Differential associations between simple physical performance tests with global and specific cognitive functions in cognitively normal and mild cognitive impairment: a cross-sectional cohort study of Asian community-dwelling older adults.

BACKGROUND: Physical performance declines and executive dysfunctions are predictors of dementia. However, their associations are not well understood in Asian older adults without dementia (cognitively normal [CN] and mild cognitive impairment [MCI]), especially in a single study. OBJECTIVE: Examine the associations between physical performance measures with executive function (EF)-based and non-EF-based neurocognitive tests and whether preclinical dementia cognitive status i.e., CN and MCI, moderated these associations. METHODS: We examined cross-sectional cohort of 716 community-dwelling older adults without dementia (CN = 562 and MCI = 154) using multivariable linear regression models. We associated three simple physical performance measures, namely timed-up-and-go (TUG), fast gait speed (FGS), and 30-s chair stand test (30 s-CST), with a comprehensive neurocognitive test battery measuring EF and non-EF cognitive functions. Moderating effects of cognitive status on the associations were examined. In all models, we controlled for pertinent covariates, including age, education, medical and psychiatric status. RESULTS: Upon controlling for covariates, TUG was most strongly and positively associated with multiple EF-based neurocognitive tests, followed by FGS, with 30 s-CST having the weakest associations. For all physical performance measures, no significant associations with non-EF-based neurocognitive tests were detected. Cognitive status significantly moderated the associations between all physical measures and several neurocognitive tests, with stronger associations in the MCI than CN. CONCLUSION: Compared to FGS and 30 s-CST, TUG had the most robust associations with multiple EF-based cognitive functions. Given their differential associations with global and detailed neurocognitive tests and significant moderating effects of cognitive status, findings highlight a need to carefully consider the choices of simple physical performance tests when using these tests with a heterogenous group of community-dwelling older adults without dementia.

The Art of Remediating Age-Related Cognitive Decline: Art Therapy Enhances Cognition and Increases Cortical Thickness in Mild Cognitive Impairment.

OBJECTIVE: Previous research on art therapy (AT) in cognitive aging has been lacking. AT can potentially engender significant cognitive gains, due to its rigorous cognitive involvement, making it useful to tackle age-related cognitive decline. Along with these cognitive gains, associated neuroplastic changes are hypothesized to arise from AT as well. The current intervention examined the effects of an AT intervention on cognitive outcomes and cortical thickness (CT) among participants with mild cognitive impairment. METHOD: Participants were assigned to AT (n = 22) and an active control group (n = 27). In both, weekly 45-min sessions were carried out across 3 months. Cognitive assessments and structural magnetic resonance imaging scans were carried out at baseline and 3-month follow-up. Whole brain analyses on CT were carried out. Cognitive outcomes were analyzed using hierarchical linear models. RESULTS: Significant gains in immediate memory and working memory span were observed in the AT group, relative to the control group. Significantly increased CT in the AT group, relative to controls, was observed in a right middle frontal gyrus (MFG) cluster. Furthermore, CT changes in this cluster were significantly and positively correlated with changes in immediate memory. CONCLUSION: These findings highlighted the role of MFG neuroplasticity in enhancing certain cognitive functions in AT. AT is a neuroplastic intervention capable of engendering significant cognitive gains and associated cortical changes in the context of age-related cognitive decline, even when executed as a low-intensity intervention across 3 months. Given the preliminary nature of these findings, future larger sampled studies are needed.

Impacts of COVID-19 and partial lockdown on family functioning, intergenerational communication and associated psychosocial factors among young adults in Singapore.

