Modifiable risk factors for mild cognitive impairment among cognitively normal community-dwelling older adults: A systematic review and meta-analysis.

Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized these findings. Five databases were searched from January 1, 2000, to December 30, 2023. The protocol was registered with PROSPERO. Data were extracted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant meta-analyses of modifiable risk factors were performed. The evidence of each factor was assessed by the GRADE for cohort studies. Of 16,651 citations, 87 studies involving 225,584 community-dwelling seniors were included. Fourteen meta-analyses involving 20 studies with 44,199 participants were performed. The analyses revealed low-to-moderate-quality evidence supporting that diabetes, 2 or more comorbidities, anxiety, apathy, depressive symptoms, and physical frailty were risk factors for incident MCI in older adults. Conversely, hypertension, agitation, and irritability might not be risk factors. Additionally, moderate-quality evidence supports the protective effect of engaging in cognitive-demanding activities on the onset of MCI. Collectively, this study constitutes the first extensive compilation of evidence regarding the various risk factors for the development of MCI in older adults. Our findings hold significant potential to guide the formulation of prevention and management strategies to either prevent or potentially reverse the onset of MCI.

Translation and validation of the Reaction to Impairment and Disability Inventory for Chinese population in Hong Kong.

PURPOSE: This study translated the reaction to impairment and disability inventory (RIDI) to Chinese and validated it for use in Hong Kong. METHODS: We conducted an instrument validation of the Chinese RIDI, with a sample of 244 persons with CID. The research questionnaire collected demographic information, illness-related variables, the Chinese version of RIDI (C-RIDI), and measures of resilience and well-being. We examined the factor structure, internal consistency, convergent validity, and criterion-related validity of the C-RIDI. RESULTS: The C-RIDI has good content validity and no major changes to the translated items were needed for the use in Hong Kong. For factor structure, we replicated the results of Livneh et al. The C-RIDI has two second-order factors of adaptive and nonadaptive scales, which interact with the two denial subscales. Internal consistency of the subscales is satisfactory except for the three-item denial subscales. Correlations of the C-RIDI subscales with illness-related variables, resilience, and mental well-being are consistent with our hypotheses and provide support for the convergent and criterion-related validity of the scale. CONCLUSIONS: The C-RIDI has satisfactory psychometric properties. The study results support its internal consistency, convergent validity, criterion-related validity, and factorial validity.IMPLICATIONS FOR REHABILITATIONEmotional adjustment to chronic illness and disability is a key determinant of illness self-management, mental well-being, and quality of life.The study translated the reaction to impairment and disability inventory into Chinese and conducted a psychometric evaluation of the translated instrument.The Chinese RIDI had a similar second-order factor structure as in the validation studies of the English version, and result of this confirmatory factor analysis support the theory underlying the design of the RIDI.The Chinese RIDI had satisfactory convergent and criterion-related validity and internal consistency, and is ready for application in rehabilitation practice and research in the Chinese context.

Can a modified theory of planned behavior explain the effects of empowerment education for people with type 2 diabetes?

BACKGROUND: The effectiveness of the Patient Empowerment Program (PEP) has been demonstrated in people with diabetes mellitus (DM); however, the underlying reasons for its effectiveness remain unclear. To improve effectiveness, we need to study the psychological mechanism(s) of PEP to understand why it is effective. This study hypothesized that the Theory of Planned Behavior (TPB), modified specifically for people with DM, could describe the mechanism explaining PEP effects. METHODS: A longitudinal design was used. Patients with type 2 DM (n = 365; 151 males; mean age = 62.9 ± 9.6 years) received two education sessions (i.e. seminars delivered by registered nurses to provide disease-specific knowledge), and some (n = 210) further enrolled afterwards in five empowerment sessions (i.e. small-group interactive workshops conducted by social workers to practice action planning, problem solving, and experience sharing). Validated questionnaires were used to measure risk perception, health literacy, attitude, subjective norm, perceived behavioral control and behavioral intention on diabetes self-care behaviors, and four diabetes self-care behaviors (diet control, exercise, blood glucose monitoring, and foot care) at baseline. Three months later (i.e. at the end of PEP), all participants completed the behavioral intention and diabetes self-care behaviors measures again. Attitude, subjective norm, perceived behavioral control, behavioral intention, and diabetes self-care behaviors were assessed to represent the TPB constructs. Risk perception and health literacy elements relevant to people with DM were assessed and added to modify the TPB. RESULTS: The behavioral intention was associated with three diabetes self-care behaviors: exercise, blood glucose monitoring, and foot care. The behavioral intention was found to be a significant mediator in the following relationships: empowerment session participation and exercise (ß = 0.045, p = 0.04), and empowerment session participation and foot care (ß = 0.099, p < 0.001). CONCLUSIONS: The effects of enrollment of empowerment sessions in PEP on exercise and foot care were likely to be mediated through behavioral intention.

