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Objective: To explore the relationship of the 4 decision-making abilities (Understanding, Appreciation, Reasoning, and Expressing a Choice) and neuropsychological performance in patients with very mild and mild dementia. Methods: Chinese subjects were recruited from local social centres and residential hostels for elderly people in Hong Kong. Clinical diagnosis was made by experienced geriatric psychiatrists. A battery of neuropsychological tests that assesses general cognitive abilities, verbal memory, executive function, concept formation, and auditory and visual attention, was administered. Mental capacity to consent to treatment was assessed using the Chinese version of the MacArthur Competence Assessment Tool DS Treatment. Results: Fifty participants with very mild or mild dementia were compared with 42 cognitively intact subjects. After controlling for the effects of age and education, stepwise linear regression analysis demonstrated that the 4 decision-making abilities correlated with different neuropsychological test performances, which predicted 45% of the common variance for Understanding, 39% for Appreciation, 20% for Reasoning, and 30% for Expressing a Choice. The Reasoning score was only predicted by the Category Verbal Fluency Test (beta = 0.4, p = 0.01). Conclusion: Neuropsychological test performance differentially predicted different decision-making abilities in older patients with mild or very mild dementia. [ABSTRACT FROM AUTHOR]

Objectives We reported the findings of a randomized controlled trial (RCT) to examine the effects of an individualized functional enhancement program (FEP) on functional skills and mood symptoms in mild and moderate dementia. Subjects & Methods 74 Chinese older persons with dementia were recruited into a skills training program by occupational therapists (OT). Thirty seven subjects were trained with an individualized selection of daily activities (FEP Intervention, I); 37 were trained with general occupational therapy (Control, C). The FEP comprised of twice weekly group sessions of skills training and problem solving using cognitive behavioral approach. Results At 1 month after completion of program, both I and C subjects showed an improvement in process skills of the assessment of motor and process skills (AMPS)(paired t-tests, p < 0.05). At 4 months post-program, the I group showed a further reduction of cornell scale for depression in dementia (CSDD) scores (paired t-test, p = 0.02); Apathy improved at 1 month post-training (p = 0.04), but deteriorated at 4 months (p = 0.01). Group differences in changes of mood and functional scores were not significant (ANVOCA, p > 0.05). Conclusions The findings suggested a potential benefit for individualized occupational therapy. It should be tailor made with individual needs and continued for sustained effectiveness. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong.Methods: The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1.Results: The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4-9.6) and 8.9% (95%CI: 7.8-10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia.Conclusions: A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity. [ABSTRACT FROM AUTHOR]

Objectives: To selectively review longitudinal cohort studies examining the relationship of leisure activities to cognitive impairment in elders and to summarise proposed mechanisms of how such activities influence cognition.Methods: Studies were identified in Ovid MEDLINE-R (2003 to March 2007) using a set of key words in titles: 'activities', 'activity', 'exercises', 'exercise', or 'leisure'. The results were cross-matched with another set of key words: 'cognitive', 'cognition', 'dementia', 'Alzheimer', 'Alzheimer's', or 'AD'. This search produced 376 studies. A total of 13 longitudinal cohort studies examining the relation between leisure activities and cognitive impairment in elders were found.Results: Six of these studies focused on physical activities, one on cognitive activities, and the rest on general leisure activities. Cognitive activities showed more consistent beneficial effects on cognition, while the effects of physical and social activities were more inconsistent. The mixed and inconsistent results might be attributed to differences in study designs, measurements, definitions and operational criteria of both participation in activities and outcome measures. Difficulties encountered in conducting these studies were demonstrated.Conclusion: Further research is needed to elucidate the distinct effects of different activities on cognition, as well as to explore the necessary duration of such activity, evaluate the underlying mechanisms of benefit, and provide evidence upon which to base strategies to prevent cognitive impairment. [ABSTRACT FROM AUTHOR]

It is estimated that 24 million people currently have dementia and that two-thirds of them live in developing countries. However, most of the assessment instruments for dementia have originated in developed countries. This paper explores the relevance of outcome measures in clinical trials of dementia drugs in different cultural groups, particularly in developing countries. The challenges of assessing treatment benefits in dementia in such groups include linguistic and cultural diversity, as well as high illiteracy rates, lack of human resources and the time constraints in assessment of patients. This paper also highlights methodological issues in cross-cultural research of cognitive assessment. Improvement in neuropsychiatric outcomes may be of particular importance to people in non-Western cultures. Functional outcomes and global outcomes are potentially useful outcome measures, but more studies are required in various countries. The use of biological markers such as neuroimaging and cerebrospinal fluid studies may not be practical in developing countries due to their costs and acceptability respectively. More work is also needed in the area of quality of life measures in various countries. [ABSTRACT FROM AUTHOR]

Background/Aims: The apolipoprotein E (ApoE) exon 4 polymorphism has been associated with vascular dementia (VaD) risk. Since not all studies confirm this finding, we explored this association in a case-control study. Methods: We genotyped ApoE in 144 VaD patients and 251 controls. Results: VaD patients were more likely than controls to have ApoE epsilon3/epsilon4 or epsilon4/epsilon4 genotypes: 23.6% versus 15.1%, odds ratio (OR) = 1.7, p = 0.036. This association remained significant after adjustment for age, sex, hypertension and diabetes by multiple logistic regression: OR = 1.9, p = 0.030. The association of epsilon3/epsilon4 or epsilon4/epsilon4 genotypes with VaD was strong among people with hypertension (OR = 2.9, p = 0.007) or diabetes (OR = 6.5, p = 0.011). The association was absent among people without hypertension (OR = 1.1, p = 0.79) or diabetes (OR = 1.3, p = 0.43). Conclusion: This interaction with hypertension and diabetes should be examined in other studies to confirm or refute this observation. Copyright (c) 2006 S. Karger AG, Basel. [ABSTRACT FROM AUTHOR]

