Skip to main content

Dementia and suicidal behavior: a review of the literature

  • Camilla Haw (a1), Daniel Harwood (a2) and Keith Hawton (a3)

Background: While dementia is more common in older people and suicide rates in many countries are higher among the elderly, there is some doubt about the association between these two phenomena.

Methods: A search of the major relevant databases was carried out to examine the evidence for this possible association.

Results: The association between dementia and suicide and also non-fatal self-harm did not appear strong but many studies have significant methodological limitations and there are few studies of suicide or self-harm in vascular, frontotemporal, Lewy body and HIV dementia where such behavior might be expected to be more common. Rates of self-harm may be increased in mild dementia and are higher before than after predictive testing for Huntington's disease. Overall, the risk of suicide in dementia appears to be the same or less than that of the age-matched general population but is increased soon after diagnosis, in patients diagnosed with dementia during hospitalization and in Huntington's disease. Putative risk factors for suicide in dementia include depression, hopelessness, mild cognitive impairment, preserved insight, younger age and failure to respond to anti-dementia drugs. Large, good quality prospective studies are needed to confirm these findings.

Conclusions: Further research should be undertaken to examine how rates of suicide and self-harm change during the course of the illness and vary according to the specific sub-type of dementia.

Corresponding author
Correspondence should be addressed to: Dr Camilla Haw, Consultant Psychiatrist, St. Andrew's Hospital, Billing Road, Northampton NN1 5DG, U.K. Phone: +44 1604 616186; Fax: +44 1604 616177. Email:
Hide All
Aarsland D., Cummings J. L., Yenner G. and Miller B. (1996). Relationship of aggressive behavior to other neuropsychiatric symptoms in patients with Alzheimer's disease. American Journal of Psychiatry, 153, 243247.
Ahearn E. P. et al. (2001). MRI correlates of suicide attempt history in unipolar depression. Biological Psychiatry, 50, 266270.
Alexopoulos G. S. (1991). Psychological autopsy of an elderly suicide. International Journal of Geriatric Psychiatry, 6, 4550.
Almqvist E. W., Bloch M., Brinkman R., Craufurd D. and Hayden M. R. (1999). A worldwide assessment of the frequency of suicide, suicide attempts, or psychiatric hospitalization after predictive testing for Huntington disease. American Journal of Human Genetics, 64, 12931304.
Ashby D., Ames D., West C. R., MacDonald A., Graham N. and Mann A. H. (1991). Psychiatric morbidity as predictor of mortality for residents of local authority homes for the elderly. International Journal of Geriatric Psychiatry, 6, 567575.
Ayalon L., Mackin S., Arean P. A., Chen H. and McDonel Herr E. C. (2007). The role of cognitive functioning and distress in suicidal ideation in older adults. Journal of the American Geriatrics Society, 55, 10901094.
Baliko L., Csala B. and Czopf J. (2004). Suicide in Hungarian Huntington's disease patients. Neuroepidemiology, 23, 258260.
Ballard C., Bannister C., Solis M., Oyebode F. and Wilcock G. (1996). The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders, 36, 135144.
Bamford C., Lamont S., Eccles M., Robinson L., May C. and Bond J. (2004). Disclosing a diagnosis of dementia: a systematic review. International Journal of Geriatric Psychiatry, 19, 151169.
Barak Y. and Aizenberg D. (2002). Suicide amongst Alzheimer's disease patients: a 10-year survey. Dementia and Geriatric Cognitive Disorders, 14, 101103.
Barraclough B. (1971). Suicide in the elderly. British Journal of Psychiatry, Special supplement 6, 8797.
Beautrais A. L. (2002). A case control study of suicide and attempted suicide in older adults. Suicide and Life-Threatening Behavior, 32, 19.
Bird T. D. (1999). Outrageous fortune: the risk of suicide in genetic testing for Huntington disease. American Journal of Human Genetics, 64, 12891292.
Broadstock M., Michie S. and Marteau T. (2000). Psychological consequences of predictive genetic testing: a systematic review. European Journal of Human Genetics, 8, 731738.