BACKGROUND: The COVID-19 pandemic has changed our daily lives. Most of the working adults adopted the work-from-home arrangement while students shifted to home-based learning. Being confined together allows families to foster stronger bonds. On the other hand, the on-going pandemic could have negative impacts on family relationships. The COVID-19 outbreak is still on-going worldwide, understanding more about the changes in family functioning and its associated psychological impacts in a pandemic would allow the authorities to provide more targeted support to families. OBJECTIVES: This study aimed to examine the factors associated with family functioning among young adults in Singapore during the COVID-19 pandemic. Family functioning refers to the quality of interactions among family members, and consists of cohesion, flexibility and communication. METHODS: A cross-sectional online survey was conducted (N = 390). The Family Adaptability and Cohesion Evaluation Scale Short Form (FACES-IV-SF) and Global Perceptions of Intergenerational Communication Scale (GPIC) were used to examine family functioning and intergeneration communication during the partial lockdown. Center for Epidemiologic Studies Depression Scale (CESD), Social Support Questionnaire-Brief (SSQ-B), Perceived Stress Scale 4 (PSS), UCLA Loneliness Scale, and Brief Resilient Coping Scale (BRCS) examined the psychosocial impact. Descriptive statistics, Pearson's correlation coefficients, and regression model were employed in the analysis. RESULTS: The FACES-IV-SF score for total circumplex ratio has a mean of 1.57(SD = 0.58), suggesting that participants generally perceived their families as functioning relatively well. The mean scores for CESD, PSS, Loneliness and BRCS were 12.4(6.2), 8.0(2.6), 5.7(1.9) and 12.6(3.1) respectively. The mean scores of the 4 domains of GPIC were 21.5(4.0) for Accommodation, 25.0(6.7) for Non-Accommodation, 17.2(3.3) for Respect-Obligation, and 18.9(4.8) for Avoidant. CONCLUSION: The results suggested that family functioning is significantly associated with intergenerational communication and satisfaction with social support in a pandemic. Participants with balanced levels of cohesion and flexibility in their families are more likely to be able to cope with the psychological impacts of the pandemic. The findings serve to inform intervention and preventive efforts to improve family functioning and reduce the risk of psychological distress in a pandemic.

Arts-based interventions to improve cognition in older persons with mild cognitive impairment: A systematic review of randomized controlled trials.

OBJECTIVES: As the global burden of dementia rises, the search for preventive measures such as interventions for mild cognitive impairment (MCI) remains a research priority. While arts-based interventions have demonstrated some success in improving cognitive functioning among older adults and those with dementia, its effectiveness for older persons with MCI remains unexplored. We conducted a systematic review to examine the effects of arts-based interventions on cognition in older persons with MCI. METHOD: The following databases were searched in November 2019: PubMed, EMBASE, PsycINFO, and CINAHL Plus, supplemented by Google Scholar and ALOIS. Study inclusion criteria were older persons aged ≥ 60 with MCI; arts-based interventions such as dance, drama, music, or visual arts; and randomized controlled trial with cognitive outcome. Database search, study selection, and data extraction were conducted independently by 2 reviewers. RESULTS: Eleven randomized controlled trials examining 13 interventions (817 participants) were identified, of which 4 involved visual arts, 4 dance/movement, 3 music, and 2 storytelling. Significant improvement on at least one cognitive outcome was reported in 10 of the 13 interventions. These included improvements in global cognition (6/7 interventions), learning and memory (5/9), complex attention (4/10), executive functioning (2/6), language (2/3), and perceptual-motor function (1/4). CONCLUSION: This review found that arts-based interventions can potentially improve various aspects of cognitive functioning in older persons with MCI, although our confidence was dampened by methodological limitations such as the moderate-to-high risk of bias present in studies and heterogeneity in the way MCI was defined. Recommendations for future research are discussed.

The individualized prediction of cognitive test scores in mild cognitive impairment using structural and functional connectivity features.

Neuropsychological assessments are essential in diagnosing age-related neurocognitive disorders. However, they are lengthy in duration and can be unreliable at times. To this end, we explored a modified connectome-based predictive modeling approach to estimating individualized scores from multiple cognitive domains using structural connectivity (SC) and functional connectivity (FC) features. Multi-shell HARDI and resting-state functional magnetic resonance imaging scans, and scores from 10 cognitive measures were acquired from 91 older adults with mild cognitive impairment. SC and FC matrices were derived from these scans and, in various combinations, entered into models along with demographic covariates to predict cognitive scores. Leave-one-out cross-validation was performed. Predictive accuracy was assessed via the correlation between predicted and observed scores (rpredicted-observed). Across all cognitive measures, significant rpredicted-observed (0.402 to 0.654) were observed from the best-predicting models. Six of these models consisted of multimodal features. For three cognitive measures, their best-predicting models' rpredicted-observed were similar to that of a model that included only demographic covariates- suggesting that SC and/or FC features did not contribute significantly on top of demographics. Cross-prediction models revealed that the best-predicting models were similarly accurate in predicting scores of related cognitive measures- suggesting their limited specificity in predicting cognitive scores. Generally, multimodal connectomes together with demographics, can be exploited as sensitive markers, though with limited specificity, to predict cognitive performance across a spectrum in multiple cognitive domains. In certain situations, it may not be worthwhile to acquire neuroimaging data, considering that demographics alone can be similarly accurate in predicting cognitive scores.

Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials.

BACKGROUND: Evidence on preventing Alzheimer's disease (AD) is challenging to interpret due to varying study designs with heterogeneous endpoints and credibility. We completed a systematic review and meta-analysis of current evidence with prospective designs to propose evidence-based suggestions on AD prevention. METHODS: Electronic databases and relevant websites were searched from inception to 1 March 2019. Both observational prospective studies (OPSs) and randomised controlled trials (RCTs) were included. The multivariable-adjusted effect estimates were pooled by random-effects models, with credibility assessment according to its risk of bias, inconsistency and imprecision. Levels of evidence and classes of suggestions were summarised. RESULTS: A total of 44 676 reports were identified, and 243 OPSs and 153 RCTs were eligible for analysis after exclusion based on pre-decided criteria, from which 104 modifiable factors and 11 interventions were included in the meta-analyses. Twenty-one suggestions are proposed based on the consolidated evidence, with Class I suggestions targeting 19 factors: 10 with Level A strong evidence (education, cognitive activity, high body mass index in latelife, hyperhomocysteinaemia, depression, stress, diabetes, head trauma, hypertension in midlife and orthostatic hypotension) and 9 with Level B weaker evidence (obesity in midlife, weight loss in late life, physical exercise, smoking, sleep, cerebrovascular disease, frailty, atrial fibrillation and vitamin C). In contrast, two interventions are not recommended: oestrogen replacement therapy (Level A2) and acetylcholinesterase inhibitors (Level B). INTERPRETATION: Evidence-based suggestions are proposed, offering clinicians and stakeholders current guidance for the prevention of AD.

Pathways to care for people with dementia: An international multicentre study.

OBJECTIVE: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. METHODS: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant. RESULTS: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care. CONCLUSIONS: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.

Early Detection of Mild Cognitive Impairment With In-Home Sensors to Monitor Behavior Patterns in Community-Dwelling Senior Citizens in Singapore: Cross-Sectional Feasibility Study.

BACKGROUND: Dementia is a global epidemic and incurs substantial burden on the affected families and the health care system. A window of opportunity for intervention is the predementia stage known as mild cognitive impairment (MCI). Individuals often present to services late in the course of their disease and more needs to be done for early detection; sensor technology is a potential method for detection. OBJECTIVE: The aim of this cross-sectional study was to establish the feasibility and acceptability of utilizing sensors in the homes of senior citizens to detect changes in behaviors unobtrusively. METHODS: We recruited 59 community-dwelling seniors (aged >65 years who live alone) with and without MCI and observed them over the course of 2 months. The frequency of forgetfulness was monitored by tagging personal items and tracking missed doses of medication. Activities such as step count, time spent away from home, television use, sleep duration, and quality were tracked with passive infrared motion sensors, smart plugs, bed sensors, and a wearable activity band. Measures of cognition, depression, sleep, and social connectedness were also administered. RESULTS: Of the 49 participants who completed the study, 28 had MCI and 21 had healthy cognition (HC). Frequencies of various sensor-derived behavior metrics were computed and compared between MCI and HC groups. MCI participants were less active than their HC counterparts and had more sleep interruptions per night. MCI participants had forgotten their medications more times per month compared with HC participants. The sensor system was acceptable to over 80% (40/49) of study participants, with many requesting for permanent installation of the system. CONCLUSIONS: We demonstrated that it was both feasible and acceptable to set up these sensors in the community and unobtrusively collect data. Further studies evaluating such digital biomarkers in the homes in the community are needed to improve the ecological validity of sensor technology. We need to refine the system to yield more clinically impactful information.