Objective: Agitation was common in patients suffering from moderate to severe dementia, for which music therapy is one of the commonly used non-pharmacological interventions. This preliminary report addresses the effectiveness of music therapy for demented patients residing in a local care setting for the elderly.Patients and Methods: This was a crossover study. Fourteen patients with dementia exhibiting at least one type of agitated behaviour were recruited and divided into 2 groups. For 3 weeks, 1 group received music therapy and the other usual care with no special intervention. Thereafter, the 2 groups were crossed over with respect to the active and control interventions for further 3 weeks. Behaviour disturbances were measured by the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. Assessments were conducted before attending (pre-music or pre-control therapy); just after completion of music or control therapy (end-music or end-control therapy) and 3 weeks after music therapy (post-music therapy).Results: There were significant reductions of total Neuropsychiatric Inventory and Cohen-Mansfield Agitation Inventory scores at the end-music therapy period (Wilcoxon signed rank tests, p < 0.001). Similar reductions were not found after usual care (end-control period). No lasting effects were observed after withdrawal of music therapy for 3 weeks (pre-music therapy vs post-music therapy; Wilcoxon signed rank tests, p = not significant).Conclusion: These preliminary results suggest that music therapy may have positive effects on behavioural disturbances manifested by demented elders. Although the effects were not persistent, music therapy may be considered for further research as a continuous means of reducing agitation in care settings for the older persons. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between behavioral and psychological symptoms of dementia (BPSD), cognitive function and clinical deterioration over 2 years.Methods: One hundred and four Chinese subjects with late-onset Alzheimer's Disease (AD) who presented to psychogeriatric clinics were followed for an average of 22.5 months. BPSD subgroups were categorized by latent class analysis using the Neuropsychiatric Inventory. Comprehensive cognitive profiles were performed with the Mattis Dementia Scale, the Hong Kong List Learning Test (HKLLT) and the Category Verbal Fluency Test. Interactions between cognitive function and behavioral syndromes were evaluated. Potential predictors for clinical deterioration were computed with logistic regression analysis.Results: Three latent classes of subjects with similar behavioral syndromes were identified: Low BPSD (44%), Affective (32%) and Psychosis (24%) groups. Association between cognitive functions and BPSD was not significant. At follow-up, a higher proportion of subjects in the Affective (70%) and Low BPSD (49%) groups remained stable at the same Clinical Dementia Rating. Baseline scores in the "recognition" test of the HKLLT and age were significant predictors for "deceased" status at 2-year follow-up.Conclusion: The lack of association between behavioral syndromes and cognitive function suggests that these relatively independent dimensions of dementia should be examined individually for different prognostic significance. [ABSTRACT FROM AUTHOR]

Objective: Due to progressive cognitive and physical deterioration, it is not uncommon for carers and medical professionals to face situations requiring proxy end-of-life decisions for patients with dementia. In this study, attitudes toward making end-of-life decisions were compared in non-demented and mildly demented Chinese subjects.Patients and Methods: Responses to three hypothetical scenarios concerning end-of-life decisions in demented subjects with different medical comorbidities were developed. 30 cognitively intact non-demented and 26 mildly demented subjects were interviewed with a semi-structured questionnaire on attitudes towards end-of-life decisions in these scenarios.Results: There were no significant differences between the groups in the proportion of subjects choosing supportive therapy to prolong life, and in attitudes towards more invasive treatment if their condition deteriorated. Compared with non-demented subjects, a higher proportion of the demented group 'highly agreed' with having their life saved by all means in the scenario of severe dementia and medical debilitation (chi-squared = 8.47, df = 3, p = 0.04). For more treat-able medical problems, the groups showed similar preference (p > 0.05). Regarding emotional reactions after making end-of-life decisions, more demented subjects had 'no special feeling' and more non-demented subjects felt 'relieved' towards possible poor treatment outcome after making end-of-life decisions, although the difference was not significant.Conclusion: Despite significant cognitive impairment, mildly demented subjects express a relatively positive view towards making end-of-life decisions. Their personal choice should be explored and respected in clinical management and planning for care. [ABSTRACT FROM AUTHOR]

