Progressing dementia risk reduction initiatives for culturally and linguistically diverse older adults in Australia

Objectives: Dementia is a global public health concern, with approximately 487,500 Australians living with this condition. As an incurable disease, collaborative public health approaches are at the forefront for risk reduction of dementia. In Australia, nearly one in three individuals older than 65 years belong to culturally and linguistically diverse populations (CALD), yet dementia prevention approaches within CALD communities remain limited. Current health services and education require a targeted multidimensional and multicultural approach for dementia prevention interventions. Methods: Recent recognition of gaps in CALD dementia awareness and accessibility has instigated a range of initiatives that address language disparities and dementia literacy within Australia's older population. While these have created pockets of dementia awareness and health promotion, a ‘whole of community’ and government approach is needed to decrease the recognised modifiable risk factors of dementia. Results: This work serves to identify effective methods to promote dementia risk factor reduction using behaviour change techniques through five key recommendations specific for CALD communities. These suggestions are covered by the need for federal funds to be allocated to specific culturally inclusive initiatives highlighted under primary care, public health, research and community sectors. Conclusions: Key recommendations are created to address language disparities and dementia literacy in Australia's older population to aid healthy brain ageing for CALD older adults

Submission to the New South Wales Government's Department of Planning, Industry and Environment regarding the Design and Place State Environmental Planning Policy 2021

We are an interdisciplinary team of researchers from Western Sydney University and University of Technology Sydney, and community representatives, advocating for the recognition and inclusion of age and dementia-friendly community design principles in the Design and Place State Environmental Planning Policy (DP SEPP) 2021. Inclusive, enabling, and supportive cities are fundamental to wellbeing, especially in ageing and culturally diverse regions like South Western Sydney. Here, over 16,462 people live with dementia, and this figure will triple to 52,059 within the next 30 years unless there is a medical breakthrough1. This region is also expected to have the highest increase in dementia prevalence in all of NSW by 20501. Many of our cities in New South Wales are grappling with an ageing population and a tsunami of dementia cases with it

Chinese patent medicine as adjuvant for mild-to-moderate active ulcerative colitis : a network meta-analysis of randomized controlled trials

Objective. To evaluate the effectiveness and safety of Chinese patent medicine for mild-to-moderate active ulcerative colitis (UC) using network meta-analysis (NMA). Methods. We systematically searched PubMed, Cochrane library, Embase, Sino-Med, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific Journal Database (VIP) databases to October, 2020. We included randomized controlled trials (RCTs) on Chinese patent medicine for mild-to-moderate active UC. The main analysis was complemented by network subanalyses and standard pairwise comparisons. Statistical heterogeneity, inconsistencies, and ranking probability were also evaluated. Results. The databases search identified 3222 citations, of which 33 RCTs involving 2971 patients met the inclusion criteria. A total of 15 Chinese patent medicines were analyzed. The overall quality of the included studies was low. Pairwise meta-analysis showed that Chinese patent medicine was superior to Mesalazine in improving disappearances of clinical symptoms, recurrence rate, and Mayo score. Based on decreases in adverse events, results from NMA showed that Xilei powder plus Mesalazine was more effective than other drugs. Other NMA results indicated that Danshen freeze-dried powder plus Mesalazine (RR: 0.13; 95% CI, 0.02–0.78) and Kangfuxin lotion plus Mesalazine (RR: 0.24; 95% CI, 0.07–0.57) were superior to Mesalazine in decreasing recurrence rate. Another NMA result indicated that Kangfuxin lotion plus Mesalazine (RR: 0.00; 95% CI, 0.00–0.02) and Zhi Kang capsule plus Mesalazine (RR: 0.00; 95% CI, 0.00–0.02) were superior to Mesalazine in increasing the disappearance of tenesmus. Conclusion. In the probability sorting, Xilei powder combined with Mesalazine ranked first for having the fewest adverse events, Maintaining Intestines Antidiarrheal Pills combined with Mesalazine ranked first for having the lowest recurrence rate, Xilei powder combined with Mesalazine ranked first for improving disappearance rate of mucopurulent bloody stool/abdominal pain, and Kangfuxin lotion combined with Mesalazine ranked first for improving the disappearance rate of diarrhea/tenesmus. However, there is a lack of direct comparisons among Chinese patent medicines for UC. More multiarm RCTs are needed in the future to provide direct comparative evidence

Does tai chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? : a systematic review

