Daily consumption of essence of chicken improves cognitive function: a systematically searched meta-analysis of randomized controlled trials.

Essence of chicken (EC) is a dietary supplement with potential benefits on one's cognitive performance. The purpose of this meta-analysis is to evaluate the effects of consuming EC on cognitive function, applying extensively represented domains. Six databases were systematically searched to yield 1760 articles. These articles were independently screened to obtain 8 eligible articles with a pooled population of 794 subjects which is more than twice the population size considered in the previous meta-analyses. Largely, favorable effects on cognitive function were observed following daily EC intake, specifically in the working memory domain (standardized mean difference: 0.31, 95% CI: 0.16, 0.46), one of the core components in executive function which showed statistically significant results. Furthermore, the observed results were also robust to sensitivity analyses and subgroup analyses. This suggests that when consumed daily, EC may improve the mental processing aspect of cognitive function amongst the healthy population.

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.

Metabolic Syndrome and Cognition: Follow-Up Study of Chinese Over-55-Year-Olds.

BACKGROUND/AIM: Studies of the associations of the metabolic syndrome (MetS) with cognitive function and decline are inconclusive. We investigated the associations of the MetS with cognitive functions in 823 Chinese >55-year-olds followed up over 4.5 years. METHODS: The relationships between the MetS and baseline and follow-up z-scores of cognitive domain functions were examined using mixed model analysis. RESULTS: There were specific inverse cross-sectional associations of single cardiometabolic risk factors with cognition, such as hyperglycemia with processing speed (p = 0.045). The MetS was negatively associated with 3 out of 4 cognitive domains (p = 0.018 to p = 0.003), and the count of cardiometabolic risk factors with all cognitive domains (p = 0.025 to p = 0.002). Longitudinally, dyslipidemia was associated with worse decline in memory and learning (p = 0.022). The count of cardiometabolic risk factors was associated with worse declines in cognition (p = 0.032 for global cognition). CONCLUSION: Among middle-aged and older Asians, an increased number of component cardiometabolic risk factors of the MetS was associated with a worse decline in cognitive function over time.

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.

The Clinical Alliance and Research in Electroconvulsive Therapy Network: An Australian Initiative for Improving Service Delivery of Electroconvulsive Therapy.

OBJECTIVE: There is currently substantial heterogeneity in electroconvulsive therapy (ECT) treatment methods between clinical settings. Understanding how this variation in clinical practice is related to treatment outcomes is essential for optimizing service delivery. The Clinical Alliance and Research in ECT Network is a clinical and research framework with the aims of improving clinical practice, enabling auditing and benchmarking, and facilitating the collection of naturalistic clinical data. METHODS: The network framework and clinical and treatment variables collected and rationale for the use of particular outcome measures are described. Survey results detailing the use of ECT across initial participating clinical centers were examined. RESULTS: The data are reported from 18 of 22 participating centers, the majority based in Australia. Melancholic unipolar depression was the most common clinical indication (78%). Right unilateral (44%) and bifrontal (39%) were the most commonly used electrode placements. Eighty one percent of the centers used individual seizure titration for initial dosing. CONCLUSIONS: There was substantial heterogeneity in the use of ECT between participating centers, indicating that the Network is representative of modern ECT practice. The Clinical Alliance and Research in ECT Network may therefore offer the opportunity to improve service delivery and facilitate the investigation of unresolved research questions pertaining to modern ECT practice.

Sleep correlates of depression and anxiety in an elderly Asian population.

BACKGROUND: Research looking at the association between sleep and psychiatric symptoms in elderly Asian populations is lacking. The present study examines the sleep correlates of depression and anxiety in a sample of cognitively healthy older adults. METHODS: The Geriatric Depression Scale, Geriatric Anxiety Inventory, and the Pittsburgh Sleep Quality Index were administered to a community sample of elderly participants (n = 107; 81 women; Mage = 71.3 years, SD = 5.7) RESULTS: Geriatric Depression Scale and Geriatric Anxiety Inventory scores are both significantly correlated with sleep disturbance. Geriatric Depression Scale scores are uniquely associated with daytime dysfunction, and Geriatric Anxiety Inventory scores are uniquely associated with perceived sleep quality, sleep latency, and global Pittsburgh Sleep Quality Index scores. CONCLUSIONS: Depression and anxiety in a cohort of elderly Asian subjects are associated with a number of sleep-related issues; both are related to a somewhat different profile of sleep problems.