Objective: To compare profiles of neuropsychological impairment in elderly Chinese patients with amnestic, multiple-domain mild cognitive impairment and patients with normal ageing and mild Alzheimer's disease.Patients and Methods: Patients with mild cognitive impairment were categorised into 2 groups: single-domain amnestic mild cognitive impairment (n = 54) and multiple-domain amnestic mild cognitive impairment (n = 93). The scores of neuropsychological tests of patients with mild cognitive impairment were compared with those of cognitively normal elderly controls (n = 78) and patients with mild Alzheimer's disease (n = 85).Results: The 2 groups of patients with mild cognitive impairment had performances in the neuropsychological tests intermediate between the normal controls and patients with mild Alzheimer's disease. Patients in the multiple-domain amnestic mild cognitive impairment group had different profiles of cognitive impairment from those in the single-domain amnestic mild cognitive impairment group, but there was no significant difference in tests on episodic memory and category verbal fluency between the 2 groups.Conclusion: Patients with mild cognitive impairment could be differentiated from cognitively normal controls, as well as from those with mild Alzheimer's disease, by neuropsychological measures. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the significance of apolipoprotein E4 (Apo E4) in Alzheimer's disease (AD) has been well established in Caucasian populations, its role in determining the rate of cognitive decline in other ethnic groups has yet to be determined. This study examined the two-year progression of cognitive decline and its association with Apo E4 allelic status in a group of Chinese elderly subjects with AD. METHOD: One hundred and four Chinese subjects with mild and moderate AD as assessed by the Clinical Dementia Rating (CDR 1 and 2) were followed up at a mean (SD) duration of 22.53 (5.21) months. The rate of cognitive decline and its association with Apo E4 allelic status was evaluated RESULTS: At follow-up, 74 (73 percent) subjects were reassessed. Forty-nine remained stable at the same CDR and 25 had deteriorated. The mean (SD) deterioration in the Mini-Mental State Examination (MMSE) was 2.52 (4.38) and in the Mattis Dementia Rating Scale (DRS) was 9.03 (14.98) (paired t-test, p < 0. 001). There was no significant difference in the baseline MMSE and DRS scores between the 'stable', 'deteriorated', or 'deceased' groups. Mildly demented subjects with the Apo E4 allele were more likely to have deteriorated to a more severe CDR than subjects without the Apo E4 allele (Pearson chi2 = 5.72, df 1, p = 0.017, Odds ratio = 6.3, CI 1.3 to 30.53). CONCLUSION: The presence of the Apo E4 allele may influence the rate of cognitive deterioration, particularly in subjects with mild AD. [ABSTRACT FROM AUTHOR]

BACKGROUND: The outbreak of severe acute respiratory syndrome (SARS) posed an unprecedented threat and a great challenge to health professionals in Hong Kong. The study reported here aimed at investigating the origin of stress and psychological morbidity among frontline healthcare workers in response to this catastrophe. METHOD: Self-administered questionnaires were sent to frontline healthcare workers in three hospitals. The General Health Questionnaire was used to identify psychological distress. Socio-demographic and stress variables were entered into a logistic regression analysis to find out the variables associated with psychological morbidity. RESULTS: The response rate was 40%. Sixty-eight per cent of participants reported a high level of stress. About 57% were found to have experienced psychological distress. The healthcare workers' psychological morbidity was best understood by the perceptions of personal vulnerability, stress and support in the workplace. CONCLUSION: These findings shed light on the need for hospital administrators to be aware of the extent and sources of stress and psychological distress among frontline healthcare workers during disease outbreak. [ABSTRACT FROM AUTHOR]

Comprehensive neuropsychological batteries focus on the subtle cognitive deficits in dementia, but a brief screening instrument is also of immense practical value. As the clock-drawing test encompasses a number of cognitive domains frequently disturbed by the dementing process, it is considered to be a suitable screening instrument for the disorder. We documented the usefulness of a new scoring method of the clock-drawing test for screening of dementia in the elderly Chinese in Hong Kong. Fifty-three demented individuals and 53 healthy elderly controls were assessed. At a cutoff score of 3/4, the sensitivity and specificity of the clock-drawing test in screening of dementia was 83% and 79%. With a composite test of clock reading and clock setting, the positive predictive value of the clock face test was 98%. This new scoring method of clock-drawing proved to be a valid measure for screening of dementia. It is applicable in non-English speaking populations and should be a useful adjunct for quick screening assessment of dementia. [ABSTRACT FROM AUTHOR]

This review highlights significant biological psychiatric research published by Chinese researchers in recent years. Chinese periodicals with full-text database (Chinese National Knowledge Infrastructure) and English periodicals with PubMed, published from 2003 to 2009 on schizophrenia, depression, bipolar affective disorder, obsessive-compulsive disorder, anxiety disorder and Alzheimer's disease, were reviewed. Articles studying the above-mentioned psychiatric disorders focusing in the area of molecular genetics, neuroendocrine immunology, electrophysiology and psychopharmacology applied to animal models or clinical populations were included. The findings suggest that biological psychiatric research is being developed at a rapid pace and covers a wide perspective from disease mechanisms to clinical interventions. [ABSTRACT FROM AUTHOR]

Objectives: This was a pilot study exploring the psychometric performance of the Chinese version of the Assessment of Capacity for Everyday Decision-Making questionnaire in financial management among Chinese psychogeriatric patients. Participants and Methods: The English version of the Assessment of Capacity for Everyday Decision-Making questionnaire was translated into Chinese. Its potential applicability was assessed by 2 focus groups. Eighteen Chinese psychogeriatric patients were recruited. Subjects were administered the Chinese instrument and assessed by independent clinician ratings based on the definition in the United Kingdom Mental Capacity Act 2005. Results: In the assessment of inter-rater reliability, the intraclass correlation coefficient showed satisfactory reliability for the ability scores of understanding (0.99), appreciation (0.97), reasoning (0.99) and expressing a choice (0.85). The internal consistency, as measured by Cronbach's alpha, was 0.83 for understanding and 0.86 for reasoning. The ability scores of understanding and reasoning correlated with the clinician ratings. Conclusion: For this pilot study, the reliability of the Assessment of Capacity for Everyday Decision-Making Ability questionnaire for Chinese older patients was satisfactory. This instrument warrants further evaluation for its validity and applicability in other Chinese populations. [ABSTRACT FROM AUTHOR]