Burns A., Jacoby R. and Levy R. (1990). Psychiatric phenomena in Alzheimer's disease. IV. Disorders of behaviour. British Journal of Psychiatry, 157, 8694.
Buter T. C., van den Hout A., Matthews F. E., Larsen J. P., Brayne C. and Aarsland D. (2008). Dementia and survival in Parkinson disease: a 12-year population study. Neurology, 70, 10171022.
Callahan C. M., Hendrie H. C., Nienaber N. A. and Tierney W. M. (1996). Suicidal ideation among older primary care patients. Journal of the American Geriatrics Society, 44, 12051209.
Carney S. S., Rich C. L., Burke P. A. and Fowler R. C. (1994). Suicide over 60: the San Diego study. Journal of the American Geriatrics Society, 42, 174180.
Chan S. S., Lyness J. M. and Conwell Y. (2007). Do cerebrovascular risk factors confer risk for suicide in later life? A case-control study. American Journal of Geriatric Psychiatry, 15, 541544.
Chiu H. F. K., Lam L. C. W., Pang A. H. T., Leung C. M. and Wong C. K. (1996). Attempted suicide by Chinese elderly in Hong Kong. General Hospital Psychiatry, 18, 444447.
Chiu H. F. K. et al. (2004). Elderly suicide in Hong Kong: a case-controlled psychological autopsy study. Acta Psychiatrica Scandinavica, 109, 299305.
Codori A. M., Slavney P. R., Rosenblatt A. and Brandt J. (2004). Prevalence of major depression one year after predictive testing for Huntington's disease. Genetic Testing, 8, 114119.
Cohen D., Vergon T. L. and Malphurs J. (1998). Case studies of suicide in older persons with Alzheimer's disease and related dementias. Journal of Mental Health and Aging, 4, 397402.
Conwell Y., Olsen K., Caine E. D. and Flannery C. (1991). Suicide in later life: psychological autopsy findings. International Psychogeriatrics, 3, 5966.
Conwell Y. et al. (2000). Completed suicide among older patients in primary care practices: a controlled study. Journal of the American Geriatrics Society, 48, 2329.
Cooper J. P. (2002). Self-harm and dementia. Internet Journal of Mental Health, 1.
de Jonghe-Rouleau A. P., Pot A. M. and de Jonghe J. F. M. (2005). Self-injurious behavior in nursing home residents with dementia. International Journal of Geriatric Psychiatry, 20, 651657.
De Leo D. and Evans R. (2004). Global trends and suicide mortality. In De Leo D. and Evans R., International Suicide Rates and Prevention Strategies (pp. 1520), Goettingen: Hogrefe & Huber.
Decruyenaere M. et al. (2003). Psychological distress in the 5-year period after predictive testing for Huntington's disease. European Journal of Human Genetics, 11, 3038.
Department of Health (2009). Living Well with Dementia: A National Dementia Strategy. London: Department of Health.
Dewey M. E., Davidson I. A. and Copeland J. R. M. (1993). Expressed wish to die and mortality in older people: a community replication. Age and Ageing, 22, 109113.
Di Maio L., Squitieri F., Napolitano G., Campanella G., Trofatter J. A. and Conneally P. M. (1993). Suicide risk in Huntington's disease. Journal of Medical Genetics, 30, 293295.
Dombrovski A. Y. et al. (2008). Cognitive performance in suicidal depressed elderly: preliminary report. American Journal of Geriatric Psychiatry, 16, 109115.
Donovan N. J., Kendall D. L., Heaton S. C., Kwon S., Velozo C. A. and Duncan P. W. (2008). Conceptualizing functional cognition in stroke. Neurorehabilitation and Neural Repair, 22, 122135.
Doshi P. K., Chhaya N. and Bhatt M. H. (2002). Depression leading to attempted suicide after bilateral subthalamic nucleus stimulation for Parkinson's disease. Movement Disorders, 17, 10841085.
Draper B. (1994). Suicidal behaviour in the elderly. International Journal of Geriatric Psychiatry, 9, 655661.
