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53 2-Back Performance Does Not Differ Between Cognitive Training Groups in Older Adults Without Dementia
- Nicole D Evangelista, Jessica N Kraft, Hanna K Hausman, Andrew O’Shea, Alejandro Albizu, Emanuel M Boutzoukas, Cheshire Hardcastle, Emily J Van Etten, Pradyumna K Bharadwaj, Hyun Song, Samantha G Smith, Steven DeKosky, Georg A Hishaw, Samuel Wu, Michael Marsiske, Ronald Cohen, Gene E Alexander, Eric Porges, Adam J Woods
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 360-361
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Objective:
Cognitive training is a non-pharmacological intervention aimed at improving cognitive function across a single or multiple domains. Although the underlying mechanisms of cognitive training and transfer effects are not well-characterized, cognitive training has been thought to facilitate neural plasticity to enhance cognitive performance. Indeed, the Scaffolding Theory of Aging and Cognition (STAC) proposes that cognitive training may enhance the ability to engage in compensatory scaffolding to meet task demands and maintain cognitive performance. We therefore evaluated the effects of cognitive training on working memory performance in older adults without dementia. This study will help begin to elucidate non-pharmacological intervention effects on compensatory scaffolding in older adults.
Participants and Methods:48 participants were recruited for a Phase III randomized clinical trial (Augmenting Cognitive Training in Older Adults [ACT]; NIH R01AG054077) conducted at the University of Florida and University of Arizona. Participants across sites were randomly assigned to complete cognitive training (n=25) or an education training control condition (n=23). Cognitive training and the education training control condition were each completed during 60 sessions over 12 weeks for 40 hours total. The education training control condition involved viewing educational videos produced by the National Geographic Channel. Cognitive training was completed using the Posit Science Brain HQ training program, which included 8 cognitive training paradigms targeting attention/processing speed and working memory. All participants also completed demographic questionnaires, cognitive testing, and an fMRI 2-back task at baseline and at 12-weeks following cognitive training.
Results:Repeated measures analysis of covariance (ANCOVA), adjusted for training adherence, transcranial direct current stimulation (tDCS) condition, age, sex, years of education, and Wechsler Test of Adult Reading (WTAR) raw score, revealed a significant 2-back by training group interaction (F[1,40]=6.201, p=.017, η2=.134). Examination of simple main effects revealed baseline differences in 2-back performance (F[1,40]=.568, p=.455, η2=.014). After controlling for baseline performance, training group differences in 2-back performance was no longer statistically significant (F[1,40]=1.382, p=.247, η2=.034).
Conclusions:After adjusting for baseline performance differences, there were no significant training group differences in 2-back performance, suggesting that the randomization was not sufficient to ensure adequate distribution of participants across groups. Results may indicate that cognitive training alone is not sufficient for significant improvement in working memory performance on a near transfer task. Additional improvement may occur with the next phase of this clinical trial, such that tDCS augments the effects of cognitive training and results in enhanced compensatory scaffolding even within this high performing cohort. Limitations of the study include a highly educated sample with higher literacy levels and the small sample size was not powered for transfer effects analysis. Future analyses will include evaluation of the combined intervention effects of a cognitive training and tDCS on nback performance in a larger sample of older adults without dementia.
61 Network Segregation Predicts Processing Speed in the Cognitively Healthy Oldest-old
- Sara A Nolin, Mary E Faulkner, Paul Stewart, Leland Fleming, Stacy Merritt, Roxanne F Rezaei, Pradyumna K Bharadwaj, Mary Kathryn Franchetti, Daniel A Raichlen, Courtney J Jessup, Lloyd Edwards, G Alex Hishaw, Emily J Van Etten, Theodore P Trouard, David S Geldmacher, Virginia G Wadley, Noam Alperin, Eric C Porges, Adam J Woods, Ronald A Cohen, Bonnie E Levin, Tatjana Rundek, Gene E Alexander, Kristina M Visscher
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 367-368
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Objective:
Understanding the factors contributing to optimal cognitive function throughout the aging process is essential to better understand successful cognitive aging. Processing speed is an age sensitive cognitive domain that usually declines early in the aging process; however, this cognitive skill is essential for other cognitive tasks and everyday functioning. Evaluating brain network interactions in cognitively healthy older adults can help us understand how brain characteristics variations affect cognitive functioning. Functional connections among groups of brain areas give insight into the brain’s organization, and the cognitive effects of aging may relate to this large-scale organization. To follow-up on our prior work, we sought to replicate our findings regarding network segregation’s relationship with processing speed. In order to address possible influences of node location or network membership we replicated the analysis across 4 different node sets.
Participants and Methods:Data were acquired as part of a multi-center study of 85+ cognitively normal individuals, the McKnight Brain Aging Registry (MBAR). For this analysis, we included 146 community-dwelling, cognitively unimpaired older adults, ages 85-99, who had undergone structural and BOLD resting state MRI scans and a battery of neuropsychological tests. Exploratory factor analysis identified the processing speed factor of interest. We preprocessed BOLD scans using fmriprep, Ciftify, and XCPEngine algorithms. We used 4 different sets of connectivity-based parcellation: 1)MBAR data used to define nodes and Power (2011) atlas used to determine node network membership, 2) Younger adults data used to define nodes (Chan 2014) and Power (2011) atlas used to determine node network membership, 3) Older adults data from a different study (Han 2018) used to define nodes and Power (2011) atlas used to determine node network membership, and 4) MBAR data used to define nodes and MBAR data based community detection used to determine node network membership.
Segregation (balance of within-network and between-network connections) was measured within the association system and three wellcharacterized networks: Default Mode Network (DMN), Cingulo-Opercular Network (CON), and Fronto-Parietal Network (FPN). Correlation between processing speed and association system and networks was performed for all 4 node sets.