Objective: To validate the Chinese version of the Involvement Evaluation Questionnaire in assessing the caregiving experience for carers of patients with schizophrenia. Participants and Methods: The Involvement Evaluation Quationnaire was translated into Chinese and back-translated to English. Two hundred and one patients with schizophrenia and their carers were recruited from a psychiatric clinic. The Chinese version of the Involvement Evaluation Questionnaire and the General Health Questionnaire, and the Cantonese version of the Family Burden Interview Schedule were administered to the carers. the patients were assessed by the Structured Clinical Interview, the Positive and Negative Symptoms Scale, and the Global Assessment of Functioning Scale. Results: Expert panel review and focus group reported content and face validity; concurrent validity was established with correlation with the General Health Questionnaire and the Family Burden Interview Schedule. Construct validity was supported by factor analysis and correlated with the Positive and Negative Symptoms Scale and Global Assessment of Functioning Scale. The Chinese version of the Involvement Evaluation Questionnaire showed substantial correlation with all the rating scales. It showed a significant positive correlation with the Positive and Negative Symptoms Scale and Family Burden Interview Schedule, and a negative correlation with the Global Assessment of Functioning Scale (p<0.001). The questionnaire demonstrated high test-retest reliability (intraclass correlation coefficient=0.97; 95% confidence interval = 0.92-0.99), inter-rater reliability (intraclass correlation coefficient=0.94; 95% confidence interval=0.86-0.97), and interval consistency (Cronbach's alpha=0.82). Conclusion: The psychometric properties of the questionnaire are satisfactory for assessing the caregiving experience among carers for the local Chinese population with schizophrenia. Further study is required to demonstrate the questionnaire's sensitivity to change and predictive validity. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of polymorphisms in the tumour necrosis factor receptor 2 (TNFR2) and tumour necrosis factor superfamily, member 6 (TNFRSF6, FAS) genes and the risk of Alzheimer's disease (AD) in a Chinese population.Patients and Methods: One hundred and fifty Chinese AD patients and 155 cognitively intact control subjects were recruited for the study. Genotypes of TNFR2+196, FAS-670, and FAS-1377 were investigated in this study by polymerase chain reaction-restriction fragment length polymorphisms. Results: The TNFR2+196 TT genotype was more prevalent in the AD group than in the controls. However, no significant difference in genotypic and allelic frequencies between AD and control groups (p = 0.68) was observed.Conclusion: We suggested that TNFR2+196, FAS-670, and FAS-1377 genotypes were not associated with the risk of AD in our Chinese population. However, evidence suggests involvement of tumour necrosis factor-alpha pathway in the pathogenesis of AD and a more comprehensive study may be required to identify the underlying associations. [ABSTRACT FROM AUTHOR]

Objectives: To determine the optimal cut-off score on the Chinese version of the Executive Interview to discriminate all-cause dementia patients from non-dementia subjects. Participants and Methods: A total of 141 community-dwelling elders were assessed with the Chinese version of the Executive Interview, the Cantonese version of the Mini-Mental State Examination, and Nelson's Modified Card Sorting Test. Severity of dementia was determined using the Clinical Dementia Rating Scale. Results: Higher total scores on the Chinese version of Executive Interview (greater impairment) yielded a statistically significant negative correlation with Nelson's Modified Card Sorting Test's 'Number of categories', but positive correlations with the test's 'Errors', 'Perseverative errors', 'Non-perseverative errors', and 'Percentage of perseverative errors'. The sensitivity and specificity at different cut-off values on the Chinese version of the Executive Interview used to plot the receiver operating characteristic curve gave an area under the curve of 0.97 (95% confidence interval, 0.94-0.99; p <= 0.01). The cut-off value of 15 best distinguished Clinical Dementia Rating 0 and 0.5 from Clinical Dementia Rating 1 and 2 (sensitivity = 90.7%; specificity = 87.2%). Conclusions: The results of the current study and the previous pilot study support that the Chinese version of the Executive Interview as a potentially useful bedside tool for executive functional assessment in Chinese elders, by virtue of good internal consistency, inter-rater reliability, concurrent validity and discriminatory power. [ABSTRACT FROM AUTHOR]

Objective: To report the prevalence of mild parkinsonian signs and their association with functional impairment in a population-based study of clinically non-demented Chinese persons. Participants and Methods: A random sample of 765 Chinese older persons from a thematic household survey was recruited. There were 389 normal elderly controls (Clinical Dementia Rating = 0), 291 with mild cognitive impairment, and 85 with very mild dementia. The prevalence of mild parkinsonian signs and its association with everyday functional performance were investigated. Results: Mild parkinsonian signs were defined as a score of 2 more in the Unified Parkinson's Disease Rating Scale-motor section. The prevalence of mild parkinsonian signs was 16.5%, 33.0% and 49.4% in the normal controls, those with mild cognitive impairment and very mild dementia, respectively. In each group, subjects with mild parkinsonian signs had lower functional scores than those without such signs, even after adjusting for the effect of age, sex, and education. Abnormality in axial function, bradykinesia, and rigidity were associated with lower scores for Instrumental Activities of Daily Living, and rigidity Was associated with lower Basic Activities of Daily Living scores. Conclusion: The prevalence of mild parkinsonian signs increased with the severity of cognitive impairment in clinically non-demented older person. Such signs were associated with functional impairment in older persons with mild-cognitive impairment and very mild dementia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate emotional response towards perceived loss of activities of daily living in Chinese elders with dementia.Patients and Methods: Eighty one elderly people with a clinical diagnosis of dementia were recruited from residential homes and social centre for the elderly in Hong Kong. A purpose-designed questionnaire on subjective evaluation of ability and emotional reactions towards functional deterioration was derived. The association between the subjective evaluation of ability, emotional reactions, and actual activities of daily living performance measured by the Chinese version of Disability Assessment for Dementia was evaluated.Results: There were no significant correlations between subjective evaluation of ability and the emotional reactions towards functional impairment. Subjects reported greater higher emotional distress over possible loss of basic activities of daily living than instrumental activities of daily living (t = 3.04, p = 0.003). Subjects with better basic activities of daily living abilities were likely to report greater distress if their instrumental activities of daily living were impaired (Spearman's rho = 0.30, p = 0.01).Conclusion: Although elderly people with dementia may have compromised cognitive abilities, attention to functional training is an important means of improving their emotional well-being. [ABSTRACT FROM AUTHOR]