Draper B., Maccuspie-Moore C. and Brodaty H. (1998). Suicidal ideation and the “wish to die” in dementia patients: the role of depression. Age and Ageing, 27, 503507.
Draper B., Brodaty H. and Low L. F. (2002). Types of nursing home residents with self-destructive behaviours: analysis of the harmful behaviours scale. International Journal of Geriatric Psychiatry, 17, 670675.
Draper B., Brodaty H., Low L. F. and Richards V. (2003). Prediction of mortality in nursing home residents: impact of passive self-harm behaviors. International Psychogeriatrics, 15, 187196.
Erlangsen A., Zarit S. H., Tu X. and Conwell Y. (2006). Suicide among older psychiatric inpatients: an evidence-based study of a high-risk group. American Journal of Geriatric Psychiatry, 14, 734741.
Erlangsen A., Zarit S. H. and Conwell Y. (2008). Hospital-diagnosed dementia and suicide: a longitudinal study using prospective, nationwide register data. American Journal of Geriatric Psychiatry, 16, 220228.
Faber R. A. (2003). Suicide in neurological disorders. Neuroepidemiology, 22, 103105.
Farrer L. A. (1986). Suicide and attempted suicide in Huntington disease: implications for preclinical testing of persons at risk. American Journal of Medical Genetics, 24, 305311.
Ferris S. H., Hofeldt G. T., Carbone G., Masciandaro P., Troetel W. M. and Imbimbo B. P. (1999). Suicide in two patients with a diagnosis of probable Alzheimer disease. Alzheimer Disease and Associated Disorders, 13, 8890.
Florio E. R., Hendryx M. S., Jensen J. E., Rockwood T. H., Raschko R. and Dyck D. G. (1997). A comparison of suicidal and nonsuicidal elders referred to a community mental health center program. Suicide and Life-Threatening Behavior, 27, 182193.
Forsell Y., Jorm A. F. and Winblad B. (1997). Suicidal thoughts and associated factors in an elderly population. Acta Psychiatrica Scandinavica, 95, 108111.
Funkiewiez A. et al. (2004). Long term of bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry, 75, 834839.
Grabbe L., Demi A., Camann M. A. and Potter L. (1997). The health status of elderly persons in the last year of life: a comparison of deaths by suicide, injury, and natural causes. American Journal of Public Health, 87, 434437.
Harris E. C. and Barraclough B. (1994). Suicide as an outcome for medical disorders. Medicine, 73, 281296.
Harris E. C. and Barraclough B. (1997). Suicide as an outcome for mental disorders: a meta-analysis. British Journal of Psychiatry, 170, 205228.
Harris E. C. and Barraclough B. (1998). Excess mortality of mental disorder. British Journal of Psychiatry, 173, 1153.
Harwood D. G. and Sultzer D. L. (2002). “Life is not worth living”: hopelessness in Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 15, 3843.
Harwood D., Hawton K., Hope T. and Jacoby R. (2001). Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study. International Journal of Geriatric Psychiatry, 16, 155165.
Hawton K. et al. (1998). The psychological autopsy approach to studying suicide: a review of methodological issues. Journal of Affective Disorders, 50, 269276.
Heinik J. (1997). Resurgence of painful past experiences as a cause of the suicide attempt in a dementia sufferer. Clinical Gerontologist, 18, 5962.
Heisel M. J., Flett G. L. and Besser A. (2002). Cognitive functioning and geriatric suicide ideation: testing a mediational model. American Journal of Geriatric Psychiatry, 10, 428436.
Henriksson M. M. et al. (1995). Mental disorders in elderly suicide. International Psychogeriatrics, 7, 275286.
Hepple J. and Quinton C. (1997). One hundred cases of attempted suicide in the elderly. British Journal of Psychiatry, 171, 4246.
Hierholzer R. (2002). Suicide in dementia: case studies of failure as a risk factor. Clinical Gerontologist, 24, 159163.
Hiroeh U., Appleby L., Mortensen P. B. and Dunn G. (2001). Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. The Lancet, 358, 21102112.
Huntington G. (1872). On chorea. Medical and Surgical Reporter, 26, 317321.