Reliability of measurements for sub-painful and painful perception on artificial electrical stimulations.

Artificial electrical stimulation is a common type of stimulus to induce sub-painful and painful sensation in clinical or neuroscience experiments. The Numerical Rating Scale (NRS) is often used to evaluate subjective perception due to external stimulations. Yet the relationship between the intensity levels of electrical stimulations and self-perception has seldom been examined. The aim of the study was to obtain evidence on the reliability and accuracy of sub-painful and painful perceptions of healthy participants using the NRS under different levels of electrical stimulus. A total of 72 pain-free healthy volunteers (female=44) were recruited. In the first experiment, each participant was given different levels of a non-nociceptive or nociceptive electrical stimulus and then asked to give a perception rating based on an 11-point NRS. In the second experiment, each participant was asked to memorize 5 levels of sub-nociceptive or nociceptive stimuli and to recognize the level of stimulus given each time. For the NRS rating task, intraclass coefficients (ICCs) reached satisfactory level for sub-nociceptive (0.85

Evaluation of the chronic disease self-management program in a Chinese population.

OBJECTIVE: This study evaluated the 6-week Chronic Disease Self-Management Program (CDSMP) in Hong Kong. METHODS: A total of 148 subjects with chronic illness were recruited. Subjects were matched on duration of illness and gender, and then randomly allocated to experimental and comparison groups. The experimental group participated in the CDSMP, while the comparison group joined a Tai-Chi interest class in a mass-activity format. Subjects completed evaluation questionnaires before beginning their program and 1 week following the program. RESULTS: Analysis of covariance showed that the CDSMP participants demonstrated significantly higher self-efficacy in managing their illness, used more cognitive methods to manage pain and symptoms, and felt more energetic than the subjects in the comparison group. The CDSMP participants also demonstrated changes in their profile of coping strategies, having a tendency to adopt the cognitive methods of diverting attention, reinterpreting pain, ignoring sensations, and making positive self-statements. CONCLUSION: The short-term evaluation results showed that the CDSMP primarily increased the self-efficacy, exercise behavior, and application of cognitive coping strategies of the participants. PRACTICE IMPLICATION: The effect of the CDSMP in a Chinese population is similar to that found in studies in Western cultures, and the CDSMP could be applied effectively in a Chinese population.

User satisfaction, community participation and quality of life among Chinese wheelchair users with spinal cord injury: a preliminary study.

The purpose of the present study was to investigate the relationships between spinal cord injury (SCI), wheelchair users' satisfaction, perceptions of their community participation and quality of life (QoL).Thirty-one community wheelchair users with SCI were administered the Chinese version of the Quebec User Evaluation of Satisfaction with assistive Technology (C-QUEST), the abbreviated Hong Kong version of the World Health Organization Quality of Life Questionnaire (WHO QoL-BREF (HK)) and selected items of 'Participation Restrictions' and 'Environmental Factors' of the International Classification of Functioning Disability and Health (ICF). Only a weak correlation was found between the C-QUEST services sub-scores and one ICF environmental factor, that is, health-related professionals (Spearman's r = 0.453; p < 0.05). The C-QUEST device sub-scores were also weakly correlated with four domain scores of the WHO QoL-BREF (HK) (Spearman's r = 0.412-0.567; p < 0.05). Social relationship, participation in leisure and driving activities had a moderate association with scores of the WHO QoL-BREF (HK) (-0.405 > Spearman's r > -0.583; p < 0.05). It is concluded that community participation (e.g. use of transportation) and human environment (e.g. friends and peers) were more related to QoL, than to users' satisfaction with a wheelchair. Further research with a larger sample is recommended to examine the variables related to SCI and QoL.

Salience of Somatosensory Stimulus Modulating External-to-Internal Orienting Attention.