Coexisting medical comorbidity and depression: multiplicative effects on health outcomes in older adults.

BACKGROUND: Depression in the elderly is often associated with coexisting medical illnesses. We investigated the individual and combined impacts of depression and medical illnesses on disability and quality of life among community-living older persons. METHODS: Cross-sectional and longitudinal analyses of data from 1,844 participants aged 55 and above of the Singapore Longitudinal Aging Study (SLAS-1). Baseline depressive symptoms (Geriatric Depressive Scale, GDS≥5) and chronic medical comorbidity (≥2) from self-reports were related to baseline and 2-year follow up instrumental and basic activities of daily living (IADL-BADL), and quality of life (Medical Outcomes Study 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) scores. RESULTS: The prevalence of depressive symptoms was 11.4%. In main effect analyses of cross-sectional and longitudinal relationships, depression and medical comorbidity were individually associated with higher risk of IADL-BADL disability and lower PCS and MCS scores of quality of life, and only medical comorbidity was associated with increased risk of hospitalization. Significant interactive effects of depression and medical comorbidity were observed in longitudinal relationships with IADL-BADL disability (p = 0.03), PCS (p < 0.01), and MCS (p < 0.01) scores at follow up. The associations of medical comorbidity with increased odds of IADL-BADL disability and decreased SF-12 PCS and MCS scores were at least threefolds stronger among depressed than nondepressed individuals. CONCLUSION: Medical comorbidities and depression exert additive and multiplicative effects on functional disability and quality of life. The adverse impact and potential treatment benefits of coexisting mental and physical conditions should be seriously considered in clinical practice.

Extended-release ketamine tablets for treatment-resistant depression: a randomized placebo-controlled phase 2 trial.

Ketamine has rapid-onset antidepressant activity in patients with treatment-resistant major depression (TRD). The safety and tolerability of racemic ketamine may be improved if given orally, as an extended-release tablet (R-107), compared with other routes of administration. In this phase 2 multicenter clinical trial, male and female adult patients with TRD and Montgomery-Asberg Depression Rating Scale (MADRS) scores ≥20 received open-label R-107 tablets 120 mg per day for 5 days and were assessed on day 8 (enrichment phase). On day 8, responders (MADRS scores ≤12 and reduction ≥50%) were randomized on a 1:1:1:1:1 basis to receive double-blind R-107 doses of 30, 60, 120 or 180 mg, or placebo, twice weekly for a further 12 weeks. Nonresponders on day 8 exited the study. The primary endpoint was least square mean change in MADRS for each active treatment compared with placebo at 13 weeks, starting with the 180 mg dose, using a fixed sequence step-down closed test procedure. Between May 2019 and August 2021, 329 individuals were screened for eligibility, 231 entered the open-label enrichment phase (days 1-8) and 168 responders were randomized to double-blind treatment. The primary objective was met; the least square mean difference of MADRS score for the 180 mg tablet group and placebo was -6.1 (95% confidence interval 1.0 to 11.16, P = 0.019) at 13 weeks. Relapse rates during double-blind treatment showed a dose response from 70.6% for placebo to 42.9% for 180 mg. Tolerability was excellent, with no changes in blood pressure, minimal reports of sedation and minimal dissociation. The most common adverse events were headache, dizziness and anxiety. During the randomized phase of the study, most patient dosing occurred at home. R-107 tablets were effective, safe and well tolerated in a patient population with TRD, enriched for initial response to R-107 tablets. ClinicalTrials.gov registration: ACTRN12618001042235 .

Hype or hope? Ketamine for the treatment of depression: results from the application of deep learning to Twitter posts from 2010 to 2023.

