The Oxford Brain Health Clinic: Protocol and Research Database

Abstract

IntroductionDespite major advances in the field of neuroscience over the last three decades, the quality of assessments available to patients with memory problems in later life has barely changed. At the same time, a large proportion of dementia biomarker research is conducted in selected research samples that often poorly reflect the demographics of the population of patients who present to memory clinics. The Oxford Brain Health Clinic (BHC) is a newly developed clinical assessment service with embedded research in which all patients are offered high quality clinical and research assessments, including MRI, as standard.Methods and analysisHere we describe the BHC protocol, including aligning our MRI scans with those collected in the UK Biobank. We evaluate rates of research consent for the first 108 patients (data collection ongoing) and the ability of typical Psychiatry-led NHS memory-clinic patients to tolerate both clinical and research assessments.Ethics and disseminationOur ethics and consenting process enables patients to choose the level of research participation that suits them. This generates high rates of consent, enabling us to populate a research database with high quality data that will be disseminated through a national platform (the Dementias Platform UK data portal).ARTICLE SUMMARYThe Oxford Brain Health Clinic embeds high-quality assessments into routine clinical care for typical patients with memory problems.The BHC MRI protocol is aligned with the UK Biobank providing a unique opportunity to link the power of big-data and individual patients at the clinical interface.The BHC ethics and consenting process, designed in partnership with an active PPI advisory group, enables patients to choose the level of research participation that suits them.The BHC research database and associated information governance will facilitate research use of real-world clinical information where consent is given.The Oxford BHC pilot required that patients were not contraindicated for MRI. Future work to expand the model will remove this constraint.

Adapting UK Biobank imaging for use in a routine memory clinic setting: the Oxford Brain Health Clinic

“…From the opening of the BHC in August 2020 to November 2021, 108 patients attended their BHC appointment and 101 consented for use of clinical data for research (age range 65-101 years, average 78.3 years, 50.5% female (O’Donoghue et al, 2022a)). As shown in Figure 2, 92.5% (N=100) completed the clinical scans.…”

“…This results in a dataset that is representative of the memory clinic population, as the patients are not selectively recruited for a research study. Because patients can also consent to be recontacted for research (current consent rate 73.1% (O'Donoghue et al, 2022a)), this protocol is also building a valuable participant database for future studies.…”

“…For more details on the non-imaging assessments performed and the research consent process, please refer to (O’Donoghue et al, 2022a).…”

“…The Oxford Brain Health Clinic (BHC) (O'Donoghue et al, 2022a) aims to address this disconnect between the research and clinical domains, whilst providing an ideal clinical setting to validate MRI analysis tools. A joint clinical-research service that opened in August 2020, the BHC augments current NHS psychiatry-led memory clinic services to give patients and clinicians access to high-quality assessments not routinely available, including MRI instead of CT. MRI sequences used in the BHC are identical to, or compatible with, the UK Biobank imaging study (UKB) (Miller et al, 2016), enabling us to directly compare and integrate BHC results with the larger UKB imaging dataset.…”

“…Finally, we compare the characteristics of BHC patients with UKB participants and discuss challenges and opportunities of using UKB as normative distributions and implementing quantitative measures in BHC reports. For more details on the non-imaging assessments performed and the research consent process, please refer to (O'Donoghue et al, 2022a).…”