Results:We replicated prior work and found the segregation of both the cortical association system, the segregation of FPN and DMN had a consistent relationship with processing speed across all node sets (association system range of correlations: r=.294 to .342, FPN: r=.254 to .272, DMN: r=.263 to .273). Additionally, compared to parcellations created with older adults, the parcellation created based on younger individuals showed attenuated and less robust findings as those with older adults (association system r=.263, FPN r=.255, DMN r=.263).
Conclusions:This study shows that network segregation of the oldest-old brain is closely linked with processing speed and this relationship is replicable across different node sets created with varied datasets. This work adds to the growing body of knowledge about age-related dedifferentiation by demonstrating replicability and consistency of the finding that as essential cognitive skill, processing speed, is associated with differentiated functional networks even in very old individuals experiencing successful cognitive aging.
4 Risk Factor and Biomarker Correlates of FLAIR White Matter Hyperintensities in Former American Football Players
- Monica T Ly, Fatima Tuz-Zahra, Yorghos Tripodis, Charles H Adler, Laura J Balcer, Charles Bernick, Elaine Peskind, Megan L Mariani, Rhoda Au, Sarah J Banks, William B Barr, Jennifer V Wethe, Mark W Bondi, Lisa Delano-Wood, Robert C Cantu, Michael J Coleman, David W Dodick, Michael D McClean, Jesse Mez, Joseph N Palmisano, Brett Martin, Kaitlin Hartlage, Alexander P Lin, Inga K Koerte, Jeffrey L Cummings, Eric M Reiman, Martha E Shenton, Robert A Stern, Sylvain Bouix, Michael L Alosco
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 608-610
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Objective:
White matter hyperintensity (WMH) burden is greater, has a frontal-temporal distribution, and is associated with proxies of exposure to repetitive head impacts (RHI) in former American football players. These findings suggest that in the context of RHI, WMH might have unique etiologies that extend beyond those of vascular risk factors and normal aging processes. The objective of this study was to evaluate the correlates of WMH in former elite American football players. We examined markers of amyloid, tau, neurodegeneration, inflammation, axonal injury, and vascular health and their relationships to WMH. A group of age-matched asymptomatic men without a history of RHI was included to determine the specificity of the relationships observed in the former football players.
Participants and Methods:240 male participants aged 45-74 (60 unexposed asymptomatic men, 60 male former college football players, 120 male former professional football players) underwent semi-structured clinical interviews, magnetic resonance imaging (structural T1, T2 FLAIR, and diffusion tensor imaging), and lumbar puncture to collect cerebrospinal fluid (CSF) biomarkers as part of the DIAGNOSE CTE Research Project. Total WMH lesion volumes (TLV) were estimated using the Lesion Prediction Algorithm from the Lesion Segmentation Toolbox. Structural equation modeling, using Full-Information Maximum Likelihood (FIML) to account for missing values, examined the associations between log-TLV and the following variables: total cortical thickness, whole-brain average fractional anisotropy (FA), CSF amyloid ß42, CSF p-tau181, CSF sTREM2 (a marker of microglial activation), CSF neurofilament light (NfL), and the modified Framingham stroke risk profile (rFSRP). Covariates included age, race, education, APOE z4 carrier status, and evaluation site. Bootstrapped 95% confidence intervals assessed statistical significance. Models were performed separately for football players (college and professional players pooled; n=180) and the unexposed men (n=60). Due to differences in sample size, estimates were compared and were considered different if the percent change in the estimates exceeded 10%.
Results:In the former football players (mean age=57.2, 34% Black, 29% APOE e4 carrier), reduced cortical thickness (B=-0.25, 95% CI [0.45, -0.08]), lower average FA (B=-0.27, 95% CI [-0.41, -.12]), higher p-tau181 (B=0.17, 95% CI [0.02, 0.43]), and higher rFSRP score (B=0.27, 95% CI [0.08, 0.42]) were associated with greater log-TLV. Compared to the unexposed men, substantial differences in estimates were observed for rFSRP (Bcontrol=0.02, Bfootball=0.27, 994% difference), average FA (Bcontrol=-0.03, Bfootball=-0.27, 802% difference), and p-tau181 (Bcontrol=-0.31, Bfootball=0.17, -155% difference). In the former football players, rFSRP showed a stronger positive association and average FA showed a stronger negative association with WMH compared to unexposed men. The effect of WMH on cortical thickness was similar between the two groups (Bcontrol=-0.27, Bfootball=-0.25, 7% difference).
Conclusions:These results suggest that the risk factor and biological correlates of WMH differ between former American football players and asymptomatic individuals unexposed to RHI. In addition to vascular risk factors, white matter integrity on DTI showed a stronger relationship with WMH burden in the former football players. FLAIR WMH serves as a promising measure to further investigate the late multifactorial pathologies of RHI.
2 Higher White Matter Hyperintensity Load Adversely Affects Pre-Post Proximal Cognitive Training Performance in Healthy Older Adults
- Emanuel M Boutzoukas, Andrew O’Shea, Jessica N Kraft, Cheshire Hardcastle, Nicole D Evangelista, Hanna K Hausman, Alejandro Albizu, Emily J Van Etten, Pradyumna K Bharadwaj, Samantha G Smith, Hyun Song, Eric C Porges, Alex Hishaw, Steven T DeKosky, Samuel S Wu, Michael Marsiske, Gene E Alexander, Ronald Cohen, Adam J Woods
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 671-672
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Objective:
Cognitive training has shown promise for improving cognition in older adults. Aging involves a variety of neuroanatomical changes that may affect response to cognitive training. White matter hyperintensities (WMH) are one common age-related brain change, as evidenced by T2-weighted and Fluid Attenuated Inversion Recovery (FLAIR) MRI. WMH are associated with older age, suggestive of cerebral small vessel disease, and reflect decreased white matter integrity. Higher WMH load associates with reduced threshold for clinical expression of cognitive impairment and dementia. The effects of WMH on response to cognitive training interventions are relatively unknown. The current study assessed (a) proximal cognitive training performance following a 3-month randomized control trial and (b) the contribution of baseline whole-brain WMH load, defined as total lesion volume (TLV), on pre-post proximal training change.
