Individual and Interactive Effects of Housing and Neighborhood Quality on Mental Health in Hong Kong: A Retrospective Cohort Study.

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

Environmental stress and emotional reactivity: an exploratory experience sampling method study.

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

Effect of increasing cognitive activity participation on default mode network in older adults with subjective cognitive decline: a randomised controlled trial.

BACKGROUND: Having more cognitive activities may prevent dementia, but its evidence of modulating the functional brain network is limited. This randomised controlled trial (RCT) investigated the effect of increased cognitive activity participation on the default mode network (DMN) in older adults who had already been having regular cognitive activity participation and experiencing subjective cognitive decline (SCD). METHODS: Community-living Chinese individuals aged 55-75 years with regular practice of Chinese calligraphy and screened positive for SCD (but negative for mild cognitive impairment or dementia) were randomly allocated to either the intervention or control group. Over 6 months, the intervention group doubled their weekly calligraphy practice time, while the control group maintained their usual amount of practice. The primary outcome was functional connectivities (FCs) of DMN, with pre-specified regions of interest including medial prefrontal cortex (mPFC), inferior parietal lobe (IPL), hippocampal formation (HF), posterior cingulate cortex (PCC), and lateral temporal cortex (LTC). FC changes were compared using repeated measures multivariate analysis of variance (MANOVA). This study is registered at the Chinese Clinical Trial Registry, ChiCTR1900024433. FINDINGS: Between 15 January 2020 and 31 December 2021, 112 individuals consented and completed the baseline assessment. The participants, who had a mean age of 66.3 (SD 4.3) years, with 83 (74%) being women, had been practising calligraphy for an average duration of 9.7 years before enrolment and, in the preceding six months, for an average of 3.1 hours per week. 96 (86%) completed the post-intervention fMRI scan. Significant between-group differences were observed in the FCs between mPFC and right LTC (group difference = 0.25 [95% CI = 0.06-0.44], p = 0.009), mPFC and right IPL (0.23 [0.06-0.39]; p = 0.007), left HF and right LTC (0.28 [0.002-0.57]; p = 0.04), and left HF and right IPL (0.34 [0.09-0.60]; p = 0.009). INTERPRETATION: Our findings, which reveal positive neuromodulatory effects with increased calligraphy practice, highlight the importance of engaging more in cognitive activities in late life for better brain health. FUNDING: Research Grants Council, Hong Kong (grant number 24114519).

Development and validation of cognitive ageing risk score (CARS) for early detection of subtle cognitive deficits in older people.

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

Using gamma-band transcranial alternating current stimulation (tACS) to improve sleep quality and cognition in patients with mild neurocognitive disorders due to Alzheimer's disease: A study protocol for a randomized controlled trial.

BACKGROUND: Sleep disturbances are highly prevalent in patients with age-related neurodegenerative diseases, which severely affect cognition and even lead to accumulated ß-amyloid. Encouraging results from recent studies on transcranial direct current stimulation (tDCS) showed moderate positive effects on sleep quality in preclinical Alzheimer's disease (AD). Compared to tDCS, transcranial alternating current stimulation (tACS) enables the entrainment of neuronal activity with optimized focality through injecting electric current with a specific frequency and has significant enhancement effects on slow wave activities. METHODS AND DESIGN: This is a randomized, double-blind, sham-controlled clinical trial comparing 40 Hz tACS with tDCS in mild neurocognitive disorders due to AD with sleep disturbances. Magnetic resonance imaging (MRI) data is used to construct personalized realistic head model. Treatment outcomes, including sleep quality, cognitive performance and saliva Aß levels will be conducted at baseline, 4th week, 8th week, 12th week and 24th week. CONCLUSIONS: It is expected that the repeated gamma-band tACS will show significant improvements in sleep quality and cognitive functions compared to tDCS and sham tDCS. The findings will provide high-level evidence and guide further advanced studies in the field of neurodegenerative diseases and sleep medicine. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05544201.

The effects of therapeutic virtual reality experience to promote mental well-being in older people living with physical disabilities in long-term care facilities.

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

Diversity in verbal fluency performance and its associations with MRI-informed brain age matrices in normal ageing and neurocognitive disorders.

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

Decoding the radiomic features of dorsolateral prefrontal cortex in individuals with accelerated cortical changes: implications for personalized transcranial magnetic stimulation.

