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Objective: Caregivers play an essential role in supporting people with Alzheimer's disease globally. User‐informed research is vital to developing trans‐cultural guidelines for dementia support organisations. While coping strategies of caregivers are well researched, the 'coping‐effectiveness' framework falls short of representing all caregiver needs. Our aim was to develop a robust and inclusive, globally applicable framework of caregiver‐informed support needs. Methods: In partnership with Alzheimer's Disease International and Roche, we conducted qualitative online semi‐structured interviews with 34 family caregivers from the Global North (UK, US) and Global South (Brazil, South Africa) in the COVID‐19 context. Participant‐generated photographs helped encourage discussions of hidden contextual issues. Iterative inductive narrative analysis of interviews and photographs was carried out with input from global and national charity and industry sectors. Results: We identified a framework of four cross‐cultural caring approaches with implications for support: (1) Empathising, using emotion‐focused strategies to develop strong expertise and coping skills, with time specific information, psychosocial and peer support needs. (2) Organising, using problem‐focused strategies, with strong narratives of expertise and advocacy which benefited from early structured information and professional confirmation. (3) Non‐identifying caregiving, where daily aspects of caring occurred without specialist knowledge and expertise, and caregivers sought assistance in managing disease‐related support. (4) Reluctance, where struggling with unwanted caring responsibilities meant caregivers looked to professionals to carry out daily care. Conclusion: Our findings move beyond the 'coping‐effectiveness' framework of support to suggest a novel 'role‐needs' framework. Our approach supports inclusive ways of tailoring support to fit individual caregiver circumstances globally. [ABSTRACT FROM AUTHOR]

Aphantasia is characterised by the inability to create mental images in one's mind. Studies investigating impairments in imagery typically focus on the visual domain. However, it is possible to generate many different forms of imagery including imagined auditory, kinesthetic, tactile, motor, taste and other experiences. Recent studies show that individuals with aphantasia report a lack of imagery in modalities, other than vision, including audition. However, to date, no research has examined whether these reductions in self-reported auditory imagery are associated with decrements in tasks that require auditory imagery. Understanding the extent to which visual and auditory imagery deficits co-occur can help to better characterise the core deficits of aphantasia and provide an alternative perspective on theoretical debates on the extent to which imagery draws on modality-specific or modality-general processes. In the current study, individuals that self-identified as being aphantasic and matched control participants with typical imagery performed two tasks: a musical pitch-based imagery and voice-based categorisation task. The majority of participants with aphantasia self-reported significant deficits in both auditory and visual imagery. However, we did not find a concomitant decrease in performance on tasks which require auditory imagery, either in the full sample or only when considering those participants that reported significant deficits in both domains. These findings are discussed in relation to the mechanisms that might obscure observation of imagery deficits in auditory imagery tasks in people that report reduced auditory imagery. [ABSTRACT FROM AUTHOR]

Background: Attachment style has been linked with basal cortisol secretion in healthy adult women. We investigated whether dysregulation in basal cortisol secretion may be evident in younger healthy females. Methods: Sixty healthy females aged 9-18 years (mean 14.16, SD [plus or minus] 2.63 years) participated in the Attachment Style Interview (ASI). Eight saliva samples, synchronised to awakening, were collected per day on two consecutive weekdays to examine the cortisol awakening response (CAR) and the subsequent diurnal decline. Results: Participants exhibiting an anxious attachment style had higher cortisol levels on awakening, in contrast to those who were securely attached. The anxious insecure group also showed an attenuated CAR compared to all other participants. Attachment style groups did not differ in cortisol secretion over the remainder of the day. Conclusions: These findings indicate that the same pattern of cortisol dysregulation associated with disorder in adulthood manifests as a function of anxious (but not avoidant) insecure attachment style in females during healthy childhood and adolescence.

