Physical fitness linked to lower cognitive impairment in dementia

Dr Eddy Davelaar from the Department of Psychological Sciences discusses the importance of physical fitness in offsetting cognitive impairment in adults with dementia.

 

Dementia and cognitive impairment cost the UK economy approximately £26 billion per year. The number of people with dementia in England and Wales has been projected to increase by 57% from 2016 to 2040, primarily because of extended life expectancy. Finding ways to slow its severity and progression could have life-changing effects for the 800,000 people estimated to be living with dementia in the UK.

With the increased incidence in dementia, people are interested to know whether it could be prevented through changes in their lifestyle, such as eating habits, exercise, and decreased environmental stress. Research does suggest that a healthy lifestyle lowers the risk of dementia. We were interested in physical fitness as one of the lifestyle factors. In our recent article published in Frontiers in Public Health, we asked the question of whether self-reported physical fitness is associated with cognitive, or thinking ability in people with dementia.

To assess this, we used a cross-sectional design with two groups. The first group was made up of 30 older individuals (aged 65+ years) with dementia, who were attending the Alzheimer’s café social events. Those people in the dementia group have lower cognitive performance than the 40 age-matched participants from our control group, who do not have dementia.

We tested everyone on a wide range of cognitive tests, such as verbal fluency, prospective memory, and clock drawing. We also administered a 15-item questionnaire on physical fitness, which asked about strength (eg. ability to lift things), balance, and aerobic conditioning (eg. taking a brisk walk or taking the stairs instead of lifts). Many studies have shown strong correlations between self-report and objective measures of physical fitness. In addition, this questionnaire is available to everyone for self-assessment.

Our findings showed that in the group of dementia patients, those with greater physical fitness also had a greater general cognitive ability. Even those patients with the best cognitive performance still performed worse than the healthy individuals, who did not show this link between physical and cognitive fitness. Thus, physical fitness seems to buffer dementia-related cognitive deterioration.

We ran a number of checks on the results and found that the association did not change when we controlled for the age of the participants, the number of years since dementia diagnosis, the type of dementia, or even whether the person used to be physically active when they were younger. The latter finding suggests that the current state of being physically fit and capable is key to observing this cognitive benefit.

There are at least two explanations for these findings. First, the cardiovascular hypothesis states that physical activity stimulates blood circulation in frontal-striatal circuits (neural pathways that connect frontal lobe regions with the basal ganglia that mediate motor, cognitive, and behavioural functions within the brain), that are critical in executive functioning, such as planning and reasoning.

A second hypothesis suggests that physical fitness measures, such as strength and balance, require efficient brain representations of motor plans. The processes by which these motor representations become more efficient also leads to enhanced cognitive representations. Both hypotheses underscore the expression, ‘what is good for the heart is good for the brain’.

We are currently in the process of addressing the question of whether physical fitness (using both self-report and objective measures) is associated with cognitive decline or cognitive impairment in the absence of dementia. This would assess whether greater physical fitness is associated with greater mental fitness in general, or with cognitive fitness specific in the context of dementia.

Future research could also extend this work using longitudinal study designs in order to address the question of whether a change in physical fitness is associated with a change in the risk of dementia, which has important implications for health policy and age-appropriate physical intervention programmes for both healthy individuals and dementia patients.

Read the original, peer-reviewed article: Increased Physical Fitness Is Associated with Higher Executive Functioning in People with Dementia (2017).

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Why are women prisoner numbers rising so rapidly?

Catherine Heard, from the Institute for Criminal Policy Research (ICPR) at Birkbeck, discusses the latest data released in the World Female Imprisonment List. Catherine directs the World Prison Research Programme at ICPR, which hosts and publishes theWorld Prison Brief.

This week at ICPR, we released the most comprehensive global dataset ever produced on women prisoner numbers. The fourth edition of our World Female Imprisonment List – published on 9 November – shows that the world’s female prison population has increased by about 53% since 2000. In comparison, the male prison population has gone up by around 20%. Numbers of women prisoners are rising in every continent of the globe, with significant increases reported in both developed and less developed countries.

The surge in numbers of incarcerated women is all the more troubling given the high levels of vulnerability we know exist among women who get caught up in criminal justice processes. Women and girls in prison usually come from backgrounds of disadvantage. They are highly likely to have been victims of crime themselves and are far more likely than other women to have histories of trauma, abuse, neglect and mental ill health. The World Health Organisation estimated in a 2009 report that up to 80% of women prisoners have an identifiable mental illness.

For virtually every country across the globe, the List gives information on the total number of women and girls in prison; the percentage of that country’s prison population comprised by women; and the number of imprisoned women and girls per 100,000 of the national population (the ‘prison population rate’). The List also includes information about trends in female imprisonment, at national, regional and continental levels. For most countries, the List gives trend data back to 2000 and at intervals since. (On the World Prison Brief website, trend data going back much further in time are available for many countries’ overall imprisonment levels.)

The List shows, for example, that in England and Wales, the total number of women prisoners has fallen somewhat since the high levels seen in 2005 and 2010, although it’s still higher than it was in 2000. We learn that our female prison population rate is 6.7 per 100,000 of the general population, compared with the Netherlands’ rate of 3.2 (reduced from over 11 per 100,000 in 2006).