Shifting between one's external and internal environments involves orienting attention. Studies on differentiating subprocesses associated with external-to-internal orienting attention are limited. This study aimed to reveal the characteristics of the disengagement, shifting and reengagement subprocesses by using somatosensory external stimuli and internally generated images. Study participants were to perceive nociceptive external stimuli (External Low (EL) or External High (EH)) induced by electrical stimulations (50 ms) followed by mentally rehearsing learned subnociceptive images (Internal Low (IL) and Internal High (IH)). Behavioral responses and EEG signals of the participants were recorded. The three significant components elicited were: fronto-central negativity (FCN; 128-180 ms), fronto-central P2 (200-260 ms), and central P3 (320-380 ms), which reflected the three subprocesses, respectively. Differences in the FCN and P2 amplitudes during the orienting to the subnociceptive images revealed only in the EH but not EL stimulus condition that are new findings. The results indicated that modulations of the disengagement and shifting processes only happened if the external nociceptive stimuli were of high salience and the external-to-internal incongruence was large. The reengaging process reflected from the amplitude of P3 correlated significantly with attenuation of the pain intensity felt from the external nociceptive stimuli. These findings suggested that the subprocesses underlying external-to-internal orienting attention serve different roles. Disengagement subprocess tends to be stimulus dependent, which is bottom-up in nature. Shifting and reengagement tend to be top-down subprocesses, which taps on cognitive control. This subprocess may account for the attenuation effects on perceived pain intensity after orienting attention.

Chinese Calligraphy Writing for Augmenting Attentional Control and Working Memory of Older Adults at Risk of Mild Cognitive Impairment: A Randomized Controlled Trial.

BACKGROUND: Nonpharmacological intervention for individuals with mild cognitive impairment (MCI) needs further investigation. OBJECTIVE: Test efficacy of an eight-week Chinese calligraphy writing training course in improving attentional control and working memory. METHODS: Ninety-nine participants with MCI were randomized into the eight-week calligraphy writing (n = 48) or control (tablet computer) training (n = 51). Outcomes of the interventions were attentional control, working memory, visual scan and processing speed. They were measured at baseline, post-training, and six-month follow-up. RESULTS: Calligraphy writing, when compared with control, significantly improved working memory as reflected from DST-Backward sequence (p = 0.009) and span scores (p = 0.002), and divided attention as reflected from CTT2 (p < 0.001), and at the post-training. The unique improvement in working memory (span: p < 0.001; sequence: p = 0.008) of the intervention group was also found at follow-up when comparing with those at baseline. Changes in the other outcome measures were not statistically significant. CONCLUSION: The findings provide support that Chinese calligraphy writing training for eight weeks using a cognitive approach would improve working memory and to a lesser extent attentional control functions of patients with early MCI. They also demonstrate the usefulness of using mind-and-body practice for improving specific cognitive functions.

A latent profile analysis on patient empowerment programme in a Hong Kong primary care setting.

OBJECTIVE: This study identified the profiles of subgroups of type 2 diabetic (T2DM) patients of the Patient Empowerment Programme (PEP) by different levels of benefits gained in diabetic self-management behaviors, self-efficacy, and health literacy. METHODS: This study adopted a non-experimental repeated-measures design on T2DM patients who joined PEP, using structured questionnaires. Latent profile analysis (LPA) was used to identify patterns of participants' change on the outcome measures. RESULTS: Findings of LPA revealed that participants who were older, unemployed, weaker in diabetic self-management, and having a higher self-perception in personal disease risk were more likely to join the empowerment sessions and gained more benefits from the program. Participants with lower impairment in energy function and lower autonomy in personal health care showed more improvement in the outcomes. CONCLUSION: The study identified significant factors associated with patients' participation on and benefits gained from a service delivery model integrating health education and patient empowerment in a primary care setting. PRACTICE IMPLICATION: Findings from this study shed light on strategies to improve the PEP design in order to meet the needs of individuals with different health-related profiles.

The validity and applicability of the Chinese version of the Quebec User Evaluation of Satisfaction With Assistive Technology for people with spinal cord injury.

The Quebec User Evaluation With Assistive Technology (Version 2.0; QUEST 2.0) has become an important outcome assessment to capture user satisfaction in the field of assistive technology. The purpose of this study is to investigate the psychometric properties of the Chinese version of the QUEST 2.0 (C-QUEST) in terms of content and substantive and factor validity and to explore its applicability on user satisfaction on mobility and equipment among Chinese people with spinal cord injury. A group of six expert members were invited to evaluate the content validity and translation quality of the 12-item C-QUEST. The revised version, along with the brief version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF [HK]), was administered on user satisfaction of people with spinal cord injury in the community. The content validity and item performance were evaluated to be satisfactory. Exploratory factor analysis with varimax rotation agreed with the bidimensional structure of Device and Services in the construct of user satisfaction (61.06% variance explained). Items in WHOQOL-BREF (HK) were shown to have positive and moderate correlations with C-QUEST Device items (r = .412-.567, p < .05) but no significant associations with the Services items (p > .05). The 12-item C-QUEST was shown to be a valid and relevant instrument to capture the user satisfaction among Chinese people with spinal cord injury in the context of mobility and seating equipment.

