Carol Brayne

University of Cambridge | Cam · Cambridge Institute of Public Health

This contribution builds on the Design Framework for System-of-Systems Resilience to investigate the potential of a new systems resilience measuring approach inspired by the Frailty Index. To explore this research direction, we provide a brief overview of the evolution of the notion of resilience, offer a characterisation of systems resilience as a...

This contribution departs from an existing model, the Design Framework for Systems-of-Systems Resilience, to explore systems resilience issues across the health, environmental, and economic domains. The reported research activities include 1) a rapid review to collect a set of systems indicators and 2) a design workshop employing causal loop diagra...

Background: There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown. Methods: Cross-sectional, community-based, nationally representative data fr...

Background People with severe mental illness (SMI) have a higher prevalence of several chronic physical health conditions, and the prevalence of physical multimorbidity is expected to rise. The aim of this study was to assess the strength of the association between SMI and physical multimorbidity. Study selection and analysis We systematically sea...

Stakeholder management often is a complex process in large, multidisciplinary projects with systemic implications. In this contribution, we adopt a systems engineering approach to stakeholder management in a large-scale landscape regeneration effort in the UK, namely the Cambridge Centre for Landscape Regeneration (CLR). Through stakeholder mapping...

The epidemiological neuropathology perspective of population and community-based studies allows unbiased assessment of the prevalence of various pathologies and their relationships to late-life dementia. In addition, this approach provides complementary insights to conventional case-control studies, which tend to be more representative of a younger...

We absolutely agree that the language used is important, and that the language of risk is very often geared towards a biomedical paradigm, in which an individual is at risk, and actions taken by them (and their healthcare provider) may or may not avoid the translation of risk into disease. We agree that this represents an insufficient perspective f...

Dementia is forecast to become increasingly prevalent, particularly in low- and middle-income countries, and is associated with high human and economic costs. Primary prevention of dementia -preventing risk factors leading to disease development - is an emerging global public health priority. Primary prevention can be achieved in two ways: individu...

Dear editor, We congratulate Professor Wimo et al. on their important model-ing study, 1 which estimated the cost effectiveness, from a societal perspective, of a multi-domain dementia prevention intervention for at-risk adults. While the authors detail several important limitations, and report several appropriate sensitivity analyses, there are tw...

Technology is widely promoted as a solution to greater independence and better health for the rapidly growing UK older population. If this is to be realised, we need to understand barriers and facilitators to uptake and investigate who wants this technology and who does not express an interest in use. This analysis is based on data from a populatio...

Regression discontinuity design (RDD) is a quasi-experimental method intended for causal inference in observational settings. While RDD is gaining popularity in clinical studies, there are limited real-world studies examining the performance on estimating known trial casual effects. The goal of this paper is to estimate the effect of statins on myo...

Although a variety of brain lesions may contribute to the pathological assessment of dementia, the relationship of these lesions to dementia, how they interact and how to quantify them remains uncertain. Systematically assessing neuropathological measures by their degree of association with dementia may lead to better diagnostic systems and treatme...

Background: Population-based autopsy studies provide valuable insights into the causes of dementia but are limited by sample size and restriction to specific populations. Harmonisation across studies increases statistical power and allows meaningful comparisons between studies. We aimed to harmonise neuropathology measures across studies and asses...

Observational population studies indicate that prevention of dementia and cognitive decline is being accomplished, possibly as an unintended result of better vascular prevention and healthier lifestyles. Population aging in the coming decades requires deliberate efforts to further decrease its prevalence and societal burden. Increasing evidence sup...

Although delirium is a significant clinical and public health problem, little is understood about how specific vulnerabilities underlie the severity of its presentation. Our objective was to quantify the relationship between baseline cognition and subsequent delirium severity. We prospectively investigated a population-representative sample of 1510...

Background and Objectives Use of OTC laxatives is common in the general population. The microbiome-gut-brain axis hypothesis suggests use of laxatives is associated with dementia. We aimed to examine the association between regular use of laxatives and incidence of dementia in UK Biobank participants. Methods This prospective cohort study was base...

Dementia is a leading global public health challenge. Prevention approaches have traditionally focused on individual‐level strategies. However, such approaches have limited potential, particularly for resource‐constrained populations in which exposure to risk factors is greatest, and exposure to protective factors is lowest. A population‐level appr...

Cardiovascular ageing contributes to cognitive impairment. However, the unique and synergistic contributions of multiple cardiovascular factors to cognitive function remain unclear because they are often condensed into a single composite score or examined in isolation. We hypothesized that vascular risk factors, electrocardiographic features and bl...

Supplementary Online Content

Infections in older people are a major cause of mortality and morbidity and may be important modifiers of outcomes for people with dementia. There is limited evidence on the role of infections and associated hospital admissions on subsequent outcomes for people living with dementia. We explored mortality in individuals with dementia admitted to hos...