Mindfulness practice alters brain connectivity in community-living elders with mild cognitive impairment.

AIM: There is increasing evidence that mild cognitive impairment (MCI) is associated with widespread brain dysconnectivity. Mindfulness practice, which involves focused attention to experience the present moment in a purposeful way, has been shown to confer positive psychological and functional brain changes in healthy practitioners. It is unclear whether mindfulness practice could improve functional brain connectivity in older adults with cognitive impairment. METHODS: Forty-seven participants with MCI were randomized into two groups: a mindfulness practice group and a control group. Functional magnetic resonance imaging of the brain and neurocognitive tests were performed before and after the 3-month intervention. A temporal efficiency analysis approach was used to examine the spatiotemporal networks of the brain. RESULTS: Participants in the mindfulness group had significantly better temporal global efficiency than controls after 3-months of intervention. Localized changes of temporal nodal properties were present in the right cingulate gyrus, insula, and left superior temporal gyrus. Together, these results suggest greater information transmission efficiency at both the global and local spatiotemporal level. In terms of cognitive function, verbal recognition memory improved in the mindfulness group compared to the controls. CONCLUSION: Elders who practiced mindfulness had better brain network efficiency and neurocognitive function relative to controls in this study, suggesting that mindfulness may be of benefit to aging adults with early cognitive degeneration.

An integrated, collaborative healthcare model for the early diagnosis and management of dementia: Preliminary audit results from the first transdisciplinary service integrating family medicine and geriatric psychiatry services to the heart of patients' homes.

BACKGROUND: The number of dementia cases is expected to rise exponentially over the years in many parts of the world. Collaborative healthcare partnerships are envisaged as a solution to this problem. Primary care physicians form the vanguard of early detection of dementia and influence clinical care that these patients receive. However, evidence suggests that they will benefit from closer support from specialist services in dementia care. An interdisciplinary, collaborative memory clinic was established in 2012 as a collaborative effort between a large family medicine based service and a specialist geriatric psychiatry service in Singapore. It is the first service in the world that integrates a family medicine based service with geriatric psychiatry expertise in conjunction with community-based partnerships in an effort to provide holistic, integrated care right into the heart of patients' homes as well as training in dementia care for family medicine physicians. We describe our model of care and the preliminary findings of our audit on the results of this new model of care. METHODS: This was a retrospective audit done on the electronic medical records of all patients seen at the Memory Clinic in Choa Chu Kang Polyclinic from August 2013 to March 2016. The information collected included gender, referral source, patient trajectories, presence of behavioural and psychological symptoms of dementia and percentage of caregivers found to be in need of support. A detailed outline of the service workflow and processes were described. RESULTS: A majority (93.5%) of the patients had their memory problems managed at the memory clinic without escalation to other specialist services. 22.7% of patients presented with behavioural and psychological symptoms of dementia. When initially assessed, a majority (82.2%) of patients' caregivers were found to be in need of support with 99.5% of such caregivers' needs addressed with memory clinic services. CONCLUSION: Our model of care has the potential to shape future dementia care in Singapore and other countries with a similar healthcare setting. Redesigning and evolving healthcare services to promote close collaboration between primary care practitioners and specialist services for dementia care can facilitate seamless delivery of care for the benefit of patients.

Decreased Serum Brain-Derived Neurotrophic Factor (BDNF) Levels in Patients with Alzheimer's Disease (AD): A Systematic Review and Meta-Analysis.

