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Zhou J, Liu W, Zhou H, Lau KK, Wong GH, Chan WC, Zhang Q, Knapp M, Wong IC, Luo H. Identifying dementia from cognitive footprints in hospital records among Chinese older adults: a machine-learning study. Lancet Reg Health West Pac 2024; 46:101060. [PMID: 38638410 PMCID: PMC11025003 DOI: 10.1016/j.lanwpc.2024.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Background By combining theory-driven and data-driven methods, this study aimed to develop dementia predictive algorithms among Chinese older adults guided by the cognitive footprint theory. Methods Electronic medical records from the Clinical Data Analysis and Reporting System in Hong Kong were employed. We included patients with dementia diagnosed at 65+ between 2010 and 2018, and 1:1 matched dementia-free controls. We identified 51 features, comprising exposures to established modifiable factors and other factors before and after 65 years old. The performances of four machine learning models, including LASSO, Multilayer perceptron (MLP), XGBoost, and LightGBM, were compared with logistic regression models, for all patients and subgroups by age. Findings A total of 159,920 individuals (40.5% male; mean age [SD]: 83.97 [7.38]) were included. Compared with the model included established modifiable factors only (area under the curve [AUC] 0.689, 95% CI [0.684, 0.694]), the predictive accuracy substantially improved for models with all factors (0.774, [0.770, 0.778]). Machine learning and logistic regression models performed similarly, with AUC ranged between 0.773 (0.768, 0.777) for LASSO and 0.780 (0.776, 0.784) for MLP. Antipsychotics, education, antidepressants, head injury, and stroke were identified as the most important predictors in the total sample. Age-specific models identified different important features, with cardiovascular and infectious diseases becoming prominent in older ages. Interpretation The models showed satisfactory performances in identifying dementia. These algorithms can be used in clinical practice to assist decision making and allow timely interventions cost-effectively. Funding The Research Grants Council of Hong Kong under the Early Career Scheme 27110519.
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Affiliation(s)
- Jiayi Zhou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Wenlong Liu
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Huiquan Zhou
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gloria H.Y. Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Qingpeng Zhang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong SAR, China
| | - Martin Knapp
- Care Policy and Evaluation Centre (CPEC), The London School of Economics and Political Science, London, UK
| | - Ian C.K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Department of Computer Science, The University of Hong Kong, Hong Kong SAR, China
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Lo HKY, Wang S, Chan JKN, Wong CSM, Wong GHS, Lei JHC, So YK, Fung VSC, Chu RST, Chung AKK, Lee KCK, Cheng CPW, Chan WC, Chang WC. The role of anxiety and insomnia in the relationship between COVID-19 perseverative cognition and depression: Parallel and serial mediation analyses. Eur Neuropsychopharmacol 2024; 84:18-19. [PMID: 38643695 DOI: 10.1016/j.euroneuro.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Heidi Ka Ying Lo
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Shiyan Wang
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Gabbie Hou Sem Wong
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Janet Hiu Ching Lei
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Yuen Kiu So
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Vivian Shi Cheng Fung
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Ryan Sai Ting Chu
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Albert Kar Kin Chung
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Krystal Chi Kei Lee
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
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Fung VSC, Chan JKN, Chui EMC, Wong CSM, Chu RST, So YK, Chan JMT, Chung AKK, Lee KCK, Lo HKY, Cheng CPW, Law CW, Chan WC, Chang WC. Network analysis on psychopathological symptoms, psychological measures, quality of life and COVID-19 related factors in Chinese psychiatric patients in Hong Kong. BMC Psychiatry 2024; 24:271. [PMID: 38609962 PMCID: PMC11010282 DOI: 10.1186/s12888-024-05690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Psychiatric patients are susceptible to adverse mental health impacts during COVID-19, but complex interplays between psychopathology and pandemic-related variables remain elusive. This study aimed to investigate concomitant associations between psychopathological symptoms, psychological measures and COVID-19 related variables in Chinese psychiatric patients during the peak of fifth pandemic wave in Hong Kong. METHODS We employed network analysis to investigate inter-relationships among psychopathological symptoms (including depression, anxiety, post-traumatic stress disorder-like [PTSD-like] symptoms, insomnia, psychotic symptoms), cognitive complaints, health-related quality of life, loneliness, resilience and selected pandemic-related factors in 415 psychiatric outpatients between 28 March and 8 April, 2022. Network comparisons between genders, diagnosis (common mental disorders [CMD] vs. severe mental disorders [SMD]), and history of contracting COVID-19 at fifth wave were performed as exploratory analyses. RESULTS Our results showed that anxiety represented the most central node in the network, as indicated by its highest node strength and expected influence, followed by depression and quality of life. Three comparatively strong connections between COVID-19 and psychopathological variables were observed including: fear of contagion and PTSD-like symptoms, COVID-19 stressor burden and PTSD-like symptoms, and COVID-19 stressor burden and insomnia. Network comparison tests revealed significant network structural difference between participants with history of contracting COVID-19 and those without, but showed no significant difference between genders as well as between CMD and SMD patients. CONCLUSIONS Our findings suggest the pivotal role of anxiety in psychopathology network of psychiatric patients amidst COVID-19. Pandemic-related variables are critically associated with trauma/stress and insomnia symptoms. Future research is required to elucidate potential network structural changes between pandemic and post-COVID periods.
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Affiliation(s)
- Vivian Shi Cheng Fung
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eileena Mo Ching Chui
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Kowloon, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ryan Sai Ting Chu
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yuen Kiu So
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jacob Man Tik Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Albert Kar Kin Chung
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Krystal Chi Kei Lee
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Heidi Ka Ying Lo
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chi Wing Law
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Kowloon, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Pok Fu Lam, Hong Kong.
- State Key Laboratory of Brain and Cognitive Science, the University of Hong Kong, Pok Fu Lam, Hong Kong.
- Department of Psychiatry, The University of Hong Kong Queen Mary Hospital, Pokfulam, Hong Kong.
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Lee CKK, Chan KNJ, Wong SMC, Wong HSG, Lei HCJ, So YK, Fung SCV, Chu STR, Chung KKA, Cheng PWC, Lo KYH, Chan WC, Chang WC. Relationships between psychopathological symptoms, pandemic-related stress, perceived social support, and COVID-19 infection history: a network analysis in Chinese college students. Front Psychiatry 2024; 15:1340101. [PMID: 38370557 PMCID: PMC10873916 DOI: 10.3389/fpsyt.2024.1340101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Previous coronavirus, 2019 (COVID-19) research has applied network analysis to examine relationships between psychopathological symptoms but rarely extended to potential risk and protective factors or the influence of COVID-19 infection history. This study examined complex inter-relationships between psychopathological symptoms, COVID-19-related stressors, perceived social support, and COVID-19 infection history among Chinese university/college students during the peak of fifth pandemic wave using a network analysis approach. Methods A Least Absolute Shrinkage and Selection Operator-regularized partial correlation network using Gaussian graphical model was constructed in 1,395 Chinese university/college students in Hong Kong who completed a survey between 15 March and 3 April, 2022. Depressive, anxiety, and acute/traumatic stress symptoms were measured by Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Impact of Event Scale-6, respectively. COVID-19-related stressors and perceived social support were measured. Network differences by COVID-19 infection history (COVID-network vs. no_COVID-network) and network communities were examined. Results Our results showed that the most influential nodes were depressed mood, uncontrollable worries, and uncontrollable thoughts about COVID-19. The main bridging symptoms were concentration problems and psychomotor problems. The COVID-network, comprising participants with a history of COVID-19 infection only, was significantly stronger than the no_COVID-network. Perceived social support and stress from conflicts with family/friends formed a unique community with negative cognition and suicidal idea in the COVID-network only. Conclusion Our findings indicate that specific interventions targeting interpersonal conflicts and concentration problems as well as facilitating stress buffering effects of social support may represent effective strategies to reduce psychological distress in university/college students during COVID-19 and should be considered for future pandemic preparedness.
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Affiliation(s)
- Chi Kei Krystal Lee
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kwun Nam Joe Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sau Man Corine Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hou Sem Gabbie Wong
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hiu Ching Janet Lei
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuen Kiu So
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shi Cheng Vivian Fung
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai Ting Ryan Chu
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kar Kin Albert Chung
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Pak Wing Calvin Cheng
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ka Ying Heidi Lo
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wai Chi Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Lo HKY, Chan JKN, Wong CSM, Wong GHS, Lei JHC, So YK, Fung VSC, Chu RST, Ling R, Chung AKK, Lee KCK, Cheng CPW, Chan WC, Chang WC. Prevalence and correlates of suicidal ideation in the general public during the fifth wave of COVID-19 pandemic in Hong Kong. Front Psychiatry 2024; 14:1252600. [PMID: 38274415 PMCID: PMC10809397 DOI: 10.3389/fpsyt.2023.1252600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Literature reveals increased suicidal ideation in the general population during pandemic. However, few COVID-19 studies comprehensively assessed factors associated with suicidal ideation, and mixed findings were observed. We aimed to examine prevalence and correlates of suicidal ideation in general public during the peak of fifth COVID-19 wave in Hong Kong based on a broad array of relevant measures. Methods This survey assessed 14,709 community-dwelling adults during March 15-April 3, 2022. Comprehensive assessment was administered including socio-demographics, pre-existing mental/physical morbidity, mental-health symptoms, resilience, loneliness, coping strategies, and pandemic-related factors. Presence of suicidal ideation was evaluated by ratings of item 9 on Patient-Health-Questionnaire-9. Results A total of 2,249 (15.3%) participants exhibited suicidal ideation. Multivariable-regression analysis found that being single and unemployed, pre-existing mental disorder, more severe depressive and anxiety symptoms, higher levels of loneliness and engagement in avoidant coping were significantly associated with suicidal ideation. Conversely, attaining tertiary educational level or above, greater resilience and adopting problem-focused coping were associated with lower likelihood of suicidal ideation. Although univariate-analyses revealed that a number of pandemic-related factors were linked to suicidal ideation, none remained significant in the multivariable model. Conclusion A significant proportion of people experienced suicidal ideation during the peak of fifth COVID-19 wave. Risk and protective factors identified would facilitate early identification of high-risk individuals and provision of targeted interventions to minimize suicidal ideation and risk of self-harm. Caution should be exercised due to study limitations of a cross-sectional design which precluded establishing causality among variables, and reliance on self-reported data.
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Affiliation(s)
- Heidi Ka Ying Lo
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Joe Kwun Nam Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Gabbie Hou Sem Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Janet Hiu Ching Lei
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yuen Kiu So
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Vivian Shi Cheng Fung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ryan Sai Ting Chu
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Rachel Ling
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Albert Kar Kin Chung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Krystal Chi Kei Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wai Chi Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Lo HKY, Chan JKN, Yip EWC, Chui EMC, Fung VSC, Wong CSM, Chu RST, So YK, Chan JMT, Chung AKK, Lee KCK, Cheng CPW, Law CW, Chan WC, Chang WC. The prevalence and correlates of suicidal ideation in Chinese psychiatric patients during the fifth wave of COVID-19 in Hong Kong. Eur Neuropsychopharmacol 2023; 77:4-11. [PMID: 37660441 DOI: 10.1016/j.euroneuro.2023.08.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
People with mental disorders have increased risk of psychological distress during COVID-19. However, there is limited research comprehensively examining factors associated with suicidal ideation, the strongest predictor of suicidal behavior, among psychiatric patients amidst pandemic. We investigated prevalence and correlates of suicidal ideation in 407 Chinese psychiatric outpatients (diagnosed with mood, anxiety or schizophrenia-spectrum disorders) aged 18-64 years during the peak of fifth COVID-19 wave in Hong Kong between 28 March and 8 April, 2022, based on a comprehensive array of variables encompassing socio-demographics, illness profile, psychopathological symptoms, psychological measures and pandemic-related factors. Univariate and multivariate logistic regression analyses were conducted to determine correlates of suicidal ideation. Results showed that 128 (31.4%) participants exhibited suicidal ideation. Univariate analyses revealed that being unemployed or full-time student, more severe depressive, anxiety, PTSD-like, insomnia and psychotic symptoms, higher levels of loneliness, avoidant-coping, greater pandemic-related stress burden and distress by social-distancing measures were related to suicidal ideation. Conversely, participants with higher monthly household-income, better quality-of-life, and greater resilience were less likely to have suicidal ideation. Notably, only depressive symptom severity was retained in final multivariate model as a factor significantly associated with suicidal ideation. Hence, we observed that approximately one-third of Chinese psychiatric patients experienced suicidal ideation during fifth pandemic wave. Our findings underscore the influence of depressive symptoms being above and beyond that of other psychopathological symptoms, psychological and pandemic-related variables on suicidal ideation. Longitudinal research is required to clarify suicidal ideation trajectories and predictors of persistent suicidal ideation across pandemic and post-pandemic periods.
