Emeritus Professor of Old Age Psychiatry
- Emeritus Fellow Linacre College
In recent years my research has focused on two areas: 1. the hazards of anti-psychotic medication in dementia and how to avoid its use; 2. clinical trials of anti-dementia drugs in Alzheimer's dementia.
Most recently I have worked on the use of B vitamins to lower plasma homocysteine in people with so-called "mild cognitive impairment" (MCI), many of whom go on to develop full-blown Alzheimer's dementia. A relatively high plasma homocysteine is a potent risk factor for dementia. The rationale for this is that slowing the pace of MCI, and thus delaying the onset of dementia, even by only a few years, in an elderly population would significantly reduce the number of people who develop the disease. Currently some 800,000 people in the UK suffer from dementia, a figure likely to rise to over a million in the next decade or so. Our work showing that B vitamins slowed down the rate of brain shrinkage in MCI now needs to be extended with a full-scale clinical trial.
Our work on anti-psychotic medication in collaboration with colleagues at King's College London and Newcastle University has led to changes in prescribing endorsed as public policy by the Department of Health. With the same colleagues we have developed a focused intervention and training programme (FITS) for staff caring for people with dementia, essentially as a substitute for anti-psychotic drugs. Our research has shown that it greatly reduced the use of these drugs in care homes. I am currently involved in a national roll-out study of FITS on behalf of the Alzheimer's Society.
Our participation in two national clinical trials on anti-dementia drugs led from King's College London has altered guidelines for prescribing by adding a sound evidence-base.
Over many years I have developed an interest in legal mental capacity in older persons, and have published on testamentary capacity and undue influence for both lawyers and doctors. I give lectures on this subject at seminars for lawyers and doctors on this subject, and have contributed to case law when giving evidence as an expert witness.
Cognitive and clinical outcomes of homocysteine-lowering B-vitamin treatment in mild cognitive impairment: a randomized controlled trial.
de Jager CA. et al, (2012), Int J Geriatr Psychiatry, 27, 592 - 600
Donepezil and memantine for moderate-to-severe Alzheimer's disease.
Howard R. et al, (2012), N Engl J Med, 366, 893 - 903
Determining the minimum clinically important differences for outcomes in the DOMINO trial.
Howard R. et al, (2011), Int J Geriatr Psychiatry, 26, 812 - 817
Homocysteine as a predictor of cognitive decline in Alzheimer's disease.
Oulhaj A. et al, (2010), Int J Geriatr Psychiatry, 25, 82 - 90
Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial.
Smith AD. et al, (2010), PLoS One, 5