In previous work, we utilised the UK-CRIS, (Case Record Interactive Search) a database of pseudonymised mental health records from 12 NHS Mental Health Trusts, to investigate the effectiveness of two types of medication in the symptomatic treatment of dementia (Vaci et al., 2020) using data from two UK Mental Health NHS Trusts (Oxford Health and Southern Health). In the sample of over 7000 patients, we show that medication prescription stabilises cognitive performance for a period of 2 to 5 months. The New Mind 2 study expands our previous work, by including diagnosis of depression and related medications, as well as symptoms and well-being measures that frequently follow these two diagnostic outcomes. Similarly to the previous work, once the information extraction systems are developed and data is structured, we plan to explain and interpret the data using frequently used statistical methods in medical research.
In this work we seek to provide evidence for the real-world effectiveness of two main medication classes aimed at slowing down the cognitive decline in people with Alzheimer’s disease. The medication classes were acetylcholinesterase inhibitor (AChEI) such as Donepezil, Rivastigmine or Galantamine and another class of Memantine. We used methods from natural language processing to develop an information extraction system to convert Clinical Record Interactive Search (CRIS) medical records into a structured table and where each observation, such as prescription of medications, had the date of prescription) . Therefore, we can create a timeline of the treatment with medications for each patient Some patients may have been treated subsequently with multiple medications. Eg. a patient started on Memantine, but later was switched to Donepezil, followed by Rivastigmine. We also extracted the information that indicates and measure s the level of cognitive ability in people with dementia. This gives us an unprecedented possibility to investigate how prescription and intake of dementia-related medication influences the cognitive ability and helps the patients. The usual pattern that we observe is that before taking any medications, patients decline rapidly in their cognitive abilities, becoming cognitively slower and impaired. Once the medication is prescribed, we observe stabilisation of this cognitive decline or even improvement of cognitive ability. In other words, medication preserves the cognitive ability of patients for some time, ranging from 2 to 6 months depending on the type of medication and the type of Alzheimer’s However, this effect is not sustained , as the cognitive performance starts to decline again, once the initial effect of medication declines.
UK Biobank (UKB) comprises a large data resource with more than 500,000 participants and with a wide variety of variables, such as demographic, lifestyle, environmental and health information for the assessment of various life-threatening and disabling conditions, including mental health disorders. However, the applicability of UKB and its relevance in a clinical setting and the assumptions required have not been sufficiently and systematically defined. Here, we present the first study to authenticate UKB’s applicability and relevance by using secondary care mental health data with linkage to UKB from Oxford – Clinical Record Interactive Search (CRIS) focusing on comparison of demographic information, diagnostic outcome, medication record and cognitive test results.
We applied a natural language processing model to extract information embedded in unstructured text from clinical notes and attachments. UKB data comprises a large variety of different data modalities, such as genomics, imaging data, self-reported outcomes, physiological time-series from wearable devices and many more, however, the UKB data are lacking follow-up records, whereas CRIS offers a longitudinal and detailed clinical picture with more than ten years of observations.
The linkage of both data sources, UKB and UK-CRIS, represents untapped potential for comprehensive research in mental health, synergistically complementing each other in various data modalities and to allow more robust research in mental health. Specifically, it is now possible to combine precise information from UKB, such as data from wearable devices, imaging and genetic data with accurate and clinically validated longitudinal data from UK-CRIS, including diagnoses, treatments, administered medications, psychological sessions and information from specialised clinics.
iASiS is an EU funded project that seeks to pave the way for precision medicine approaches by utilising insights from patient data. It aims to combine information from medical records, imaging databases and genomics data to enable more personalised diagnosis and treatment approaches in two disease areas – lung cancer and Alzheimer’s disease. In the above study (study title), will be analysing data of Dementia and Alzheimer’s patients from Oxford’s UK-CRIS.
This is a prescribed app. It should only be used alongside a face to face intervention provided by a mental health worker. Check with your local service to see if they subscribe to the app.