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Affiliation(s)
- Heidi Ka Ying Lo
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | | | | | - Vivian Shi Cheng Fung
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Ryan Sai Ting Chu
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Yuen Kiu So
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Jacob Man Tik Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Albert Kar Kin Chung
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Krystal Chi Kei Lee
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Chi Wing Law
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Science, the University of Hong Kong, Hong Kong.
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Fong TKH, Cheung T, Ngan STJ, Tong K, Lui WYV, Chan WC, Wong CSM, Cheng CPW. Transcranial pulse stimulation in the treatment of mild neurocognitive disorders. Ann Clin Transl Neurol 2023; 10:1885-1890. [PMID: 37607114 PMCID: PMC10578878 DOI: 10.1002/acn3.51882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE There are limited effectiveness and potential side effects of existing pharmacological approach in treating mild neurocognitive disorder (NCD). Transcranial pulse stimulation (TPS) applies repetitive single high-pressure ultrashort shockwave pulses to stimulate the brain, which has been shown to effectively improve cognition in major NCD. However, the effectiveness of TPS in mild NCD patients remained unknown. This study aims to assess the effectiveness and tolerability of TPS with neuro-navigation in old-age adults with mild NCD by both clinical and biochemical assessments. METHODS An open-label study recruited older adults with mild NCD to receive neuro-navigated TPS intervention for two weeks with three sessions per week. Assessments included detailed cognitive assessments, APOE genotype, and brain-derived neurotrophic factor (BDNF). RESULTS Nineteen participants (12 females and 7 males) completed the whole TPS interventions with no serious adverse effects reported. Repeated measures ANOVA showed statistically significant effects of time on HK-MoCA (F (3, 54) = 4.99, P = 0.004), 30-sec interval of Verbal Fluency Test (F (3, 54) = 2.94, P = 0.041), Stroop interference (F (3, 54) = 3.46, P = 0.023), and Chinese IADL (F (3, 54) = 2.78, P = 0.050) after receiving the intervention. Bonferroni post hoc comparisons on HK-MoCA showed a significant improvement after intervention. There was no significant change in serum BDNF level. INTERPRETATION TPS has brought significant improvement in cognition of elderly with mild NCD. It has a great potential to delay the deterioration of cognition in older adults. The long-term effect of TPS in cognition would benefit from further large-scale, randomized, sham-controlled trials.
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Affiliation(s)
| | - Teris Cheung
- School of NursingThe Hong Kong Polytechnic UniversityHong KongChina
| | | | - Kelvin Tong
- Department of PsychiatryThe University of Hong KongHong KongChina
| | | | - Wai Chi Chan
- Department of PsychiatryThe University of Hong KongHong KongChina
| | - Corine Sau Man Wong
- Division of Community Medicine and Public Health PracticeThe University of Hong KongHong KongChina
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Ruan J, Chen S, Liang J, Ho FYY, Cheung T, Ho JYS, Chan WC, Chen H, Au DCW, Lee RWY, Mak YW, Yeung WF. Traditional Chinese medicine-based integrated health interventions for depression: A systematic review and meta-analysis. J Clin Nurs 2023; 32:5632-5651. [PMID: 36946424 DOI: 10.1111/jocn.16666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Some traditional Chinese medicine (TCM)-based integrated health interventions have been used for depression, but pooled efficacy remains unknown. AIMS AND OBJECTIVES This study aimed to systematically evaluate the efficacy of TCM-based integrated health interventions for relieving depression. DESIGN Systematic review and meta-analysis. METHODS A comprehensive literature search was conducted on 17 databases from inception up to June 2022. Randomised controlled trials (RCTs) that examined an integrated health intervention based on TCM theory for depression were included. The risk of bias was assessed using the second version of the Cochrane risk-of-bias tool for randomised trials, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system. RESULTS Eighteen RCTs with a total of 1448 depressed participants were included. Health care providers, mainly nurses (14 studies), implemented TCM-based integrated health interventions. The pooled results showed that TCM-based integrated health interventions had larger effects on reducing depressive symptoms (15 studies; standardised mean difference = -2.05; 95% CI: -2.74, -1.37; p < .00001) compared with usual care at posttreatment but showed no significant difference contrasted to cognitive behavioural therapy (two studies, p = .31). However, the overall evidence was low. CONCLUSIONS The meta-analysis results indicated that TCM-based integrated health interventions were effective in reducing depression. However, the results should be interpreted with caution because of the low quality of the included studies. Future RCTs with rigorous designs should be conducted to provide robust evidence of the efficacy of TCM-based integrated health interventions in treating depression. RELEVANCE TO CLINICAL PRACTICE TCM-based integrated health interventions might be a potentially effective alternative for depression. Nurses could play an important role in designing and providing TCM-based integrated nursing interventions for patients with depression. NO PATIENT OR PUBLIC CONTRIBUTION This is a systematic review and meta-analysis based on data from previous studies.
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Affiliation(s)
- Jiayin Ruan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Shucheng Chen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Jiagui Liang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
- School of Nursing, The Capital Medical University, Beijing, China
| | - Fiona Yan Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Janice Yuen Shan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Haiyong Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dennis Cheuk Wing Au
- Hong Kong Association of Traditional Chinese Medicine, Hong Kong Special Administrative Region, China
| | - Rebecca Wing Yan Lee
- Sin-Hua Herbalists' and Herb Dealers' Promotion Society Limited, Hong Kong Special Administrative Region, China
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
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Fung VSC, Chan JMT, Chui EMC, Wong CSM, Chan JKN, Chu RST, So YK, Chung AKK, Lee KCK, Cheng CPW, Law CW, Chan WC, Chang WC. Prevalence and correlates of subjective cognitive impairment in Chinese psychiatric patients during the fifth wave of COVID-19 in Hong Kong. Front Psychiatry 2023; 14:1216768. [PMID: 37663610 PMCID: PMC10469870 DOI: 10.3389/fpsyt.2023.1216768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The extent of cognitive impairment and its association with psychological distress among people with pre-existing mental illness during COVID-19 is understudied. This study aimed to investigate prevalence and correlates of subjective cognitive impairment (SCI) in Chinese psychiatric patients during fifth-wave of COVID-19 in Hong Kong (HK). Methods Four-hundred-eight psychiatric outpatients aged 18-64 years were assessed with questionnaires between 28 March and 8 April 2022, encompassing illness profile, psychopathological symptoms, coping-styles, resilience, and COVID-19 related factors. Participants were categorized into moderate-to-severe and intact/mild cognitive impairment (CI+ vs. CI-) groups based on severity of self-reported cognitive complaints. Univariate and multivariate regression analyses were conducted to determine variables associated with CI+ status. Results One-hundred-ninety-nine participants (48.8%) experienced CI+. A multivariate model on psychopathological symptoms found that depressive and post-traumatic-stress-disorder (PTSD)-like symptoms were related to CI+, while a multivariate model on coping, resilience and COVID-19 related factors revealed that avoidant coping, low resilience and more stressors were associated with CI+. Final combined model demonstrated the best model performance and showed that more severe depressive and PTSD-like symptoms, and adoption of avoidant coping were significantly associated with CI+. Conclusion Almost half of the sample of psychiatric patients reported cognitive complaints during fifth-wave of COVID-19 in HK. Greater depressive and PTSD-like symptom severity, and maladaptive (avoidant) coping were found as correlates of SCI. COVID-19 related factors were not independently associated with SCI in psychiatric patients. Early detection with targeted psychological interventions may therefore reduce psychological distress, and hence self-perceived cognitive difficulties in this vulnerable population.
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Affiliation(s)
- Vivian Shi Cheng Fung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jacob Man Tik Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | | | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Joe Kwun Nam Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ryan Sai Ting Chu
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yuen Kiu So
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Albert Kar Kin Chung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Krystal Chi Kei Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chi Wing Law
- Department of Psychiatry, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
| | - Wai Chi Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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10
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Ngan JST, Chan WC, Wong ST, Wong CSM, Cheng CPW. Reward System in Late-Life Depression: a Cross-Sectional Case-Control Study. East Asian Arch Psychiatry 2023; 33:71-76. [PMID: 37400229 DOI: 10.12809/eaap2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Anhedonia, commonly defined as a reduced ability to feel pleasure, is a core clinical symptom of late-life depression (LLD). Deficits in reward processing are hypothesised to be associated with anhedonia. We examined differences in reward sensitivity between patients with LLD and healthy controls and explored the associations between LLD-related symptomatology, global cognition, and the reward system. METHODS The reward responsiveness of 63 patients with LLD and 58 healthy controls aged ≥60 years was assessed using the probabilistic reward learning task with an asymmetric reward schedule. RESULTS Compared with healthy controls, patients with LLD displayed lower response bias and reward learning. Global cognition of all participants was positively correlated with response bias. In patients with LLD, anhedonia severity explained impaired reward learning. CONCLUSION A deficit in reward processing is implicated in patients with LLD. Our findings suggest that executive dysfunction and anhedonia contribute to lower sensitivity to reward learning in patients with LLD.
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Affiliation(s)
- J S T Ngan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - W C Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong SAR, China
| | - S T Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C S M Wong
- Division of Community Medicine and Public Health Practice, School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - C P W Cheng
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
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11
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Lo HKY, Wong GHS, Chan JKN, Wong CSM, Lei JHC, So YK, Fung VSC, Chu RST, Chung AKK, Lee KCK, Cheng CPW, Chan WC, Chang WC. COVID-19 perseverative cognition and depressive symptoms in Hong Kong: The moderating role of resilience, loneliness and coping strategies. J Affect Disord 2023:S0165-0327(23)00699-7. [PMID: 37230268 DOI: 10.1016/j.jad.2023.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic significantly increased depression prevalence in general population. However, the relationship between persistent dysfunctional thinking associated with COVID-19 (perseverative-cognition) and depression, and its potential moderators are understudied. We aimed to examine the association between COVID-19 perseverative-cognition and depression, and the moderating effect of potential risk and protective factors on this association in general public during the peak of fifth COVID-19 wave in Hong Kong. METHODS This survey recruited 14,269 community-dwelling adults between March 15-April 3, 2022 to investigate association between COVID-19 perseverative-cognition and depression, and the moderating effect of resilience, loneliness and three coping strategies (including emotion-focused, problem-focused and avoidant coping) on this association, using hierarchical regression models and simple slope analyses. COVID-19 perseverative cognition was assessed by the Obsession with COVID-19 Scale (OCS) and depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9). RESULTS Perseverative-cognition was positively associated with depression severity. Resilience, loneliness and three coping strategies moderated the association between perseverative-cognition and depression. Specifically, greater resilience and emotion-focused coping ameliorated the association between perseverative-cognition and depression, while higher levels of loneliness, avoidant and problem-focused coping accentuated such association. LIMITATIONS Cross-sectional design precluded establishing causality among variables. CONCLUSION This study affirms that COVID-19 perseverative-cognition is significantly related to depression. Our findings indicate the potential critical role of enhanced personal resilience and social support, and adoption of emotion-focused coping in mitigating negative effect of COVID-19 related maladaptive thinking on depression severity, thereby facilitating development of targeted strategies to reduce psychological distress amidst the prolonged pandemic.