Differentiating cognitive functions of poststroke patients with specific brain lesions: A preliminary study on the clinical utility of Cognistat-P.

The Cognistat is widely used to measure the cognitive profile of neurological patients. This study aimed to further obtain evidence on the construct and discriminative validity of the Putonghua version of the Cognistat (Cognistat-P) on poststroke patients with specific brain lesions. Cognistat-P was administered to poststroke patients (n = 98), as well as healthy elderly (n = 40) and adult (n = 34) participants as the control groups. Poststroke patients were further categorized into 4 lesion groups using standard brain slice templates. Exploratory factory analysis reflected a 2-factor structure for the Cognistat-P that resembles that for the original English version. The Construction, Similarities, and Judgment subtests were found to differentiate patients with frontal or parietal lesions from those with subcortical lesions (p < .01, R(2) = .48). The Construction subtest, tapping the "fluid" ability, was the most useful for differentiating patients with parietal lesions from those with subcortical lesions. The Similarities subtest together with the Construction subtest was the most useful for differentiating patients with frontal lesions from those with subcortical lesions. This study established the validity of the Cognistat-P for differentiating poststroke patients with specific brain lesions. Future studies should replicate the results on a larger sample size and test the clinical significance of the Cognistat-P profiles.

Generalization of Context-Specific Training in Individuals with Mild Cognitive Impairment: An Event-Related Potential Study.

BACKGROUND: This study examined the neural processes associated with the generalization of the effect of context-specific (CS) training to noncontextual situations among individuals with mild cognitive impairment (MCI). METHODS: Fourteen and 16 participants with MCI were randomly allocated to a Chinese calligraphy writing (CW) training or a control group, respectively. The CW participants learned how to write Chinese strokes in a semicursive style to construct characters, tapping on working memory functions. The control group, on the other hand, learned how to use a tablet computer without emphasis on working memory functions. They then performed two 2-back tasks with CS semicursive strokes and non-context-specific (NCS) digits. Event-related electroencephalogram signals were concurrently recorded. RESULTS: The CW participants had a significantly shorter reaction time in the CS than in the NCS task (p < 0.05). They showed significantly longer latency in working memory updating (N200; t₁₁ = 4.70, p = 0.05) and shorter latency in the evaluation of visual representation (P300; t₁₂ = 4.67; p = 0.05) than the control group when performing the 2-back CS task. Shorter P300 latency was also revealed in the 2-back NCS task (t₁₂ = 5.15, p = 0.041), suggesting a possible generalization of the training effect among the CW participants. CONCLUSION: The results suggest that CS working memory is likely to be generalized to NCS domains among individuals with MCI. Future research should extend the scope of the generalization and apply it beyond experimental conditions.

Chronic disease self-management program for Chinese patients: a preliminary multi-baseline study.

This study reports the preliminary findings on the effects of the Chronic Disease Self-management Program on a group of Chinese participants who suffered from chronic diseases. A total of 23 participants were recruited in a multi-baseline study protocol. Their self-management behaviors, self-efficacy and health status were captured over three baseline assessments and one post-test assessment. The results indicated significant increases in the performance of stretching exercises, the management of cognitive symptoms and communication with physicians. Their self-efficacy in terms of these aspects was found to be significantly increased. However, changes in other aspects of self-management which required more special skills and coordination with outside agencies were not significant. The changes in the physical and mental statuses of the participants were also not significant. It was observed that the positive effects of the program could be attributed to traditional Chinese beliefs of 'self-discipline' and a welcoming response towards self-efficacy strategies. Further studies should adhere to standards of a randomized clinical trial and further examine the mechanisms underpinning the changes in self-management behaviors among Chinese people with chronic diseases.

A conceptual model of patient-professional communication as a self-management skill: A latent growth change modeling.