Participants and Methods:Sixty-two healthy older adults ages 65-84 completed either adaptive cognitive training (CT; n=31) or educational training control (ET; n=31) interventions. Participants assigned to CT completed 20 hours of attention/processing speed training and 20 hours of working memory training delivered through commercially-available Posit Science BrainHQ. ET participants completed 40 hours of educational videos. All participants also underwent sham or active transcranial direct current stimulation (tDCS) as an adjunctive intervention, although not a variable of interest in the current study. Multimodal MRI scans were acquired during the baseline visit. T1- and T2-weighted FLAIR images were processed using the Lesion Segmentation Tool (LST) for SPM12. The Lesion Prediction Algorithm of LST automatically segmented brain tissue and calculated lesion maps. A lesion threshold of 0.30 was applied to calculate TLV. A log transformation was applied to TLV to normalize the distribution of WMH. Repeated-measures analysis of covariance (RM-ANCOVA) assessed pre/post change in proximal composite (Total Training Composite) and sub-composite (Processing Speed Training Composite, Working Memory Training Composite) measures in the CT group compared to their ET counterparts, controlling for age, sex, years of education and tDCS group. Linear regression assessed the effect of TLV on post-intervention proximal composite and sub-composite, controlling for baseline performance, intervention assignment, age, sex, years of education, multisite scanner differences, estimated total intracranial volume, and binarized cardiovascular disease risk.
Results:RM-ANCOVA revealed two-way group*time interactions such that those assigned cognitive training demonstrated greater improvement on proximal composite (Total Training Composite) and sub-composite (Processing Speed Training Composite, Working Memory Training Composite) measures compared to their ET counterparts. Multiple linear regression showed higher baseline TLV associated with lower pre-post change on Processing Speed Training sub-composite (ß = -0.19, p = 0.04) but not other composite measures.
Conclusions:These findings demonstrate the utility of cognitive training for improving postintervention proximal performance in older adults. Additionally, pre-post proximal processing speed training change appear to be particularly sensitive to white matter hyperintensity load versus working memory training change. These data suggest that TLV may serve as an important factor for consideration when planning processing speed-based cognitive training interventions for remediation of cognitive decline in older adults.
1 Task-Based Functional Connectivity and Network Segregation of the Useful Field of View (UFOV) fMRI task
- Jessica N Kraft, Hanna K Hausman, Cheshire Hardcastle, Alejandro Albizu, Andrew O’Shea, Nicole D Evangelista, Emanuel M Boutzoukas, Emily J Van Etten, Pradyumna K Bharadwaj, Hyun Song, Samantha G Smith, Steven T DeKosky, Georg A Hishaw, Samuel Wu, Michael Marsiske, Ronald Cohen, Eric Porges, Adam J Woods
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 606-607
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Objective:
Interventions using a cognitive training paradigm called the Useful Field of View (UFOV) task have shown to be efficacious in slowing cognitive decline. However, no studies have looked at the engagement of functional networks during UFOV task completion. The current study aimed to (a) assess if regions activated during the UFOV fMRI task were functionally connected and related to task performance (henceforth called the UFOV network), (b) compare connectivity of the UFOV network to 7 resting-state functional connectivity networks in predicting proximal (UFOV) and near-transfer (Double Decision) performance, and (c) explore the impact of network segregation between higher-order networks and UFOV performance.
Participants and Methods:336 healthy older adults (mean age=71.6) completed the UFOV fMRI task in a Siemens 3T scanner. UFOV fMRI accuracy was calculated as the number of correct responses divided by 56 total trials. Double Decision performance was calculated as the average presentation time of correct responses in log ms, with lower scores equating to better processing speed. Structural and functional MRI images were processed using the default pre-processing pipeline within the CONN toolbox. The Artifact Rejection Toolbox was set at a motion threshold of 0.9mm and participants were excluded if more than 50% of volumes were flagged as outliers. To assess connectivity of regions associated with the UFOV task, we created 10 spherical regions of interest (ROIs) a priori using the WFU PickAtlas in SPM12. These include the bilateral pars triangularis, supplementary motor area, and inferior temporal gyri, as well as the left pars opercularis, left middle occipital gyrus, right precentral gyrus and right superior parietal lobule. We used a weighted ROI-to-ROI connectivity analysis to model task-based within-network functional connectivity of the UFOV network, and its relationship to UFOV accuracy. We then used weighted ROI-to-ROI connectivity analysis to compare the efficacy of the UFOV network versus 7 resting-state networks in predicting UFOV fMRI task performance and Double Decision performance. Finally, we calculated network segregation among higher order resting state networks to assess its relationship with UFOV accuracy. All functional connectivity analyses were corrected at a false discovery threshold (FDR) at p<0.05.
Results:ROI-to-ROI analysis showed significant within-network functional connectivity among the 10 a priori ROIs (UFOV network) during task completion (all pFDR<.05). After controlling for covariates, greater within-network connectivity of the UFOV network associated with better UFOV fMRI performance (pFDR=.008). Regarding the 7 resting-state networks, greater within-network connectivity of the CON (pFDR<.001) and FPCN (pFDR=. 014) were associated with higher accuracy on the UFOV fMRI task. Furthermore, greater within-network connectivity of only the UFOV network associated with performance on the Double Decision task (pFDR=.034). Finally, we assessed the relationship between higher-order network segregation and UFOV accuracy. After controlling for covariates, no significant relationships between network segregation and UFOV performance remained (all p-uncorrected>0.05).