Background: Psychological risk factors have been recognised as potential, modifiable risk factors in the development and progression of cardiovascular disease (CVD). Tai Chi, a mind-body exercise, has the potential to improve psychological well-being and quality of life. We aim to assess the effects and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors. Methods: We searched for randomised controlled trials evaluating Tai Chi for psychological well-being and quality of life in people with CVD and cardiovascular risk factors, from major English and Chinese databases until 30 July 2021. Two authors independently conducted study selection and data extraction. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Review Manager software was used for meta-analysis. Results: We included 37 studies (38 reports) involving 3525 participants in this review. The methodological quality of the included studies was generally poor. Positive effects of Tai Chi on stress, self-efficacy, and mood were found in several individual studies. Meta-analyses demonstrated favourable effects of Tai Chi plus usual care in reducing anxiety (SMD − 2.13, 95% confidence interval (CI): − 2.55, − 1.70, 3 studies, I2 = 60%) and depression (SMD -0.86, 95% CI: − 1.35, − 0.37, 6 studies, I2 = 88%), and improving mental health (MD 7.86, 95% CI: 5.20, 10.52, 11 studies, I2 = 71%) and bodily pain (MD 6.76, 95% CI: 4.13, 9.39, 11 studies, I2 = 75%) domains of the 36-Item Short Form Survey (scale from 0 to 100), compared with usual care alone. Tai Chi did not increase adverse events (RR 0.50, 95% CI: 0.21, 1.20, 5 RCTs, I2 = 0%), compared with control group. However, less than 30% of included studies reported safety information. Conclusions: Tai Chi seems to be beneficial in the management of anxiety, depression, and quality of life, and safe to practice in people with CVD and/or cardiovascular risk factors. Monitoring and reporting of safety information are highly recommended for future research. More well-designed studies are warranted to determine the effects and safety of Tai Chi on psychological well-being and quality of life in this population

Electrophysiological correlates of the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism

The brain-derived neurotrophic factor (BDNF) protein is essential for neuronal development. Val66Met (rs6265) is a functional polymorphism at codon 66 of the BDNF gene that affects neuroplasticity and has been associated with cognition, brain structure and function. The aim of this study was to clarify the relationship between BDNF Val66Met polymorphism and neuronal oscillatory activity, using the electroencephalogram (EEG), in a normative cohort. Neurotypical (N = 92) young adults were genotyped for the BDNF Val66Met polymorphism and had eyes open resting-state EEG recorded for four minutes. Focal increases in right fronto-parietal delta, and decreases in alpha-1 and right hemispheric alpha-2 amplitudes were observed for the Met/Met genotype group compared to Val/Val and Val/Met groups. Stronger frontal topographies were demonstrated for beta-1 and beta-2 in the Val/Met group versus the Val/Val group. Findings highlight BDNF Val66Met genotypic differences in EEG spectral amplitudes, with increased cortical excitability implications for Met allele carriers

“We need a one-stop-shop” : co-creating the model of care for a multidisciplinary memory clinic with community members, GPs, aged care workers, service providers, and policy-makers

Background: Timely diagnosis of dementia has a wide range of benefits including reduced hospital emergency department presentations, admissions and inpatient length of stay, and improved quality of life for patients and their carers by facilitating access to treatments that reduce symptoms, and allow time to plan for the future. Memory clinics can provide such services, however there is no 'gold standard' model of care. This study involved the co-creation of a model of care for a new multidisciplinary memory clinic with local community members, General Practitioners (GPs), policy-makers, community aged care workers, and service providers. Methods: Data collection comprised semi-structured interviews (N=98) with 20 GPs, and three 2-h community forums involving 53 seniors and community/local government representatives, and 25 community healthcare workers. Interviews and community forums were audio-recorded, transcribed verbatim, and coded by thematic analysis using Quirkos. Results: GPs’ attitudes towards their role in assessing people with dementia varied. Many GPs reported that they found it useful for patients to have a diagnosis of dementia, but required support from secondary care to make the diagnosis and assist with subsequent management. Community forum participants felt they had a good knowledge of available dementia resources and services, but noted that these were highly fragmented and needed to be easier to navigate for the patient/carer via a 'one-stop-shop' and the provision of a dementia key worker. Expectations for the services and features of a new memory clinic included diagnostic services, rapid referrals, case management, education, legal services, culturally sensitive and appropriate services, allied health, research participation opportunities, and clear communication with GPs. Participants described several barriers to memory clinic utilisation including transportation access, funding, awareness, and costs. Conclusion: This study demonstrates the importance of working with stakeholders to co-design models of care for people with dementia that take into account the local communities’ needs. Findings pave the way for the development of a potential new “gold standard” memory clinic model of care and operationalise new national clinical guidelines

Data-driven derivation of natural EEG frequency components : an optimised example assessing resting EEG in healthy ageing