Objective: To investigate societal perceptions of ketamine's use in depression therapy by analysing Twitter posts from January 1, 2010 to April 1, 2023. Methods: Using Twitter as the social media platform of choice, and employing search terms based on (depression OR depressed OR depressive) AND (ketamine OR esketamine OR Spravato), we collected English-language tweets from January 1, 2010, to April 1, 2023. Using unsupervised machine learning and natural language processing (NLP) techniques, including Bidirectional Encoder Representations from Transformers (BERT) and BERTopic, the study identified prevalent topics surrounding public chatter around the use of ketamine in depression treatment. Manual thematic analyses further refined these topics into themes. Results: Out of an initial dataset of 99,405 tweets, after removing duplicate tweets, re-tweets and tweets posted by organizations over Twitter, 18,899 unique tweets from presumably individual users were analysed. Analysis of temporal trends revealed a shift in public attitudes, particularly after the United States Food and Drug Administration (FDA)'s 2019 approval of ketamine for depression. Three major themes emerged: a changing regulatory landscape, cautious optimism, and personal experiences with the drug. There was an initial spike in discussions post-FDA approval in 2019. Thereafter, cautious optimism (Theme 2) decreased among the general public, with more personal accounts (Theme 3) highlighting the potential benefits for some treatment-resistant patients. Limitations of the study include Twitter's inherent biases towards younger, English-speaking demographics. Conclusion: In summary, the public's multifaceted perception leans towards a hopeful stance on ketamine's therapeutic potential for depression.

The impact of 5-hydroxytryptophan supplementation on sleep quality and gut microbiota composition in older adults: A randomized controlled trial.

BACKGROUND & AIMS: Sleep quality is a pivotal part of health and there is growing evidence on the association between gut microbiota composition and sleep quality. 5-Hydroxytryptophan (5-HTP) is known as a precursor of the sleep regulating neurotransmitter and hormone. However, efficacy of 5-HTP supplementation for improving sleep quality in older adults is unclear. Hence, the aim of this study is to assess the impact of 5-HTP supplementation on sleep quality and gut microbiota composition in older adults. METHODS: This is a single-blinded, 12-week parallel randomized controlled trial. Thirty older adults (66 ± 3 years) in Singapore were randomly assigned to either consume or not consume 100 mg 5-HTP daily. Every 4 weeks, sleep quality was assessed via both subjective (Pittsburg Sleep Quality Index) and objective (actigraphy watch) measures. A global sleep score (GSS) was obtained from the PSQI, where a GSS>5 defines as poor sleeper while a GSS≤5 defines as good sleeper. Blood serotonin level, urine melatonin concentration, gut microbiota composition and stool short chain fatty acids (SCFA) content were assessed at week 0 and 12. This study was registered in clinicaltrials.gov as NCT04078724 (https://clinicaltrials.gov/ct2/show/NCT04078724). RESULTS: 5-HTP supplementation showed an overall favorable effect on certain sleep quality components and an increase in serum serotonin concentration. In particular, at week 12, not good sleepers but poor sleepers with 5-HTP supplementation were able to significantly improve subjective GSS (ΔSL5-HTP: -2.80 ± 1.10 min, p-value = 0.005). In addition, they showed an increase in microbiota diversity (Simpson5-HTP vs. SimpsonControl: 0.037 ± 0.032 a.u. vs. -0.007 ± 0.022 a.u.; pinteraction: 0.013) and relative abundance of SCFA producing bacteria in the gut. CONCLUSIONS: 5-HTP supplementation can improve certain sleep quality components in older adults and this benefit was more prominently observed in poor sleepers. 5-HTP was also able to improve the gut microbiota composition in poor sleepers.

A Southeast Asia Consensus on the Definition and Management of Treatment-Resistant Depression.

Introduction: Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD and available treatment pathways for the management of TRD vary across the Southeast Asia (SEA) region, highlighting the need for a uniform definition and treatment principles to optimize the management TRD in SEA. Methods: Following a thematic literature review and pre-meeting survey, a SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA Appropriateness Method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. Results: The expert panel agreed that "pharmacotherapy-resistant depression" (PRD) is a more suitable term for TRD and defined it as "failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode". A stepwise treatment approach should be employed for the management of PRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Non-pharmacological treatments, such as electroconvulsive therapy and repetitive transcranial magnetic stimulation, are also appropriate options for patients with PRD. Conclusion: These consensus recommendations on the operational definition of PRD and treatment principles for its management can be adapted to local contexts in the SEA countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with PRD.