Conclusions:To date, this is the first study to assess task-based functional connectivity during completion of the UFOV task. We observed that coherence within 10 a priori ROIs significantly predicted UFOV performance. Additionally, enhanced within-network connectivity of the UFOV network predicted better performance on the Double Decision task, while conventional resting-state networks did not. These findings provide potential targets to optimize efficacy of UFOV interventions.
78 BVMT-R Learning Ratio Moderates Cognitive Training Gains in Useful Field of View Task in Healthy Older Adults
- Cheshire Hardcastle, Jessica N. Kraft, Hanna K. Hausman, Andrew O’Shea, Alejandro Albizu, Nicole D. Evangelista, Emanuel Boutzoukas, Emily J. Van Etten, Pradyumna K. Bharadwaj, Hyun Song, Samantha G. Smith, Eric Porges, Steven DeKosky, Georg A. Hishaw, Samuel Wu, Michael Marsiske, Ronald Cohen, Gene E. Alexander, Adam J. Woods
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 180-181
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Cognitive training using a visual speed-of-processing task, called the Useful Field of View (UFOV) task, reduced dementia risk and reduced decline in activities of daily living at a 10-year follow-up in older adults. However, there is variability in the level of cognitive gains after cognitive training across studies. One potential explanation for this variability could be moderating factors. Prior studies suggest variables moderating cognitive training gains share features of the training task. Learning trials of the Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R) recruit similar cognitive abilities and have overlapping neural correlates with the UFOV task and speed-ofprocessing/working memory tasks and therefore could serve as potential moderators. Exploring moderating factors of cognitive training gains may boost the efficacy of interventions, improve rigor in the cognitive training literature, and eventually help provide tailored treatment recommendations. This study explored the association between the HVLT-R and BVMT-R learning and the UFOV task, and assessed the moderation of HVLT-R and BVMT-R learning on UFOV improvement after a 3-month speed-ofprocessing/attention and working memory cognitive training intervention in cognitively healthy older adults.
Participants and Methods:75 healthy older adults (M age = 71.11, SD = 4.61) were recruited as part of a larger clinical trial through the Universities of Florida and Arizona. Participants were randomized into a cognitive training (n=36) or education control (n=39) group and underwent a 40-hour, 12-week intervention. Cognitive training intervention consisted of practicing 4 attention/speed-of-processing (including the UFOV task) and 4 working memory tasks. Education control intervention consisted of watching 40-minute educational videos. The HVLT-R and BVMT-R were administered at the pre-intervention timepoint as part of a larger neurocognitive battery. The learning ratio was calculated as: trial 3 total - trial 1 total/12 - trial 1 total. UFOV performance was measured at pre- and post-intervention time points via the POSIT Brain HQ Double Decision Assessment. Multiple linear regressions predicted baseline Double Decision performance from HVLT-R and BVMT-R learning ratios controlling for study site, age, sex, and education. A repeated measures moderation analysis assessed the moderation of HVLT-R and BVMT-R learning ratio on Double Decision change from pre- to post-intervention for cognitive training and education control groups.
Results:Baseline Double Decision performance significantly associated with BVMT-R learning ratio (β=-.303, p=.008), but not HVLT-R learning ratio (β=-.142, p=.238). BVMT-R learning ratio moderated gains in Double Decision performance (p<.01); for each unit increase in BVMT-R learning ratio, there was a .6173 unit decrease in training gains. The HVLT-R learning ratio did not moderate gains in Double Decision performance (p>.05). There were no significant moderations in the education control group.
Conclusions:Better visuospatial learning was associated with faster Double Decision performance at baseline. Those with poorer visuospatial learning improved most on the Double Decision task after training, suggesting that healthy older adults who perform below expectations may show the greatest training gains. Future cognitive training research studying visual speed-of-processing interventions should account for differing levels of visuospatial learning at baseline, as this could impact the magnitude of training outcomes.
6 Adjunctive Transcranial Direct Current Stimulation and Cognitive Training Alters Default Mode and Frontoparietal Control Network Connectivity in Older Adults
- Hanna K Hausman, Jessica N Kraft, Cheshire Hardcastle, Nicole D Evangelista, Emanuel M Boutzoukas, Andrew O’Shea, Alejandro Albizu, Emily J Van Etten, Pradyumna K Bharadwaj, Hyun Song, Samantha G Smith, Eric S Porges, Georg A Hishaw, Samuel Wu, Steven DeKosky, Gene E Alexander, Michael Marsiske, Ronald A Cohen, Adam J Woods
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 675-676
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Aging is associated with disruptions in functional connectivity within the default mode (DMN), frontoparietal control (FPCN), and cingulo-opercular (CON) resting-state networks. Greater within-network connectivity predicts better cognitive performance in older adults. Therefore, strengthening network connectivity, through targeted intervention strategies, may help prevent age-related cognitive decline or progression to dementia. Small studies have demonstrated synergistic effects of combining transcranial direct current stimulation (tDCS) and cognitive training (CT) on strengthening network connectivity; however, this association has yet to be rigorously tested on a large scale. The current study leverages longitudinal data from the first-ever Phase III clinical trial for tDCS to examine the efficacy of an adjunctive tDCS and CT intervention on modulating network connectivity in older adults.