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Affiliation(s)
- Heidi Ka Ying Lo
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Gabbie Hou Sem Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Janet Hiu Ching Lei
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Yuen Kiu So
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Vivian Shi Cheng Fung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Ryan Sai Ting Chu
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Albert Kar Kin Chung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Krystal Chi Kei Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
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12
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Koka H, Bodelon C, Horvath S, Lee PMY, Wang D, Song L, Zhang T, Hurson AN, Guida JL, Zhu B, Bailey-Whyte M, Wang F, Wu C, Tsang KH, Tsoi YK, Chan WC, Law SH, Hung RKW, Tse GM, Yuen KKW, Karlins E, Jones K, Vogt A, Zhu B, Hutchinson A, Hicks B, Garcia-Closas M, Chanock S, Barnholtz-Sloan J, Tse LA, Yang XR. DNA methylation age in paired tumor and adjacent normal breast tissue in Chinese women with breast cancer. Clin Epigenetics 2023; 15:55. [PMID: 36991516 PMCID: PMC10062015 DOI: 10.1186/s13148-023-01465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Few studies have examined epigenetic age acceleration (AA), the difference between DNA methylation (DNAm) predicted age and chronological age, in relation to somatic genomic features in paired cancer and normal tissue, with less work done in non-European populations. In this study, we aimed to examine DNAm age and its associations with breast cancer risk factors, subtypes, somatic genomic profiles including mutation and copy number alterations and other aging markers in breast tissue of Chinese breast cancer (BC) patients from Hong Kong. METHODS We performed genome-wide DNA methylation profiling of 196 tumor and 188 paired adjacent normal tissue collected from Chinese BC patients in Hong Kong (HKBC) using Illumina MethylationEPIC array. The DNAm age was calculated using Horvath's pan-tissue clock model. Somatic genomic features were based on data from RNA sequencing (RNASeq), whole-exome sequencing (WES), and whole-genome sequencing (WGS). Pearson's correlation (r), Kruskal-Wallis test, and regression models were used to estimate associations of DNAm AA with somatic features and breast cancer risk factors. RESULTS DNAm age showed a stronger correlation with chronological age in normal (Pearson r = 0.78, P < 2.2e-16) than in tumor tissue (Pearson r = 0.31, P = 7.8e-06). Although overall DNAm age or AA did not vary significantly by tissue within the same individual, luminal A tumors exhibited increased DNAm AA (P = 0.004) while HER2-enriched/basal-like tumors exhibited markedly lower DNAm AA (P = < .0001) compared with paired normal tissue. Consistent with the subtype association, tumor DNAm AA was positively correlated with ESR1 (Pearson r = 0.39, P = 6.3e-06) and PGR (Pearson r = 0.36, P = 2.4e-05) gene expression. In line with this, we found that increasing DNAm AA was associated with higher body mass index (P = 0.039) and earlier age at menarche (P = 0.035), factors that are related to cumulative exposure to estrogen. In contrast, variables indicating extensive genomic instability, such as TP53 somatic mutations, high tumor mutation/copy number alteration burden, and homologous repair deficiency were associated with lower DNAm AA. CONCLUSIONS Our findings provide additional insights into the complexity of breast tissue aging that is associated with the interaction of hormonal, genomic, and epigenetic mechanisms in an East Asian population.
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Affiliation(s)
- Hela Koka
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- San Diego Institute of Science, Alto Labs, San Diego, CA, USA
| | - Priscilla Ming Yi Lee
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong., Prince of Wales Hospital, Sha Tin, N.T., Hong Kong SAR, China
| | - Difei Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Lei Song
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Tongwu Zhang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Amber N Hurson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Jennifer Lyn Guida
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Bin Zhu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Maeve Bailey-Whyte
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Feng Wang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong., Prince of Wales Hospital, Sha Tin, N.T., Hong Kong SAR, China
| | - Cherry Wu
- Department of Pathology, North District Hospital, Hong Kong, China
| | - Koon Ho Tsang
- Department of Pathology, Yan Chai Hospital, Hong Kong, China
| | - Yee-Kei Tsoi
- Department of Surgery, North District Hospital, Hong Kong, China
| | - W C Chan
- Department of Surgery, North District Hospital, Hong Kong, China
| | - Sze Hong Law
- Department of Surgery, North District Hospital, Hong Kong, China
| | - Ray Ka Wai Hung
- Department of Surgery, North District Hospital, Hong Kong, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Eric Karlins
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Kristine Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Aurelie Vogt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Bin Zhu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Amy Hutchinson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Belynda Hicks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Stephen Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Jill Barnholtz-Sloan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong., Prince of Wales Hospital, Sha Tin, N.T., Hong Kong SAR, China.
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
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Ngan STJ, Chan LK, Chan WC, Lam LCW, Li WK, Lim K, Or E, Pang PF, Poon TK, Wong MCM, Wu YKA, Cheng PWC. 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. Trials 2022; 23:914. [PMID: 36307858 DOI: 10.1186/s13063-022-06855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Sze Ting Joanna Ngan
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong
| | - Lap Kei Chan
- Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong, Hong Kong
| | - Wai Chi Chan
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong
| | - Linda Chiu Wa Lam
- Department of Psychiatry, Tai Po Hospital, G/F, Multi-Centre, Tai Po, Hong Kong, Hong Kong
| | - Wan Kei Li
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong
| | - Kelvin Lim
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ego Or
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong
| | - Pui Fai Pang
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong, Hong Kong
| | - Ting Keung Poon
- Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong, Hong Kong
| | - Mei Cheung Mimi Wong
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong, Hong Kong
| | - Ying King Anna Wu
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, Hong Kong
| | - Pak Wing Calvin Cheng
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong.
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Lam LCW, Chan WC, Kwok TCY, Lee JSW, Yu BML, Lee S, Lee ATC, Ma SL, Cheng ST. Combined physical exercise-working memory training on slowing down cognitive decline in elders with mild clinical Alzheimer disease: a randomised controlled study (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 3:28-30. [PMID: 35701227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - T C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - J S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - B M L Yu
- Social Welfare Department, Hong Kong SAR Government
| | - S Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - A T C Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S T Cheng
- Department of Health and Physical Education, The Education University of Hong Kong
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15
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Lee PMY, Kwok CH, Tsoi YK, Wu C, Law SH, Tsang KH, Yeung YC, Chan WC, Tse GM, Yuen KKW, Hung RKW, Wang F, Tse LA. Associations between Preserved foods and Breast Cancer Risk in Hong Kong Chinese Women. Cancer Prev Res (Phila) 2022; 15:497-507. [PMID: 35504011 DOI: 10.1158/1940-6207.capr-21-0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/21/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Preserved food such as cured foods may contain nitrate and nitrite that may contribute to the breast cancer development. Evidence on the associations between these preserved food intakes and risk of breast cancer is sparse. This study aimed to examine the associations between preserved foods (i.e. cured meat, pickled vegetables, canned meat, canned fruit/vegetables) and breast cancer risk in Hong Kong Chinese women. A total of 1307 breast cancer cases and 1050 age-matched controls were recruited from three hospitals during 11/2011-01/2018. We used a standardized questionnaire to collect information on dietary factors including preserved foods. Unconditional multiple logistic regression was performed to calculate the adjusted odds ratio(AOR) of breast cancer in relation to preserved food with adjustment of potential confounders. We further performed stratified analysis according to the breast cancer biology subtypes. We found that cured meat consumption was significantly associated with the risk of breast cancer [AOR=1.32, 95% confidence interval 95%CI)=1.06-1.64]. Compared to no cured meat consumption, cured meat intake {greater than or equal to} once per week was associated with an AOR of 2.66 (95%CI=1.38-5.35). Women with canned fruit/vegetable {greater than or equal to} consumption once per week had a higher risk of breast cancer (OR=1.19, 95%CI=1.00-1.41), particularly for the HER2-positive subtypes, but it became borderline after adjustment of confounders. Our study reveals a positive association between consumption of cured meat and breast cancer risk in Chinese population. Cured meat intake might be a potential novel risk factor for breast cancer but this would have to be confirmed by large prospective cohort studies.
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Affiliation(s)
| | - Chi-Hei Kwok
- Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Yee-Kei Tsoi
- North District Hospital, Hong Kong, Hong Kong, China
| | | | | | | | | | - W C Chan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Gary M Tse
- Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | | | | | - Feng Wang
- Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Lap Ah Tse
- Chinese University of Hong Kong, Hong Kong, Hong Kong
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16
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Liu T, Leung DKY, Lu S, Kwok WW, Sze LCY, Tse SSK, Ng SM, Wong PWC, Lou VWQ, Tang JYM, Wong DFK, Chan WC, Kwok RYK, Lum TYS, Wong GHY. Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial. Trials 2022; 23:280. [PMID: 35410292 PMCID: PMC8996671 DOI: 10.1186/s13063-022-06122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Late-life depression is common, modifiable, yet under-treated. Service silos and human resources shortage contribute to insufficient prevention and intervention. We describe an implementation research protocol of collaborative stepped care and peer support model that integrates community mental health and aged care services to address service fragmentation, using productive ageing and recovery principles to involve older people as peer supporters to address human resource issue.
Methods/design
This is a non-randomised controlled trial examining the effectiveness and cost-effectiveness of the “Jockey Club Holistic Support Project for Elderly Mental Wellness” (JC JoyAge) model versus care as usual (CAU) in community aged care and community mental health service units in 12 months. Older people aged 60 years and over with mild to moderate depressive symptoms or risk factors for developing depression will be included. JoyAge service users will receive group-based activities and psychoeducation, low-intensity psychotherapy, or high-intensity psychotherapy according to the stepped care protocol in addition to usual community mental health or aged care, with support from an older peer supporter. The primary clinical outcome, depressive symptoms, and secondary outcomes, self-harm risk, anxiety symptoms, and loneliness, will be measured with the Patient Health Questionnaire-9 (PHQ-9), Self-Harm Inventory, Generalized Anxiety Disorder 7-item scale (GAD-7), and UCLA Loneliness 3-item scale (UCLA-3) respectively. Cost-effectiveness analysis will assess health-related quality of life using the EQ-5D-5L and service utilisation using the Client Service Receipt Inventory (CSRI). We use multilevel linear mixed models to compare outcomes change between groups and calculate the incremental cost-effectiveness ratio in terms of quality-adjusted life years.
Discussion
This study will provide evidence about outcomes for older persons with mental health needs receiving collaborative stepped care service without silos and with trained young-old volunteers to support engagement, treatment, and transitions. Cost-effectiveness findings from this study will inform resource allocation in this under-treated population.
Trial registration
ClinicalTrials.gov NCT03593889. Registered on 20 July 2018.
