Healthy cognitive ageing is a societal and public health priority. Cerebrovascular risk factors increase the likelihood of dementia in older people but their impact on cognitive ageing in younger, healthy brains is less clear. The UK Biobank provides cognition and brain imaging measures in the largest population cohort studied to date. Here we show that cognitive abilities of healthy individuals (N = 22,059) in this sample are detrimentally affected by cerebrovascular risk factors. Structural equation modelling revealed that cerebrovascular risk is associated with reduced cerebral grey matter and white matter integrity within a fronto-parietal brain network underlying executive function. Notably, higher systolic blood pressure was associated with worse executive cognitive function in mid-life (44–69 years), but not in late-life (>70 years). During mid-life this association did not occur in the systolic range of 110–140 mmHg. These findings suggest cerebrovascular risk factors impact on brain structure and cognitive function in healthy people.

Aims:To determine the use of antibiotics in patients with renal colic and an elevated white cell count (WCC) in the absence of other features of infection.Materials and Methods:A retrospective audit of patients presenting to an emergency department with renal colic caused by a solitary ureteric stone over a 6 month period.Statistical Analysis Used:Student's t-test.Results:Fifty patients met the inclusion criteria for this study. In 42 patients (84%) the urinalysis showed hematuria only and all urine culture results were negative for microbial growth. The mean WCC was 11.5 × 109 (4-22.1) and was raised in 34 patients (80.9%). The mean neutrophil count was 8.75 × 109/L (2.3-18.6) and C-reactive protein (CRP) 15.9 (1-192). Antibiotics were commenced in 34 patients (80.9%) based solely on the raised WCC. In eight patients (16%) there were leucocytes and/or nitrites on urinalysis and all urine cultures were positive for growth (coliforms in five, streptococcus in two and candida in one specimen). The mean WCC was 10.5 × 109/L (7.7-16.5) and was raised in four patients. The mean neutrophil count was 8.4 × 109/L (4.9-15.2) and CRP 40.79 (3-86). One patient had pyrexia. All eight patients were commenced on antibiotics based on the WCC and/or urinalysis result.Conclusions:Over three-quarters of the patients (80.9%) in this study who presented with renal colic were unjustifiably commenced on antibiotics based solely on an elevated WCC. Antibiotic use in renal colic should be reserved for when there are features of sepsis or the urinalysis is positive. Further work is required to determine the significance of the observed results and the threshold for starting antibiotics.

Autoimmune Limbic Encephalitis (ALE) is a neurological disease characterised by inflammation of the limbic regions of the brain, mediated by pathogenic autoantibodies. Because cognitive deficits persist following acute treatment of ALE, the accurate assessment of long-term cognitive outcomes is important for clinical assessments and trials. However, evaluating cognition is costly and an unmet need for validated digital methods exists. We investigated whether remote digital methods could identify previously characterised cognitive impairments in ALE patients and would correlate with standard neuropsychological assessment and hippocampal volume. The cognitive performance of 21 chronic ALE patients along with 54 age-matched healthy controls was assessed with a battery of 12 cognitive tasks from the Cognitron online platform. ALE patients performed significantly worse in memory, visuospatial abilities, executive function, and language. No impairments in digit & spatial span, target detection (attention) and emotion discrimination were observed. The global score on the online cognitive tasks correlated significantly with the established Addenbrooke's Cognitive Examination III (ACE) pen-and-paper test. Deficits in visuospatial processing and language were identified in ALE compared to controls using remote digital testing but not the ACE, highlighting higher sensitivity of computerised testing to residual cognitive impairment. Finally, the hippocampal volume of ALE patients and healthy controls correlated with online cognitive scores. Overall, these findings demonstrate that remote, online testing may facilitate the characterisation of cognitive profiles in complex neurological diseases.