Participants and Methods:This sample included 209 older adults (mean age = 71.6) from the Augmenting Cognitive Training in Older Adults multisite trial. Participants completed 40 hours of CT over 12 weeks, which included 8 attention, processing speed, and working memory tasks. Participants were randomized into active or sham stimulation groups, and tDCS was administered during CT daily for two weeks then weekly for 10 weeks. For both stimulation groups, two electrodes in saline-soaked 5x7 cm2 sponges were placed at F3 (cathode) and F4 (anode) using the 10-20 measurement system. The active group received 2mA of current for 20 minutes. The sham group received 2mA for 30 seconds, then no current for the remaining 20 minutes.
Participants underwent resting-state fMRI at baseline and post-intervention. CONN toolbox was used to preprocess imaging data and conduct region of interest (ROI-ROI) connectivity analyses. The Artifact Detection Toolbox, using intermediate settings, identified outlier volumes. Two participants were excluded for having greater than 50% of volumes flagged as outliers. ROI-ROI analyses modeled the interaction between tDCS group (active versus sham) and occasion (baseline connectivity versus postintervention connectivity) for the DMN, FPCN, and CON controlling for age, sex, education, site, and adherence.
Results:Compared to sham, the active group demonstrated ROI-ROI increases in functional connectivity within the DMN following intervention (left temporal to right temporal [T(202) = 2.78, pFDR < 0.05] and left temporal to right dorsal medial prefrontal cortex [T(202) = 2.74, pFDR < 0.05]. In contrast, compared to sham, the active group demonstrated ROI-ROI decreases in functional connectivity within the FPCN following intervention (left dorsal prefrontal cortex to left temporal [T(202) = -2.96, pFDR < 0.05] and left dorsal prefrontal cortex to left lateral prefrontal cortex [T(202) = -2.77, pFDR < 0.05]). There were no significant interactions detected for CON regions.
Conclusions:These findings (a) demonstrate the feasibility of modulating network connectivity using tDCS and CT and (b) provide important information regarding the pattern of connectivity changes occurring at these intervention parameters in older adults. Importantly, the active stimulation group showed increases in connectivity within the DMN (a network particularly vulnerable to aging and implicated in Alzheimer’s disease) but decreases in connectivity between left frontal and temporal FPCN regions. Future analyses from this trial will evaluate the association between these changes in connectivity and cognitive performance post-intervention and at a one-year timepoint.
53 Change in Cerebral Metabolite Concentrations Following Bariatric Surgery
- Sarah Bottari, Ronald Cohen, Jeffrey Friedman, Eric Porges, Alexa Chen, John Gunstad, Adam Woods, John Williamson
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 462-463
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Obesity is associated with adverse effects on brain health, including increased risk for neurodegenerative diseases. Changes in cerebral metabolism may underlie or precede structural and functional brain changes. While bariatric surgery is known to be effective in inducing weight loss and improving obesity-related medical comorbidities, few studies have examined whether it may be able to improve brain metabolism. In the present study, we examined change in cerebral metabolite concentrations in participants with obesity who underwent bariatric surgery.
Participants and Methods:35 patients with obesity (BMI > 35 kg/m2) were recruited from a bariatric surgery candidate nutrition class. They completed single voxel 1H-proton magnetic resonance spectroscopy at baseline (pre-surgery) and within one year post-surgery. Spectra were obtained from a large medial frontal brain region. Tissue-corrected absolute concentrations for metabolites including choline-containing compounds (Cho), myo-inositol (mI), N-acetylaspartate (NAA), creatine (Cr), and glutamate and glutamine (Glx) were determined using Osprey. Paired t-tests were used to examine within-subject change in metabolite concentrations, and correlations were used to relate these changes to other health-related outcomes, including weight loss and glycemic control.
Results:Bariatric surgery was associated with a reduction in cerebral Cho (f[34j = -3.79, p < 0.001, d = -0.64) and mI (f[34] = -2.81, p < 0.01, d = -0.47) concentrations. There were no significant changes in NAA, Glx, or Cr concentrations. Reductions in Cho were associated with greater weight loss (r = 0.40, p < 0.05), and reductions in mI were associated with greater reductions in HbA1c (r = 0.44, p < 0.05).
Conclusions:Participants who underwent bariatric surgery exhibited reductions in cerebral Cho and mI concentrations, which were associated with improvements in weight loss and glycemic control. Given that elevated levels of Cho and mI have been implicated in neuroinflammation, reduction in these metabolites after bariatric surgery may reflect amelioration of obesity-related neuroinflammatory processes. As such, our results provide evidence that bariatric surgery may improve brain health and metabolism in individuals with obesity.
28 Factor Structure of Conventional Neuropsychological Tests and NIH-Toolbox in Healthy Older Adults
- Kailey Langer, Cheshire Hardcastle, Hanna Hausman, Jessica Kraft, Alejandro Albizu, Nicole Evangelista, Emanuel Boutzoukas, Andrew O’Shea, Emily Van Etten, Samantha Smith, Hyun Song, Pradyumna Bharadwaj, Georg Hishaw, Samuel Wu, Steven DeKosky, Gene Alexander, Eric Porges, Michael Marsiske, Ronald Cohen, Adam Woods
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 710
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The National Institutes of Health-Toolbox cognition battery (NIH-TCB) is widely used in cognitive aging studies and includes measures in cognitive domains evaluated for dimensional structure and psychometric properties in prior research. The present study addresses a current literature gap by demonstrating how NIH-TCB integrates into a battery of traditional clinical neuropsychological measures. The dimensional structure of NIH-TCB measures along with conventional neuropsychological tests is assessed in healthy older adults.
Participants and Methods:Baseline cognitive data were obtained from 327 older adults. The following measures were collected: NIH-Toolbox cognitive battery, Controlled Oral Word Association (COWA) letter and animals tests, Wechsler Test of Adult Reading (WTAR), Stroop Color-Word Interference Test, Paced Auditory Serial Addition Test (PASAT), Brief Visuospatial Memory Test (BVMT), Letter-Number Sequencing (LNS), Hopkins Verbal Learning Test (HVLT), Trail Making Test A&B, Digit Span. Hmisc, psych, and GPARotation packages for R were used to conduct exploratory factor analyses (EFA). A 5-factor solution was conducted followed by a 6-factor solution. Promax rotation was used for both EFA models.