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17
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Cheng ST, Chan WC, Fung HH, Lam LCW. Self-efficacy in controlling upsetting thoughts, but not positive gains, mediates the effects of benefit-finding group intervention for Alzheimer family caregivers. Psychol Aging 2021; 37:766-775. [PMID: 34843329 DOI: 10.1037/pag0000654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study aimed to examine the therapeutic mechanism of the benefit-finding therapeutic (BFT) intervention that used cognitive reappraisal and alternative thinking to construct positive aspects of caregiving (PAC), in a cluster-randomized controlled trial for Alzheimer caregivers. Forty two caregivers received BFT, whereas 87 received psychoeducation as control. Depressive symptoms and global burden were outcomes measured at baseline, postintervention, and 4- and 10-month follow-up. Mediators considered included PAC (measured by benefit word count to a qualitative measure) and three self-efficacies-controlling upsetting thoughts (SE-CUT), responding to disruptive behaviors, and obtaining respite. Using mixed-effects regression, we demonstrated that benefit-finding increased caregivers' PAC and SE-CUT, but that only SE-CUT uniquely predicted depressive symptoms and global burden longitudinally. Path analyses with bootstrapped confidence intervals, using full information maximum likelihood estimation to retain the whole sample with partial missing data, showed that SE-CUT change from baseline to postintervention mediated intervention effects on depressive symptoms, but not global burden, at both follow-ups. No mediation effects were found for PAC and the other self-efficacies. The BFT effect on depressive symptoms was partly accounted for by improvement in SE-CUT. The therapeutic mechanism for the effect on burden remained unknown. The study sheds light on the importance of actively promoting positive caregiver functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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18
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Chan SKW, Lee KKW, Chan VHY, Pang HH, Wong CSM, Hui CLM, Chang WC, Lee EHM, Chan WC, Cheung EFC, Chiu HFK, Chiang TP, Lam M, Lau JTF, Ng RMK, Hung SF, Lam LCW, Chen EYH. 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. Psychol Med 2021; 51:2501-2508. [PMID: 32466813 DOI: 10.1017/s0033291720001452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | | | - Veronica Hei Yan Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Herbert H Pang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | | | | | | | | | - Joseph Tak Fai Lau
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong
| | | | - Se Fong Hung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | | | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
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19
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Wong YL, Cheng CPW, Wong CSM, Wong SN, Wong HL, Tse S, Wong GHY, Chan WC. Cognitive Stimulation for Persons with Dementia: a Systematic Review and Meta-Analysis. East Asian Arch Psychiatry 2021; 31:55-66. [PMID: 34588315 DOI: 10.12809/eaap2102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We aim to provide an up-to-date systematic review and meta-analysis of the effects of cognitive stimulation (CS) on cognition, depressive symptoms, and quality of life in persons with dementia. Factors affecting the treatment effect were examined. METHODS A literature search was performed on databases of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, and Cochrane Library up to 7 March 2019. Only randomised controlled trials investigating the effects of CS in persons with dementia were included. The outcome measures were cognitive function, depressive symptoms, and quality of life. RESULTS 20 randomised controlled trials with a total of 1251 participants (intervention group: 674; control group: 577) were included for meta-analysis. Most participants had mild to moderate dementia. CS had a significant positive small-to-moderate effect on cognition (Hedges's g = 0.313, p < 0.001). Heterogeneity of CS was low to moderate (Q=30.5854, df=19, p < 0.05, I2 = 37.877%). Inconclusive results were found for depressive symptoms and quality of life. CONCLUSION CS has a significant positive effect on cognitive function, but its effect on depressive symptoms and quality of life was inconclusive. Future studies with more robust methodology establishing evidence of its efficacy are required.
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Affiliation(s)
- Y L Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - C P W Cheng
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - C S M Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - S N Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - H L Wong
- Department of Psychology, The University of Hong Kong, Hong Kong
| | - S Tse
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - G H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - W C Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
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20
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Leung DKY, Chan WC, Spector A, Wong GHY. Prevalence of depression, anxiety, and apathy symptoms across dementia stages: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1330-1344. [PMID: 33905138 DOI: 10.1002/gps.5556] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The present study aimed to resolve inconsistency in reported prevalence of affective symptoms by dementia stage. METHODS/DESIGN We conducted a meta-analysis of studies with data on dementia stage and prevalence of depression, anxiety, or apathy assessed using validated tools. We performed random-effects meta-analysis and subgroup analysis on symptom prevalence by dementia stage, according to CDR. RESULTS The meta-analysis included 5897 people with dementia from 20 studies. Prevalence rates of depression in mild, moderate, and severe dementia were 38% (95% CI 32%-45%), 41% (95% CI 33%-49%), and 37% (95% CI 17%-56%) respectively. The corresponding prevalence for anxiety was 38% (95% CI 31%-45%), 41% (95% CI 31%-52%), and 37% (95% CI -8%-82%); and 54% (95% CI 45%-62%), 59% (95% CI 44%-73%), and 43% (95% CI 10%-75%) for apathy. The prevalence of depression, anxiety, and apathy did not differ with regard to dementia stage and type. The prevalence of depression in Alzheimer's disease (AD) was significantly lower when it was assessed using diagnostic criteria compared to screening tools. The prevalence of depression in AD was lowest in America, while anxiety in vascular dementia was higher in Europe than Asia. CONCLUSIONS Depression, anxiety, and apathy symptoms are highly prevalent across dementia stages. There is no evidence of any changes in prevalence of affective symptom as the illness progresses. Evaluation methods and cultural difference may explain some of the variance, suggesting further investigation of factors that may influence the report of symptoms, such as carer psychosocial characteristics, and more cross-cultural studies are needed.
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Affiliation(s)
- Dara K Y Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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21
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Shih VWY, Chan WC, Tai OK, Wong HL, Cheng CPW, Wong CSM. Mindfulness-Based Cognitive Therapy for Late-Life Depression: a Randomised Controlled Trial. East Asian Arch Psychiatry 2021; 31:27-35. [PMID: 34987115 DOI: 10.12809/eaap2075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Rumination and overgeneral autobiographical memory are dysfunctional cognitions commonly found in older adults with depression. The theoretical underpinnings of mindfulness-based cognitive therapy (MBCT) address the ruminative tendencies and the non-specific retrieval of autobiographical memories. This study aims to examine the efficacy and cognitive mechanisms of MBCT in older adults with active depressive symptoms. METHODS 57 older adults (mean age, 70 years) with normal cognition and mild to moderate depressive symptoms were randomly allocated to either the MBCT group or the active control group for 8 weeks. The MBCT group consisted of eight 2-hour weekly sessions and a 7-hour full-day retreat, with different themes for each class, guided mindfulness exercises, feedback and discussion, homework review, and psychoeducation. The active control group comprised a 1-hour physical exercise and a standardised health education of the specific theme with group discussion (eg fall prevention, chronic pain). Participants were assessed before and after the 8-week intervention for four outcome measures: the Hamilton Depression Rating Scale (HAMD), the Ruminative Response Scale (RRS), the Autobiographical Memory Test (AMT), and the Mindful Attention Awareness Scale (MAAS). RESULTS There was a significant reduction in severity of depressive symptoms (HAMD score) in both the MBCT group (F(1, 27) = 35.9, p < 0.001, η2 = 0.57) and the active control group (F(1, 28) = 9.29, p < 0.01, η2 = 0.24), but only the MBCT group showed substantial improvements in autobiographical memory specificity (AMT score), rumination (RRS score), and mindfulness (MAAS score). CONCLUSION Although both MBCT and active control programme decrease the severity of depressive symptoms in older adults, only MBCT improves AMS, rumination, and mindfulness. Our findings provide empirical support for the theoretical underpinnings of MBCT. Older adults with more severe depression and more severe dysfunctional cognition may benefit more from the specific therapeutic effects of MBCT.
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Affiliation(s)
- V W Y Shih
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - W C Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - O K Tai
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - H L Wong
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - C P W Cheng
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - C S M Wong
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
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22
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Abstract
OBJECTIVES To compare older adults with late-life depression (LLD) and healthy controls in terms of suicidal ideation during the COVID-19 pandemic, and to determine predictors of suicidal ideation. METHODS Between March and April 2020, old adults diagnosed with major depressive disorder (single or recurrent episode) as defined by the DSM-5 were recruited from psychiatric clinics or inpatient wards, whereas 31 healthy older adults without a history of depression or other psychiatric illnesses were recruited from voluntary organisations or elderly community centres. Their depressive symptoms, perceived severity of the pandemic, perceived time spent on receiving related information, perceived health, levels of loneliness, perceived coping efficacy, suicidal ideation, and the level of symptomatic responses to a specific traumatic stressor in the past week were assessed. RESULTS In total, 21 men and 43 women aged 61 to 89 years were interviewed through telephone by trained research assistants. Of them, 33 were older adults with LLD (cases) and 31 were healthy older adults (controls). Older people with LLD had a higher level of suicidal ideation than healthy controls, after controlling for the level of depression and medical comorbidity (F (1, 59) = 5.72, p = 0.020). Regression analyses showed that coping efficacy and loneliness accounted for a significant portion of the variance in suicidal ideation, and loneliness significantly predicted the level of stress. Mediation analyses reveal an indirect effect between group and suicidal ideation through coping efficacy (Z = 2.43, p = 0.015). CONCLUSIONS Older people with LLD are at increased suicidal risk and require timely mental health support. Coping efficacy and loneliness are important predictors for suicidal ideation and stress.
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Affiliation(s)
- L L C Louie
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - C P W Cheng
- Department of Psychiatry, The University of Hong Kong, Hong Kong
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23
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Makkar SR, Lipnicki DM, Crawford JD, Kochan NA, Castro-Costa E, Lima-Costa MF, Diniz BS, Brayne C, Stephan B, Matthews F, Llibre-Rodriguez JJ, Llibre-Guerra JJ, Valhuerdi-Cepero AJ, Lipton RB, Katz MJ, Wang C, Ritchie K, Carles S, Carriere I, Scarmeas N, Yannakoulia M, Kosmidis M, Lam L, Chan WC, Fung A, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Suh SW, Riedel-Heller SG, Roehr S, Pabst A, Ganguli M, Hughes TF, Snitz B, Anstey KJ, Cherbuin N, Easteal S, Haan MN, Aiello AE, Dang K, Pin Ng T, Gao Q, Zin Nyunt MS, Brodaty H, Trollor JN, Leung Y, Lo JW, Sachdev P. APOE ε4 and the Influence of Sex, Age, Vascular Risk Factors, and Ethnicity on Cognitive Decline. J Gerontol A Biol Sci Med Sci 2021; 75:1863-1873. [PMID: 32396611 DOI: 10.1093/gerona/glaa116] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Indexed: 01/08/2023] Open
Abstract
We aimed to examine the relationship between Apolipoprotein E ε4 (APOE*4) carriage on cognitive decline, and whether these associations were moderated by sex, baseline age, ethnicity, and vascular risk factors. Participants were 19,225 individuals aged 54-103 years from 15 longitudinal cohort studies with a mean follow-up duration ranging between 1.2 and 10.7 years. Two-step individual participant data meta-analysis was used to pool results of study-wise analyses predicting memory and general cognitive decline from carriage of one or two APOE*4 alleles, and moderation of these associations by age, sex, vascular risk factors, and ethnicity. Separate pooled estimates were calculated in both men and women who were younger (ie, 62 years) and older (ie, 80 years) at baseline. Results showed that APOE*4 carriage was related to faster general cognitive decline in women, and faster memory decline in men. A stronger dose-dependent effect was observed in older men, with faster general cognitive and memory decline in those carrying two versus one APOE*4 allele. Vascular risk factors were related to an increased effect of APOE*4 on memory decline in younger women, but a weaker effect of APOE*4 on general cognitive decline in older men. The relationship between APOE*4 carriage and memory decline was larger in older-aged Asians than Whites. In sum, APOE*4 is related to cognitive decline in men and women, although these effects are enhanced by age and carriage of two APOE*4 alleles in men, a higher numbers of vascular risk factors during the early stages of late adulthood in women, and Asian ethnicity.
