Age, Education, and Cognitive Decline: a prospective study of cognitive function in community-dwelling Chinese older adults in Hong Kong

Conference Theme: Mental Health for AllFree Paper 3.1 – Neuroscience and Mental HealthBackground: This study aimed to investigate the changes in cognitive profiles and the effect of age and education on such changes in an older community cohort over a 5-year period. Methods: A random sample of 787 non-demented Chinese elders in Hong Kong was assessed with a comprehensive neuropsychological battery at baseline, in the 2nd and 5th year. Results: A total of 454 subjects were assessed at the 5th year. For subjects with normal cognitive function at baseline, 186 (56.9%) remained cognitively normal, 115 (35.2%) had mild cognitive impairment (MCI), and 26 (7.9%) became demented. For subjects with MCI at baseline, 28 (22%) reverted to normal, 59 (46.5%) remained as MCI, 40 (31.5%) became demented. The decline in scores of Cantonese Mini-Mental State Examination was significant over the years, with the rate of decline being greater after the 2nd year. Using logistic regression, age and education had significant predictive effects on the progression to dementia, but the protective effect of education was lost if the subjects were already suffering from MCI at the baseline. Age was a significant factor affecting the cognitive function over time, while the effect of education was lost in the baseline MCI subjects. Conclusions: A decline in cognitive profile took place before the clinical diagnosis of dementia. The protective effect of education on cognitive function appeared to have lost when the person started to have MCI

Cognitive predictors for five-year conversion to dementia in community-dwelling Chinese older adults

BACKGROUND: This study evaluates which cognitive measure is best for predicting incident dementia in a population-based random sample of Chinese older adults without dementia over a five-year period. METHODS: A total of 787 community-dwelling Chinese older adults without dementia in Hong Kong were assessed at baseline (T0), at two years (T1), and at five years (T2). RESULTS: The annual conversion rate to dementia was 1.6% and 6.3% for baseline normal participants and baseline mild cognitive impairment (MCI) participants, respectively. The Cantonese version of Mini-mental State Examination (CMMSE) scores declined significantly over time. In participants who progressed to dementia, Category Verbal Fluency Test (CVFT) scores dropped significantly from T0 to T1. A 1-SD drop of either CMMSE or CVFT in two years predicted dementia at five years with 91.5% sensitivity and 62.0% specificity. A stable CMMSE and CVFT at two years predicted a 91% chance of not progressing to clinical dementia at five years. CONCLUSION: In this community sample of Chinese older adults, a decline in cognitive screening tests in short term (two years) offered useful information in predicting dementia conversion over a longer period.published_or_final_versio

Would Older Adults with Mild Cognitive Impairment Adhere to and Benefit from a Structured Lifestyle Activity Intervention to Enhance Cognition?: A Cluster Randomized Controlled Trial

Background Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI). Method and Findings This was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI), 260 with single-domain deficit (sdMCI)) were recruited. Participants were randomized into physical exercise (P), cognitive activity (C), integrated cognitive and physical exercise (CP), and social activity (S, active control) groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB) scores. Secondary outcomes included Chinese versions of Alzheimer's Disease Assessment Scale Cognitive subscale (ADAS-Cog), delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT) and Disability Assessment for Dementia - Instrumental Activities of Daily Living (DAD-IADL). Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2%) completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (p<0.05). Post-hoc subgroup analyses showed that the CP group, compared with other intervention groups, had more significant improvements of ADAS-Cog, delayed recall and CVFT performance with sdMCI participants (p<0.05). Overall adherence rate was 73.3%. Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age, education, and intervention groups (univariate analyses). Conclusions Structured lifestyle activity interventions were not associated with changes in everyday functioning, albeit with some improvements in cognitive scores across time. Higher adherence was associated with greater improvement in cognitive scores. Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline.published_or_final_versio

Risk of incident dementia varies with different onset and courses of depression

Background: This study aims to examine if risk of dementia differs between adult- and late-onset depression. Methods: 16,608 community-living dementia-free older adults were followed for 6 years to the outcome of incident dementia. Depression was diagnosed according to international diagnostic guidelines. Depression in adulthood or late life was categorized using age 65 as cutoff. Hazard ratio for dementia was estimated using Cox regression analysis. Results: People with depression in adulthood only did not have higher dementia incidence, suggesting those in remission from adult-onset depression are not at greater risk of dementia. Conversely, having depression in both adulthood and late life was associated with higher dementia risk, and improvement in depression in late life was associated with lower risk, suggesting persistent or recurrent lifetime depression is a risk factor for dementia. Those with depression in late life only were not associated with higher dementia risk after controlling for the longitudinal changes in depressive symptoms, consistent with late-onset depression being a prodrome of dementia. Limitations: Reverse causation is a potential limitation. This was minimized by careful ascertainment of depression and dementia cases, exclusion of individuals with suspected dementia at baseline and those who developed dementia within 3 years after baseline, and controlling for various important confounders. Conclusions: Risk of incident dementia varies with presence and resolution of depression at different ages. Further studies are needed to test whether treating adult-onset depression may prevent dementia. Older adults with a history of depression present for an extended time should be monitored for cognitive decline

COSMIC (Cohort Studies of Memory in an International Consortium): An international consortium to identify risk and protective factors and biomarkers of cognitive ageing and dementia in diverse ethnic and sociocultural groups

Background: A large number of longitudinal studies of population-based ageing cohorts are in progress internationally, but the insights from these studies into the risk and protective factors for cognitive ageing and conditions like mild cognitive impairment and dementia have been inconsistent. Some of the problems confounding this research can be reduced by harmonising and pooling data across studies. COSMIC (Cohort Studies of Memory in an International Consortium) aims to harmonise data from international cohort studies of cognitive ageing, in order to better understand the determinants of cognitive ageing and neurocognitive disorders.Methods/Design: Longitudinal studies of cognitive ageing and dementia with at least 500 individuals aged 60 years or over are eligible and invited to be members of COSMIC. There are currently 17 member studies, from regions that include Asia, Australia, Europe, and North America. A Research Steering Committee has been established, two meetings of study leaders held, and a website developed. The initial attempts at harmonising key variables like neuropsychological test scores are in progress.Discussion: The challenges of international consortia like COSMIC include efficient communication among members, extended use of resources, and data harmonisation. Successful harmonisation will facilitate projects investigating rates of cognitive decline, risk and protective factors for mild cognitive impairment, and biomarkers of mild cognitive impairment and dementia. Extended implications of COSMIC could include standardised ways of collecting and reporting data, and a rich cognitive ageing database being made available to other researchers. COSMIC could potentially transform our understanding of the epidemiology of cognitive ageing, and have a world-wide impact on promoting successful ageing. © 2013 Sachdev et al.; licensee BioMed Central Ltd

Effect of physical exercise and medication on enhancing cognitive function in older adults with vascular risk

202204 bcvcAccepted ManuscriptOthersThe Lui Che Woo Institute of Innovative MedicinePublishe

Validation of a computerized Hong Kong - Vigilance and Memory Test (HK-VMT) to detect early cognitive impairment in healthy older adults

202204 bcvcAccepted ManuscriptOthersThe Lui Che Woo Institute of Innovative MedicinePublishe

Respite care

202204 bcvcNot applicableSelf-fundedPublished36 month

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

202109 bchyVersion of RecordPublishe

Loneliness interacts with family relationship in relation to cognitive function in Chinese older adults

202204 bcvcAccepted ManuscriptOthersThe Lui Che Woo Institute of Innovative MedicinePublishe