Daniel Davis is an SpR in Geriatric Medicine on the NW Thames Rotation, spending 50% of his research time as a Clinical Research Fellow at the MRC Unit for Lifelong Health and Ageing at UCL.
Daniel is the joint winner, alongside Roman Romero-Ortuno, of the BGS Rising Star Award 2015.
I have been a SpR in geriatric medicine since 2006, the longer route being through pursuit of an academic career alongside clinical training. My core interest is the relationship between delirium and/or acute illness and trajectories of cognitive decline in large population-representative studies. These are complex relationships which need a wide range of research, from the biological underpinnings through to the implications for health care policy.
The impact of delirium on trajectories of cognitive decline had not previously been investigated in population samples. I produced the first study to show that delirium is a strong predictor of dementia and cognitive decline in the general population. I also explored the pathological substrates of this association (from these studies’ brain donation programmes), demonstrating that delirium interacts with, but is distinct from, classical dementia pathology. These findings lead to new possibilities regarding the pathological correlates of cognitive impairment, positioning delirium and/or its precipitants as critically inter-related processes. This was funded by a Wellcome Research Training Fellowship at the University of Cambridge. The training in epidemiology and biostatistics has led to a wide range of other projects, including work on methods in diagnostic test accuracy studies in dementia (Cochrane Collaboration) and global surveillance of HIV drug resistance (World Health Organization).
For me, epidemiological research is a natural scientific counterpart for geriatric medicine, where careful measurement of cognitive and functional assessments can provide new insights into health and ageing at the individual and population levels. My current appointment is at the MRC Unit for Lifelong Health and Ageing. This research uses data from the NRC National Survey for Health and Development (the 1946 Birth Cohort), the world’s longest continuously running cohort study. I am actively involved with study management and design of future assessment schedules. This is an unrivalled opportunity to follow-up a generalisable population sample (all exactly the same age, 69 years) as they age, with the hope of understanding how life course factors lead to healthy ageing, or, functional and cognitive impairment.
I’ve been actively involved with the European Delirium Association, chairing the Scientific Organising Committee for the 10th Conference of the European Delirium Association in London in September 2015. This is being held in conjunction with the BGS Dementia and Related Disorders SIG, and King’s Health Partners. Work with the European Delirium Association is important to me as a means of generally promoting delirium research, education and policy.
The BGS has long been a great source of support; a medical student elective grant and SpR travel grant both contributed to career-changing experiences. Both locally and nationally, many of its members have offered mentorship and advice. Involvement in the Spring and Summer meetings have provided key opportunities for networking and scientific dissemination.
In the medium term, I am applying for Intermediate Fellowship/Clinician Scientist level grants. This would enable me to continue my population-based epidemiological research. The objective is to track cognitive and functional changes in older people longitudinally across care settings (primary, secondary, intermediate). This will describe the progression of impairments in older age and quantify how these trajectories may be punctuated by acute illness with/without incomplete recovery. There is potential for a large clinical impact given the increasing prevalence of these disorders. Eventually, the plan is to identify novel pathways from systemic illness to delirium and cognitive impairment, in epidemiological and clinical cohorts.