Findings from previous studies reporting the levels of serum brain-derived neurotrophic factor (BDNF) in patients with Alzheimer's disease (AD) and individuals with mild cognitive impairment (MCI) have been conflicting. Hence, we performed a meta-analysis to examine the aggregate levels of serum BDNF in patients with AD and individuals with MCI, in comparison with healthy controls. Fifteen studies were included for the comparison between AD and healthy control (HC) (n = 2067). Serum BDNF levels were significantly lower in patients with AD (SMD: -0.282; 95% confidence interval [CI]: -0.535 to -0.028; significant heterogeneity: I² = 83.962). Meta-regression identified age (p < 0.001) and MMSE scores (p < 0.001) to be the significant moderators that could explain the heterogeneity in findings in these studies. Additionally, there were no significant differences in serum BDNF levels between patients with AD and MCI (eight studies, n = 906) and between MCI and HC (nine studies, n = 5090). In all, patients with AD, but not MCI, have significantly lower serum BDNF levels compared to healthy controls. This meta-analysis confirmed the direction of change in serum BDNF levels in dementia. This finding suggests that a significant change in peripheral BDNF levels can only be detected at the late stage of the dementia spectrum. Molecular mechanisms, implications on interventional trials, and future directions for studies examining BDNF in dementia were discussed.

Directional associations between memory impairment and depressive symptoms: data from a longitudinal sample and meta-analysis.

BACKGROUND: Previous cross-lagged studies on depression and memory impairment among the elderly have revealed conflicting findings relating to the direction of influence between depression and memory impairment. The current study aims to clarify this direction of influence by examining the cross-lagged relationships between memory impairment and depression in an Asian sample of elderly community dwellers, as well as synthesizing previous relevant cross-lagged findings via a meta-analysis. METHODS: A total of 160 participants (Mage = 68.14, s.d. = 5.34) were assessed across two time points (average of 1.9 years apart) on measures of memory and depressive symptoms. The data were then fitted to a structural equation model to examine two cross-lagged effects (i.e. depressive symptoms→memory; memory→depressive symptoms). A total of 14 effect-sizes for each of the two cross-lagged directions were extracted from six studies (including the present; total N = 8324). These effects were then meta-analyzed using a three-level mixed effects model. RESULTS: In the current sample, lower memory ability at baseline was associated with worse depressive symptoms levels at follow-up, after controlling for baseline depressive symptoms. However, the reverse effect was not significant; baseline depressive symptoms did not predict subsequent memory ability after controlling for baseline memory. The results of the meta-analysis revealed the same pattern of relationship between memory and depressive symptoms. CONCLUSIONS: These results provide robust evidence that the relationship between memory impairment and depressive symptoms is unidirectional; memory impairment predicts subsequent depressive symptoms but not vice-versa. The implications of these findings are discussed.

Clinical Use of Mood Stabilizers With Antidepressants in Asia: Report From the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) Projects in 2004 and 2013.

OBJECTIVE: As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries. METHODS: This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling. RESULTS: Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P < 0.001), but not with country, sex, or AD dose. CONCLUSIONS: The findings provide a broad picture of contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.

Emotion regulation and emotional distress: The mediating role of hope on reappraisal and anxiety/depression in newly diagnosed cancer patients.

PURPOSE: A proportion of newly diagnosed cancer patients may experience anxiety and depression. Emotion suppression has been associated with poorer psychoemotional outcomes, whereas reappraisal may be an adaptive emotion regulation strategy. Few studies have examined potential mechanisms linking reappraisal to psychoemotional outcomes in cancer patients. This study aims to replicate findings on reappraisal and suppression and further examines if hope mediates the association between reappraisal and anxiety/depression in patients newly diagnosed with cancer. METHODS: Participants were 144 adult cancer patients (65.3% female, mean age = 48.96 years, SD = 9.23). Patients completed a set of study questionnaires, including the Emotion Regulation Questionnaire, Adult Hope Scale, and the Hospital Anxiety and Depression Scale. Path analysis was used to examine if hope mediated the association between reappraisal and anxiety/depression. RESULTS: Prevalence of anxiety was 39.6% and depression was 25.0%. Reappraisal and hope were correlated with lower anxiety and depression, whereas suppression was correlated with higher anxiety and depression. The hypothesized mediation model provided fit to the data, comparative fit index = 0.95, Tucker-Lewis index = 0.94, root-mean-square-error of approximation = 0.05. There was a significant indirect effect of reappraisal on anxiety and depression via hope, b = -0.95, SE = 0.42, 95% confidence interval = -1.77 to -0.12, whereas the direct effect of reappraisal was nonsignificant. CONCLUSION: The study findings suggest that hope mediated the association between reappraisal and anxiety/depression outcomes. Moreover, the high prevalence of anxiety and depression implies a need for healthcare providers to attend to the psychoemotional needs of newly diagnosed cancer patients.

