In the next of the series of reflections from our Research Training Fellows, Lucy Beishon, who is researching the benefits of “brain training” as a treatment for Alzheimer’s disease and mild cognitive impairment, as well as prevention in healthy older adults, has kindly agreed to share her experience of the first year of her fellowship.
What has been your experience of your fellowship so far?
I started my Dunhill Research Training Fellowship in August 2018, and already I feel I have gained so much, in terms of both new experiences and skills. The most enjoyable aspect has been taking an idea from inception and developing it into a fully-fledged study. Being able to develop my own research idea has given me a great sense of ownership and has been immensely satisfying to see it running on a day-to-day basis.
I started the process in August with an idea and worked with my patient and public involvement group, supported by the Alzheimer’s society, to develop and grow these initial thoughts further into a full proposal. I subsequently took this proposal to the research ethics committee, gaining a favourable outcome, and have since navigated the other key regulatory approvals. Without the help and support of my patient group, I don’t think the journey would have been quite so smooth!
The fellowship has given me hands-on day-to-day experience of the practicalities of research and opened up a number of training opportunities. In November 2018, I attended the Nottingham Clinical Trials Unit course where I was able to gain in-depth knowledge of the design, management, and organization of a clinical trial. In turn, this course fed back into my current study, allowing me to make important changes during the development stage to improve the quality and overall design of the trial. In addition to this, I am currently attending a course on Mixed Methods research design at the University of Birmingham. Mixed methods is an entirely new concept to me, and the fellowship has given me the opportunity to develop this relatively unique skill set and apply it practically to a clinical study. I chose a mixed-methods approach for my study in order to deliver a more patient-centered approach to trial design and to gain different perspectives and insights on the barriers and benefits of brain training for people living with dementia. This is going to be a particular challenge for myself, having come from a largely quantitative background, not only to undertake a qualitative element, but also to look at how these two components can be fused to give a better understanding of cognitive interventions in dementia. I am excited to take these skills forward in the future and identify research problems which can be solved using a mixed methods approach. Finally, the fellowship has given me the opportunity to submit a number of papers across a range of topics, including; a systematic review of brain training studies which have looked at brain imaging outcomes, an original article examining the physiology of ageing and the research protocol for my study. I will also be presenting the findings from my initial work at the Alzheimer’s Research UK and Alzheimer’s Society conference this spring.
Why did you choose a career in ageing-related research and how do you see it progressing?
My background is clinical, having completed my medical degree in 2013, I always knew I wanted a career in the care of older people. I am particularly passionate about this because of the complexity of geriatrics as a medical specialty and the extra care and support we need to provide for older adults. Geriatrics was often referred to as a “Cinderella” specialty, and I think this pushed my passion further by wanting to care for a group who can often be undervalued, misunderstood, and poorly represented. I see it as part of my role to be an advocate for older people and to try and get their views, opinions, and concerns heard by the wider community. As a specialty, geriatrics has much to offer, being one where caring and compassion are key qualities, but where medical skills often need to be well honed to try and take a holistic approach to the complexity associated with frailty, ageing, multiple co-morbidity and polypharmacy. These factors combine with often difficult psychological and social circumstances, which makes caring for older people a challenging, but phenomenally rewarding specialty.
How is your research progressing?
I have currently gained all my regulatory approvals for the study and I have begun recruitment with healthy older adults. I have had a good response from this group and currently have seven participants enrolled on the study, as well as thirteen more in the screening phase. After the protocol has been completed with healthy older adults, I plan to start recruitment for people living with either mild cognitive impairment or early Alzheimer’s disease. After baseline assessments, participants are allocated at random to either a control group (usual care), or to brain training for twelve weeks. At this time, participants will return for a follow-up, and a sub-group will be invited for either an interview or focus group to evaluate the training programme.
I see it as part of my role to be an advocate for older people and to get their views, opinions and concerns heard by the wider community
In addition to running the study, I have been working on a systematic review looking at studies which have used brain imaging to try and understand the mechanisms by which cognitive training may lead to improvements for people with dementia and this is currently under review with a journal. I have also been undertaking a Cochrane review on the use of a clinical tool used for screening in dementia. This is another new challenge, allowing me to experience the gold standard of systematic reviewing by working closely with the Cochrane group to undertake a review to their high standards. The protocol for this is due to be published shortly and we will begin working on the screening phase in the next month.
I am particularly looking forward to bringing the study into the next phase of recruiting people living with Alzheimer’s disease or mild cognitive impairment. I am also excited to begin synthesizing the quantitative and qualitative components to bring the study together as a whole and gaining that broader appreciation of the role of cognitive interventions for people living with dementia. I would like to end by thanking the Dunhill Medical Trust for giving me this incredible opportunity, but also to my supportive and proactive research supervisors, without whom none of this would have been possible.