Background The majority of electroencephalographic (EEG) investigations in normal ageing have determined EEG spectra from epochs recorded in the eyes-closed (EC) and/or eyes-open (EO) resting states, and summed amplitudes or power estimates within somewhat-arbitrary and/or inconsistently defined traditional frequency band limits. New method Natural frequency components were sought using a data-driven frequency Principal Components Analysis (f-PCA) approach, optimised to reduce between-condition and between-group misallocation of variance. Frequency component correspondence was screened using the Congruence Coefficient and topographic correlations for potential matches on Condition and/or Group. The amplitudes of corresponding natural components were then explored as a function of these independent variables. Results Separate f-PCAs with Young and Older adults’ EC and EO data each yielded between six and nine components that peaked across the traditional delta to beta band ranges. Across these, two components were matched on Group and Condition, while a further six were matched on Condition (within-groups), and four on Group (within-conditions). Comparison with Existing Methods Multiple frequency components were found within the traditional bands, and provided a wider perspective in terms of additional natural component details. In addition to novel insights, the well-documented age-related spectral reductions were seen in the common delta component, and in one EC (but no EO) alpha component. Conclusions This combination of optimised f-PCA approach and component screening procedure has wide potential in the EEG field beyond the ageing topic explored here, being applicable across an extensive range of studies using EEG oscillations to explore aspects of cognitive processing and individual differences

E・ルンドベルク著 吉野俊彦訳 景気変動と経済政策 : 経済統制か金融政策か

Neuropsychological research and practice rely on cognitive task performance measures as indicators of brain functioning. The neural activity underlying stimulus-response processes can be assessed with ERPs, but the relations between these cognitive processes and the brain's intrinsic resting state EEG activity are less understood. This study focused on the neurocognitive functioning of 20 healthy young adults in an equiprobable go/no-go task to map the ERP correlates of behavioral responses and examine contributions of the resting state intrinsic EEG to task-related outcomes. Continuous EEG was recorded during pretask eyes-closed (EC) and eyes-open (EO) conditions, and in the subsequent task. Delta, theta, alpha, and beta band amplitudes were assessed for the EC state and also for the reactive change to EO. Go/no-go ERPs were submitted to temporal principal components analysis, where the P2, N2, P3, and slow wave components of interest were extracted. The performance measure of reaction time (RT) variability was positively correlated with no-go and go errors, and also with go P2 amplitude, linking these to stimulus discrimination efforts involved in appropriate response selection. An N2c-P3b pairing was enhanced for shorter mean RTs, supporting their involvement in the decision to execute a response. A stepwise regression model identified EC midline delta as a predictor of P3b positivity, highlighting the relevance of delta in the neural mechanisms of attentional processes. These findings clarify the electrophysiology underlying decision-making processes in executive function, and provide a platform for further research assessing performance outcomes in larger samples and in developmental/clinical contexts

Electrophysiological underpinnings of response variability in the Go/NoGo task

Response variability has been identified as a useful predictor of executive function and performance in non-clinical samples in the Go/NoGo task. The present study explores the utility of reaction time variability (RTV) and EEG measures as predictors of Go/NoGo performance outcomes and ERP component amplitudes. Forty-four young adults had EEG recorded across eyes-closed (EC) and eyes-open (EO) resting states, and during an auditory Go/NoGo task. The 18 individuals with the lowest/highest RTV were assessed for differences in behavioural outcomes. As expected, individuals with high RTV committed more Go/NoGo errors and had smaller Go P3b and NoGo P3a amplitudes, and greater Go Slow Wave positivity, reflecting inefficient decision-making and response control efforts underlying performance. When RTV and EEG measures were modelled as predictors of Go/NoGo responses, RTV and task-related changes in delta were identified as positive predictors of Go SW amplitude; while RTV and prestimulus delta amplitudes negatively predicted NoGo accuracy rates. Prestimulus delta was also found to solely predict Go mean RT and NoGo SW negativity; effects that were independent of RTV. As delta has been implicated in attention-related mechanisms, these findings suggest that inadequate attention and task engagement underpin the variability in Go/NoGo performance

Clarifying the sequential processes involved in a cued continuous performance test

We aimed to clarify sequential processes for cue and imperative stimuli (targets/nontargets) in a continuous performance test (CPT), and how the preparatory contingent negative variation (CNV) affects physiological and behavioral responses. Single-trial event-related potentials (ERPs) obtained from 70 participants during a cued CPT were baselined to the cue (BtC) to include the CNV, or to the imperatives (BtI) to remove the CNV. Principal components analysis obtained cue and imperative ERP components, and congruence coefficients (rc) evaluated similarities. The cue and imperative components were comparable, more so for the BtI- than BtC-imperative components (rc = .85). N1, PN, P2, N2c, and SW components were similar, but not the N2b and P3s. Imperative ERPs were largely unaffected by the resolving CNV. Similar cue and imperative components suggest similar sequential processes, while preparatory CNV activity enhanced physiological and behavioral responses