People working in the music industry report significantly higher levels of anxiety and depression than the general population, but to date, studies have not explored the differences between professional musicians and those who perform music primarily for recreation. In this study, 254 musicians from 13 countries completed measures of anxiety, depression, and wellbeing as well as answering questions about their professional status, level of success, and income. Across the whole sample, we found that over half had high levels of anxiety, and a third were experiencing depression. We showed that musicians who viewed music as their main career were more likely to have poor mental wellbeing and had significantly higher levels of clinical depression. Status as a solo or lead artist and perceived level of success also significantly predicted higher levels of anxiety and depression, and lower levels of positive wellbeing. We conclude that low mental wellbeing in musicians is the result of working as a professional musician, as opposed to being an inherent trait. Future work should explore underlying beliefs and perceptions of career musicians alongside other key factors, such as health behaviors and social support, with the aim of making specific recommendations to the music industries and educators. [ABSTRACT FROM AUTHOR]

This study is the first to demonstrate that a self-defining period (SP) for personally relevant music emerges spontaneously in a public naturalistic setting. While previous research has demonstrated that people tend to have better memory and preference for songs from their teenage years, the theoretical relevance of these studies has been limited by their reliance on forced-choice methodology and a confinement to contemporary popular Western music. Here, we examine the record choices of famous guests (n = 80; mean age = 61.6 years) interviewed for Desert Island Discs, a long-running popular radio programme on BBC Radio 4. Half of all choices were shown to have been most important between the ages of 10 and 30 years, and the most popular reason for their relevance was the song's link to memories of a person, period, or place. We suggest that music is a defining feature of the SP, intrinsically connected to the developing self. [ABSTRACT FROM AUTHOR]

Little is known about our autobiographical memories for cultural events. This represents an opportunity for cultural institutions such as museums, as examination of visitor memories is one way in which they can seek to understand the long-term impact they may have on their visitors. This research applied a coding model developed from autobiographical memory theory to analysis of participants' memories for museum visits, considering the distribution of memories across the life span, types of memories and content. Differences between visitor groups (age, visit frequency) were also considered. Findings showed a strong recency effect in the life-span distribution, suggesting the importance of social sharing in memories of cultural experience. Analysis of content showed a hierarchy of information that was present in museum memories. Knowledge acquired during the event of the visit was important, as was contextualising information whereby visitors situated the memory within their autobiographical knowledge and chronology. Emotions and thoughts were also salient. Visitor differences had minimal impact on content, with the exception of some effects that were consistent with the literature on memory and ageing. This research develops understanding of autobiographical memories for cultural experiences and provides insight to museums, with practical implications in terms of understanding visitors' experiences. [ABSTRACT FROM AUTHOR]

Background: Wearable camera photographs have been shown to be an effective memory aid in people with and without memory impairment. Most studies using wearable cameras as a memory aid have presented photographs on a computer monitor and used a written diary or no review as a comparison. In this pioneering study, we took a new and innovative approach to wearable camera photograph review that embeds the photographs within a virtual landscape. This approach may enhance these benefits by reinstating the original environmental context to increase participants' sense of re-experiencing the event.Objective: We compare the traditional computer monitor presentation of wearable camera photographs and actively taken digital photographs with the presentation of wearable camera photographs in a new immersive interface that reinstates the spatiotemporal context.Methods: Healthy older adults wore wearable or took digital photographs during a staged event. The next day and 2 weeks later, they viewed wearable camera photographs on a computer monitor or in context on an immersive interface, or digital photographs.Results: Participants who viewed wearable camera photographs in either format recalled more details during photo viewing and subsequent free recall than participants who viewed digital photographs they had taken themselves.Conclusion: Wearable camera photographs are an effective support for event memory, regardless of whether they are presented in context in an experience-near format. [ABSTRACT FROM AUTHOR]