BACKGROUND: Patient Communication with healthcare professionals is an integral self-management skill. Yet the underlying mechanisms explaining how such communication might be enhanced across time have not been well studied. OBJECTIVES: Based on the transtheoretical model, the study aimed to develop an across-time Attitude-Social Influence-Efficacy model in order to explain changes in participants' patient-professional communication behaviors in the Chronic Disease Self-management Program (CDSMP). Readiness-to-change construct was hypothesized to be the overall predictors of psychological and behavioral parameters. It was hypothesized that social norm and attitude toward behaviors would be the indirect predictors of communication behavior. METHODS: One hundred and thirty-six Chinese participants with chronic diseases underwent a 6-week CDSMP. Their attitude toward behavior, self-efficacy, social norm, readiness to change and communication behavior were obtained at 1st, 4th and 6th week of the structured program. RESULTS: A modified latent growth change curve model yielded satisfactory model fit (χ(2)/df = 1.32; RMSEA = 0.063 (90% CI = 0.018-0.96)). The results showed that readiness to change had a positive influence on attitude and self-efficacy. Both attitude and social norm positively affected self-efficacy. Attitude and self-efficacy in turn positively influenced communication behavior at the beginning of the program. Across 6 weeks, self-efficacy imposed a negative influence on communication behavior while social norm exerted a positive influence on the behavior. CONCLUSION: This study revealed possible underlying mechanisms influencing CDSMP participants' communication with professionals. The results could shed light on further improvement of the structured program.

Orienting attention modulates pain perception: an ERP study.

INTRODUCTION: Research has shown that people with chronic pain have difficulty directing their attention away from pain. A mental strategy that incorporates focused attention and distraction has been found to modulate the perception of pain intensity. That strategy involves placing attention on the nociceptive stimulus felt and shifting attention to a self-generated sub-nociceptive image and rehearsing it. Event-related potential was used to study the possible processes associated with the focus-then-orient strategy. METHODS: Eighteen pain-free participants received different levels of 50-ms nociceptive stimulations elicited by electric shocks at the right lateral malleolus (ankle). In perception trials, participants maintained the perceived nociceptive stimulus in working memory for 3,000 ms. In imagery trials, participants mentally generated and maintained the corresponding sub-nociceptive image they had learned previously. After both types of trials, participants evaluated the pain intensity of the incoming stimulus by recalling the feeling of the nociceptive stimulation at the beginning of the trial. RESULTS: Shifting attention from the incoming nociceptive to a self-generated sub-nociceptive image elicited central P2 and centro-parietal P3 waves, which were found to correlate with proportional scores on the Stroop Test. They were followed by a frontal N400 and a parietal P600, denoting generation of sub-nociceptive images in working memory. The voltages elicited in these potentials correlated moderately with attenuation of the pain ratings of the recalled nociceptive stimulations. CONCLUSIONS: Focus-and-orient attention across nociceptive and sub-nociceptive images appears to be related to response inhibition. Mental rehearsal of the sub-nociceptive images was found to modulate the perception of the nociceptive sensation felt prior to the imagery. Such modulation seems to be mediated by generating and maintaining sub-nociceptive images in working memory. Future studies should explore the mental processes associated with orienting attention for pain modulation among people with pathological pain and frontal lobe dysfunction.

Attitude, social influence, and self-efficacy among Chinese participants of chronic disease self-management program: a latent growth curve modeling study.

OBJECTIVES: This study aimed to examine temporal relationships among psychological parameters (readiness to change, changes in self-efficacy [SE], social norm [SN], attitude [AT]) and two self-management behaviors: cognitive symptom management (CSM) and tangible help-seeking (TH) by constructing latent growth change models. METHOD: This was a longitudinal study of 60 Chinese participants with various chronic diseases who completed a 6-week chronic disease self-management program. Psychological and behavioral variables were assessed at the beginning of the 1st, 4th, and 6th week of the program. RESULTS: Latent growth change curve analysis revealed that, in the early stages of engagement in CSM, SE was a key determinant of behavior. During the 6-week period, changes in SE were influenced directly by both SN and AT. When engaging in TH, SE influenced the behavior with direct and indirect effect from AT and SN. Readiness for change, on the other hand, appeared to be more associated with psychological rather than behavioral changes. This study revealed different underlying change mechanisms for two types of self-management behaviors. CONCLUSION: The findings shed light on program modifications that could further strengthen the therapeutic effects of the program.

Age effects on the asymmetry of the motor system: evidence from cortical oscillatory activity.

Functional hemispheric asymmetry can be lost with aging. In this electroencephalographic study, we assessed hemispheric asymmetries in regulating motor responses by analyzing oscillatory brain activity during a go/nogo task in younger and older right-handed participants. Three conditions were embedded in the task: go, high-conflict and low-conflict nogo. The hand used to respond to go stimuli was varied block-wise. Independently of the go/nogo conditions and responding hand, young participants showed asymmetric desynchronizations in the mu (10 Hz) and beta (18-22 Hz) frequency bands that was stronger in the scalp sensorimotor region contralateral to the hand used for the go responses, while older adults showed a more symmetric pattern of desynchronization. These findings indicate that a loss of hemispheric asymmetry is a hallmark of the aging motor system, consistent with a decline of inter-hemispheric motor inhibition in normal aging.