Objective: We aimed to develop a standardized method to investigate the relationship between estimated brain age and regional morphometric features, meeting the criteria for simplicity, generalization, and intuitive interpretability., Methods: We utilized T1-weighted magnetic resonance imaging (MRI) data from the Cambridge Centre for Ageing and Neuroscience project (N = 609) and employed a support vector regression method to train a brain age model. The pre-trained brain age model was applied to the dataset of the brain development project (N = 547). Kraskov (KSG) estimator was used to compute the mutual information (MI) value between brain age and regional morphometric features, including gray matter volume (GMV), white matter volume (WMV), cerebrospinal fluid (CSF) volume, and cortical thickness (CT)., Results: Among four types of brain features, GMV had the highest MI value (8.71), peaking in the pre-central gyrus (0.69). CSF volume was ranked second (7.76), with the highest MI value in the cingulate (0.87). CT was ranked third (6.22), with the highest MI value in superior temporal gyrus (0.53). WMV had the lowest MI value (4.59), with the insula showing the highest MI value (0.53). For brain parenchyma, the volume of the superior frontal gyrus exhibited the highest MI value (0.80)., Conclusion: This is the first demonstration that MI value between estimated brain age and morphometric features may serve as a benchmark for assessing the regional contributions to estimated brain age. Our findings highlighted that both GMV and CSF are the key features that determined the estimated brain age, which may add value to existing computational models of brain age., Critical Relevance Statement: Mutual information (MI) analysis reveals gray matter volume (GMV) and cerebrospinal fluid (CSF) volume as pivotal in computing individuals' brain age., Key Points: Mutual information (MI) interprets estimated brain age with morphometric features. Gray matter volume in the pre-central gyrus has the highest MI value for estimated brain age. Cerebrospinal fluid volume in the cingulate has the highest MI value. Regarding brain parenchymal volume, the superior frontal gyrus has the highest MI value. The value of mutual information underscores the key brain regions related to brain age., (© 2024. The Author(s).)

Existing literature has widely explored the individual roles of housing and neighborhood quality, and there is limited research examining their interactive effects on mental health. This 3-year cohort study utilized a longitudinal design to investigate the individual and interactive effects of housing and neighborhood quality on mental health among 962 community-dwelling adults in Hong Kong. Participants were asked to rate their residential qualities over the 3-year period. Mental health outcomes, including levels of psychological distress and common mental disorders (CMD), were assessed using the Revised Clinical Interview Schedule (CIS-R). Logistic regression and generalized linear models were used to examine the association between housing and neighborhood quality and CMD/psychological distress, adjusting for sociodemographic and residential characteristics and baseline mental disorders. Housing quality was associated with the 3-year CMD (adjusted OR 0.95; 95% CI 0.91 to 0.98). Likewise, neighborhood quality was associated with CMD over 3 years (adjusted OR 0.92; 95% CI 0.87 to 0.96). In a separate model including both quality measures, the effect of housing quality on CMD was attenuated, whereas the neighborhood impact remained significant (adjusted OR 0.92; 95% CI 0.87 to 0.98). Generalized linear models indicated that for participants residing in substandard housing, those with high neighborhood quality had lower CIS-R scores at follow-up compared to those with low neighborhood quality (p = 0.041). Better neighborhood quality alleviated the detrimental effects of poor housing quality on mental health. Planning for an enhanced neighborhood would improve population mental health in an urban environment., (© 2024. The Author(s).)

Background: CA19-9 is elevated in pancreatic cancer and other malignancies, and commonly used in clinical practice. Unfortunately, CA19-9 immunoassays are not harmonized, and reference intervals may differ between assays. The aim of this study was to establish the reference interval of the ADVIA Centaur/Atellica IM CA19-9 assay in an apparently healthy Singapore adult population., Methods: This is a retrospective cross-sectional study. De-identified data from Health Screening participants were extracted from our database. Subjects with biochemical results suggesting anaemia, diabetes mellitus, viral hepatitis or abnormal liver, and renal and tumour markers were excluded. Outlier and subclass analyses by age and sex were performed. CA19-9 reference limits and 90% confidence intervals were then determined for candidate subclasses., Results: Data from 12,174 subjects (5846 males and 6328 females) were available after exclusion criteria were applied. CA19-9 results did not follow a normal distribution and were higher in females compared to males ( P < .001). Although CA19-9 means were statistically different between certain age groups, the evaluable 99th percentile reference limits were not statistically different. The overall 99th percentile reference limits for the Centaur/Atellica CA19-9 assay was 37 U/mL for males 21-80 years, and 60 U/mL for females 21-80 years., Conclusions: Our results suggest that separate CA19-9 reference intervals should be applied for males and females., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Previous studies have shown a relationship between environments and mental health. However, limited studies have investigated the impact of environment stress (ES) on emotional reactivity. Our study aimed to fill this gap by examining how daily ES affects momentary emotional reactivity using experience sampling method (ESM)., Methods: Participants were randomly recruited from a prospective cohort study in Hong Kong to participate in a 7-day ESM study. The participants received eight electronic signals daily assessing their ES, positive affect (PA) and negative affect (NA). Participants were categorized into depressed group or control group based on Revised Clinical Interview Schedule. Psychometric properties of the ESM assessment were evaluated. Multilevel linear regression analyzes were conducted to examine the association of ES with PA, NA and the group status of the participants (cases versus controls)., Results: A total of 15 participants with depression and 15 healthy controls were recruited, and 1307 momentary assessments were completed with a compliance rate of 77.8%. The depressed group demonstrated a significant increase in NA in response to ES, while the control group showed a decrease in PA. In addition, the depressed group reported a lower perception of control and interaction with their environment compared to the control group., Conclusion: Using ESM, a valid, reliable, and easy-to-use self-reporting tool, our findings provided valuable insights on the potential mechanisms underlying emotional responses to stressful environments., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wong, Chan, Lo, Chen and Lam.)