Objective: It has been established that capturing how an individual draws the Rey Complex Figure Task (RCF) is as important as assessing what is drawn (Rey, 1941, Osterrieth, 1944). Despite the development of multiple systems that have been designed to measure these qualitative characteristics there are still no systematic means to measure adherence to the temporal-spatial heuristic that represents a typical drawing practice in healthy, neurotypical adults (Visser, 1973; Hamby et al, 1993).This study sought to develop a system for scoring temporal-spatial adherence when drawing the figure to provide objective, continuous data. Participants and Methods: Fifty-three English-speaking adults (mean age 44.61 yrs, SD 12.48; 44 female) were recruited. Exclusion criteria included vision and hearing impairment not corrected by aids; neurodivergent, neurological or psychiatric diagnosis, cancer or brain injury history. Participants completed the RCF copy phase as part of an extended neuropsychological battery. The RCF drawing process was recorded via video and a ball-point pen that digitally recorded drawing. Order data for the 18 RCF elements (Osterrieth, 1944,Taylor, 1959) was recorded by two scorers and analysed via Principal Component Analysis (PCA) with an equimax rotation to identify elements typically drawn together by a healthy, neurotypical adult. Using scoring methodology adapted from Geary et al (2011), the extent to which participants drew consecutively the member elements of each factor or 'strategy cluster' was calculated and recorded. Strategy Cluster Scores across the population sample were examined to understand normative performance. Results: Order data was examined for interrater reliability via Pearson's correlation coefficient and was considered good (r2 = 0.78, p < 0.001). PCA identified four factors or 'strategy clusters' that were statistically robust and accounted for 67.34% of total variation. The strategy clusters were Core Structure (rectangle, diagonal, horizontal, vertical); Triangular Structure (triangle, horizontal in triangle, vertical in triangle, diamond); Internal Left-Hand Side (four horizontal lines, smaller rectangle, horizontal in top-left quad); and Internal Right-Hand Side (five lines, circle, vertical top-right quad, small triangle). The mean RCF Strategy Cluster Score was 6.23 (SD 1.94; possible range: 2.75 to 10). Population data spread indicated that healthy neurotypical adults only partially observed a temporal-spatial heuristic, rather than strict, absolute adherence. Conclusions: Four strategy clusters were identified where cluster members were typically drawn consecutively. RCF Cluster Strategy scoring was shown to measure the temporal-spatial heuristic objectively, providing continuous data that lends itself to clinical standardisation. Further, the study demonstrated that whilst healthy, neurotypical adults copy the RCF using a temporal-spatial heuristic, it is only partially adhered to. Traditionally deviation from strict adherence to the four strategy clusters during drawing was deemed to be indicative of cognitive dysregulation, however our findings demonstrate a normal distribution of typical population performance. These findings have important implications for interpreting how RCF drawing strategy informs clinical assessment and diagnosis as both very strict and very weak adherence to a temporal-spatial heuristic can be indicative of atypical function. The study supports this novel scoring system as a fast and reliable means to systematically measure RCF Cluster Strategy that with further validation could be adopted within clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Evidence regarding cognitive impairment following concussion/mild traumatic brain injury (mTBI) has been conflicting. Criticism has focused on what is being measured, how it is being measured, and who is being measured (Pertab et al, 2009; Iverson, 2010). However, literature suggests that clinicians and researchers should examine how individuals complete a task rather than what they achieve (Geary et al, 2011). Studies examining the drawing process used to complete the Rey-Osterrieth Complex Figure Task (RCF) have been inconclusive and methodologically weak. The current study addressed several criticisms and limitations by examining whether observing RCF drawing process, including a novel strategy construct, could support a diagnosis of persisting post-concussive symptoms. Participants and Methods: Sixteen individuals with a history of concussion/mTBI and sixteen matched controls (age, sex, IQ) were included in multiple regression analyses to examine whether RCF drawing constructs predict post-concussive symptoms (mean age 43.59 years; 22 female). At least 3 months had passed since the concussive/mTBI event. Post-concussive symptoms were assessed with the Rivermead Post-Concussive Symptoms Questionnaire (RPCSQ) and the Mental Fatigue Scale (MFS). Separate regression analyses were conducted for each scale. Predictor variables were statistically selected from a catalogue of 4 RCF drawing process constructs - Wholeness, Order, Continuation and Strategy; 15 traditional measures of cognitive function; and 3 psychological state measures. 17 variables were included in the model for the RPCSQ, including Order and Strategy. 18 variables were included for the MFS, including Order, Continuation and Strategy. Results: Order scores were found to be one of the strongest predictors of RPCSQ scores (B = -2.06; ß= 0.20), and MFS scores (B = -1.54, ß = 0.26). Individuals drawing fewer core elements at the start of the drawing process were found to report more post-concussive symptoms. Participants who observed a stronger temporal-spatial strategy heuristic, as measured by the Strategy construct, reported more symptoms, particularly mental fatigue (RPCSQ: B = 0.49, ß = 0.09; MFS: B = 0.58, ß = 0.19). Continuation was also found to be predictive of MFS scores (B = -0.24, ß = -0.14), such that the fewer continuation points that were observed, the greater the MFS score. Conclusions: Two constructs of RCF drawing process - Order and Strategy - were found to predict persisting post-concussive symptoms generally, and mental fatigue specifically. Continuation was also found to predict mental fatigue. Such findings provide a cognitive explanation for patient reports of mental fatigue following concussion - recognised as the most common and persistent symptom. Strict adherence to a temporal-spatial strategy may indicate cognitive inflexibility - a theory supported by the inclusion and influence of other cognitive tasks in the regression models that rely on cognitive flexibility. Individuals exert more effort to shift between perceptual planes and to override global bias, thereby expending cognitive resources more quickly and to a greater extent. These findings provide a credible explanation for the lack of evidence of cognitive impairments in previous research, where neuropsychological tasks focus on attainment rather than process. These findings highlight the clinical importance of assessing cognitive dysregulation, specific cognitive processes and cognitive deficits post-concussion/mTBI. [ABSTRACT FROM AUTHOR]