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Affiliation(s)
- Steve R Makkar
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | | | | | - Breno Satler Diniz
- Department of Psychiatry, Faculty of Medicine University Toronto, Ontario, Canada.,Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, UK
| | - Blossom Stephan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jorge J Llibre-Guerra
- Institute of Neurology and Neurosurgery, Havana, Cuba.,Memory and Aging Center, UCSF, San Francisco, California
| | | | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Cuiling Wang
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Karen Ritchie
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France.,Université de Montpellier, Montpellier, France
| | - Sophie Carles
- Inserm, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France.,Paris Descartes University, Paris, France
| | - Isabelle Carriere
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France.,Université de Montpellier, Montpellier, France
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Taub Institute for Research in Alzheimer's disease and the Aging Brain, Gertrude H Sergievsky Center, Department of Neurology, Columbia University, New York city, New York
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics (M.Y.), Harokopio University, Athens, Greece
| | - Mary Kosmidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Linda Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The Chinese University of Hong Kong
| | - Ada Fung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University
| | | | | | | | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, Ohio
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, Australia.,Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Simon Easteal
- John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Mary N Haan
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, California
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina.,Carolina Population Center, Chapel Hill, North Carolina
| | - Kristina Dang
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, California
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Australia
| | - Yvonne Leung
- School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre, University of New South Wales Sydney, Sydney, Australia
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Lam LCW, Lee ATC, Cheng ST, Yip BHK, Chan WC, Fung AWT, Ma SL, Cheng CPW, Kong R, Chiu HTS, Lai FHY, Wong SYS. Mindfulness Awareness Is Associated With a Lower Risk of Anxiety and Depressive Symptoms in Older Adults With Neurocognitive Disorders. Front Psychiatry 2021; 12:721583. [PMID: 34744817 PMCID: PMC8566433 DOI: 10.3389/fpsyt.2021.721583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Linda Chiu Wa Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR China
| | - Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR China
| | - Sheung Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, SAR China
| | - Benjamin H K Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR China
| | - Wai Chi Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR China
| | - Ada W T Fung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, SAR China
| | - Suk Ling Ma
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR China
| | - Calvin P W Cheng
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR China
| | - Ryan Kong
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR China
| | - Henry T S Chiu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR China
| | - Frank H Y Lai
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, SAR China
| | - Samuel Yeung Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR China
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25
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Chan S, Chan WC, Ng SM, Yu CHA. Mindfulness Meditation and Tai Chi Chuan on Sleep Disturbance in Chinese Older People: A Randomized Controlled Trial. Innov Aging 2020. [PMCID: PMC7740189 DOI: 10.1093/geroni/igaa057.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sleep disturbances are common during the aging process and can result in a reduced quality of life. Many older people who experience sleep disturbances would consider turning to complementary and alternative medicine (CAM) due to the limitations of traditional pharmaceutical or psychological and behavioural treatments. Mindfulness Meditation (MM) and Tai Chi Chuan (TCC) are two common forms of mind-body based CAM. The former focuses more on mind-based practices whereas the latter emphasizes predominantly on body or movement-based practices. An etiological model of sleep disturbance (Shallcross et al., 2019) can lay the groundwork for a better understanding of the mechanisms of MM and TCC in relation to sleep disturbances. This study aims at comparing the effects of MM and TCC with Sleep Hygiene Education (SHE) control group. A three-armed randomized controlled pilot trial was conducted involving 45 community-dwelling older adults aged 65 to 82 with symptoms of sleep disturbance. Moderate effect sizes (Cohen’s d = 0.7 and 0.56) were found for the primary outcome of insomnia severity at post-intervention as comparing MM and TCC groups with SHE control group, respectively. More specific, participants in the MM group showed more amelioration on mental health status, introspective awareness, and objective measure of EEG-based brain arousal level; whereas participants in the TCC group showed better improvement on physical health status and subjective measure of hyperarousal. Findings demonstrate the unique therapeutic effects of MM and TCC on improving sleep problem in older people. The application in a Chinese context will be discussed.
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Affiliation(s)
- Sunny Chan
- The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Siu Man Ng
- The University of Hong Kong, Hong Kong, China
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26
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Chan WC, Lam LCW, Lautenschlager N, Dow B, Ma SL. Home-based exercise intervention for caregivers of persons with dementia: a randomised controlled trial: abridged secondary publication. Hong Kong Med J 2020; 26 Suppl 7:13-16. [PMID: 33229611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - N Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- NorthWestern Aged Mental Health, Royal Park Campus, Parkville, Australia
- School of Clinical Neurosciences and the Western Australia Centre and Health and Ageing, University of Western Australia, Perth, Australia
| | - B Dow
- National Ageing Research Institute, The University of Melbourne, Melbourne, Australia
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong
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27
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Ho RTH, Fong TCT, Chan WC, Kwan JSK, Chiu PKC, Yau JCY, Lam LCW. Psychophysiological Effects of Dance Movement Therapy and Physical Exercise on Older Adults With Mild Dementia: A Randomized Controlled Trial. J Gerontol B Psychol Sci Soc Sci 2020; 75:560-570. [PMID: 30496547 DOI: 10.1093/geronb/gby145] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Dementia interferes with older adults' functioning in cognitive, daily, psychosocial, and neuroendocrine domains. The present study examined the psychophysiological effects of dance movement therapy (DMT) and physical exercise for older adults with dementia. METHODS This randomized controlled trial recruited 204 older adults diagnosed with mild dementia into the DMT, exercise, or waitlist control group. Both DMT and exercise interventions had similar intensity and comprised 24 hr of intervention that spanned over 12 weeks. All participants completed self-report questionnaires on psychosocial well-being, daily functioning, neurocognitive assessments, and salivary cortisol measures at baseline and 3 follow-up measurements more than 1 year. RESULTS The DMT group showed significant decreases in depression, loneliness, and negative mood (d = 0.33-0.42, p < .05) and improved daily functioning (d = 0.40, p < .01) and diurnal cortisol slope (d = 0.30, p < .01). The effects on daily functioning and cortisol slope remained at 1-year follow-up. The exercise group of matched intensity showed no significant effects on the outcomes. DISCUSSION The study findings support the potential utility of DMT as a multifaceted intervention for improving various aspects of functioning in older adults with declining cognitive abilities. The lack of beneficial effects for our exercise intervention and long-term DMT effects highlights the need to maintain persistent levels of exercise with adequate intensity and duration.
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Affiliation(s)
- Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Joseph S K Kwan
- Department of Medicine, The University of Hong Kong, Hong Kong
| | | | - Joshua C Y Yau
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
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28
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Cheng PWC, Louie LLC, Wong YL, Wong SMC, Leung WY, Nitsche MA, Chan WC. The effects of transcranial direct current stimulation (tDCS) on clinical symptoms in schizophrenia: A systematic review and meta-analysis. Asian J Psychiatr 2020; 53:102392. [PMID: 32956993 DOI: 10.1016/j.ajp.2020.102392] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aims to examine the effects of transcranial direct current stimulation (tDCS) on clinical symptoms in schizophrenia. METHODS A literature search was performed for articles published in English using the following databases: MEDLINE, EMBASE, PsycINFO, INSPEC, the Cumulative Index to Nursing & Allied Health Literature Plus (CINAHL Plus), AMED, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, EU Clinical Trials Register, and WHO International Clinical Trials Registry Platform, from their inception to October 2019. The primary outcome variables were the clinical symptoms of schizophrenia including positive symptoms, negative symptoms, and auditory hallucinations. RESULTS 16 randomized controlled trials (RCTs) were included in the meta-analysis, with a sample of 326 patients with active and with 310 sham tDCS. Active tDCS was found to be more effective in improving positive symptoms [standardized mean difference (SMD) = 0.17; 95 % confidence interval (CI) 0.001 to 0.33], negative symptoms [SMD = 0.43, 95 % CI 0.11, 0.75] and auditory hallucinations [SMD = 0.36 95 % CI 0.02, 0.70]. Subgroup analyses showed better results in cases of pure diagnosis of schizophrenia, higher frequency and more sessions of stimulation. CONCLUSION tDCS was effective in improving positive symptoms, negative symptoms and auditory hallucination in schizophrenia. It therefore has potential as a safe and well-tolerated adjunctive intervention for schizophrenia.
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Affiliation(s)
| | | | - Yiu Lung Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | | | | | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, TU Dortmund University, Germany
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
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29
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Makkar SR, Lipnicki DM, Crawford JD, Kochan NA, Castro-Costa E, Lima-Costa MF, Diniz BS, Brayne C, Stephan B, Matthews F, Llibre-Rodriguez JJ, Llibre-Guerra JJ, Valhuerdi-Cepero AJ, Lipton RB, Katz MJ, Zammit A, Ritchie K, Carles S, Carriere I, Scarmeas N, Yannakoulia M, Kosmidis M, Lam L, Fung A, Chan WC, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Suh SW, Riedel-Heller SG, Roehr S, Pabst A, Ganguli M, Hughes TF, Jacobsen EP, Anstey KJ, Cherbuin N, Haan MN, Aiello AE, Dang K, Kumagai S, Narazaki K, Chen S, Ng TP, Gao Q, Nyunt MSZ, Meguro K, Yamaguchi S, Ishii H, Lobo A, Lobo Escolar E, De la Cámara C, Brodaty H, Trollor JN, Leung Y, Lo JW, Sachdev P. Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment. Arch Gerontol Geriatr 2020; 91:104112. [PMID: 32738518 PMCID: PMC7724926 DOI: 10.1016/j.archger.2020.104112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 05/01/2020] [Accepted: 05/12/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND We examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4). METHODS Participants were 30,785 dementia-free individuals aged 55-103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School. RESULTS Compared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P < 0.001) education were related to reduced CI risk. The decreased risk of CI associated with Middle education weakened with older baseline age (HR = 1.029, P = 0.056) and was stronger in women than men (HR = 1.309, P = 0.001). The association between High School and lowered CI risk, however, was not moderated by sex or baseline age, but was stronger in Asians than Whites (HR = 1.047, P = 0.044), and significant among Asian (HR = 0.34, P < 0.001) and Black (HR = 0.382, P = 0.016), but not White, APOE*4 carriers. CONCLUSION High School completion may reduce risk of CI associated with advancing age and APOE*4. The observed ethnoregional differences in this effect are potentially due to variations in social, economic, and political outcomes associated with educational attainment, in combination with neurobiological and genetic differences, and warrant further study.
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Affiliation(s)
- Steve R Makkar
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | | | | | - Breno Satler Diniz
- Department of Psychiatry, Faculty of Medicine University, Toronto, Canada; Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, UK
| | - Blossom Stephan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jorge J Llibre-Guerra
- Institute of Neurology and Neurosurgery Havana, Cuba, Memory and Aging Center, UCSF San Francisco, United States
| | | | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States; Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States
| | - Andrea Zammit
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States
| | - Karen Ritchie
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France; Université de Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Sophie Carles
- Inserm, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, F-75014 France; Paris Descartes University, Paris, France; Univ Paris-Sud, Villejuif, France
| | - Isabelle Carriere
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France; Université de Montpellier, Montpellier, France
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H Sergievsky Center, Department of Neurology, Columbia University, New York, NY, United States
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics (M.Y.), Harokopio University, Athens, Greece
| | - Mary Kosmidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Linda Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Ada Fung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Antonio Guaita
- Golgi Cenci Foundation, Corso San Martino 10, 20081 Abbiategrasso, Italy
| | - Roberta Vaccaro
- Golgi Cenci Foundation, Corso San Martino 10, 20081 Abbiategrasso, Italy
| | - Annalisa Davin
- Golgi Cenci Foundation, Corso San Martino 10, 20081 Abbiategrasso, Italy
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, OH, United States
| | - Erin P Jacobsen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Mary N Haan
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, CA, United States
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Carolina Population Center, Chapel Hill, NC, United States
| | - Kristina Dang
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, CA, United States
| | - Shuzo Kumagai
- Center for Health Science and Counseling, Kyushu University, 6-1 Kasuga kouen, Kasuga City, Fukuoka, 816-8580, Japan
| | - Kenji Narazaki
- Faculty of Socio-Environmental Studies, Department of Socio-Environmental Studies, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka 811-0295, Japan
| | - Sanmei Chen
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjyuku-ku, Tokyo 162-8655, Japan
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kenichi Meguro
- Geriatric Behavioral Neurology, Tohoku University, Japan
| | | | - Hiroshi Ishii
- Geriatric Behavioral Neurology, Tohoku University, Japan
| | - Antonio Lobo
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Zaragoza, Zaragoza, Spain
| | - Elena Lobo Escolar
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Zaragoza, Zaragoza, Spain
| | - Concepción De la Cámara
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Zaragoza, Zaragoza, Spain
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Australia
| | - Yvonne Leung
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
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Ho RTH, Fong TCT, Yau JCY, Chan WC, Kwan JSK, Chiu PKC, Lam LCW. Diurnal Cortisol Slope Mediates the Association Between Affect and Memory Retrieval in Older Adults With Mild Cognitive Impairment: A Path-Analytical Study. Front Aging Neurosci 2020; 12:35. [PMID: 32153385 PMCID: PMC7047326 DOI: 10.3389/fnagi.2020.00035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 02/04/2020] [Indexed: 12/28/2022] Open
Abstract
Background Memory deficits are linked to dysfunctional HPA axis activity and negative affect in older adults. This study evaluated the mediating effect of the diurnal cortisol pattern on the relationship between affect and memory in older people with mild cognitive impairment (MCI). Methods This longitudinal study recruited 189 Chinese older adults with MCI from elderly centers in Hong Kong. The participants completed assessments of affect, salivary cortisol, and digit spans at baseline; neurocognitive assessments on verbal fluency, memory retrieval, and digit spans at 6-month follow-up; and instrumental activities of daily living (IADL) at 1-year follow-up. Structural equation modeling examined the direct and indirect effects of negative affect on memory and IADL via diurnal cortisol pattern. Results Controlling for covariates, negative affect significantly predicted flattened diurnal cortisol slopes (β = 0.17, p < 0.05) but not memory or IADL (p = 0.23 – 0.91) directly. Diurnal cortisol slopes negatively predicted memory retrieval (β = −0.20, p < 0.05), which in turn positively predicted IADL (β = 0.22, p < 0.01). The indirect effect from negative affect to IADL via cortisol slope and memory retrieval was significant and negative (αβγ = −0.05, 95% bootstrapped CI = −0.248 to −0.001). Discussion The present study established certain temporal linkages among affect and cortisol slopes at baseline, memory retrieval at 6 months, and functional decline 1 year later in older adults with MCI. Flattened diurnal cortisol slopes might mediate the detrimental effects of negative affect on memory retrieval and functioning across 1 year.