Ito T. et al. (2002). A study of suicidal cases of vascular dementia. Seishin Igaku, 44, 12951303.
Jorm A. F. (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychological Medicine, 24, 145153.
Jorm A. F., Henderson A. S., Scott R., Korten A. E., Christensen H. and MacKinnon A. J. (1995). Factors associated with the wish to die in elderly people. Age and Ageing, 24, 389392.
Juurlink D. N., Herrmann N., Szalai J. P., Kopp A. and Redelmeier D. A. (2004). Medical illness and the risk of suicide in the elderly. Archives of Internal Medicine, 164, 11791184.
Kaye K., Grigsby J., Robbins L. J. and Korzun B. (1990). Prediction of independent functioning and behavior problems in geriatric patients. Journal of the American Geriatrics Society, 38, 13041310.
Keene J., Hope T., Fairburn C. G. and Jacoby R. (2001). Death and dementia. International Journal of Geriatric Psychiatry, 16, 969974.
Keilp J. G., Sackeim H. A., Brodsky B. S., Oquendo M. A., Malone K. M. and Mann J. J. (2001). Neuropsychological dysfunction in depressed suicide attempters. American Journal of Psychiatry, 158, 735741.
King D. A., Conwell Y., Cox C., Henderson R. E., Denning D. G. and Caine E. D. (2000). A neuropsychological comparison of depressed suicide attempters and nonattempters. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 6470.
Kishi Y., Robinson R. G. and Kosier J. T. (1996). Suicidal plans in patients with stroke: comparison between acute-onset and delayed-onset suicidal plans. International Psychogeriatrics, 8, 623634.
Kishi Y., Robinson R. G. and Kosier J. T. (2001). Suicidal ideation among patients with acute life-threatening physical illness: patients with stroke, traumatic brain injury, myocardial infarction, and spinal cord injury. Psychosomatics, 42, 382390.
Kishikawa Y., Friedland R. P., Ueda H., Kitabayashi Y. and Fukui K. (2007). Socio-psychological factors in suicide with Alzheimer's disease: comparative case studies of two patients in the USA and Japan. Psychogeriatrics, 7, 3739.
Knopman D. S., Kitto J., Deinard S. and Heiring J. (1988). Longitudinal study of death and institutionalization in patients with primary degenerative dementia. Journal of the American Geriatrics Society, 36, 108112.
Larsson M. U., Luszcz M. A., Bui T. H. and Wahlin T. B. R. (2006). Depression and suicidal ideation after predictive testing for Huntington's disease: a two-year follow-up study. Journal of Genetic Counseling, 15, 361374.
Lawrence D., Almeida O. P., Hulse G. K., Jablensky A. V. and Holman C. D. J. (2000). Suicide and attempted suicide among older adults in Western Australia. Psychological Medicine, 30, 813821.
Lebret S., Perret-Vaille E., Mulliez A., Gerbaud L. and Jalenques I. (2006). Elderly suicide attempters: characteristics and outcome. International Journal of Geriatric Psychiatry, 21, 10521059.
Lieberman A. (2006). Are dementia and depression in Parkinson's disease related? Journal of the Neurological Sciences, 248, 138142.
Lim W. S., Rubin E. H., Coats M. and Morris J. C. (2005). Early-stage Alzheimer disease represents increased suicidal risk in relation to later stages. Alzheimer Disease and Associated Disorders, 19, 214219.
London School of Economics Personal Social Services Research Unit and Institute of Psychiatry King's College London (2007). Dementia UK, London: Alzheimer's Society. (Available at:
Lyness J. M., Conwell Y. and Nelson J. C. (1992). Suicide attempts in elderly psychiatric inpatients. Journal of the American Geriatrics Society, 40, 320324.
MacDonald A. J. D. and Dunn G. (1982). Death and the expressed wish to die in the elderly: an outcome study. Age and Ageing, 11, 189195.
Mann J. J. (2003). Neurobiology of suicidal behaviour. Nature Reviews Neuroscience, 4, 819828.
Margo G. M. and Finkel J. A. (1990). Early dementia as a risk factor for suicide. Hospital and Community Psychiatry, 41, 676678.