Evaluation of a brief pilot psychoeducational support group intervention for family caregivers of cancer patients: a quasi-experimental mixed-methods study.

BACKGROUND: Family caregivers of cancer patients often experience an impaired quality of life (QOL) and emotional distress as a result of their caregiving duties, which may potentially influence the quality of care of their care recipients. The COPE (Caregivers of cancer Outpatients' Psycho-Education support group therapy) intervention was developed as a response to the lack of work done among family caregivers of ambulatory cancer patients in Asia. This group intervention comprised four weekly sessions simultaneously targeting psychoeducation, skills training, and supportive therapy. The present study sought to evaluate the pilot COPE intervention using both quantitative and qualitative measures. The Hospital Anxiety and Depression Scale (HADS) was used to measure both depression and anxiety, while the Caregiver QOL - Cancer (CQOLC) measured caregiver QOL. These instruments were measured at baseline pre-intervention, and immediately post-intervention. A waitlist control group design was adopted. A subset of caregivers from the intervention group were invited for a semi-structured interview post-intervention. FINDINGS: Quantitative analyses suggest that while QOL remained stable in control group participants, intervention group participants experienced QOL improvements - both in overall QOL and in the specific domain of burden. There were no significant differences in the trajectories of depression and anxiety in both groups. Qualitative analyses suggest that this might have been a result of the intervention not only equipping participants with the relevant coping skills, but also providing a platform for emotional expression and situational reappraisal. CONCLUSIONS: The COPE intervention has shown some efficacy in helping family caregivers of cancer patients, but more work is required before this can be implemented. TRIAL REGISTRATION: Current Controlled Trials NCT02120183 . Registered 17 April 2014. Retrospectively registered.

Effects of horticultural therapy on elderly' health: protocol of a randomized controlled trial.

BACKGROUND: Due to a rapidly ageing population in the world, it is increasingly pertinent to promote successful ageing strategies which are cost-effective, easily accessible, and more likely to be acceptable to the elderly. Past research associates exposure to natural environments and horticultural therapy (HT) with positive psychological, social and physical health benefits. This Randomized Controlled Trial (RCT) is designed to evaluate the efficacy of HT in promoting Asian elderly' mental health, cognitive functioning and physical health. METHODS/DESIGN: 70 elderly participants aged 60 to 85 years old will be randomized to participate in either the active horticultural therapy group or be in the waitlist control. Sessions will be weekly for 12 weeks, and monthly for 3 months. Mental health will be assessed through self-reports of depressive and anxiety symptomatology, life satisfaction, social connectedness and psychological well-being, collaborated with immunological markers. Outcome measures of cognitive functioning and physical health include neuropsychological tests of cognitive function and basic health screening. Outcomes will be assessed at baseline, 3 months and 6 months post-intervention. DISCUSSION: This RCT comprehensively investigates the efficacy of a non-invasive intervention, HT, in enhancing mental health, cognitive functioning and physical health. The results have tremendous potential for supporting future successful ageing programs and applicability to larger populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT02495194 . Trial registration date: July 13, 2015. Retrospectively registered.

Poor sleep quality is observed in mild cognitive impairment and is largely unrelated to depression and anxiety.

BACKGROUND: Individuals with mild cognitive impairment (MCI) commonly experience a number of sleep quality related issues. However, it remains unclear if these issues are specific to MCI or are simply attributed to the elevated levels depression and anxiety symptoms frequently observed among those with MCI. The present study sought to examine group differences between participants with MCI and matched controls on self-reported measures of sleep quality while controlling for depression and anxiety levels. METHODS: Participants with MCI (N = 48) and demographically matched controls (N = 48) were administered with self-reported measures of anxiety, depression and sleep quality. Sleep quality between both groups were first analyzed using a Multivariate Analysis of Variance, and then subsequently a Multivariate Analysis of Covariance incorporating depression and anxiety scores as covariates. RESULTS: The MCI group had significantly higher levels of depression and anxiety than the controls. On the sleep-related measures, the MCI group had significantly worse outcomes in sleep duration, disturbances, latency, efficiency, quality and daytime dysfunction. After controlling for depression and anxiety levels, with the exception of daytime dysfunction, all other differences remain significant, and are also associated with moderate to large effect sizes. CONCLUSION: The results suggest that sleep quality issues are present in MCI and are largely independent of depression and anxiety.