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Affiliation(s)
- Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Joshua C Y Yau
- Centre on Behavioral Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Joseph S K Kwan
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Patrick K C Chiu
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
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31
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Volpe U, Amin H, Ayinde OO, Burns A, Chan WC, David R, Dejanovic SD, Djokic G, Eraslan D, Fischer GAL, Gracia-García P, Hamdani SU, Han C, Jafri H, Kallivayalil RA, Kriekaart RL, Kua EH, Lam LCW, Lecic-Tosevski D, Leroi I, Lobo A, Mihai A, Minhas FA, Mistry H, Ogundele AT, Olde Rikkert MGM, Olivera J, Palumbo C, Parker A, Pejuskovic B, Riese F, Robert P, Semrau M, Stoppe G, Sudhakar S, Tirintica AR, Tofique S, Tsoi C, Wolski L, Yalug I, Wang H, Yu X, Sartorius N. Pathways to care for people with dementia: An international multicentre study. Int J Geriatr Psychiatry 2020; 35:163-173. [PMID: 31657091 DOI: 10.1002/gps.5223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/24/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. METHODS We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant. RESULTS The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care. CONCLUSIONS The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.
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Affiliation(s)
- Umberto Volpe
- Department of Neuroscience/DIMSC, Università Politecnica delle Marche, Ancona, Italy
| | - Hania Amin
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Rawalpindi, Pakistan
| | - Olatunde O Ayinde
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Alistair Burns
- Greater Manchester NIHR Clinical Research Network, University of Manchester, UK, Manchester, UK
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Renaud David
- CoBTEK lab, Research Memory center, University Côte d'Azur, Nice, France
| | | | | | | | - Giulia A L Fischer
- Division of Old Age Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Patricia Gracia-García
- Department of Medicine and Psychiatry, University of Zaragoza; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Syed Usman Hamdani
- WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Rawalpindi, Pakistan
- Human Development Research Foundation, Islamabad, Pakistan
| | - Changsu Han
- Department of Psychiatry, Mind-Medical Research Lab, Korea University, Seoul, Korea
| | | | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
| | - Roderick Leonard Kriekaart
- Department of Geriatrics, Radboud Alzheimer Centre, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ee Heok Kua
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Linda C W Lam
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | | | - Iracema Leroi
- Global Brain Health Institute, Department of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Antonio Lobo
- Department of Medicine and Psychiatry, University of Zaragoza; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | | | | | - Heena Mistry
- Greater Manchester NIHR Clinical Research Network, University of Manchester, UK, Manchester, UK
| | | | - Marcel G M Olde Rikkert
- Department of Geriatrics, Radboud Alzheimer Centre, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Angela Parker
- Greater Manchester NIHR Clinical Research Network, University of Manchester, UK, Manchester, UK
| | - Bojana Pejuskovic
- Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Florian Riese
- Division of Old Age Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Philippe Robert
- CoBTEK lab, Research Memory center, University Côte d'Azur, Nice, France
| | - Maya Semrau
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton; and King's College, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Sanu Sudhakar
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
| | - Andreea Raluca Tirintica
- Global Brain Health Institute, Department of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Chris Tsoi
- Department of Psychological Medicine, National University Hospital, Singapore
| | | | - Irem Yalug
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, 100191, China
| | - Xin Yu
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, Beijing, 100191, China
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
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Wong HL, Chan WC, Wong YL, Wong SN, Yung HY, Wong SMC, Cheng PWC. High-definition transcranial direct current stimulation-An open-label pilot intervention in alleviating depressive symptoms and cognitive deficits in late-life depression. CNS Neurosci Ther 2019; 25:1244-1253. [PMID: 31657152 PMCID: PMC6834921 DOI: 10.1111/cns.13253] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 12/31/2022] Open
Abstract
The efficacy of high-definition transcranial direct current stimulation (HD-tDCS) in late-life depression (LLD) remains unknown due to limited research on its therapeutic effects on the hallmarks of LLD-the depressive and cognitive symptoms. The present open-label pilot study aimed to examine the effectiveness of HD-tDCS as an augmentation therapy with antidepressants in improving the depressive and cognitive symptoms for LLD. Significant improvements were hypothesized in the depressive, cognitive, and daily functioning outcomes over time. A total of 15 subjects with LLD (13 females, mean age = 73.27 ± 6.25) received five consecutive daily sessions of 20-minute active HD-tDCS interventions weekly for 2 weeks, with a 2 mA anodal stimulation over F3 and cathodal stimulation over FC1, AF3, F7, and FC5. Depressive symptoms and cognitive and daily functioning were assessed across five assessment timepoints. The results revealed that the HD-tDCS was effective in reducing the depressive severity and the remission rates, with a sustained effect at both the 1-month and 3-month follow-up. Pre-post improvements were seen in the overall cognitive functioning and in verbal fluency, but not in executive functioning. Our pilot study provides a preliminary result of HD-tDCS in LLD, which was a safe and effective treatment in alleviating depressive symptoms, with mild cognitive improvements observed. Further larger scale randomized controlled trials are needed to confirm this result.
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Affiliation(s)
- Hau-Lam Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Yiu-Lung Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Sze-Nga Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Hui-Yan Yung
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
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Lu H, Chan SSM, Chan WC, Lin C, Cheng CPW, Linda Chiu Wa L. Randomized controlled trial of TDCS on cognition in 201 seniors with mild neurocognitive disorder. Ann Clin Transl Neurol 2019; 6:1938-1948. [PMID: 31529691 PMCID: PMC6801176 DOI: 10.1002/acn3.50823] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the efficacy and safety of combined transcranial direct current stimulation (tDCS) and working memory training (WMT) in enhancing the cognitive functions for individuals with mild neurocognitive disorder due to AD (NCD-AD). METHODS In this double-blind, sham-controlled randomized clinical trial (RCT), 201 patients with NCD-AD were randomly assigned for a 4-week intervention of either a combination of tDCS and WMT, sham tDCS and WMT, or tDCS and control cognitive training (CCT). Global cognition and domain-specific cognitive function were assessed before and after the intervention with Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog), category verbal fluency test, logical memory, digit, and visual span tests. RESULTS Study participants did not show intervention group differences in baseline demographics, or cognitive characteristics (ANOVA). Cognitive enhancement was found across three groups after 4 weeks intervention. Combined tDCS-WMT group showed significantly greater improvement compared with single-modality groups in delayed recall (P = 0.043, η2 = 0.036) and working memory capacity (P = 0.04, η2 = 0.038) at 4th week, and logical memory at 12th week (P = 0.042, η2 = 0.037). Adverse events, including skin lesions (2.2%), were similar between groups. INTERPRETATION tDCS or WMT could be a safe, feasible, and effective intervention for individuals with NCD-AD. A combination of tDCS and WMT presents greater cognitive enhancement, which may highlight the potential synergistic effects of combined modality intervention on cognition.
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Affiliation(s)
- Hanna Lu
- Department of PsychiatryThe Chinese University of Hong KongHong Kong SARChina
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental DisordersGuangzhouChina
| | - Sandra Sau Man Chan
- Department of PsychiatryThe Chinese University of Hong KongHong Kong SARChina
| | - Wai Chi Chan
- Department of PsychiatryThe University of Hong KongHong Kong SARChina
| | - Cuichan Lin
- Department of PsychiatryThe Chinese University of Hong KongHong Kong SARChina
| | | | - Lam Linda Chiu Wa
- Department of PsychiatryThe Chinese University of Hong KongHong Kong SARChina
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Ma SL, Tang NLS, Wat KHY, Tang JHY, Lau KH, Law CB, Chiu J, Tam CCW, Poon TK, Lin KL, Kng CPL, Kong HL, Chan TY, Chan WC, Lam LCW. Effect of CYP2D6 and CYP3A4 Genotypes on the Efficacy of Cholinesterase Inhibitors in Southern Chinese Patients With Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2019; 34:302-307. [PMID: 31064198 PMCID: PMC10852420 DOI: 10.1177/1533317519848237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Alzheimer's disease (AD) is the most prevalent form of dementia, and age is strongly associated with the incidence of AD. This study aimed to investigate the association between the genotypes of CYP2D6, CYP3A4, and CYP2C9 genes to the clinical efficacy and tolerability of cholinesterase inhibitors (ChEIs) in Chinese patients with AD. One hundred seventy-nine patients with AD with newly prescribed with ChEIs were recruited. The clinical response and tolerability were evaluated at baseline, 3rd-, 6th-, and 12th-month follow-ups and were compared according to their genotypes of CYP2D6, CYP3A4, and CYP2C9. Among patients prescribed with donepezil/galantamine, CYP2D6*10 carriers showed significantly less side effects (P = .009). CYP2D6*10 carriers responded better to ChEIs and resulted in better improvement in Alzheimer's Disease Assessment Scale-Cognitive subscale (P = .027) and Mini-Mental State Examination (P = .012). Further study is required to replicate the finding, and it might be useful for clinicians to decide the medication based on the patients' CYP genotypes.
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Affiliation(s)
- Suk Ling Ma
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, China
| | - Nelson Leung Sang Tang
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, China
- Functional Genomics and Biostatistical Computing Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
- Laboratory of Genetics of Disease Susceptibility, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | | | - John Chiu
- Princess Margaret Hospital, Hong Kong, China
| | | | | | - Ka Leung Lin
- Ruttonjee Hospital and Tang Shiu Kin Hospital, Hong Kong, China
| | | | - Hing Leung Kong
- Ruttonjee Hospital and Tang Shiu Kin Hospital, Hong Kong, China
| | | | | | - Linda Chiu Wa Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, China
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Abstract
OBJECTIVES Mild cognitive impairment (MCI) refers to an early but abnormal state of cognitive impairment with minimal functional impairment. The present study aimed to evaluate the validity of Fuld Object Memory Evaluation (FOME) as a measure of episodic memory function. METHOD The study sample included 204 Chinese older adults with cognitive impairments. The participants completed five recall trials and a delayed trial in FOME, neurocognitive measures on digit spans and trail making, and daily functioning. Discriminative power of FOME to differentiate between MCI and dementia was inspected via receiver operating characteristic curve analysis. RESULTS FOME showed good test-retest reliability and convergent validity with digit spans and trail making. Controlling for gender, age, and education, lower levels of FOME total retrieval, verbal fluency, and daily functioning significantly predicted a higher likelihood of dementia compared to MCI. The optimal cut-off scores for total retrieval, verbal fluency, and daily functioning to differentiate dementia were 37/38 (77% sensitivity and 83% specificity), 28/29 (85% sensitivity and 72% specificity), and 14/15 (92% sensitivity and 78% specificity), respectively, in the younger subgroup. The corresponding figures were 34/35 (69% sensitivity and 76% specificity) and 27/28 (92% sensitivity and 62% specificity), and 11/12 (74% sensitivity and 80% specificity), respectively, in the older subgroup. CONCLUSION The findings support the FOME as a valid assessment tool of episodic memory function in older Chinese adults. The combined use of FOME and daily functioning is recommended to distinguish persons with dementia from MCI.