Meiser B. and Dunn S. (2000). Psychological impact of genetic testing for Huntington's disease: an update of the literature. Journal of Neurology Neurosurgery and Psychiatry, 69, 574578.
Meltzer C. C. et al. (1998). Serotonin in aging, late-life depression, and Alzheimer's disease: the emerging role of functional imaging. Neuropsychopharmacology, 18, 407430.
Mendez M. F., Bagert B. A. and Edwards-Lee T. (1997). Self-injurious behavior in frontotemporal dementia. Neurocase, 3, 231235.
Menghini V. V. and Evans J. M. (2000). Suicide among nursing home residents: a population-based study. Journal of the American Directors Association, 1, 4750.
Myslobodsky M., Lalonde F. M. and Hicks L. (2001). Are patients with Parkinson's disease suicidal? Journal of Geriatric Psychiatry and Neurology, 14, 120124.
Nelson F. L. and Farberow N. L. (1980). Indirect self-destructive behavior in the elderly nursing home patient. Journals of Gerontology, 35, 949957.
Nowers M. (1993). Deliberate self-harm in the elderly: a survey of one London borough. International Journal of Geriatric Psychiatry, 8, 609614.
Osgood N. J., Brant B. A. and Lipman A. (1991). A scientific study of suicide in institutions. InOsgood N. J., Brant B. A. and Lipan A. (eds.), Suicide among the Elderly in Long-Term Care Facilities (pp. 3764). New York: Greenwood Press.
Osvath P., Kovacs A., Voros V. and Fekete S. (2005). Risk factors of attempted suicide in the elderly: the role of cognitive impairment. International Journal of Psychiatry in Clinical Practice, 9, 221225.
Paulsen J. S., Hoth K. F., Nehl C. and Stierman L. (2005). Critical periods of suicide risk in Huntington's disease. American Journal of Psychiatry, 162, 725731.
Peisah C., Snowdon J., Gorrie C., Kril J. and Rodriguez M. (2007). Investigation of Alzheimer's disease-related pathology in community dwelling older subjects who committed suicide. Journal of Affective Disorders, 99, 127132.
Pierce D. (1987). Deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry, 2, 105110.
Pierce D. W. (1996). Repeated deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry, 11, 983986.
Pies R. W. and Popli A. P. (1995). Self-injurious behavior: pathophysiology and implications to treatment. Journal of Clinical Psychology, 56, 580588.
Pohjasvaara T., Vataja R., Leppävuori A., Kaste M. and Erkinjuntti T. (2001). Suicidal ideas in stroke patients 3 and 15 months after stroke. Cerebrovascular Diseases, 12, 2126.
Préville M., Hébert R., Boyer R., Bravo G. and Seguin M. (2005). Physical health and mental disorder in elderly suicide: a case-control study. Aging and Mental Health, 9, 576584.
Rao R., Dening T., Brayne C. and Huppert F. A. (1997). Suicidal thinking in community residents over eighty. International Journal of Geriatric Psychiatry, 12, 337343.
Rapp M. A. et al. (2006). Increased hippocampal plaques and tangles in patients with Alzheimer's disease with a lifetime history of major depression. Archives of General Psychiatry, 63, 161167.
Ravina B. et al. (2007). The impact of depressive symptoms in early Parkinson disease. Neurology, 69, 342347.
Robins Wahlin T. B. (2007). To know or not to know: a review of behaviour and suicidal ideation in preclinical Huntington's disease. Patient Education and Counseling, 65, 279287.
Robins Wahlin T. B., Bäckman L., Lundin A., Haegermark A., Winblad B. and Anvret M. (2000). High suicidal ideation in persons testing for Huntington's disease. Acta Neurologica Scandinavica, 102, 150161.
Robins A. H. (1976). Depression in patients with parkinsonism. British Journal of Psychiatry, 128, 141145.
Robinson R. G., Morris P. L. P. and Fedoroff J. P. (1990). Depression and cerebrovascular disease. Journal of Clinical Psychiatry, 51 (Suppl. 7), 2631.
