I am a physician at Oxford University Hospitals NHS Foundation Trust (OUHFT) and Professor of Medicine and Old Age Neuroscience at the University of Oxford. I work 50/50 in clinical and research work.
I studied pre-clinical medicine at Cambridge and then clinical medicine at Oxford before working as a junior doctor in London and Grenoble, France, returning to Oxford in 1995.
I have supervised numerous junior doctors, medical students, nursing trainees and visiting fellows as well as clinical, non-clinical and nursing doctoral candidates.
I am a member of the Editorial boards of Stroke, International Journal of Stroke, Neurology, and Cerebrovascular Diseases. I am lead author on four books on TIA/stroke, neurology in general medicine and geriatrics and senior editor of a series of case-based learning books (OUP) covering medical/surgical specialities; several are recommended reading for speciality exit examinations.
I have participated in local BBC TV, radio interviews and local and national newspaper features on dementia and delirium in the hospital setting.
MA (Cantab), BM BCh (Oxon), FRCP, DPhil
Professor of Medicine and Old Age Neuroscience
Dementia and delirium: Impact of cerebrovascular events and acute illness on cognition
My clinical duties include stints of acute internal and complex medicine as well as specialist clinics in memory and multi-morbid complex problems. I am also OUHFT Clinical Lead for Dementia and Delirium working closely with the Electronic Patient Record (EPR) Team and senior OUHFT management to implement improvements to the process of care for older and multi-morbid patients.
My research is supported by the NIHR Oxford Biomedical Research Centre and is focused on the short- and long-term cognitive impacts of acute (systemic) illness and cerebrovascular disease with a substantial translational component.
Cognitive impact of acute cerebrovascular disease
I lead the day-to-day assembly and follow-up of three Oxford Vascular Study (OXVASC - director Professor Peter Rothwell) population-based TIA/stroke cohorts (n>3000 patients, n=500 controls) examining risk factors, biomarkers and prediction of cognitive decline. Work on these cohorts including almost complete ascertainment and follow-up to >5 years culminated in a landmark paper, commentary and personal profile (Lancet Neurol. 2019) on the risks and predictors of dementia after TIA and stroke, and the following impacts:
- International Stroke Recovery and Rehabilitation Roundtable consensus-based recommendations (Int J Stroke 2019;8:774-782; Neurorehab Neur Repair 32019; 3:943-950)
- European Stroke Organisation/European Academy of Neurology guidelines (in progress)
Cognitive impact of acute illness: Delirium, cognitive and physical frailty
Since 2010, I have led the manual collection of highly phenotyped cohorts of consecutive unselected acute medicine patients (n>1700) managed by myself/Dr Sarah Smith during two month cycles of duty (2010, 2012, 2015, 2016, 2017/18, 2018). Latterly, this has been extended to the Same Day Emergency Care Service (SDEC, Abingdon Emergency Medicine Unit, 2017). Findings have led to major changes to the process of care for older patients including the implementation of Trust-wide routine cognitive screening via the Electronic Patient Record (EPR, 2015-).
In 2019, I set-up the Oxford Cognitive Comorbidity, Frailty and Ageing Research Database (ORCHARD, 2019-, n>30,000 patient admission episodes to date). ORCHARD contains extensive data from EPR, other electronic sources and relevant audits, on cognitive and physical frailty markers, diagnoses, illness severity, brain imaging and outcomes. ORCHARD is supported by a patient and public involvement (PPI) group highlighted in the BRC mid-term review. Impacts include:
- Trust-wide revision of consent forms to include a regarding capacity assessment in patients with delirium or dementia (2016-18)
- Facilitation of NHS England mandatory "dementia screening" requirements
- A 6-fold increase from 2010-18 in sensitivity of hospital administrative coding for delirium without loss of specificity, improving tariff remuneration and mortality adjustment
- Development of a delirium susceptibility score to identify patients at-risk.