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Affiliation(s)
- Rainbow T H Ho
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong.,b Department of Social Work & Social Administration , The University of Hong Kong , Hong Kong.,c Sau Po Centre on Aging , The University of Hong Kong , Hong Kong
| | - Ted C T Fong
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong.,b Department of Social Work & Social Administration , The University of Hong Kong , Hong Kong
| | - Tiffany Hon
- a Centre On Behavioral Health , The University of Hong Kong , Hong Kong
| | - Wai Chi Chan
- d Department of Psychiatry , The University of Hong Kong , Hong Kong
| | - Joseph S K Kwan
- e Department of Medicine , The University of Hong Kong , Hong Kong
| | - Patrick K C Chiu
- e Department of Medicine , The University of Hong Kong , Hong Kong
| | - Linda C W Lam
- f Department of Psychiatry , The Chinese University of Hong Kong , Hong Kong
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Lu H, Sau Man Chan S, Chiu Wa Lam L, Pak Wing Cheng C, Chi Chan W, He H, Zhao S, Ning Y. Towards individualized psychiatric practice: The legacy of neurotherapeutics. Chin Sci Bull 2018. [DOI: 10.1360/n972018-00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cheng CPW, Wong CSM, Lee KK, Chan APK, Yeung JWF, Chan WC. Effects of repetitive transcranial magnetic stimulation on improvement of cognition in elderly patients with cognitive impairment: a systematic review and meta-analysis. Int J Geriatr Psychiatry 2018; 33:e1-e13. [PMID: 28493371 DOI: 10.1002/gps.4726] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to examine the effects of repetitive transcranial magnetic stimulation (rTMS) on cognitive function in older patients with cognitive impairment. METHODS A literature search was performed for articles published in English using the 10 databases (MEDLINE, EMBASE, PsycINFO, INSPEC, the Cumulative Index to Nursing and Allied Health Literature Plus, AMED, Biological Sciences, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews) from their inception to May 2016. The primary outcome was cognitive function as measured by the Mini-Mental State Examination or the Alzheimer's Disease Assessment Scale-cognitive subscale. RESULTS Seven RCTs were included in the meta-analysis, with a sample of 107 active and 87 sham rTMS. Active rTMS was found to be more effective in improving cognition (Hedges' g = 0.48; 95% confidence interval 0.12 to 0.84). CONCLUSIONS High-frequency rTMS showed a benefit on cognition amongst older patients with mild to moderate Alzheimer's disease. rTMS was shown to have great potential as a safe and well-tolerated alternative intervention for cognition. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Calvin Pak Wing Cheng
- Department of Psychiatry, Queen Mary Hospital, Hong Kong.,Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | | | | | | | - Wai Chi Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong.,Department of Psychiatry, The University of Hong Kong, Hong Kong
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Chang WC, Wong CSM, Chen EYH, Lam LCW, Chan WC, Ng RMK, Hung SF, Cheung EFC, Sham PC, Chiu HFK, Lam M, Lee EHM, Chiang TP, Chan LK, Lau GKW, Lee ATC, Leung GTY, Leung JSY, Lau JTF, van Os J, Lewis G, Bebbington P. Lifetime Prevalence and Correlates of Schizophrenia-Spectrum, Affective, and Other Non-affective Psychotic Disorders in the Chinese Adult Population. Schizophr Bull 2017; 43:1280-1290. [PMID: 28586480 PMCID: PMC5737409 DOI: 10.1093/schbul/sbx056] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Lifetime prevalence of psychotic disorders varies widely across studies. Epidemiological surveys have rarely examined prevalences of specific psychotic disorders other than schizophrenia, and the majority used a single-phase design without employing clinical reappraisal interview for diagnostic verification. The current study investigated lifetime prevalence, correlates and service utilization of schizophrenia-spectrum, affective, and other non-affective psychotic disorders in a representative sample of community-dwelling Chinese adult population aged 16-75 years (N = 5719) based on a territory-wide, population-based household survey for mental disorders in Hong Kong. The survey adopted a 2-phase design comprising first-phase psychosis screening and second-phase diagnostic verification incorporating clinical information from psychiatrist-administered semi-structured interview and medical record review to ascertain DSM-IV lifetime diagnosis for psychotic disorders. Data on sociodemographics, psychosocial characteristics and service utilization were collected. Our results showed that lifetime prevalence was 2.47% for psychotic disorder overall, 1.25% for schizophrenia, 0.15% for delusional disorder, 0.38% for psychotic disorder not otherwise specified, 0.31% for bipolar disorder with psychosis, and 0.33% for depressive disorder with psychosis. Schizophrenia-spectrum disorder was associated with family history of psychosis, cigarette smoking and variables indicating socioeconomic disadvantage. Victimization experiences were significantly related to affective psychoses and other non-affective psychoses. Around 80% of participants with any psychotic disorder sought some kind of professional help for mental health problems in the past year. Using comprehensive diagnostic assessment involving interview and record data, our results indicate that approximately 2.5% of Chinese adult population had lifetime psychotic disorder which represents a major public health concern.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, the University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong,To whom correspondence should be addressed; Department of Psychiatry, Queen Mary Hospital, Pokfulam, Hong Kong; tel: 852-22554486, fax: 852-28551345, e-mail:
| | | | - Eric Yu Hai Chen
- Department of Psychiatry, the University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Linda Chiu Wa Lam
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, the University of Hong Kong, Hong Kong
| | | | - Se Fong Hung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | | | - Pak Chung Sham
- Department of Psychiatry, the University of Hong Kong, Hong Kong,State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | | | - Ming Lam
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | | | - Tin Po Chiang
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | - Lap Kei Chan
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | | | | | | | | | - Joseph Tak Fai Lau
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University, Maastricht, Netherlands
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
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Mikhail MA, Mangioris G, Best RM, McGimpsey S, Chan WC. Management of giant retinal tears with vitrectomy and perfluorocarbon liquid postoperatively as a short-term tamponade. Eye (Lond) 2017; 31:1290-1295. [PMID: 28799563 PMCID: PMC5601443 DOI: 10.1038/eye.2017.157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/05/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeThe purpose of this study was to study outcomes after using perfluorocarbon liquid (PFCL) as a short-term postoperative vitreous substitute in eyes with retinal detachment from giant retinal tears (GRTs).Patients and methodsA retrospective consecutive case series of patients with retinal detachment from GRT, who underwent vitrectomy using PFCL as short-term postoperative retinal tamponade. PFCL was left in the eye for a mean of 6.7 days (range 7-8 days) and then replaced with gas or silicone oil (SO). The anatomical and functional outcomes and postoperative complications are reported.ResultsA total of 30 eyes of 29 patients with a follow-up of 26.8 months (range 9-55 months) were included. GRTs had a mean size of 150° (range 90°-270°) with 46.6% of eyes with a tear of >180°. Intraoperative retinal re-attachment was achieved in all cases. No cases of retinal slippage were recorded. Four eyes (13.3%) had re-detachment and further surgery required. At final review, 27 eyes (90.9%) had attached retinas, while the remaining 9.1% had SO in situ. The visual acuity improved in 70% of eyes with 41% improving at least 2 Snellen lines and 35% with visual acuity of 6/12 or better. Mild anterior uveitis developed in six eyes (20%), which resolved on topical steroids. Glaucoma developed in one eye and was controlled medically.ConclusionOur study supports the safety and efficacy of PFCL as a short-term postoperative tamponade in cases of GRTs. As it reduces retinal slippage, the use of SO as a primary tamponade decreased in significant proportion of cases.
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Affiliation(s)
- M A Mikhail
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
| | - G Mangioris
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
| | - R M Best
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
| | - S McGimpsey
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
| | - W C Chan
- Vitreoretinal Service, Ophthalmology Department, Royal Victoria Hospital, Belfast, UK
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Gnana Jothi V, McGimpsey S, Sharkey JA, Chan WC. Retinal detachment repair and cataract surgery in patients with atopic dermatitis. Eye (Lond) 2017; 31:1296-1301. [PMID: 28799561 DOI: 10.1038/eye.2017.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/22/2017] [Indexed: 12/28/2022] Open
Abstract
PurposeThe aim of this study is to report a case series of ocular complications including retinal detachment (RD) and cataract in atopic dermatitis (AD) and surgical management involving a majority of Caucasian patients.Patients and methodsThis study is an observational case series, originally designed as an audit. It involves detailed discussion of history, clinical features, and surgical management of patients presenting with retinal detachment and cataracts secondary to severe AD. Six consecutive patients with diagnosis of severe AD requiring posterior segment and cataract surgery were included in the study.ResultsEight eyes of six patients had retinal detachment. Most of them involved the temporal retina. The retinal breaks were located anteriorly close to the ora serrata in six eyes and Giant tear retinal (GRT) detachment was found in two eyes. Five eyes had proliferative vitreo-retinopathy (PVR) at presentation. All six patients had bilateral cataracts and cataract surgery was performed in eleven eyes. Bilateral simultaneous surgery was essential in two patients. Three eyes had secondary intra-ocular lens (IOL) implantation with pars plana vitrectomy for subluxed lens implant.ConclusionsAnterior retinal breaks and temporal RD are common in retinal detachment secondary to AD. PVR is often present, which makes surgical management difficult. Cataract formation is quite often and late subluxation of IOL may occur.
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Affiliation(s)
- V Gnana Jothi
- Department of Ophthalmolgy, Royal Victoria Hospital, Belfast, UK
| | - S McGimpsey
- Department of Ophthalmolgy, Royal Victoria Hospital, Belfast, UK
| | - J A Sharkey
- Department of Ophthalmolgy, Royal Victoria Hospital, Belfast, UK
| | - W C Chan
- Department of Ophthalmolgy, Royal Victoria Hospital, Belfast, UK
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Chan WC, Wong CS, Chen EY, Ng RM, Hung SF, Cheung EF, Sham PC, Chiu HF, Lam M, Chang WC, Lee EH, Chiang TP, Lau JT, van Os J, Lewis G, Bebbington P, Lam LC. Validation of the Chinese Version of the Revised Clinical Interview Schedule: Findings from Hong Kong Mental Morbidity Survey. East Asian Arch Psychiatry 2017; 27:3-10. [PMID: 28387207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aimed to assess the psychometric properties of the Chinese version of the Revised Clinical Interview Schedule (C-CIS-R), and explore its applicability as a diagnostic instrument for common mental disorders (CMDs) in Hong Kong. Its psychometric properties were evaluated among 140 patients and 161 healthy controls. In comparison to the diagnoses made by the Structured Clinical Interview for the DSM-IV, the C-CIS-R showed good criterion validity in diagnosing CMDs. The correlation of the total score of C-CIS-R with the 12-item General Health Questionnaire and Hospital Anxiety and Depression Scale was satisfactory, indicating favourable convergent validity as well. The inter-rater and test-retest reliability were also satisfactory. Receiver operating characteristic analyses suggested an optimal cut-off point of 11/12 for detecting diagnosable CMDs (sensitivity: 0.69; specificity: 0.93) and 17/18 for identifying a need for treatment (sensitivity: 0.70; specificity: 0.95). In conclusion, C-CIS-R is a valid diagnostic instrument for CMDs in a Chinese community. Its cut-off points for clinically significant symptoms and treatment needs among Chinese are identical to those adopted in the original English version.