Degree, but not direction of grip strength asymmetries, is related to depression and anxiety in an elderly population.

Despite the abundance of studies on asymmetries in manual laterality, a marker for atypical brain lateralization in depression and anxiety, findings in this area are mixed. Traditionally, research have looked at individual differences in depression and anxiety as a function of the direction of asymmetry. However, recent research has emphasized on studying the degree of asymmetry in addition to its direction. To these ends, the present study aims to unravel the associations between the degree and direction of manual lateralization, and depression/anxiety. Cognitively healthy elderlies (N = 326, 91 males, Mage = 68) were administered grip strength assessments on both hands and self-report measures of depression and anxiety. Partial correlation analyses controlling for age, education and sex revealed significant positive associations between degree of lateralization and anxiety in the overall sample and among right-dominant participants, as well as a significant positive relationship between degree of lateralization and depression among right-dominant participants. None of the correlations involving the direction of lateralization yielded significance, neither was there significant differences between left- and right-dominant participants on depression and anxiety scores. These findings suggest that the degree of manual lateralization, but not direction, is related to depression and anxiety at least among right-dominant individuals.

Factors Associated With Antidepressant Dosing in Asia: Findings From the Research on Asian Psychotropic Prescription Study.

In this study, we sought to examine factors associated with dosing of antidepressants (ADs) in Asia. Based on reported data and clinical experience, we hypothesized that doses of ADs would be associated with demographic and clinical factors and would increase over time. This cross-sectional, pharmacoepidemiological study analyzed data collected within the Research Study on Asian Psychotropic Prescription Pattern for Antidepressants from 4164 participants in 10 Asian countries, using univariate and multivariate methods. The AD doses varied by twofold among countries (highest in PR China and RO Korea, lowest in Singapore and Indonesia), and averaged 124 (120-129) mg/d imipramine-equivalents. Average daily doses increased by 12% between 2004 and 2013. Doses were significantly higher among hospitalized patients and ranked by diagnosis: major depression > anxiety disorders > bipolar disorder, but were not associated with private/public or psychiatric/general-medical settings, nor with age, sex, or cotreatment with a mood stabilizer. In multivariate modeling, AD-dose remained significantly associated with major depressive disorder and being hospitalized. Doses of ADs have increased somewhat in Asia and were higher when used for major depression or anxiety disorders than for bipolar depression and for hospitalized psychiatric patients.

A Risk Score for the Prediction of Neurocognitive Disorders among Community-Dwelling Chinese Older Adults.

BACKGROUND: Several risk scores have been developed for predicting cognitive impairment and dementia, but none have been validated in Asian samples. We aimed to produce a risk score that best predicts incident neurocognitive disorder (NCD) among Chinese elderly and to validate this score against the modified risk score derived from the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study. METHODS: Data from participants enrolled in the Singapore Longitudinal Ageing Study (SLAS) 1 were analyzed. A total of 957 participants >55 years of age with normal cognition at baseline were included. Incident cases of NCD were measured using the global Clinical Dementia Rating (CDR) and determined by a consensus panel. RESULTS: The best prediction model from SLAS included age, gender, education, depression, heart disease, social and productive activities and Mini-Mental State Examination score. This model predicted the short-term risk of incident NCD in elderly participants moderately well, with a C statistic (area under the curve) of 0.72. Modified CAIDE models applied to our sample had a C statistic of 0.71. CONCLUSION: Our risk score performs as well as other available risk scores. It is the only risk score formulated for ethnic Chinese, rendering it valuable for clinical use in Asia; at-risk individuals can be identified for early intervention.