Background: Having more cognitive activities may prevent dementia, but its evidence of modulating the functional brain network is limited. This randomised controlled trial (RCT) investigated the effect of increased cognitive activity participation on the default mode network (DMN) in older adults who had already been having regular cognitive activity participation and experiencing subjective cognitive decline (SCD)., Methods: Community-living Chinese individuals aged 55-75 years with regular practice of Chinese calligraphy and screened positive for SCD (but negative for mild cognitive impairment or dementia) were randomly allocated to either the intervention or control group. Over 6 months, the intervention group doubled their weekly calligraphy practice time, while the control group maintained their usual amount of practice. The primary outcome was functional connectivities (FCs) of DMN, with pre-specified regions of interest including medial prefrontal cortex (mPFC), inferior parietal lobe (IPL), hippocampal formation (HF), posterior cingulate cortex (PCC), and lateral temporal cortex (LTC). FC changes were compared using repeated measures multivariate analysis of variance (MANOVA). This study is registered at the Chinese Clinical Trial Registry, ChiCTR1900024433., Findings: Between 15 January 2020 and 31 December 2021, 112 individuals consented and completed the baseline assessment. The participants, who had a mean age of 66.3 (SD 4.3) years, with 83 (74%) being women, had been practising calligraphy for an average duration of 9.7 years before enrolment and, in the preceding six months, for an average of 3.1 hours per week. 96 (86%) completed the post-intervention fMRI scan. Significant between-group differences were observed in the FCs between mPFC and right LTC (group difference = 0.25 [95% CI = 0.06-0.44], p = 0.009), mPFC and right IPL (0.23 [0.06-0.39]; p = 0.007), left HF and right LTC (0.28 [0.002-0.57]; p = 0.04), and left HF and right IPL (0.34 [0.09-0.60]; p = 0.009)., Interpretation: Our findings, which reveal positive neuromodulatory effects with increased calligraphy practice, highlight the importance of engaging more in cognitive activities in late life for better brain health., Funding: Research Grants Council, Hong Kong (grant number 24114519)., Competing Interests: Declaration of interests AL holds the following leadership roles: he is Vice President of the Chinese Dementia Research Association and a member of the Council of the Hong Kong College of Psychiatrists. Neither of these organizations were involved in this study, nor did they provide any financial support for it. LS and YL are now the director and employee of BrainNow Medical Technology Limited, respectively. BrainNow Medical Technology Limited did not provide funding to or receive funding from this study. The remaining authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Early cognitive deficits commonly seen in older people have not been well defined and managed in primary care. The objectives are (1) to develop and validate a new risk score to estimate the risk of dementia in Chinese older population; and (2) to evaluate the use of risk score in conjunction with cognitive screening in detecting early cognitive deficits in community older people., Methods: A development cohort of 306 cognitive healthy older adults aged 60 or above were followed for 6 years. A CARS was constructed using the estimated coefficients of risk factors associated with dementia at follow up. Validation was carried out in another five-year cohort of 383 older adults. The usefulness of CARS in detecting early cognitive deficits was evaluated., Results: Risk factors include older age, male gender, low level of education, poorly controlled diabetes, prolonged sleep latency, fewer mind body or light exercise, loneliness, and being apolipoprotein e4 carriers. A cutoff of CARS at -1.3 had a sensitivity of 83.9% and a specificity of 75.4% to predict dementia. The area under curve was 82.5% in the development cohort. Early cognitive deficits were characterized by impaired retention (p <.001, 95% CI 0.2-0.9) and attention (p =.012, 95% CI 0.1-0.8)., Conclusion: The CARS can be used as a standard risk assessment of dementia or in conjunction with a computerized cognitive screening to evaluate a full cognitive profile for detecting early cognitive deficits. The result put forward the integration of risk algorithm into smart healthcare system to provide personalized lifestyle interventions., (© 2024. The Author(s).)