Results:The 6-factor EFA solution is reported here. Results indicated the following 6 factors: working memory (Digit Span forward, backward, and sequencing, PASAT trials 1 and 2, NIH-Toolbox List Sorting, LNS), speed/executive function (Stroop color naming, word reading, and color-word interference, NIH-Toolbox Flanker, Dimensional Change, and Pattern Comparison, Trail Making Test A&B), verbal fluency (COWA letters F-A-S), crystallized intelligence (WTAR, NIH-Toolbox Oral Recognition and Picture Vocabulary), visual memory (BVMT immediate and delayed), and verbal memory (HVLT immediate and delayed. COWA animals and NIH-Toolbox Picture Sequencing did not adequately load onto any EFA factor and were excluded from the subsequent CFA.
Conclusions:Findings indicate that in a sample of healthy older adults, these collected measures and those obtained through the NIH-Toolbox battery represent 6 domains of cognitive function. Results suggest that in this sample, picture sequencing and COWA animals did not load adequately onto the factors created from the rest of the measures collected. These findings should assist in interpreting future research using combined NIH-TCB and neuropsychological batteries to assess cognition in healthy older adults.
9 Connecting memory and functional brain networks in older adults: a resting state fMRI study
- Jori L Waner, Hanna K Hausman, Jessica N Kraft, Cheshire Hardcastle, Nicole D Evangelista, Andrew O’Shea, Alejandro Albizu, Emanuel M Boutzoukas, Emily J Van Etten, Pradyumna K Bharadwaj, Hyun Song, Samantha G Smith, Steven T DeKosky, Georg A Hishaw, Samuel S Wu, Michael Marsiske, Ronald Cohen, Gene E Alexander, Eric C Porges, Adam J Woods
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 527-528
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Objective:
Nonpathological aging has been linked to decline in both verbal and visuospatial memory abilities in older adults. Disruptions in resting-state functional connectivity within well-characterized, higherorder cognitive brain networks have also been coupled with poorer memory functioning in healthy older adults and in older adults with dementia. However, there is a paucity of research on the association between higherorder functional connectivity and verbal and visuospatial memory performance in the older adult population. The current study examines the association between resting-state functional connectivity within the cingulo-opercular network (CON), frontoparietal control network (FPCN), and default mode network (DMN) and verbal and visuospatial learning and memory in a large sample of healthy older adults. We hypothesized that greater within-network CON and FPCN functional connectivity would be associated with better immediate verbal and visuospatial memory recall. Additionally, we predicted that within-network DMN functional connectivity would be associated with improvements in delayed verbal and visuospatial memory recall. This study helps to glean insight into whether within-network CON, FPCN, or DMN functional connectivity is associated with verbal and visuospatial memory abilities in later life.
Participants and Methods:330 healthy older adults between 65 and 89 years old (mean age = 71.6 ± 5.2) were recruited at the University of Florida (n = 222) and the University of Arizona (n = 108). Participants underwent resting-state fMRI and completed verbal memory (Hopkins Verbal Learning Test - Revised [HVLT-R]) and visuospatial memory (Brief Visuospatial Memory Test - Revised [BVMT-R]) measures. Immediate (total) and delayed recall scores on the HVLT-R and BVMT-R were calculated using each test manual’s scoring criteria. Learning ratios on the HVLT-R and BVMT-R were quantified by dividing the number of stimuli (verbal or visuospatial) learned between the first and third trials by the number of stimuli not recalled after the first learning trial. CONN Toolbox was used to extract average within-network connectivity values for CON, FPCN, and DMN. Hierarchical regressions were conducted, controlling for sex, race, ethnicity, years of education, number of invalid scans, and scanner site.
Results:Greater CON connectivity was significantly associated with better HVLT-R immediate (total) recall (ß = 0.16, p = 0.01), HVLT-R learning ratio (ß = 0.16, p = 0.01), BVMT-R immediate (total) recall (ß = 0.14, p = 0.02), and BVMT-R delayed recall performance (ß = 0.15, p = 0.01). Greater FPCN connectivity was associated with better BVMT-R learning ratio (ß = 0.13, p = 0.04). HVLT-R delayed recall performance was not associated with connectivity in any network, and DMN connectivity was not significantly related to any measure.
Conclusions:Connectivity within CON demonstrated a robust relationship with different components of memory function as well across verbal and visuospatial domains. In contrast, FPCN only evidenced a relationship with visuospatial learning, and DMN was not significantly associated with memory measures. These data suggest that CON may be a valuable target in longitudinal studies of age-related memory changes, but also a possible target in future non-invasive interventions to attenuate memory decline in older adults.
Contents
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- Boydell & Brewer
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- 05 August 2023, pp iii-iii
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Introduction to the series
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- Boydell & Brewer
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- 05 August 2023, pp viii-x
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Summary
THE BEDFORDSHIRE CHURCHES SERIES
This is to be a series of three volumes covering Bedfordshire churches in the nineteenth century. The volumes will contain descriptions of churches “on the eve of restoration” together with contemporary illustrations –most of which will be published for the first time.