Purpose: Image-guided transcranial magnetic stimulation (TMS) is an emerging research field in neuroscience and rehabilitation medicine. Cortical morphometry, as a radiomic phenotype of aging, plays a vital role in developing personalized TMS model, yet few studies are afoot to examine the aging effects on region-specific morphometry and use it in the estimation of TMS-induced electric fields. Our study was aimed to investigate the radiomic features of bilateral dorsolateral prefrontal cortex (DLPFC) and quantify the TMS-induced electric fields during aging. Approach: Baseline, 1-year and 3-year structural magnetic resonance imaging (MRI) scans from normal aging (NA) adults ( n = 32 ) and mild cognitive impairment (MCI) converters ( n = 22 ) were drawn from the Open Access Series of Imaging Studies. The quantitative measures of radiomics included cortical thickness, folding, and scalp-to-cortex distance. Realistic head models were developed to simulate the impacts of radiomic features on TMS-induced E-fields using the finite-element method. Results: A pronounced aging-related decrease was found in the gyrification of left DLPFC in MCI converters ( t = 2.21 , p = 0.035 ), which could predict the decline of global cognition at 3-year follow up. Along with the decreased gyrification in left DLPFC, the magnitude of TMS-induced E-fields was rapidly decreased in MCI converters ( t = 2.56 , p = 0.018 ). Conclusions: MRI-informed radiomic features of the treatment targets have significant effects on the intensity and distribution of the stimulation-induced electric fields in prodromal dementia patients. Our findings highlight the importance of region-specific radiomics when conducting the transcranial brain stimulation in individuals with accelerated cortical changes, such as Alzheimer's disease.

Effect of computerized cognitive training on mood, cognition, and serum brain-derived neurotrophic factor level in late-life depression - a pilot randomized controlled trial.

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

High-definition transcranial direct current stimulation (HD-tDCS) as augmentation therapy in late-life depression (LLD) with suboptimal response to treatment-a study protocol for a double-blinded randomized sham-controlled trial.

BACKGROUND: Late-life depression (LLD) has a poorer prognosis and higher relapse rate than younger adults, with up to one third of patients with LLD showing suboptimal response to antidepressant therapy. LLD has been associated with significant impairment in cognition and daily functioning. Few studies have evaluated the therapeutic effects of high-definition transcranial direct current stimulation (HD-tDCS) on depressive and cognitive symptoms of LLD. The current randomized controlled trial assesses the efficacy of HD-tDCS as an augmentation therapy with antidepressants compared to sham-control in subjects with LLD. METHODS: Fifty-eight patients with LLD will be recruited and randomly assigned to the active HD-tDCS or sham HD-tDCS group. In both groups, patients will receive the active or sham intervention in addition to their pre-existing antidepressant therapy, for 2 weeks with 5 sessions per week, each lasting 30 min. The primary outcome measures will be the change of depressive symptoms, clinical response and the remission rate as measured with the Hamilton Depression Rating scale (HAMD-17) before and after the intervention, and at the 4th and 12th week after the completed intervention. Secondary outcome measures include cognitive symptoms, anxiety symptoms, daily functioning and adverse effects.  DISCUSSION: Older adults with depression are associated with poorer outcomes or unsatisfactory responses to antidepressant therapy, and significant cognitive decline. Therefore, a new effective treatment option is needed. This randomized control trial aims at assessing the efficacy of HD-tDCS on ameliorating the depressive, cognitive and anxiety symptoms, and improving the daily functioning of subjects with LLD. TRIAL REGISTRATION: ClinicalTrials.gov NCT05322863. Registered on 11 April 2022.

Clinical and radiomic features for predicting the treatment response of repetitive transcranial magnetic stimulation in major neurocognitive disorder: Results from a randomized controlled trial.