Background: Caregivers play an essential role in supporting people living with Alzheimer's disease globally. Cross‐country research on caregivers' experiences of coping is a prerequisite to developing useful trans‐cultural guidelines for support organisations. While some coping strategies of caregivers globally have been identified, these are neither well understood or elaborated, nor linked effectively into carer support offerings. Methods: In partnership with Alzheimer's Disease International (ADI) and Roche, we conducted in‐depth qualitative interviews with photo‐elicitation with 34 caregivers from UK, US, Brazil, and South Africa to understand critical factors in coping during and after the pandemic. Inductive narrative analysis of data and participant generated images coded to dominant themes (Relationships and Caring role) were developed with input from global and national charity and industry sectors. Results: We uncovered four caregiving styles: Empaths used emotion‐focused strategies to construct their caring role ('put yourself in that person's shoes'). They tended to develop strong coping skills, but needed psychosocial support and time specific information. Organisers used problem‐focused strategies and sought information and training early on ('I'm a pretty good expert now'). They developed strong narratives of organisation, advocacy and expertise. Non‐identifiers managed some aspects of the caring role but felt isolated and lacked knowledge and expertise ('do everything I can...there's nobody else'). They sought others to manage disease related support. Reluctants struggled with unwanted caring duties ('I didn't sign up for this'). They needed support in coming to terms with their loved one's diagnosis and professional help with the day‐to‐day caring role. Conclusion: Our findings highlight the need for tailored user‐driven support offerings, that begin with the individual carer's experiences and needs. Our typology will be used in the communication and development of findings and best practice guidelines to inform charities and policy makers about cost effective ways of tailoring support to fit individual carer circumstances globally. [ABSTRACT FROM AUTHOR]

Objective To compare the incidence of silent cerebral infarction and impact on cognitive function following transcatheter aortic valve implantation (TAVI) with the firstgeneration CoreValve (Medtronic, Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston Scientific, Natick Massachusetts, USA). Design A prospective observational study comprising a 1.5 T cerebral MRI scan, performed preoperatively and immediately following TAVI, and neurocognitive assessments performed at baseline, 30 days and 1 year follow-up. Setting University hospitals of Leeds and Leicester, UK. Patients 66 (80.6±8.0 years, 47% male) patients with high-risk severe symptomatic aortic stenosis recruited between April 2012 and May 2015. Main outcome measures Incidence of new cerebral microinfarction and objective decline in neurocognitive performance. Results All underwent cerebral MRI at baseline and immediately following TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments at baseline, 30 days and 1 year. There was a significantly greater incidence of new cerebral microinfarction observed following the Lotus TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean volume of infarcted cerebral tissue per patient was equivalent following the two prostheses (p=0.166). More patients suffered new anterior (14 (48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%), p=0.005) lesions following Lotus. Lotus was associated with a decline in verbal memory and psychomotor speed at 30 days. However, performance longitudinally at 1 year was preserved in all neurocognitive domains. Conclusions There was a higher incidence of silent cerebral microinfarction and a greater number of lesions per patient following Lotus compared with CoreValve. However, there was no objective decline in neurocognitive function discernible at 1 year following TAVI with either prosthesis. [ABSTRACT FROM AUTHOR]