Background: The aim of this pilot randomized controlled trial was to test the feasibility of a computerized cognitive training targeting executive dysfunction in late-life depression and to investigate its impact on mood, cognition, and brain-derived neurotrophic factor (BDNF) levels., Methods: A total of 28 community-living Chinese individuals aged 55-75 with moderate-to-severe depression and cognitive symptoms (but without mild cognitive impairment or dementia) were recruited from a community centre in Hong Kong. Participants were randomly allocated to either the experimental (receiving computerized cognitive training) or the control group (receiving computer-based health education). Both programs lasted for one hour and were conducted twice a week for 6 weeks at the community centre. We assessed mood using the Hamilton Rating Scale for Depression (HAM-D) and Patient Health Questionaire-9 (PHQ-9), cognition using the Montreal Cognitive Assessment (MoCA), and serum BDNF levels at baseline and follow-up. We performed repeated measures analysis of variance to compare the differences in outcome changes between groups and correlation analysis to test if changes in mood and cognition correlated with changes in BDNF level., Results: Our sample had a mean age of 66.8 (SD = 5.3) years, a mean HAM-D score of 19.4 (SD = 7.5), and a mean PHQ-9 score of 18.0 (SD = 6.3). No adverse effects were reported. Significant differences were observed between the experimental and control groups in changes in HAM-D (-8.4 vs. -2.9; group difference = -5.5; p  = 0.01), PHQ-9 (-6.6 vs. -0.6; -6.0; p  < 0.001), MoCA (1.4 vs. -1.3; 2.7; p  = 0.001), and serum BDNF levels (in pg/ml; 2088.3 vs. -3277.4; 5365.6; p  = 0.02). Additionally, changes in HAM-D, PHQ-9, and MoCA scores correlated significantly with changes in BDNF level., Conclusion: With computerized cognitive training improving mood and cognition and increasing serum BDNF levels in 6 weeks, it may serve as a safe and effective evidence-based alternative or adjuvant treatment for late-life depression., Clinical Trial Registration: https://www.chictr.org.cn/indexEN.html, identifier ChiCTR1900027029., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ma, Tang, Lau, Chiu, Lin, Lam and Lee.)

Introduction: One major challenge in developing personalised repetitive transcranial magnetic stimulation (rTMS) is that the treatment responses exhibited high inter-individual variations. Brain morphometry might contribute to these variations. This study sought to determine whether individual's brain morphometry could predict the rTMS responders and remitters., Methods: This was a secondary analysis of data from a randomised clinical trial that included fifty-five patients over the age of 60 with both comorbid depression and neurocognitive disorder. Based on magnetic resonance imaging scans, estimated brain age was calculated with morphometric features using a support vector machine. Brain-predicted age difference (brain-PAD) was computed as the difference between brain age and chronological age., Results: The rTMS responders and remitters had younger brain age. Every additional year of brain-PAD decreased the odds of relieving depressive symptoms by ∼25.7% in responders (Odd ratio [OR] = 0.743, p  = .045) and by ∼39.5% in remitters (OR = 0.605, p  = .022) in active rTMS group. Using brain-PAD score as a feature, responder-nonresponder classification accuracies of 85% (3 rd week) and 84% (12 th week), respectively were achieved., Conclusion: In elderly patients, younger brain age appears to be associated with better treatment responses to active rTMS. Pre-treatment brain age models informed by morphometry might be used as an indicator to stratify suitable patients for rTMS treatment., Trial Registration: ClinicalTrials.gov Identifier: ChiCTR-IOR-16008191.

Background: Mental well-being is poor in long-term care facilities (LTCF) residents. Physical disabilities, impaired social engagement, and environmental stress are also common in LTCF which exacerbate the decline of the mental well-being of older people living in LTCF. Protective elements, including nature-based, reminiscence, outdoor, and group activities, are known to be effective to promote the mental well-being of older people living in LTCF. However, limited by their physical disabilities and poor social support, older people living in LTCF are not likely to benefit from these effective measures. Virtual reality has been proven to be feasible to be environmentally unrestricted to providing LTCF residents with all protective elements promoting mental well-being. However, its effects on the mental well-being of LTCF residents living with physical disabilities are unclear., Methods: This study employs a single-blinded, two-parallel-group (intervention-to-control group ratio = 1:1), non-inferiority, randomized controlled trial. Eligible participants are aged 60 years or above, LTCF residents, and living with physical disabilities. The study will be conducted in LTCF. In the intervention group, participants will receive a 6-week VR experience program. In the control group, participants will receive the usual care provided by the LTCF. The primary outcome is mental well-being, as measured by World Health Organization Five Well-being Index at the time point of baseline (i.e., week 0) and after completion of the intervention (i.e., week 7). This study aims to recruit a total of 216 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention., Trial Registration: The trial has been registered at ClinicalTrials.gov (Identifier: NCT05818579 ), Registered on April 5, 2023. The latest version of the protocol was published online on 19 April 2023. All items come from the World Health Organization Trial Registration Data Set. This study has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2023158). The findings will be disseminated in peer-reviewed journals, presented at international and local conferences with related themes, and shared in local media., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Hong Kong is among the many populations that has experienced the combined impacts of social unrest and the COVID-19 pandemic. Despite concerns about further deteriorations in youth mental health globally, few epidemiological studies have been conducted to examine the prevalence and correlates of major depressive episode (MDE) and other major psychiatric disorders across periods of population-level changes using diagnostic interviews., Methods: We conducted a territory-wide household-based epidemiological study from 2019 to 2022 targeting young people aged 15-24 years. MDE, generalised anxiety disorder (GAD), panic disorder (PD), and bipolar disorder (BD) were assessed using the Composite International Diagnostic Interview-Screening Scales in 3340 young people. Psychotic disorders were assessed by experienced psychiatrists according to the DSM. Help-seeking patterns were also explored., Findings: 16.6% had any mental disorder (13.7% 12-month MDE, 2.3% BD, 2.1% GAD, 1.0% PD, 0.6% psychotic disorder). The prevalence of MDE increased from 13.2% during period 1 (May 2019-June 2020) to 18.1% during period 2 (July-December 2020), followed by 14.0% during period 3 (January-June 2021) and 13.2% during period 4 (July 2021-June 2022). Different stressors uniquely contributed to MDE across periods: social unrest-related stressors during period 1, COVID-19 stressors during period 2, and personal stressors during periods 3-4. Lower resilience, loneliness, frequent nightmares, and childhood adversity were consistently associated with MDE. Compared to other conditions, those with MDE showed the lowest service utilisation rate (16.7%). Perceiving services to "cost too much" and "talked to friends or relatives instead" were among the major reasons for not seeking help. MDE was also significantly associated with poorer functioning and health-related quality of life., Interpretation: MDE can be sensitive to population-level changes, although its persistently elevated prevalence across the study period is of concern. Efforts to mitigate their impacts on youth mental health alongside personal risk factors are needed. Further work is required to increase the availability and acceptability of youth-targeted mental health services., Funding: Food and Health Bureau (HKSAR Government)., Competing Interests: EYHC has received speaker honoraria from Otsuka and research funding from Janssen. PJB is a trustee of the MQ Mental Health Research, Mental Health Research, UK, and Wolfson College, Cambridge, and has participated in the advisory board for MSD: The Future of Mental Health 2021., (© 2023 The Author(s).)