Image-guided repetitive transcranial magnetic stimulation (rTMS) has shown clinical effectiveness in senior adults with co-occurring depression and cognitive impairment, yet the imaging markers for predicting the treatment response are less investigated. In this clinical trial, we examined the efficacy and sustainability of 10 Hz rTMS for the treatment of depression and cognitive impairment in major neurocognitive disorder (NCD) patients and tested the predictive values of imaging-informed radiomic features in response to rTMS treatment. Fifty-five major NCD patients with depression were randomly assigned to receive a 3-week rTMS treatment of either active 10 Hz rTMS (n = 27) or sham rTMS (n = 28). Left dorsolateral prefrontal cortex (DLPFC) was the predefined treatment target. Based on individual structural magnetic resonance imaging scans, surface-based analysis was conducted to quantitatively measure the baseline radiomic features of left DLPFC. Severity of depression, global cognition and the serum brain-derived neurotrophic factor (BDNF) level were evaluated at baseline, 3-, 6- and 12-week follow-ups. Logistic regression analysis revealed that advanced age, higher baseline cognition and randomized group were associated with the remission of depression. Increased cortical thickness and gyrification in left DLPFC were the significant predictors of clinical remission and cognitive enhancement. A 3-week course of 10 Hz rTMS is an effective adjuvant treatment for rapid ameliorating depressive symptoms and enhancing cognitive function. Pre-treatment radiomic features of the stimulation target can predict the response to rTMS treatment in major NCD. Cortical thickness and folding of treatment target may serve as imaging markers to detect the responders. ChiCTR-IOR-16008191, registered on March 30, 2016.

Inequalities in Psychiatric Morbidity in Hong Kong and Strategies for Mitigation.

This study explores the social gradient of psychiatric morbidity. The Hong Kong Mental Morbidity Survey (HKMMS), consisting of 5719 Chinese adults aged 16 to 75 years, was used. The Chinese version of the Revised Clinical Interview Schedule (CIS-R) was employed for psychiatric assessment of common mental disorders (CMD). People with a less advantaged socioeconomic position (lower education, lower household income, unemployment, small living area and public rental housing) had a higher prevalence of depression and anxiety disorder. People with lower incomes had worse physical health (OR 2.01, 95% CI 1.05-3.82) and greater odds of having CMD in the presence of a family history of psychiatric illnesses (OR 1.67, 95% CI 1.18-2.36). Unemployment also had a greater impact for those in lower-income groups (OR 2.67; 95% CI 1.85-3.85), whereas no significant association was observed in high-income groups (OR 0.56; 95% CI 0.14-2.17). Mitigating strategies in terms of services and social support should target socially disadvantaged groups with a high risk of psychiatric morbidity. Such strategies include collaboration among government, civil society and business sectors in harnessing community resources.

Mindfulness Awareness Is Associated With a Lower Risk of Anxiety and Depressive Symptoms in Older Adults With Neurocognitive Disorders.

Background: Apart from depressive disorders, there are great interests in adopting mindfulness based interventions (MBIs) for other mental health conditions. Depression and anxiety are common in people with neurocognitive disorders (NCD). The potential of MBIs as an adjuvant treatment in this cognitively at-risk group should be further explored. Objectives: The current study explored the association between depression and anxiety symptoms with dispositional mindfulness in older adults, and if same association stays in the context of cognitive impairment. Methods: The Hong Kong Mental Morbidity Survey for Older People (MMSOP) is an ongoing epidemiology study of the prevalence of neurocognitive and mental disorders in adults aged 60 years or over in Hong Kong. MMSOP evaluated cognitive function, psychiatric symptoms (Clinical Interview Schedule-revised, CIS-R), chronic physical disease burden, psychosocial support, and resilience factors, including dispositional mindfulness as measured by the Mindful Attention Awareness Scale (MAAS). We analyzed the impact of MAAS on CIS-R and potential moderation effects of mindfulness. Results: In March 2021, 1,218 community dwelling participants completed assessments. The mean age of the sample is 69.0 (SD 6.9) years. Eight hundred and two participants (65.7%) were not demented (CDR 0) and 391 (32%) and 25 (2%) were categorized as having mild NCD (CDR 0.5) and major NCD (CDR 1 or more), respectively. One hundred forty-three (11.7%) satisfied ICD-10 criteria for anxiety or depressive disorder as measured by CIS-R. Linear regression analysis showed that female gender, CIRS, and MAAS scores were significant factors associated with CIS-R scores. MAAS scores moderated and attenuated the impact CIRS on CIS-R (adjusted R 2 = 0.447, p < 0.001). MAAS scores remained as significant moderator for CIRS in patients with NCD (CDR ≥ 0.5) (adjusted R 2 = 0.33, p < 0.001). Conclusion: Interim findings of the MMSOP suggested that dispositional mindfulness is associated with lower level of mood symptoms in community dwelling older adults in Hong Kong. The interaction effects further suggested that high mindful awareness may reduce the adverse effects of chronic physical morbidity on mental health. The observation stayed in the participants with cognitive impairment. We should further explore MBIs as a non-pharmacological treatment for in older adults at-risk of physical morbidity and cognitive decline.