Some of the biggest increases have occurred in countries struggling with severely overcrowded prisons, where conditions are already reported as inhumane. In El Salvador, for example, female prisoners are now at 10 times the level they were in 2000, while in Cambodia and Indonesia, numbers have increased six-fold. The data present a worrying picture of uncontrolled growth in numbers, often in countries whose prison systems are being expected to deal with ever-larger influxes, while deprived of the resources to do so.

If we set these new figures within the wider context of what we know about prison conditions and human rights infringements in some parts of the world, the implications are alarming. In Brazil, for example, where around about 44,700 women and girls are now in prison – more than four times the number in 2000 – severe resource constraints make it impossible for the country’s prison system to comply with laws stipulating that women prisoners be housed in separate facilities from men. As a result, some women are held in designated wings of men’s prisons, leading to a risk of assaults and violence from male prisoners and staff, as Human Rights Watch has reported. Female prisoners who are held in women-only prisons endure appalling levels of overcrowding and a lack of access to even basic medical care and treatment.

Our prisons research at ICPR aims to bring about a deeper understanding of the many interwoven factors that combine to drive increases in countries’ use of imprisonment and to find concrete, practical solutions to end the unsustainable increases in imprisonment levels that we have seen in recent history. To do this, we need to focus on providing a much better account of who it is that our states choose to imprison, and why.

This is the aim of our current project, Understanding and reducing the use of imprisonment worldwide, which we are undertaking in collaboration with a network of NGOs, academics, lawyers and criminal justice practitioners. The project entails an in-depth exploration of imprisonment in 10 jurisdictions across all five continents. Those countries are Kenya, South Africa, Brazil, the United States, India, Thailand, England & Wales, Hungary, the Netherlands and Australia. Among these are countries with some of the largest prison populations in the world: the USA, Brazil, India and Thailand are all in the top six globally. Most of these 10 countries have seen very significant increases in their female prison populations since 2000, as the List shows.

In our report, Prison: Evidence of its use and over-use from around the world, we discuss some of the key themes to be addressed if we are to reverse this worrying trend of rising prison populations. Perhaps the most challenging, yet important, among these themes is the need to ask what purposes imprisonment can reasonably and realistically be expected to serve, both as a matter of general principle and in individual cases.

Women across the world are predominantly incarcerated for minor, non-violent, property or drug-related crimes and are often primary carers for one or more children or older family members. This surely suggests that the economic and social costs of imprisoning women will, in most cases, outweigh the supposed benefits, which should prompt us to look more carefully at whom we imprison and ask, in every case, why we imprison and what we expect prison to achieve.

A note on the data

Compiling the List and all the comparative and trend data it contains is no mean feat – one that Roy Walmsley has undertaken every year since the World Prison Brief was founded in 2000. Having to work to the same cut-off date for all countries inevitably means that, by the time the List is published, more recent figures will have been released for many countries. People wanting to ensure they have the very latest data available should always check the World Prison Brief website – whether they are looking for data on a particular country or region, or want to see how countries rank globally.

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What drives efficiency in knowledge transfer?

Dr Federica Rossi, lecturer in business economics discusses increasing expectations on universities to demonstrate the positive economic and social impacts of their activities, and her research into measuring the efficiency of their efforts. 

Knowledge transfer is a term used to encompass a broad range of activities to support mutually beneficial collaborations between universities, businesses and the public sector. In the face of demands from funding bodies and ultimately taxpayers, universities all over the world are increasingly expected to demonstrate that their activities have a positive economic and social impact. Direct knowledge transfer to businesses, governments and society in general allows universities to make a visible contribution outside the ‘ivory tower’ of academia and can also help them to raise additional funds.

Measuring efficiency

Since knowledge transfer has become as important as a university’s longstanding commitment to teaching and research, the question of how well they perform this mission has gained prominence. Most universities attempt to measure performance in knowledge transfer, but focus on a quantity of outputs rather than the quality or efficiency. Even studies that measure efficiency tend to focus on a limited set of knowledge transfer activities, like technology through the commercialisation of patent licenses, creation of spin-out companies or research contracting with industry.

However, universities fulfil their knowledge transfer mission through many other activities, which include delivering knowledge-intensive services such as consultancies, clinical tests, prototypes and professional development courses, engaging in informal networks and staff exchanges with industry, contributing to community regeneration programmes and engaging with the public through different media.

Findings

The efficiency of 97 universities in the United Kingdom was measured for a range of knowledge transfer activities: research contracts, consultancies, professional development courses, generation of intellectual property and public engagement. Compared with a restrictive definition of knowledge transfer that only includes research contracts and intellectual property, this broader approach produces a different ranking for the most efficient universities: more universities achieve efficiency, and the distribution of efficiency scores is less skewed.