Background: Sleep disturbances are highly prevalent in patients with age-related neurodegenerative diseases, which severely affect cognition and even lead to accumulated β-amyloid. Encouraging results from recent studies on transcranial direct current stimulation (tDCS) showed moderate positive effects on sleep quality in preclinical Alzheimer's disease (AD). Compared to tDCS, transcranial alternating current stimulation (tACS) enables the entrainment of neuronal activity with optimized focality through injecting electric current with a specific frequency and has significant enhancement effects on slow wave activities., Methods and Design: This is a randomized, double-blind, sham-controlled clinical trial comparing 40 Hz tACS with tDCS in mild neurocognitive disorders due to AD with sleep disturbances. Magnetic resonance imaging (MRI) data is used to construct personalized realistic head model. Treatment outcomes, including sleep quality, cognitive performance and saliva Aβ levels will be conducted at baseline, 4th week, 8th week, 12th week and 24th week., Conclusions: It is expected that the repeated gamma-band tACS will show significant improvements in sleep quality and cognitive functions compared to tDCS and sham tDCS. The findings will provide high-level evidence and guide further advanced studies in the field of neurodegenerative diseases and sleep medicine., Trial Registration: ClinicalTrials.gov Identifier: NCT05544201., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Lu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study examined the latent structure of the broad range of complex neuropsychiatric morbidities occurring 1 year after COVID-19 infection. As part of the CU-COVID19 study, 248 (response rate=39.3%) of 631 adults hospitalized for COVID-19 infection in Hong Kong completed an online survey between March-2021 and January-2022. Disorder prevalence was compared against a random non-infected household sample (n=1834). 248 surveys were received on average 321 days post-infection (Mean age: 48.9, 54% female, moderate/severe/critical infection: 58.2%). 32.4% were screened to have at least one mental disorder, 78.7% of whom had concurrent fatigue/subjective cognitive impairment (SCI). Only PTSD (19.1%) was significantly more common than control (14%, p=0.047). Latent profile analysis classified individuals into P1 (12·4%)-no current neuropsychiatric morbidities, P2 (23.1%)-SCI/fatigue, P3 (45.2%)-anxiety/PTSD, P4 (19.3%)-depression. SCI and fatigue pervaded in all profiles (P2-4) with neuropsychiatric morbidities one-year post-infection. PTSD, anxiety and depressive symptoms were most important in differentiating P2-4. Past mental health and P4 independently predicted functional impairment. Neuropsychiatric morbidity was associated with past mental health, reduced resilience, financial problems, but not COVID-19 severity. Their confluence with depressive and anxiety symptoms predicted impairment and are associated with psychological and environmental factors., (© 2023. The Author(s).)

Introduction: Category verbal fluency test (CVFT) has been widely used to assess and monitor the cognitive capacities in epidemiological studies and clinical trials. Pronounced discrepancy in CVFT performance has been found in individuals with different cognitive statuses. This study aimed to combine the psychometric and morphometric approaches to decode the complex verbal fluency performance in senior adults with normal ageing and neurocognitive disorders., Methods: This study adopted a two-stage cross-sectional design involving quantitative analyses of neuropsychological and neuroimaging data. In study I, capacity- and speed-based measures of CVFT were developed to evaluate the verbal fluency performance in normal ageing seniors (n = 261), those with mild cognitive impairment (n = 204), and those with dementia (n = 23) whose age range is from 65 to 85 years. In study II, structural magnetic resonance imaging-informed gray matter volume (GMV) and brain age matrices were calculated in a subsample (n = 52) from Study I through surface-based morphometry analysis. With age and gender as covariates, Pearson's correlation analysis was used to examine the associations of CVFT measures, GMV, and brain age matrices., Results: Speed-based measures showed extensive and stronger associations with other cognitive functions than capacity-based measures. The component-specific CVFT measures showed shared and unique neural underpinnings with lateralized morphometric features. Moreover, the increased CVFT capacity was significantly correlated with younger brain age in mild neurocognitive disorder (NCD) patients., Conclusion: We found that the diversity of verbal fluency performance in normal ageing and NCD patients could be explained by a combination of memory, language, and executive abilities. The component-specific measures and related lateralized morphometric correlates also highlight the underlying theoretical meaning of verbal fluency performance and its clinical utility in detecting and tracing the cognitive trajectory in individuals with accelerated ageing., (© 2023 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.)