Rohde K., Peskind E. R. and Raskind M. A. (1995). Suicide in two patients with Alzheimer's disease. Journal of the American Geriatrics Society, 43, 187189.
Rubio A., Vestner A. L., Stewart J. M., Forbes N. T., Conwell Y. and Cox C. (2001). Suicide and Alzheimer's pathology in the elderly: a case-control study. Biological Psychiatry, 49, 137145.
Ruths F. A., Tobiansky R. I. and Blanchard M. (2005). Deliberate self-harm (DSH) among older people: a retrospective study in Barnet, North London. International Journal of Geriatric Psychiatry, 20, 106112.
Schneider B., Maurer K. and Frölich L. (2001). Dementia and suicide. Fortschritte der Neurologie Psychiatrie, 69, 164169.
Scocco P. et al. (2006). Suicidal behaviour in nursing homes: a survey in a region of north-east Italy. International Journal of Geriatric Psychiatry, 21, 307311.
Selnes O. A. and Vinters H. V. (2006). Vascular cognitive impairment. Nature Clinical Practice Neurology, 2, 538547.
Snowdon J. and Baume P. (2002). A study of suicides of older people in Sydney. International Journal of Geriatric Psychiatry, 17, 261269.
Steinbart E. J., Smith C. O., Poorkaj P. and Bird T. D. (2001). Impact of DNA testing for early-onset familial Alzheimer disease and frontotemporal dementia. Archives of Neurology, 58, 18281831.
Stenager E. N., Wermuth L., Stenager E. and Boldsen J. (1994). Suicide in patients with Parkinson's disease: an epidemiological study. Acta Psychiatrica Scandinavica, 90, 7072.
Stenager E. N., Madsen C., Stenager E. and Boldsen J. (1998). Suicide in patients with stroke: epidemiological study. BMJ, 316, 12061210.
Suominen K., Henriksson M., Isometsä E., Conwell Y., Heilä H. and Lönnqvist J. (2003). Nursing home suicides: a psychological autopsy study. International Journal of Geriatric Psychiatry, 18, 10951101.
Takahashi Y. et al. (1995). Suicide and aging in Japan: an examination of treated elderly suicide attempters. International Psychogeriatrics, 7, 239251.
Teasdale T. W. and Engberg A. W. (2001). Suicide after a stroke: a population study. Journal of Epidemiology and Community Health, 55, 863866.
Teri L., Baer L. C. and Reifler B. V. (1991). Depression in Alzheimer's patients: investigation of symptom patterns and frequency. Clinical Gerontologist, 11, 4758.
Tsai C. F., Tsai S. J., Yang C. H. and Hwang J. P. (2007). Chinese demented inpatients admitted following a suicide attempt: a case series. International Journal of Geriatric Psychiatry, 22, 11061109.
Turnbull Q., Wolf A. M. D. and Holroyd S. (2003). Attitudes of elderly subjects toward “truth telling” for the diagnosis of Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 16, 9093.
Turvey C. L. et al. (2002). Risk factors for late-life suicide: prospective, community-based study. American Journal of Geriatric Psychiatry, 10, 398406.
Upadhyaya A. K., Conwell Y., Duberstein P. R., Denning D. and Cox C. (1999). Attempted suicide in older depressed patients: Effect of cognitive functioning. American Journal of Geriatric Psychiatry, 7, 317320.
Vega U., Kishikawa Y., Ricanati E. and Friedland R. P. (2002). Suicide and Alzheimer disease. American Journal of Geriatric Psychiatry, 10, 484485.
Waern M., Rubenowitz E., Runeson B., Skoog I., Wilhelmsson K. and Allebeck P. (2002a). Burden of illness and suicide in elderly people: case-control study. BMJ, 324, 13551357.
Waern M. et al. (2002b). Mental disorder in elderly suicides: a case-control study. American Journal of Psychiatry, 159, 450455.
Waern M., Rubenowitz E. and Wilhelmson K. (2003). Predictors of suicide in the old elderly. Gerontology, 49, 328334.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 6
Total number of PDF views: 92 *
Loading metrics...

Abstract views

Total abstract views: 476 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th November 2017. This data will be updated every 24 hours.