The universities that increase their efficiency when a broader definition of knowledge transfer is used have a lower share of staff in medicine and natural sciences and a higher share of staff in the arts and humanities; they are less likely to have a university hospital, and are more teaching-intensive. By adopting a broader approach to measuring knowledge transfer, some universities that are less research-oriented and less focused on science and medicine can better demonstrate their efficiency. More efficient institutions have a larger amount of staff and students; they are older, but have a more recently established knowledge transfer office; and they are specialised in a few subject areas (although some diversified universities are also efficient). Research, teaching intensity, and geographical location do not have a significant effect on efficiency.

Implications

The findings suggest that universities with different production models can be equally efficient in generating knowledge transfer outputs, and that research intensity is not a prerequisite for efficiency. Universities can achieve efficiency by adopting a model of knowledge transfer engagement that is consistent with their resources, without needing to replicate the knowledge transfer strategies of prominent institutions whose resources may be very different. By improving their reputation for excellence in specific activities that best fit the institution’s resources, universities may increase their ability to generate further knowledge transfer outputs. In fact, institutional reputation appears to increase knowledge transfer opportunities, with more reputable older, larger and diversified institutions achieving greater efficiency.

Another implication of the findings is that, rather than having an established Knowledge Transfer Office (KTO), what affects efficiency are its practices and policies, and the professionalism of its staff. KTOs therefore need to invest in staff training and in the development of best practices. Developing specialised, subject-specific skills and structures to support knowledge transfer, rather than generic ones may also pay off.

While performance is often measured by looking at outputs, thinking about performance in terms of efficiency helps us recognise that universities work with very different resources, which affects the nature of their knowledge transfer engagement. Changes in the resources available to universities, through potential changes in the rules governing the allocation of public funds, will also change their ability to engage in knowledge transfer.

Policymakers need to think systematically about the effect of changes in funding for research and teaching (for example, the replacement of recurrent grants with competitive funding) on a university’s ability to engage in knowledge transfer. The relationship between funding sources and knowledge transfer strategies, which has been largely unexplored to date, would merit greater attention from both researchers and policymakers.

The detailed empirical analysis on which these results build is presented in:

Rossi, F. (2017) The drivers of efficient knowledge transfer performance: evidence from British universities, Cambridge Journal of Economics.

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The Seasons in Quincy UK release

On 23 June The Seasons in Quincy: Four Portraits of John Berger, a film produced by Birkbeck’s Derek Jarman lab, will be released in the UK and Ireland, screening in cinemas in London, Glasgow, Manchester and Bristol, among others. It will also be available online via Curzon Home Cinema, and a DVD will come out in August. Lily Ford, Deputy Director of the Derek Jarman Lab and producer of the film, explains the significance of the film’s cinematic release for research-based film-making.

siq_ukquad_master_medThe Seasons in Quincy is the first feature-length documentary to be produced by the Derek Jarman Lab, Birkbeck’s audiovisual hub, and was made by graduate students there (Lily Ford, Bartek Dziadosz and Walter Stabb) in collaboration with Tilda Swinton, Christopher Roth, Simon Fisher Turner and Colin MacCabe.

The Seasons started out as a film-making exercise, and the open-endedness of the project as it evolved over several years allowed for a great degree of creative freedom and experiment. We were extremely lucky to have the goodwill of John Berger, and the close involvement of Tilda Swinton. We travelled to the Alps as a capsule crew, conducting our shoots as efficiently and unobtrusively as possible and without a script or fixed shotlist, then spent a long time editing each part of the film. It took two years to find the right edit for the first part of the film, ‘Ways of Listening’; we then used this to raise funds for three more chapters from the Silicon Valley Community Foundation and the Pannonia Foundation, via the University of Pittsburgh. The nature of the funding, and our home within Birkbeck, enabled the Lab to give the process the necessary time, and to involve other Birkbeck students in filming, editing and disseminating the finished film.

Over 2016 the film had a vigorous festivals run, and was distributed in the US and Canada, making us realise that there was a wider audience and some commercial potential for it. We were really delighted to get UK and Ireland distribution this year, both as recognition of the quality of the film, and to enable a broader public around the two countries to watch it on big and small screens. It is almost unprecedented for a British university to produce a feature film that is commercially viable; Birkbeck and the Derek Jarman Lab have done this.

John Berger’s humanist commitment, accessible erudition and generosity of spirit is already well known, and it gives all of us great pleasure to have preserved this in the film, now that he is no longer with us. He was of course no stranger to the camera, and we were able to draw on his broadcast past in The Seasons; in this respect the film consists of many more than four portraits. The essayistic approach we took, a hallmark of the Lab’s modus operandi, makes the film very different from a classic biographical documentary and allows space for quite unique forms of engagement with Berger’s work. The critical reception of the film, as well as the warm audience response, confirms that it is a necessary and rewarding approach.

It is this kind of filmmaking – collaborative, innovative and intellectually engaged – that a university-based organisation such as the Derek Jarman Lab can undertake. We continue to advocate for research-based filmmaking, reaching out to graduate students and faculty at Birkbeck and encouraging them to think with film. While digital video and online platforms have made the moving image a very accessible medium for research output, the success of The Seasons in Quincy shows there is also scope for more long-form and cinematic enterprises from within the academic environment.

Further information:

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