Most autopsy samples are based on clinical cohorts or case series; the distribution of neuropathologies may be biased in these samples compared to the general population. A small number of population‐based neuropathology cohorts address these concerns but are often limited by small sample sizes and restrictions to specific geographic locations or g...

Editorial providing a sense of perspective on the hyperbolic reporting of the phase III trial results for lecanemab.

An international consensus report in 2019 recommended a classification system for limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC). The suggested neuropathologic staging system and nomenclature have proven useful for autopsy practice and dementia research. However, some issues remain unresolved, such as cases w...

Background Ambient air pollution is a pervasive and ubiquitous hazard, which has been linked to premature morbidity and a growing number of morbidity endpoints. Air pollution may be linked to neurodegeneration, and via this or other pathways, to neurodegenerative diseases. Emerging evidence suggests that air pollution may contribute to neurodegener...

Introduction: There are limited data on prevalence of dementia in centenarians and near-centenarians (C/NC), its determinants, and whether the risk of dementia continues to rise beyond 100. Methods: Participant-level data were obtained from 18 community-based studies (N = 4427) in 11 countries that included individuals ≥95 years. A harmonization...

Identifying and monitoring of health inequalities requires good-quality data. The aim of this work is to systematically review the evidence base on approaches taken within the healthcare context to improve the quality of data for the identification and monitoring of health inequalities and describe the evidence base on the effectiveness of such app...

A disconnect has developed over the past two decades between neurological and neuroscientific research, which have seen notable innovation and development, and our increasing understanding of the role of social and commercial determinants of health, including the health of the nervous system. Over the next two decades, grounding neurological resear...

Background: The COVID-19 pandemic and associated social distancing measures have profoundly impacted society and social contact patterns, with older people disproportionately affected. Concerns have been raised about a resulting pandemic of loneliness in older people, although the current evidence is mixed. This study provides a unique perspective...

Background In both scale and impact, population ageing has far reaching implications for our planet, not least as a major driver of population growth and the ever-increasing human demands on natural resources and ecosystems. This fundamentally impacts sustainable development efforts to eradicate poverty, achieve food security, build inclusive and r...

Background: Understanding how certain factors affect autism incidence can help to identify inequities in diagnostic access. We aimed to investigate the incidence of autism in England as a function of geography and sociodemographics, examining spatial distribution across health service boundaries. Methods: In this retrospective, longitudinal, sch...

Background The COVID-19 pandemic has caused the loss of millions of lives and economic breakdowns in many countries across the globe. Despite the limited availability of vaccines and the challenges of poor health infrastructure, few interventions have been developed and implemented for those who live in rural areas, particularly in sub-Saharan Afri...

Introduction: Coronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotox...

South‐Eastern Europe only recently was required to adapt their domestic law to adhere to European Union legislations and standards. As such, it forms an excellent case study on how and to what extent the ‘Europeanisation’ process is interacting with the development of special education needs (SEN) policy, particularly focusing on autistic children....

While there is growing evidence of associations between infections and dementia risk, associations with cognitive impairment and potential structural correlates of cognitive decline remain underexplored. Here we aimed to investigate the presence and nature of any associations between common infections, cognitive decline and neuroimaging parameters....

Large-scale volunteer databanks (LSVD) have emerged from the recognized value of cohorts, attracting substantial funding and promising great scientific value. A major focus is their size, with the implicit and sometimes explicit assumption that large size (thus power) creates generalizability. We contend that this is open to challenge. In the conte...

Lay Summary: We examined the impact of infections in people living with dementia by examining hospital admissions data. We found that people with dementia who were admitted for infections were more likely to die than people with dementia admitted for other causes or not not admitted at all. These findings suggest infections are an important issue f...

Dementia is a leading global cause of morbidity and mortality. Evidence suggests that tackling modifiable lifecourse risk factors could prevent or delay a significant proportion of cases. Population- and community-based approaches change societal conditions such that everyone across a given community is more likely to live more healthily. We system...

Dementia has been recognised as a key challenge in many ageing societies across the world. Several population-based studies have been developed to investigate dementia and cognitive ageing from perspectives of biology, health, psychology and social sciences. However, there is a need to provide a better understanding of ‘contexts’, the circumstance...

Background Numerous determinants have been linked to public mental health; however, they have not been brought together in a comprehensive conceptual framework. The goal of this work was to bring together academic research, practitioner expertise, and public perspectives to create a public mental health conceptual framework. Methods The developmen...

Climate change is a global problem, but climate solutions primarily need to be deployed at a local level. Local stakeholders play a vital role in taking decisive action to meet national and international climate targets. Effective local, regional and national policy and governance frameworks are needed. During the 2021-2022 academic year, the Cambr...

Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) and Alzheimer’s disease neuropathologic change (ADNC) are each associated with substantial cognitive impairment in aging populations. However, the prevalence of LATE-NC across the full range of ADNC remains uncertain. To address this knowledge gap, neuropathologic...