The Ketamine Side Effect Tool (KSET): A comprehensive measurement-based safety tool for ketamine treatment in psychiatry.

OBJECTIVES: On a background of the rapidly expanding clinical use of ketamine and esketamine for treatment of depression and other conditions, we examined safety monitoring, seeking to identify knowledge gaps relevant to clinical practice. METHODS: An international group of psychiatrists discussed the issue of safety of ketamine and esketamine and came to a consensus on key safety gaps. RESULTS: There is no standard safety monitoring for off-label generic ketamine. For intranasal esketamine, each jurisdiction providing regulatory approval may specify monitoring. Treatment is often provided beyond the period for which safety has been demonstrated, with no agreed framework for monitoring of longer term side effects for either generic ketamine or intranasal esketamine. LIMITATIONS: The KSET has established face and content validity, however it has not been validated against other measures of safety. CONCLUSIONS: We recommend the Ketamine Side Effect Tool (KSET) as a comprehensive safety monitoring tool for acute and longer term side effects.

A Systematic Review and Meta-Analysis of the Impact of Different Intensity of Dietary Counselling on Cardiometabolic Health in Middle-Aged and Older Adults.

Dietary counselling has been identified as one of the nutritional strategies to alleviate cardiometabolic health conditions. Its effectiveness however may vary due to factors such as intensity level and provider while this has not been comprehensively studied. This systematic review and meta-analysis aimed to assess the effects of dietary counselling on the cardiometabolic health in middle-aged and older adults and the sub-group analyses with dietary counselling intensity and the provider were also assessed. Four databases including PubMed, CINAHL Plus with Full Text, Cochrane Library and EMBASE were systematically searched. Data from 22 randomised controlled trials (RCTs) were compiled and those from 9 RCTs were utilised for meta-analysis. Dietary counselling lowered total cholesterol (TC) and fasting blood sugar (FBS) but had no impact on triglycerides (TG) and low-density lipoprotein (LDL). Sub-group analysis revealed significant lowering effect of high intensity dietary counselling for TG (weighted mean difference (WMD): -0.24 mmol/L, 95% confidence intervals (CIs): -0.40 to -0.09), TC (WMD: -0.31 mmol/L, 95% CIs: -0.49 to -0.13), LDL (WMD: -0.39 mmol/L, 95% CIs: -0.61 to -0.16) and FBS (WMD: -0.69 mmol/L, 95% CIs: -0.99 to -0.40) while medium or low intensity dietary counselling did not show favouring effects. Counselling provider showed differential responses on cardiometabolic health between dietitian and all other groups. The findings from this systematic review and meta-analysis suggest that dietary counselling is a beneficial dietary strategy to improve cardiometabolic health in middle-aged and older adults with the emphasis on the counselling intensity.

Mindfulness intervention for mild cognitive impairment led to attention-related improvements and neuroplastic changes: Results from a 9-month randomized control trial.

Mindfulness-based interventions can enhance cognitive abilities among older adults, thereby effectively delaying cognitive decline. These cognitive enhancements are theorized to accompany neuroplastic changes in the brain. However, this mindfulness-associated neuroplasticity has yet to be documented adequately. A randomized controlled trial was carried out among participants with mild cognitive impairment (MCI) to examine the effects of a mindfulness-based intervention on various cognitive outcomes and cortical thickness (CT) in the context of age-related cognitive impairment. Participants were assigned to a mindfulness awareness program (MAP)(n = 27) and an active control condition - health education program (n = 27). In both, they attended weekly sessions for three months and subsequently, monthly sessions for six months. Cognitive assessments and structural scans were carried out across three time-points. Whole brain analyses on CT were carried out and were supplemented with region of interest-based analyses. ROI values and cognitive outcomes were analyzed with mixed MANOVAs and followed up with univariate ANOVAs. Nine-month MAP-associated gains in working memory span and divided attention, along with an increased CT in the right frontal pole and decreased CT in the left anterior cingulate were observed. Three-month MAP-associated CT increase was observed in the left inferior temporal gyrus but did not sustain thereafter. MAP led to significant cognitive gains and various CT changes. Most of these neurobehavioral changes, may require sustained effort across nine months, albeit at a reduced intensity. MAP can remediate certain cognitive impairments and engender neuroplastic effects even among those with MCI.

