advanced statistical methods (eg, machine learning) and shared with clinicians to aid assessment of people with psychosis' mental health, enabling timely intervention. Such methods show promise in detecting early signs of psychosis relapse.

A meta-analysis of persuasive design, engagement, and efficacy in 92 RCTs of mental health apps.

This systematic review and meta-analysis examined the efficacy of digital mental health apps and the impact of persuasive design principles on intervention engagement and outcomes. Ninety-two RCTs and 16,728 participants were included in the meta-analyses. Findings indicate that apps significantly improved clinical outcomes compared to controls (g = 0.

Mixed-Methods Evaluation of the Expanded Implementation of Supported Education Within Community Youth Mental Health Services.

Aims: Education is a key goal of young people experiencing mental ill-health and is crucial for many aspects of enjoyable, meaningful lives. However, the completion of education can be a challenge. This paper evaluated the expanded implementation of a targeted education support programme for young people with mental ill-health.

Concurrent validity, test-retest reliability, and normative properties of the ignite app: A cognitive assessment for frontotemporal dementia.

Objective: Digital biomarkers can provide frequent, real-time monitoring of health-related behavior and could play an important role in the assessment of cognition in frontotemporal dementia (FTD). However, the validity and reliability of digital biomarkers as measures of cognitive function must first be determined.

Method: The Ignite cognitive app contains iPad-based measures of executive function, social cognition, and other domains affected in FTD.

How theories, models, and frameworks have been used to implement digital health interventions in services for people with severe mental health problems: a scoping review.

Background: Digital health interventions have the potential to improve the efficacy and accessibility of mental health services for people with severe mental health problems, but their integration into routine practice is a challenge. The real-world implementation of digital health interventions should be considered alongside digital intervention development. However, little is known about the quality of implementation research in this area, including the extent to which implementation science theories, models and frameworks are used.

Pattern Mixture Sensitivity Analyses via Multiple Imputations for Non-Ignorable Dropout in Joint Modeling of Cognition and Risk of Dementia.

Motivated by the Swedish Betula study, we consider the joint modeling of longitudinal memory assessments and the hazard of dementia. In the Betula data, the time-to-dementia onset or its absence is available for all participants, while some memory measurements are missing. In longitudinal studies of aging, one cannot rule out the possibility of dropout due to health issues resulting in missing not at random longitudinal measurements.

Predicting clinical improvement in youth using a national-scale multicomponent digital mental health intervention.

Introduction: Youth mental health services are characterised by high demand and modest clinical outcomes. While digital mental health interventions (DMHIs) have been shown to be clinically effective, the relationship between DMHI use and outcome is unclear. The current study sought to identify the factors affecting the relationship between DMHI use and depression and anxiety symptom improvement in sub-groups of young people.

Remote cognitive tests predict neurodegenerative biomarkers in the Insight 46 cohort.

Background: Alzheimer's disease-related biomarkers detect pathology years before symptoms emerge, when disease-modifying therapies might be most beneficial. Remote cognitive testing provides a means of assessing early cognitive changes. We explored the relationship between neurodegenerative biomarkers and cognition in cognitively normal individuals.

The relationship between leisure time physical activity patterns, Alzheimer's disease markers and cognition.

We assessed the association between leisure time physical activity patterns across 30 years of adulthood with a range of Alzheimer's disease-related neurodegenerative markers and cognition, and their interplay, at age 70. Participants from the 1946 British birth cohort study prospectively reported leisure time physical activity five times between ages 36 and 69 and were dichotomized into (i) not active (no participation/month) and (ii) active (participated once or more/month) and further derived into: (0) never active (not active); (1) active before 50's only (≤43 years); (2) active from 50's onwards only (≥53 years); (3) always active (active throughout). Participants underwent 18F-florbetapir Aβ and magnetic resonance imaging at age 70.

Exploring the Implementation of Cognitive Screening in First-Episode Psychosis Settings: The CogScreen Implementation Study.

Aim: Accurate and appropriate cognitive screening can significantly enhance early psychosis care, yet no screening tools have been validated for the early psychosis population and little is known about current screening practices, experiences, or factors that may influence implementation. CogScreen is a hybrid type 1 study aiming to validate two promising screening tools with young people with first episode psychosis (primary aim) and to understand the context for implementing cognitive screening in early psychosis settings (secondary aim). This protocol outlines the implementation study, which aims to explore the current practices, acceptability, feasibility and determinants of cognitive screening in early psychosis settings from the perspective of key stakeholders.

Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis.

Background: Digital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low.

Objective: This prospectively registered systematic review examined barriers and facilitators of clinician and patient engagement with DMHIs, to inform implementation within real-world settings.

Methods: A systematic search of 7 databases identified empirical studies reporting qualitative or quantitative data about factors affecting staff or patient engagement with DMHIs aiming to monitor or improve the mental or physical health of people with psychosis or bipolar disorder.

A Personalized, Transdiagnostic Smartphone App (Mello) Targeting Repetitive Negative Thinking for Depression and Anxiety: Qualitative Analysis of Young People's Experience.

Background: The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving most young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative just-in-time adaptive interventions, which provide support based on real-time data.

Evaluating the effectiveness of simvastatin in slowing the progression of disability in secondary progressive multiple sclerosis (MS-STAT2): protocol for a multicentre, randomised controlled, double-blind, phase 3 clinical trial in the UK.

Introduction: There remains a high unmet need for disease-modifying therapies that can impact disability progression in secondary progressive multiple sclerosis (SPMS). Following positive results of the phase 2 MS-STAT study, the MS-STAT2 phase 3 trial will evaluate the efficacy and cost-effectiveness of repurposed high-dose simvastatin in slowing the progression of disability in SPMS.

Methods And Analysis: MS-STAT2 will be a multicentre, randomised, placebo-controlled, double-blind trial of participants aged between 25 and 65 (inclusive) who have SPMS with an Expanded Disability Status Scale (EDSS) score of 4.

Application of information from external data to correct for collider bias in a Covid-19 hospitalised cohort.

Background: Throughout the Covid-19 pandemic, researchers have made use of electronic health records to research this disease in a rapidly evolving environment of questions and discoveries. These studies are prone to collider bias as they restrict the population of Covid-19 patients to only those with severe disease. Inverse probability weighting is typically used to correct for this bias but requires information from the unrestricted population.