Objectives: To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic. Methods: People with dementia and their carers completed assessments before (July 2019-March 2020; 206 dyads) and after (July-October 2020) the first Covid-19 'lockdown' in England. At follow-up, the analytic sample comprise...

Current evidence is inconclusive on cognitive benefits or harms of statins among stroke patients, who have high risk of dementia. This observational cohort study investigated the association between statin use and post-stroke dementia using data from the Clinical Practice Research Datalink. Patients without prior dementia who had an incident stroke...

Objectives To evaluate the characteristics of individuals recorded as having a dementia diagnosis in different routinely collected records and to examine the extent of overlap of dementia coding across data sources. Also, to present comparisons of secondary and primary care records providing value for researchers using routinely collected records f...

Although a variety of brain lesions may contribute to the pathological diagnosis of dementia, the relationship of these lesions to dementia, how they interact and how to quantify them remain uncertain. Systematically assessing neuropathological measures in relation to the cognitive and functional definitions of dementia may enable the development o...

Introduction: COVID-19 has impacted people with dementia and their family carers, yet little is known about effects on overall quality of life. Methods: In a UK cohort study, pre- and post-pandemic data were collected from 114 carers and 93 recently diagnosed people with dementia. Latent growth curve modeling examined change in quality of life....

In an increasingly interconnected world, changes of uncertain nature and impact affect the functioning of human societies that depend on health, ecological, and economic systems. The proposed framework for systems-of-systems resilience explains ways of accommodating and responding to these challenges while encompassing the interfaces of the health,...

Although a variety of brain lesions may contribute to the pathological diagnosis of dementia, the relationship of these lesions to dementia, how they interact and how to quantify them remain uncertain. Systematically assessing neuropathological measures in relation to the cognitive and functional definitions of dementia may enable the development o...

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 ris...

Background Previous research has examined the improvements in healthy years if different health conditions are eliminated, but often with cross-sectional data, or for a limited number of conditions. We used longitudinal data to estimate disability-free life expectancy (DFLE) trends for older people with a broad number of health conditions, identify...

Background: There is an unmet public health need to understand better the relationship between baseline cognitive function, the occurrence and severity of delirium, and subsequent cognitive decline. Our aim was to quantify the relationship between baseline cognition and delirium and follow-up cognitive impairment. Methods: We did a prospective l...

Vascular, cardiovascular and neurovascular ageing processes contribute to cognitive impairment. However, the unique and synergistic contributions of cardiovascular factors to cognitive function remain unclear because they are often condensed into a single composite score or examined in isolation of each other. We hypothesized that vascular risk fac...

Background: Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for publ...

Brain health as expressed in our mental health and occurrence of specific disorders such as dementia and stroke is vitally important to quality of life, functional independence, and risk of institutionalization. Maintaining brain health is, therefore, a societal imperative, and public health challenge, from prevention of acquisition of brain disord...

Background Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for publi...

Objectives We investigated whether people with dementia or low memory/orientation reported more help misaligned with needs – more unmet need and/or more unrequired help – than other people with similar levels of functional limitation, and examined associations with quality of life. Methods From pooled English Longitudinal Study of Ageing data from...

Background The roles of blood low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides in the development of post-stroke dementia remain uncertain. Methods We conducted a retrospective cohort study using Clinical Practice Research Datalink. Patients with first-ever stroke but no prior dementia wer...

Background: Mobile health (mHealth) has the potential to bring preventive healthcare within reach of populations with limited access to preventive services, by delivering personalized support at low cost. Although numerous mHealth interventions are available, very few have been developed following an evidence-based rationale or have been tested for...

Importance The optimal systolic blood pressure (SBP) to minimize the risk of dementia in older age is unknown. Objective To investigate whether the association between SBP and dementia risk is U-shaped and whether age and comorbidity play a role in this association. Design, Setting, and Participants This cohort study used an individual participan...

Background Universal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving th...

Genetic discoveries of Alzheimer’s disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study res...

Background While age specific prevalence of dementia has recently declined in some high‐income countries it is unclear whether or how the milder end of the spectrum, including Mild Cognitive Impairment might also have changed across generations. This is likely to vary according to how cognitive impairment has been defined, including exclusion crite...

Background Engagement with digital health tools ihas not been well‐studied in older populations. We aimed to describe engagement with a preventive eHealth intervention designed to reduce dementia and cardiovascular risk, identify factors associated with engagement, and examine associations between engagement and changes in dementia and cardiovascul...

Background Musical instrument playing provides intellectual stimulation, which is hypothesised to generate cognitive reserve that protects against cognitive impairment. Method A systematic review and meta‐analysis of all studies with musical instrument playing as the exposure, and cognitive impairment and/or dementia as the outcome. This was follo...