Mindfulness Awareness Practice (MAP) to Prevent Dementia in Older Adults with Mild Cognitive Impairment: Protocol of a Randomized Controlled Trial and Implementation Outcomes.

BACKGROUND: With an aging population, developing non-pharmacological interventions (NPIs) to delay dementia has become critical. Apart from cognitive decline, dementia is associated with multiple pathophysiology, including increased oxidative stress, dysregulated gene expressions, cytokine, neurotrophin, and stress markers, telomere shortening, and deteriorations in brain connectivity. Although mindfulness practices have been proposed to ameliorate these biological changes, no empirical studies were conducted. We thus aimed to investigate the effects of mindfulness awareness practice (MAP) to prevent cognitive decline and improve peripheral biomarkers in community-dwelling older adults diagnosed with mild cognitive impairment (MCI). METHODS/DESIGN: This was a single-blinded and parallel-group randomized controlled trial with two arms (intervention and active control arms), conducted over nine months. A total of 60 consenting community-dwelling older adults diagnosed with MCI were planned to be randomized in a 1:1 ratio to either the MAP or the Health Education Program (HEP). Interventions were performed weekly for the initial 12 weeks, and monthly for the subsequent six months. Outcome measures were assessed at baseline, 3-month, and 9-month post-intervention by blinded assessors. Primary outcomes were neurocognitive tests, comprehensive peripheral biomarkers, and brain imaging scans. Secondary outcomes included basic health screening measures, affective symptoms, and measures of physical functions. Linear-mixed models were used to examine the effects of MAP on these outcome measures. SIGNIFICANCE: This is the first randomized controlled trial to systematically investigate the effects of a mindfulness intervention in improving cognitive functions and various biomarkers in community-dwelling older adults diagnosed with MCI. Our findings have the potential to inform mindfulness intervention as a novel approach to delay dementia.

Electroconvulsive therapy for catatonia in neuropsychiatric systemic lupus erythematosus.

Neuropsychiatric systemic lupus erythematosus encompasses neurological syndromes of the central, peripheral, and autonomic nervous system and a variety of psychiatric syndromes. Neuropsychiatric systemic lupus erythematosus presenting as catatonia is uncommon, and treatment of this condition is not well defined. Here we describe a case of neuropsychiatric systemic lupus erythematosus with catatonia and our treatment approach focusing on electroconvulsive therapy in conjunction with cyclophosphamide. We also discuss the pathophysiological underpinnings of the condition and the basis for treatment.

Neuroanatomy of Patients with Deficit Schizophrenia: An Exploratory Quantitative Meta-Analysis of Structural Neuroimaging Studies.

Little is known regarding the neuroanatomical correlates of patients with deficit schizophrenia or persistent negative symptoms. In this meta-analysis, we aimed to determine whether patients with deficit schizophrenia have characteristic brain abnormalities. We searched PubMed, CINAHL and Ovid to identify studies that examined the various regions of interest amongst patients with deficit schizophrenia, patients with non-deficit schizophrenia and healthy controls. A total of 24 studies met our inclusion criteria. A random-effects model was used to calculate a combination of outcome measures, and heterogeneity was assessed by the I2 statistic and Cochran's Q statistic. Our findings suggested that there was statistically significant reduction in grey matter volume (-0.433, 95% confidence interval (CI): -0.853 to -0.014, p = 0.043) and white matter volume (-0.319, 95% CI: -0.619 to -0.018, p = 0.038) in patients with deficit schizophrenia compared to healthy controls. There is also statistically significant reduction in total brain volume (-0.212, 95% CI: -0.384 to -0.041, p = 0.015) and white matter volume (-0.283, 95% CI: -0.546 to -0.021, p = 0.034) in patients with non-deficit schizophrenia compared to healthy controls. Between patients with deficit and non-deficit schizophrenia, there were no statistically significant differences in volumetric findings across the various regions of interest.