Memory complaints are a key diagnostic criterion for dementia and mild cognitive impairment. Rating scales can be used to capture information about individuals’ memory problems from informants such as family members. However, problems with scale reliability suggest that individual differences influence the ratings informants provide. This project tested whether informants’ neuroticism was associated with their ratings of an older adult’s memory. In an online study, 293 volunteers completed a Five-Factor Personality Questionnaire and used 2 memory questionnaires to provide ratings of memory problems in an older individual they knew well. Rater neuroticism correlated positively with estimates of memory problems: More neurotic informants provided higher estimates of memory difficulties in the person they were rating. A second study replicated this finding with 786 volunteers and another widely used memory measure, the AD8. In both studies, exploratory analyses suggested the effect size was large enough to impact on clinical practice. [ABSTRACT FROM AUTHOR]

Remembering and imagining are intricately related, particularly in imagining the future: episodic future thinking. It is proposed that remembering the recent past and imagining the near future take place in what we term the remembering–imagining system. The remembering–imagining system renders recently formed episodic memories and episodic imagined near-future events highly accessible. We suggest that this serves the purpose of integrating past, current, and future goal-related activities. When the remembering–imagining system is compromised, following brain damage and in psychological illnesses, the future cannot be effectively imagined and episodic future thinking may become dominated by dysfunctional images of the future. [ABSTRACT FROM AUTHOR]

Although there is well-documented evidence for hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis function in anorexia nervosa (AN), there has been little research into secretory patterns of salivary cortisol and dehydroepiandrosterone (DHEA) in this condition. The cortisol awakening response (CAR), a prominent and discrete feature of the cortisol cycle, has not been extensively explored in adolescent AN. Saliva samples were collected at awakening, 30 min and 12 h post-awakening on two consecutive weekdays from eight female adolescents with clinically diagnosed AN and 41 healthy control (HC) age-matched females. Adolescent AN patients had greater salivary cortisol and DHEA concentrations than HC girls at all points. Increased hormone secretion was unrelated to body mass index. However, despite hypersecretion of both hormones, the circadian pattern including the CAR paralleled that of the HC group. Findings from this preliminary study confirm dysregulation of HPA axis function in adolescent AN as evidenced by hypersecretion of both cortisol and DHEA, which share the common secretagogue adrenocorticotropic hormone. However, the parallel diurnal profiles for AN and HC participants, including the CAR, may indicate hypersecretion per se rather than differential regulation of the diurnal pattern of these two adrenal steroids in AN. [ABSTRACT FROM AUTHOR]

In the neurodevelopment of adolescent anorexia nervosa (AN), dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is proposed to be a central component. Furthermore, a therapeutic milieu focusing on affect regulation can contribute much to treatment, given the emotional processing difficulties associated with this disorder. Studies of HPA axis function following such specialist treatments for adolescent AN, however, are rare. This study describes the diurnal pattern of HPA axis activation, including the cortisol awakening response (CAR), in a 16-year-old female diagnosed with AN both during illness and at clinical recovery following milieu therapy with a focus on affect regulation. Specialised single-case study statistics were used to assess whether the patient's data were significantly different from the healthy "norm" at illness and recovery. During illness, her measure of affective problems was outside of the normal range and cortisol and DHEA secretory profiles were significantly elevated across the diurnal period. However, at recovery both her affective state and HPA axis function became comparable to healthy controls. This case study suggests that salivary markers of HPA axis function can be feasibly incorporated into the clinical regime within a specialist adolescent AN residential service and could be used by clinicians to monitor prognosis and interventions. [ABSTRACT FROM AUTHOR]

Forgetting is a normal and everyday occurrence that may sometimes reflect a complete loss of the mnemonic record or a failure to encode it in the first place. However, on many occasions with the help of cues we can eventually or suddenly recall a memory that seemed to be lost, thus highlighting the probability that many instances of “forgetting” may in fact reflect inaccessibility rather than true loss. We report here on our amnesic patient CR who presents an extreme example of this normal everyday forgetting. For 4 weeks, CR recorded regular personal autobiographical events both on a SenseCam (henceforth SC) and in a written diary form. Subjective and objective aspects of recall were measured each weekend both without any cues and then with either a SC or diary cue. We show that the SC enabled CR to recall significantly more detailed episodic memories than reading the diary and importantly we observed that the qualitative nature of these memories was different. We comment on the considerable potential of SC for therapeutic purposes. [ABSTRACT FROM PUBLISHER]