For each church, there will be extracts from original records amplified by a commentary and explanatory footnotes. The main source material consists of:
1. Extracts from church inventories – mainly 1822
2. Antiquarian notes on churches by Archdeacon Bonney, c.1840
3. Archdeacon Bonney’s visitation notebooks 1823-1839
4. Articles on churches by W.A. – John Martin, the librarian at Woburn Abbey - 1845-1854
5. Church descriptions by Sir Stephen Glynne 1830-1870
There is considerable value in having these key sources, with illustrations and commentary, in one place. The descriptions by Bonney and Glynne are purely factual, but John Martin’s articles, highlighting abuses and neglect, make colourful and at times controversial reading. Bonney’s visitation notes - and the supporting evidence from contemporary records such as churchwardens’ accounts – give a clear indication that church buildings were far from neglected in the opening decades of the nineteenth century. Together these sources document features that can still be seen today, and provide information on others that have been lost.
The aim has been to present the text of contemporary sources in their original state, to convey a feeling for the times as well as to provide information. It is recognised that most of the sources could have been condensed by editing - for instance the lists of registers in the glebe terriers and the quotations in the articles by W.A. – but the Editorial Group felt that they should nevertheless be published in extenso.
The introductory commentary for each church includes a summary of the history of the building, focusing especially on eighteenth and nineteenth century restoration and alterations. These introductory notes are generally brief, but may be longer where differences between present and past external appearance merit detailed discussion. Detailed footnotes explain and amplify features mentioned in the text of the original sources and so lead the reader to additional research material.
Frontmatter
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- 05 August 2023, pp i-ii
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Notes on sources: The sources - introduction
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- 05 August 2023, pp 2-25
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Summary
The Sources – Introduction
Bedfordshire churches on the eve of restoration are well documented in a number of sources. First, there are a great many pictures of churches by artists such as Thomas Fisher and George Shepherd dating from the early Cl9th. Secondly, there are the manuscript sources which describe the condition of church buildings and ornaments in the years leading up to “the age of restoration”.
These sources are described and discussed in detail below. In outline, however, they include the glebe terriers for 1822 which describe the plan of each church and list the ornaments and furnishings. As Archdeacon of Bedford from 1821 to 1844, Dr. Henry Kaye Bonney compiled two notebooks on the churches in his care. In the one, he made detailed architectural notes on each church and its fittings, and in the other he kept a record of the orders made at his archidiaconal visitations between 1823 and 1839. Another commentator was John Martin, the Librarian at Woburn Abbey, who using the signature W.A. wrote a series of pithy articles on Bedfordshire churches for the Northampton Mercury and Bedfordshire Times between 1845 and 1854. Lastly, there are the notebooks of Sir Stephen Glynne who visited over a third of the churches in the County between 1830 and 1870.
Together these sources provide a colourful image of the appearance, condition and atmosphere of Bedfordshire churches at a time when on the one hand they were nearer their mediaeval state than they are today but when on the other they were arguably in their greatest need of attention.
Glebe Terriers (extracts) 1822
After the Reformation, the ecclesiastical authorities became increasingly aware of the need to keep proper records of church possessions. The documents known as glebe terriers fulfil this purpose, and include terriers (recording property and endowments) and inventories (listing goods and chattels). The existence of such records helped to prevent the loss and misappropriation of church property.
Terriers had been compiled for purely parochial purposes in mediaeval times, but in compliance with an archiepiscopal order or canon of 1571 it became a requirement for copies of these documents to be lodged in diocesan registries for safe-keeping.
Symbols Used In Transcription
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- 05 August 2023, pp xiii-xiii
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The Churches
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- 05 August 2023, pp 41-318
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Summary
AMPTHILL
Although the present church dates chiefly from the Cl4th and Cl5th, the foundations of the Cl2th church were discovered during excavations in 1975. The later church has a chancel, nave with north and south aisles, south porch and west tower. It retains its Cl5th roof with angels and shields (though the painted decoration is modem) and there is a ceilure above the former rood.
In 1696 a private pew was constructed for Lord Ashbumham of Ampthill Park in the south aisle of the church. Sir Christopher Wren and his pupil Nicholas Hawksmoor were involved in the design, and the pew was built by Alexander Fort, the King’s joiner. There was a heated legal dispute between Lord Ashburnham and Lord Ailesbury of Houghton House about this pew, which was eventually removed in 1847. The entrance through the east wall of the south aisle is shown in Buckler’s drawing dated 1835 (Plate 2). Lord Ailesbury had his own pew in the church, and there are faculties and papers regarding other Cl8th pews. In 1827 Boissier described the church as “crowded with pews & galleries”. Between 1823 and 1839 Bonney ordered several improvements to the pews, and in 1845 W.A. was highly critical of the arrangement of the church interior.
A faculty was obtained in 1728 to replace the pulpit, take down the chancel screen, and alter various windows. It was probably at this date that the pulpit was placed centrally in the chancel arch where it remained until 1847. Other repairs and alterations in the Cl8th and early Cl9th are recorded in the churchwardens’ accounts from 1718, vestry minutes from 1767, and churchwardens bills from 1823 (listed individually by Andrew Underwood) in the parish records.
Restoration came in 1847-8 under James Tacy Wing of Bedford, who provided new seats and galleries in the nave (Plate 3) and renewed the east window, repaired the roof and stonework, and added a small vestry on the north side of the chancel. In 1851-2 the church was lit by gas.
The tracery of the windows in the south aisle was renewed in 1872-3. Further work followed in 1877 when the vestry on the north side of the chancel was enlarged under James Piers St. Aubyn, although not all the work authorised by the faculty was carried out.
General Introduction
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- 05 August 2023, pp 1-1
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Summary
The parish churches of England are among the most noble and conspicuous of the nation’s architectural monuments. Their survival, however, owes more to chance than to good stewardship. Neglect, decay, and deliberate destruction are as much a part of their history as the work of dedicated benefactors and parishioners who strove to make our churches worthy for Christian worship.