Do people with mental health problems have lower adherence to precautionary measures in COVID-19 pandemic? A cross-sectional observational study in Hong Kong.

OBJECTIVES: Mental health problems are prevalent during the COVID-19 pandemic, but their effect on adherence to precautionary measures is not well understood. Given that psychological morbidities are associated with lower treatment adherence, and that precautionary measures are important in containing the spread of COVID-19, this study aims to determine if people with mental health problems have lower adherence to precautionary measures against COVID-19. DESIGN: We conducted a cross-sectional territory-wide online survey between 17 June and 31 July 2020 during the COVID-19 pandemic. Clinically significant mental health problems, adherence to precautionary behaviours, and confounding factors such as sociodemographic factors and self-reported physical health were assessed. SETTING: The link to the questionnaire was disseminated to the general population in all 18 districts of Hong Kong using various social media platforms. PARTICIPANTS: 1036 individuals completed the survey. Of them, 1030 met the inclusion criteria of being adult Hong Kong residents. PRIMARY OUTCOME: Adherence to precautionary measures against COVID-19, including wearing face mask, frequent handwashing, household disinfection, social distancing, minimising unnecessary travel, and stocking up on food and daily essentials. RESULTS: Of the 1030 participants, 166 (16.1%) had clinically significant mental health problems. Interestingly, they were more likely to stock up on food and daily essentials during the pandemic (7 (4.2%) vs 15 (1.7%), p=0.04; unadjusted OR=2.49, 95% CI=1.00 to 6.21, p<0.05) and had a lesser tendency to stop social distancing even if the pandemic subsides (86 (51.8%) vs 513 (59.4%), p=0.07; unadjusted OR=0.74, 95% CI=0.53 to 1.03, p=0.07). The latter association remained significant after adjusting for the confounding factors (adjusted OR=0.68, 95% CI=0.48 to 0.96, p=0.03). CONCLUSIONS: Contrary to our hypothesis, people who are mentally unwell might go beyond the recommended precautionary measures. Our findings highlight the need to identify mental health problems and provide care and support for those who might go too far with precautionary measures. TRIAL REGISTRATION NUMBER: ChiCTR 2000033936.

Knowledge of mental health symptoms and help seeking attitude in a population-based sample in Hong Kong.

BACKGROUND: Mental health symptoms can be subtle, resulting in delaying treatment. A prompt identification of mental signs and symptoms is important for preventing mental disorders in the public. This study examined whether local public have adequate knowledge to identify mental health symptoms and the need to get timely professional help. METHODS: The population-based telephone surveys were conducted in 2015 and 2018. It involved a random sample of 4033 respondents aged 12-75 years. Mental health knowledge and help seeking attitude were assessed using six vignettes depicting subtle and obvious symptoms of anxiety disorders, mixed anxiety and depressive disorders, and dementia. Logistic regression models were performed to examine association between mental health knowledge and help-seeking attitude. RESULTS: Individuals with poor knowledge in subtle symptoms were more likely to be males (t = - 5.0, p < .001), younger (F = 15.0, p < .001), have tertiary education (F = 15.0, p < .001), and employed (t = - 2.1, p = .037). The knowledge scores of subtle and obvious symptoms were 1.5 and 2.3 respectively. Binary logistic regression found that poor knowledge of subtle symptoms was associated with reluctance to professional help seeking. CONCLUSIONS: Poorly identified subtle mental health symptoms is a major barrier to early professional help in highly educated working males. Future research should explore specific interventions to increase knowledge and professional help seeking in this group.

Dynamic changes of region-specific cortical features and scalp-to-cortex distance: implications for transcranial current stimulation modeling.

