Neuropsychology and Cognitive Neuroscience

Principal Investigator:

Professor Niall Pender

Researchers:

Ms Marta Pinto-Grau,

Mr Emmet Costello,

Dr Tom Burke,

Ms Sile Carney,

Ms Caroline Wheeler,

Mr Donal Campbell,

Mr Colm Peelo.

Neuropsychological Research Programme:

Neuropsychology is a branch of Psychology which studies the relationship between brain changes and changes on cognition, behaviour and emotion. The neuropsychological research undertaken in the Academic Unit of Neurology, in collaboration with the Department of Psychology, Beaumont Hospital, aims to investigate the nature, extent and progression of neuropsychological changes that occur in neurological conditions such as the neurodegenerative diseases of Motor Neurone Disease, multiple sclerosis and Huntington’s disease. We are particularly interested in the fractionation of cognitive/behavioural functions following disruption of neural circuitry such as the fronto-striatal circuitry and how we measure these changes. The Neuropsychology group has four sub-themes that guide our research programme.

The Neuropsychological research programme

1. Accurate Measurement: Understanding the psychometric and statistical properties of cognitive/behavioural tests.

Our team has examined the statistical properties of cognitive tests in neurological patients and specifically have validated cognitive tools for the Irish population and developed expertise in managing large longitudinal neuropsychological studies. We are currently collaborating with our Colleague in Edinburgh Professor Sharon Abrahams on a validation of the Edinburgh Cognitive ALS Screen for Huntington’s patients.

2. Neuropsychological Phenotypes: Understanding the cognitive and behavioural profile of neurological patients.

This research is part of the ongoing deep phenotyping of ALS/MND, which aims to identify cognitive markers and characterize different phenotypes within the ALS spectrum. Accurate cognitive phenotyping also contributes to improved disease care management and allows for an informed decision making process regarding treatment plans and interventions to happen.

We are also undertaking a deep phenotyping of the cognitive and behavioural presentation of HD in Ireland with the help of a grant from the Monkstown Foundation.

We are also collaborating with Mr Mohsen Javadpour, Consultant Neurosurgeon (Beaumont Hospital and TCD) and Prof. Matt Campbell (Dept of Genetics, TCD) in developing an understanding of the cognitive/behavioural consequences of neurovascular brain injury by examining patients following Sub Arachnoid Haemorrhage in addition to those with living unruptured aneurysms and Arterio-Venous Malformations.

3. Developing and testing psychological interventions for patients;

This is a vital component of our research which aims to develop and standardise treatment interventions for neurological patients. We are developing RCTs for patients and caregivers of neurodegenerative diseases using standardised chronic illness models and in collaboration

with Professor Anne Hickey of the RCSI we are undertaking a HRB ICE funded RCT of a cognitive intervention for stroke.

4. In collaboration with our colleagues in the health service theme, the development of interventions and support for caregivers in addition to understanding the psychological factors in healthcare utilisation.

We are then taking this knowledge and expanding it to the carers of neurological patients and testing the utility of the Building Better Caregivers raining group in addition to completing a long-term follow up of the psychological features of MND caregivers.

Ongoing research

ALS/MND research programme:

Up to date, the team has published the first incident population-based study of cognition in ALS and has shown that executive dysfunction is a negative prognostic indicator for survival. A comprehensive behavioural assessment has also been develop and validated, and used to assess the prevalence of behavioural changes in this patient group. The Neuropsychology strand of the MND research team has also been collaborating with other centres within Europe to develop a disease staging system that considers cognitive and behavioural changes in disease progression. As a result of this collaboration, a cognitive screen for ALS has been validated in Ireland, which has allowed for this standardized tool to now be employed in clinical practise.

As a natural continuation of the ongoing deep phenotyping in ALS in a population-based setting of incident cases, a longitudinal study investigating language changes in ALS is now being carried out. This project aims to investigate the nature, frequency and progression of language changes in an incident sample of ALS patients, as well as to examine the relationship between language changes and changes in other cognitive domains. Moreover, the presence of language-variant FTD in conjunction with ALS is also explored.

Concurrently, in collaboration with the Health Services Research theme, evidence-based guidelines for the management of ALS with cognitive and behavioural deficits have been developed, and psychoeducational sessions with families and healthcare professionals working with ALS patients have been carried out. Moreover, the consequences that cognitive and behavioural changes have on caregiver burden are also systematically investigated and tailored interventions are planned to best address the needs of those caring for ALS patients.

Neurovascular research:

In collaboration with Mr Mohsen Javadpour consultant neurosurgeon we are investigating the neurocognitive effects of neurovascular lesions. In particular we are examining the effects of Sub Arachnoid Haemorrhage (SAH) arising from ruptured aneurysms, angio-negative SAH, and the effects of un ruptured aneurysms. Our preliminary data reveal a range of cognitive impairments in these samples and highlight the need for services aimed at helping SAH patients recover from the cognitive and behavioural effects of their brain injury. This research is funded by Friends of A.

ENROLL-HD at Beaumont:

ENROLL-HD is a multi-national, multi-disciplinary observational platform for the longitudinal investigation of Huntington’s disease. We are the only Irish site for ENROLL-HD and Niall Pender is the

site PI. There are currently over 20,000 patients registered with the platform worldwide. This research is funded by CHDI/Quintiles.

Stroke:

We are currently collaborating with colleagues at the RCSI on an RCT of a cognitive intervention for post-stroke patients. This project funded by the HRB is investigating the benefits of a specific cognitive rehabilitation programme for stroke patients.

Concussion:

We are collaborating with colleagues at St James’ hospital and TCD on a project investigating the effects of concussion on neurological functioning and ways to measure and improve these skills.

Acknowledgements