As the sources selected for inclusion in this series demonstrate all too clearly, many Bedfordshire churches were in a dilapidated state in the opening decades of the nineteenth century. Others, whilst structurally sound and decently furnished for the worship of the day, needed “restoration” – a term meaning much more than just repair. This was the situation facing the Victorians who – far from vandalising our heritage – sought to restore these precious buildings from years of neglect and adapt them to suit the new liturgical arrangements of the time.
The coming of the ecclesiological movement in the 1840s brought a new concern for the ceremonial aspects of worship – the ministry of the sacraments instead of the ministry of the word. This entailed a change in the arrangement of church buildings, the old “preaching boxes” of the Cl8th giving way to churches in which all attention focused on the chancel and the holy table in the sanctuary. The reformers often exaggerated the poor state of church buildings as a means of drawing attention to the need for change, and the Victorians were invariably critical of alterations and repairs carried out in previous centuries when utility had been regarded as more important than sanctity.
Between about 1840 and 1914 virtually every parish church in England was in some measure restored, and vast sums of money were spent on what was seen to be one of the most worthy causes of the Victorian era. Many churches were rescued from the brink of collapse and given a new lease of life. Some were restored to their former glory. Others were mutilated beyond recognition or wholly rebuilt. Churches viewed by the Victorians as “tainted by classical alterations” were gothicised. Sound buildings were “improved” to suit the needs of a new religious age.
Bedfordshire churches 1550-1914 - a general survey
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- Boydell & Brewer
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- 05 August 2023, pp xl-40
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Summary
Churches remaining “unrestored” in appearance are to be seen at Chaigrave, Dean, Knotting, Odell, Shelton and Wymington (to name a few of the more rewarding examples in the County), but sadly the phrase “over restored” is all too common in the Bedfordshire volume of Dr. Nikolaus Pevsner’s Buildings of England series.
A brief general survey of post-Reformation church work in the County will be useful as an introduction to the subject. It seems sensible to frame the review round the work of architects - the designers of buildings and of furnishing schemes - who worked at different periods and in different styles. In this way, it is possible to view the changes in ecclesiastical taste in the County in their broader national context.
Post-Reformation church building to 1800
In general terms, church building activity came to an abrupt end at the time of the Reformation. There are, however, exceptions and recent studies in the neighbouring county of Huntingdonshire have demonstrated the extent of building work and improvements to churches into the seventeenth century. This may be untypical of the general picture, and Bedfordshire lacks any particularly distinguished examples of churches dating from the period between 1550 and 1800. Those mentioned below are all relatively minor when compared with the treasures in neighbouring counties, such as:
In Bedfordshire, Hulcote church was rebuilt by the Chemocke family in the late sixteenth century. It is gothic in form, but with a distinctly Renaissance feel. The tower at Blunham was rebuilt in 1583. At Odell there is a fine screen and ringing gallery of 1637 in the tower arch. At Campton, the north aisle dates from 1649. Whipsnade church was rebuilt in 1719. Melchboume has a seventeenthcentury porch brought, it is said, from Woodford in Northamptonshire. The body of the church was rebuilt in the classical style in about 1770. Shillington tower, destroyed in a storm in 1701, was rebuilt in brick in 1750. The 1783 black basalt Wedgwood font at Cardington - another formerly existed at Melchboume - is a particularly memorable example of eighteenth-century church furnishing. In every one of these cases the identity of the architect is unknown.
Miscellaneous Frontmatter
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- 05 August 2023, pp iv-v
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Preface and acknowledgments
- Edited by Chris Pickford
- Alan F. Cirket, Andrew Underwood, Anne Buck, Bernard Cashman, Colin Chapman, David Baker, David Bushby, Edwin Welch, Elizabeth Moser, Eric Stockdale, Herman Wellenreuther, James Collett-White, Margaret McGregor, Richard Marks, Richard Wildman, Simon Houfe, Sylvia Woods
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- Bedfordshire Churches in the Nineteenth Century
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- 05 August 2023, pp x-xi
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Summary
Having lived and worked in Bedfordshire for the past sixteen years, I have visited every church in the County in the course of my work. While on the staff of the Bedfordshire County Record Office I have been responsible for surveying and listing all the church records, and I am fortunate that this has enabled me to develop an intimate knowledge of the churches and their history.
It is my hope that in preparing these volumes I may be able to pass on some of this knowledge for the benefit of people interested either in specific churches or in the subject generally. I should like to thank the Society for publishing this book. I also wish to thank Gordon Vowles, the General Editor, and my colleagues on the Editorial Group for their constructive comments and suggestions throughout its gestation period.
Formal acknowledgment is due to the authorities and owners who have allowed the publication of their material. The 1822 glebe terriers are published here by kind permission of Lincoln Diocesan Record Office. Archdeacon Bonney’s church notes were among the manuscripts transferred to the County Record Office from the old Bedford Library, while Bonney’s visitation notes appear by kind permission of the present Archdeacon of Bedford, the Ven. Malcolm Lesiter. Sir Stephen Glynne’s Bedfordshire church notes are published by kind permission of Sir William Gladstone. Thanks are also due to Geoffrey Veysey, the Clwyd County Archivist, for providing information on the notes and for allowing me to quote from his article about Sir Stephen Glynne. The sources of illustrations are acknowledged separately.
Material for this volume has been gathered from several record repositories and institutions. My first debt of gratitude is to my colleagues in the Bedfordshire County Record Office, but I must also thank the staff at the British Library, the British Newspaper Library, the library of the Society of Antiquaries of London, the Bedfordshire County Library Service, Lambeth Palace Library, Cambridge University Library, Lincolnshire Archives, and the Hertfordshire County Record Office for their help and advice.
Thanks are also due to all those who have typed parts of the text including Deborah Blake and Ellen Collier, but especially to Pauline Newbery on whom the main body of the work has fallen.