BACKGROUND: Transcranial current stimulation in rehabilitation is a fast-growing field featured with computational and biophysical modeling. Cortical features and scalp-to-cortex distance (SCD) are key variables for determining the strength and distribution of the electric field, yet longitudinal studies able to capture these dynamic changes are missing. We sought to investigate and quantify the ageing effect on the morphometry and SCD of left primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) in normal ageing adults and mild cognitive impairment (MCI) converters. METHODS: Baseline, 1-year and 3-year follow-up structural magnetic resonance imaging scans from normal ageing adults (n = 32), and MCI converters (n = 22) were drawn from the Open Access Series of Imaging Studies. We quantified the changes of the cortical features and SCDs of left M1 and DLPFC, including grey matter volume, white matter volume, cortical thickness, and folding. Head model was developed to simulate the impact of SCD on the electric field induced by transcranial current stimulation. RESULTS: Pronounced ageing effect was found on the SCD of left DLPFC in MCI converters. The SCD change of left DLPFC from baseline to 3-year follow-up demonstrated better performance to discriminate MCI converters from normal ageing adults than the other morphometric measures. The strength of electric field was consequently decreased with SCD in MCI converters. CONCLUSION: Ageing has a prominent, but differential effect on the region-specific SCD and cortical features in older adults with cognitive impairments. Our findings suggest that SCD, cortical thickness, and folding of the targeted regions could be used as valuable imaging markers when conducting transcranial brain stimulation in individuals with brain atrophy.

Aerobic exercise in older people with subclinical sporadic cerebral small vessel disease: A randomized clinical trial.

INTRODUCTION: The benefit and risk of aerobic exercise among older people harboring advanced cerebral small vessel disease (CSVD) upon cognition, mood, and motor functions are unknown. METHODS: This rater-blind randomized trial examined effects of a 24-week aerobic exercise training (60 min/session, twice/week) upon clinical (cognition, mood, motor functions) and hemodynamic (pulse pressure [PP], blood pressure [BP], pulsatility index) measures in older people harboring moderate to severe CSVD, as evidenced by confluent white matter hyperintensity and/or ≥2 lacunes on magnetic resonance imaging. We further investigated interactions between treatment conditions and hemodynamics measures. RESULTS: Fifty-three and 54 subjects were randomized into the active and control group, respectively. There was no between-group difference in any of the clinical outcomes. The active group had a greater between-group reduction in systolic BP and PP than the control group. Within-group comparison showed that global cognition of the active group remained similar at end of the study compared to baseline, whereas it declined significantly in the control group. We observed "diverging" interaction effects in that greater reduction in systolic BP/PP was associated with greater improvement in memory functions and global cognition but worsening in processing speed in the active group. Side effects were comparable between the two groups. DISCUSSION: Future study should investigate the mechanisms of the diverging impacts of aerobic exercise upon different cognitive domains so that the benefit-risk ratio of aerobic exercise in older people harboring more advanced CSVD can be better defined.

The 12-month prevalence of psychotic experiences and their association with clinical outcomes in Hong Kong: an epidemiological and a 2-year follow up studies.

BACKGROUND: The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms. METHOD: This is a population-based two-phase household survey of Chinese population in Hong Kong aged 16-75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up. RESULTS: The 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up. CONCLUSIONS: Results highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.

Validation of a computerized Hong Kong - vigilance and memory test (HK-VMT) to detect early cognitive impairment in healthy older adults.

Objectives: Hong Kong - Vigilance and Memory Test (HK-VMT) is developed to distinguish early cognitive impairment in the pre-symptomatic phase from normal cognitive ageing in older adults. The objectives were to validate HK-VMT to differentiate mild cognitive impairment (MCI) and healthy control (HC), and to explore the cut-off scores for different educational levels.Method: A total of 606 older adults underwent the HK-VMT and conventional cognitive tests. HK-VMT is a 15 minutes cognitive battery that assesses episodic memory, attention, and visuospatial ability. The HK-VMT total is the sum of accuracy of all subtests with a range of 0 to 40. Differences in socio-demographic and clinical characteristics between groups were explored. Receiver operating characteristic (ROC) analyses were used to compare HK-VMT and Cantonese Mini Mental State Examination (CMMSE). A sample of 50 participants repeated the HK-VMT in 1 month to evaluate test-retest reliability.Results: ROC analysis of Area Under Curve (AUC) demonstrated that HK-VMT (AUC 0.793) was comparable to CMMSE (AUC 0.748) in differentiating MCI from HC in a matched sample. A cutoff at 21/22 was chosen yielding a sensitivity of 86.1% and a specificity of 75.3% for differentiating MCI and HC. Test-retest reliability of HK-VMT total was 0.71 (p<.001) in a month time.Conclusion: HK-VMT has demonstrated satisfactory validity in detecting cognitive impairment with good test-retest reliability in local older adults. It also performed favourably in the highly educated group when compared to CMMSE.