Music may play several roles and have many effects in advertising; it may attract attention, carry the product message, act as a mnemonic device, and create excitement or a state of relaxation. In this paper, the role of music within advertising is evaluated during low-attention conditions. The current experiment was carried out whereby participants were exposed to an advert that was embedded into a sequence of three other adverts, presented in the middle of an engaging TV programme, thus replicating natural conditions. There were four audio conditions examined in an example advertisement: jingle, instrumental music, instrumental music with voiceover and environmental sounds with voiceover, all four containing identical verbal information. The duration of the target advert was approximately 45 secs. Results indicate that music is effective in facilitating both implicit learning and recall of the advertised product, showing that, under non-attentive conditions, there appears to be a certain mechanism of unconscious elaboration of the musical signal. The role of previous musical training of the participants was shown to have little significance. [ABSTRACT FROM AUTHOR]

Background Despite significant advances in treating and improving the prognosis of individuals with hydrocephalus and spina bifida, many of these individuals continue to experience specific cognitive difficulties in the areas of memory, language, attention and executive function and these can often have a significant negative impact on everyday functioning [1-3]. Materials and methods A comprehensive questionnaire was designed, based on known cognitive and emotional sequelae, to assess patient and caregiver perceptions of the specific difficulties experienced by people with hydrocephalus and spina bifida and the extent to which these are being addressed. In order to establish levels of insight, this questionnaire was correlated with detailed neuropsychological data to triangulate actual cognitive performance with subjective self-assessment obtained from patients and the objective view of caregivers. Results Questionnaire data will be presented that will highlight specific areas of discrepancy and concordance between patients and their caregivers (n = 60) and will be discussed in relation to actual performance on a range of cognitive tasks and the subsequent implications for strategic advice and intervention. Conclusion The data is being used to tailor specific cognitive strategies based on enhanced self-awareness, as part of small group and individual cognitive training interventions, within a multidisciplinary setting. It is hoped that the dissemination of the materials and methods designed for this study will inform best practice guidelines for these individuals and their caregivers and provide measurable outcomes for cognitive performance discrepancy, meta-awareness, strategy implementation and evaluation. [ABSTRACT FROM AUTHOR]

Objective: To compare the incidence of silent cerebral infarction and impact on cognitive function following transcatheter aortic valve implantation (TAVI) with the first-generation CoreValve (Medtronic, Minneapolis, Minnesota, USA) and second-generation Lotus valve (Boston Scientific, Natick Massachusetts, USA)., Design: A prospective observational study comprising a 1.5 T cerebral MRI scan, performed preoperatively and immediately following TAVI, and neurocognitive assessments performed at baseline, 30 days and 1 year follow-up., Setting: University hospitals of Leeds and Leicester, UK., Patients: 66 (80.6±8.0 years, 47% male) patients with high-risk severe symptomatic aortic stenosis recruited between April 2012 and May 2015., Main Outcome Measures: Incidence of new cerebral microinfarction and objective decline in neurocognitive performance., Results: All underwent cerebral MRI at baseline and immediately following TAVI, and 49 (25 Lotus, 24 CoreValve) completed neurocognitive assessments at baseline, 30 days and 1 year. There was a significantly greater incidence of new cerebral microinfarction observed following the Lotus TAVI (23 (79%) vs 22 (59%), p=0.025) with a greater number of new infarcts per patient (median 3.5 (IQR 7.0) vs 2.0 (IQR 3.0), p=0.002). The mean volume of infarcted cerebral tissue per patient was equivalent following the two prostheses (p=0.166). More patients suffered new anterior (14 (48%) vs 2 (5%), p=0.001) and vertebrobasilar (15 (52%) vs 7 (19%), p=0.005) lesions following Lotus. Lotus was associated with a decline in verbal memory and psychomotor speed at 30 days. However, performance longitudinally at 1 year was preserved in all neurocognitive domains., Conclusions: There was a higher incidence of silent cerebral microinfarction and a greater number of lesions per patient following Lotus compared with CoreValve. However, there was no objective decline in neurocognitive function discernible at 1 year following TAVI with either prosthesis., Competing Interests: Competing interests: DJB and CM are consultants and proctors for both Medtronic and Boston Scientific. JPG and SP have received an educational research grant from Philips Healthcare., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)