Development of the Ketamine Side Effect Tool (KSET).

BACKGROUND: Currently, no specific, systematic assessment tool for the monitoring and reporting of ketamine-related side effects exists. Our aim was to develop a comprehensive Ketamine Side Effect Tool (KSET) to capture acute and longer-term side effects associated with repeated ketamine treatments. METHODS: Informed by systematic review data and clinical research, we drafted a list of the most commonly reported side effects. Face and content validation were obtained via feedback from collaborators with expertise in psychiatry and anaesthetics, clinical trial piloting and a modified Delphi Technique involving ten international experts. RESULTS: The final version consisted of four forms that collect information at time points: screening, baseline, immediately after a single treatment, and longer-term follow-up. Instructions were developed to guide users and promote consistent utilisation. LIMITATIONS: Further evaluation of feasibility, construct validity and reliability is required, and is planned across multiple international sites. CONCLUSIONS: The structured Ketamine Side Effect Tool (KSET) was developed, with confirmation of content and face validity via a Delphi consensus process. This tool is timely, given the paucity of data regarding ketamine's safety, tolerability and abuse potential over the longer term, and its recent adoption internationally as a clinical treatment for depression. Although based on data from depression studies, the KSET has potential applicability for ketamine (or derivatives) used in other medical disorders, including chronic pain. We recommend its utilisation for both research and clinical scenarios, including data registries.

Mindfulness improves inflammatory biomarker levels in older adults with mild cognitive impairment: a randomized controlled trial.

Few randomized controlled trials investigated the effects of mindfulness intervention on older adults diagnosed with mild cognitive impairment (MCI). Furthermore, there have been hypotheses and theoretical mechanisms on the benefits of mindfulness intervention on biomarkers of stress, inflammation, and neuroplasticity implicated in MCI that warrant empirical evidence. We conducted a pilot randomized controlled trial to examine whether Mindful Awareness Practice (MAP) improved biomarker levels in older adults with MCI. Fifty-five community-dwelling older adults aged 60 and above were randomized into either the treatment arm, MAP, or the active control arm, the health education program (HEP). Researchers who were blinded to treatment allocation assessed the outcomes at baseline, 3-month, and 9-month follow-ups. Linear-mixed models were used to examine the effect of MAP on biomarker levels. MAP participants had significantly decreased high-sensitivity c-reactive protein (hs-CRP) levels at 9-month (ß = -0.307, 95% CI = -0.559 to -0.054 P = 0.018). Exploratory sub-group analyses by sex showed significantly decreased hs-CRP in females only (ß = -0.445, 95% CI = -0.700 to -0.189, P = 0.001), while stratification by MCI subtype showed hs-CRP decreased only in amnestic-MCI (aMCI) (ß = -0.569, 95% CI = -1.000 to -0.133, P = 0.012). Although total sample analyses were not significant, males had significantly decreased interleukin (IL)-6 (ß = -1.001, 95% CI = -1.761 to -0253, P = 0.011) and IL-1ß (ß = -0.607, 95% CI = -1.116 to -0.100, P = 0.021) levels at 3-month and non-significant improvements at 9-month time-point. MAP improved inflammatory biomarkers in sex- and MCI subtype-specific manners. These preliminary findings suggest the potential of mindfulness intervention as a self-directed and low-cost preventive intervention in improving pathophysiology implicated in MCI.

Dementia care in low and middle-income countries.

PURPOSE OF REVIEW: Recent reports from low and middle-income countries (LMICs) on the care of person with dementia (PWD). RECENT FINDINGS: Detection of PWDs in the community in LMICs is still problematic because of inappropriate screening questionnaires. Early diagnosis of dementia is also handicapped by lack of awareness, knowledge and stigma. The family is the main caregiver in LMICs and there is a paucity of community dementia services. SUMMARY: In LMICs, the burden of care of PWDs rests on the family and there is an urgent need to improve and expand community services. The digital media could be a platform for e-learning and assessment of cognitive impairment. Innovative ideas to link specialist care with primary care doctors and nongovernmental organisations will be beneficial.