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Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C Sm Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Yh Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - R Mk Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong SAR, China
| | - E Fc Cheung
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - P C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - H Fk Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Hm Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - T P Chiang
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - J Tf Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - P Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - L Cw Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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Sitt JCM, Ni SY, Tsoi VYK, Chan WC, Chau HHL. Giant Fibroadenoma Presenting as an Axillary Mass in a Young Renal Transplant Recipient on Long-term Cyclosporine A Therapy. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1615367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lee AT, Chan WC, Chiu HF, Richards M, Hui LY, Ng SP, Chan WM, Lam LC. Physical health and lifestyle predictors for significant cognitive impairment in community-dwelling Chinese older adults in Hong Kong. Hong Kong Med J 2016; 22 Suppl 6:37-39. [PMID: 27807316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- A Tc Lee
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - H Fk Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - M Richards
- MRC Unit for Lifelong Health and Ageing, UK
| | - L Yf Hui
- Elderly Health Service, Department of Health, Hong Kong
| | - S Ps Ng
- Elderly Health Service, Department of Health, Hong Kong
| | - W M Chan
- Elderly Health Service, Department of Health, Hong Kong
| | - L Cw Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
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Ma DY, Wong CHY, Leung GTY, Fung AWT, Chan WC, Lam LCW. Physical Exercise Helped to Maintain and Restore Functioning in Chinese Older Adults With Mild Cognitive Impairment: A 5-Year Prospective Study of the Hong Kong Memory and Ageing Prospective Study (HK-MAPS). J Am Med Dir Assoc 2016; 18:306-311. [PMID: 27876478 DOI: 10.1016/j.jamda.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study investigated the potential of physical exercise habit as a lifestyle modification against cognitive and functional decline at the community level. METHODS A total of 454 community-dwelling Chinese older adults without dementia participated in the Hong Kong Memory and Ageing Prospective Study at baseline and follow-up at 5 years. Their cognitive and functional performances were assessed by the Cantonese version of the Mini-Mental State Examination (CMMSE) and the Chinese version of Disability Assessment in Dementia (DAD). Hierarchical multiple regression analyses were performed to examine whether physical exercise was a significant predictor of the follow-up CMMSE and DAD scores after controlling for the covariates. Subgroup analyses were performed with a group of 127 participants with mild cognitive impairment at baseline. RESULTS Physical exercise habit was a significant predictor for both the follow-up CMMSE scores and DAD scores. Participants with exercise habits of 5 years or more showed better cognitive and functional performances at follow-up. Participants who picked up exercise habits only after the baseline assessment also demonstrated better functioning at follow-up. The same patterns were observed in the subgroup analyses with the mild cognitive impairment group. CONCLUSION Results suggested that prolonged exercise habit is required for positive effects on cognition to emerge, but benefits on functioning can be observed when individuals take up an exercise habit later in life or even after the beginning of cognitive decline. These findings are encouraging in promoting an exercise habit among older adults living in the community.
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Affiliation(s)
- Duan Yang Ma
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po, Hong Kong.
| | - Candy H Y Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Grace T Y Leung
- Department of Psychiatry, Tai Po Hospital, Tai Po, Hong Kong
| | - Ada W T Fung
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po, Hong Kong
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Chan WC, Lautenschlager N, Dow B, Ma SL, Wong CSM, Lam LCW. A home-based exercise intervention for caregivers of persons with dementia: study protocol for a randomised controlled trial. Trials 2016; 17:460. [PMID: 27655115 PMCID: PMC5031263 DOI: 10.1186/s13063-016-1582-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 08/27/2016] [Indexed: 12/23/2022] Open
Abstract
Background Family members, who provide the majority of care for persons with dementia, are especially vulnerable to developing depression. Interventions targeting their depressive symptoms have been proposed but their efficacies vary considerably. It has been suggested that interventions carried out in the home setting and involving both caregivers and care recipients are more efficacious. This study aims to compare the efficacy of a home-based structured exercise programme involving both persons with dementia and their caregivers with nonexercise social contact control in treating depression among caregivers. Methods/design This is a parallel-group, assessor-blind, randomised controlled trial. A total of 136 caregiver-care-recipient dyads (i.e. 272 participants in total) will be recruited and randomly allocated to either a home-based structured exercise (sitting Tai Chi) group or a social contact control group. The trial comprises a 3-month intervention phase followed by an extended observation phase of another 3 months. All participants will be assessed at baseline, 6th week, 12th week and 24th week. The primary outcome will be the reduction in depression among caregivers as measured by the Hamilton Rating Scale for Depression. The secondary outcomes will be burden, quality of life, cognitive performance and balance ability of the caregivers, as well as the neuropsychiatric symptoms, cognitive function, balance and functional abilities of the persons with dementia. We will also examine whether the brain-derived neurotrophic factor gene modulates mood changes in response to exercise. Discussion The findings offer a potential avenue of intervention by providing a low-cost, safe and effective treatment for depression among dementia caregivers, which may in turn also benefit the care recipients. Trial registration ClinicalTrials.gov Identifier: NCT02132039, registered on 28 April 2014.
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Affiliation(s)
- Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
| | - Nicola Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,NorthWestern Aged Mental Health, Royal Park Campus, Parkville, VIC, Australia.,School of Clinical Neurosciences and the Western Australia Centre and Health and Ageing, University of Western Australia, Perth, WA, Australia
| | - Briony Dow
- National Ageing Research Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Suk Ling Ma
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Tai Po, Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Linda Chiu Wa Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, Tai Po, Hong Kong
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Rohr J, Guo S, Huo J, Bouska A, Lachel C, Li Y, Simone PD, Zhang W, Gong Q, Wang C, Cannon A, Heavican T, Mottok A, Hung S, Rosenwald A, Gascoyne R, Fu K, Greiner TC, Weisenburger DD, Vose JM, Staudt LM, Xiao W, Borgstahl GEO, Davis S, Steidl C, McKeithan T, Iqbal J, Chan WC. Recurrent activating mutations of CD28 in peripheral T-cell lymphomas. Leukemia 2015; 30:1062-70. [PMID: 26719098 DOI: 10.1038/leu.2015.357] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/30/2015] [Accepted: 12/15/2015] [Indexed: 11/09/2022]
Abstract
Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of mature T-cell neoplasms with a poor prognosis. Recently, mutations in TET2 and other epigenetic modifiers as well as RHOA have been identified in these diseases, particularly in angioimmunoblastic T-cell lymphoma (AITL). CD28 is the major co-stimulatory receptor in T cells which, upon binding ligand, induces sustained T-cell proliferation and cytokine production when combined with T-cell receptor stimulation. We have identified recurrent mutations in CD28 in PTCLs. Two residues-D124 and T195-were recurrently mutated in 11.3% of cases of AITL and in one case of PTCL, not otherwise specified (PTCL-NOS). Surface plasmon resonance analysis of mutations at these residues with predicted differential partner interactions showed increased affinity for ligand CD86 (residue D124) and increased affinity for intracellular adaptor proteins GRB2 and GADS/GRAP2 (residue T195). Molecular modeling studies on each of these mutations suggested how these mutants result in increased affinities. We found increased transcription of the CD28-responsive genes CD226 and TNFA in cells expressing the T195P mutant in response to CD3 and CD86 co-stimulation and increased downstream activation of NF-κB by both D124V and T195P mutants, suggesting a potential therapeutic target in CD28-mutated PTCLs.
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Affiliation(s)
- J Rohr
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - S Guo
- Department of Pathology, Xi Jing Hospital, Fourth Military Medical University, Xi'an, Shaan Xi Province, China
| | - J Huo
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - A Bouska
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - C Lachel
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Y Li
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - P D Simone
- Internal Medicine Residency Program, Florida Atlantic University College of Medicine, Boca Raton, FL, USA
| | - W Zhang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Q Gong
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - C Wang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA.,School of Medicine, Shandong University, Jinan, China
| | - A Cannon
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - T Heavican
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - A Mottok
- Department for Lymphoid Cancer Research, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - S Hung
- Department for Lymphoid Cancer Research, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Rosenwald
- Institute of Pathology and Comprehensive Cancer Center Mainfranken (CCC MF), University of Wuerzburg, Wuerzburg, Germany
| | - R Gascoyne
- Department for Lymphoid Cancer Research, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - T C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - D D Weisenburger
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - J M Vose
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - L M Staudt
- National Institutes of Health, Bethesda, MD, USA
| | - W Xiao
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, Food and Drug Administration, Washington, DC, USA
| | - G E O Borgstahl
- Eppley Institute for Cancer Research and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Davis
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - C Steidl
- Department for Lymphoid Cancer Research, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T McKeithan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - J Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - W C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
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Cheng CPW, Chan SSM, Mak ADP, Chan WC, Cheng ST, Shi L, Wang D, Lam LCW. Would transcranial direct current stimulation (tDCS) enhance the effects of working memory training in older adults with mild neurocognitive disorder due to Alzheimer's disease: study protocol for a randomized controlled trial. Trials 2015; 16:479. [PMID: 26499250 PMCID: PMC4619532 DOI: 10.1186/s13063-015-0999-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/06/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There has been longstanding interesting in cognitive training for older adults with cognitive impairment. In this study, we will investigate the effects of working memory training, and explore augmentation strategies that could possibly consolidate the effects in older adults with mild neurocognitive disorder. Transcranial direct current stimulation (tDCS) has been demonstrated to affect the neuronal excitability and reported to enhance memory performance. As tDCS may also modulate cognitive function through changes in neuroplastic response, it would be adopted as an augmentation strategy for working memory training in the present study. METHODS/DESIGN This is a 4-week intervention double-blind randomized controlled trial (RCT) of tDCS. Chinese older adults (aged 60 to 90 years) with mild neurocognitive disorder due to Alzheimer's disease (DSM-5 criteria) would be randomized into a 4-week intervention of either tDCS-working memory (DCS-WM), tDCS-control cognitive training (DCS-CC), and sham tDCS-working memory (WM-CD) groups. The primary outcome would be working memory test - the n-back task performance and the Chinese version of the Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog). Secondary outcomes would be test performance of specific cognitive domains and mood. Intention-to-treat analysis would be carried out. Changes of efficacy indicators with time and intervention would be tested with mixed effect models. DISCUSSION This study adopts the theory of neuroplasticity to evaluate the potential cognitive benefits of non-invasive electrical brain stimulation, working memory training and dual stimulation in older adults at risk of cognitive decline. It would also examine the tolerability, program adherence and adverse effects of this novel intervention. Information would be helpful for further research of dementia prevention studies. TRIAL REGISTRATION ChiCTR-TRC- 14005036 Date of registration: 31 July 2014.
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Affiliation(s)
- Calvin P W Cheng
- Department of Psychiatry, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong.
| | - Sandra S M Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Rm G25, G/F, Multi-center, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong.
| | - Arthur D P Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Rm G25, G/F, Multi-center, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong.
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, 3/F, HKJC for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong.
| | - Sheung Tak Cheng
- Department of Health and Physical Education, Hong Kong Institute of Education, Rm D4-2/F-03, Block D4, 10 Lo Ping Road, Tai Po, NT, Hong Kong.
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F, Lui Che Woo Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong.
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
| | - Linda Chiu-Wa Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Rm G25, G/F, Multi-center, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong.
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Abstract
Metholodogy This study examined the prevalence and correlates of mental illness in homeless people in Hong Kong and explored the barriers preventing their access to health care. Ninety-seven Cantonese-speaking Chinese who were homeless during the study period were selected at random from the records of the three organisations serving the homeless population. The response rate was 69%. Seventeen subjects could not give valid consent due to their poor mental state, so their responses were excluded from the data analysis. A psychiatrist administered the Structured Clinical Interview for DSM-IV Axis-I disorders (SCID-I) and the Mini -Mental State Examination. Consensus diagnoses for subjects who could not complete the SCID-I were established by three independent psychiatrists. Findings The point prevalence of mental illness was 56%. Seventy-one percent of the subjects had a lifetime history of mental illness, 30% had a mood disorder, 25% had an alcohol use disorder, 25% had a substance use disorder, 10% had a psychotic disorder, 10% had an anxiety disorder and 6% had dementia. Forty-one percent of the subjects with mental illness had undergone a previous psychiatric assessment. Only 13% of the subjects with mental illness were receiving psychiatric care at the time of interview. The prevalence of psychotic disorders, dementia and the rate of under treatment are hugely underestimated, as a significant proportion (18%) of the subjects initially selected were too ill to give consent to join the study. Conclusion The low treatment rate and the presence of this severely ill and unreached group of homeless people reflect the fact that the current mode of service delivery is failing to support the most severely ill homeless individuals.
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Affiliation(s)
- Larina Chi-Lap Yim
- Department of Psychiatry, Prince of Wales Hospital, Shatin, Hong Kong
- * E-mail:
| | | | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Marco Ho-Bun Lam
- Department of Psychiatry, Prince of Wales Hospital, Shatin, Hong Kong
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Ho RTH, Cheung JKK, Chan WC, Cheung IKM, Lam LCW. A 3-arm randomized controlled trial on the effects of dance movement intervention and exercises on elderly with early dementia. BMC Geriatr 2015; 15:127. [PMID: 26481870 PMCID: PMC4615324 DOI: 10.1186/s12877-015-0123-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background Dementia is characterized by a progressive decline and deterioration of brain regions such as memory, spatial navigation and language, along with disturbances in daily functioning. Non-pharmacological interventions that offer a holistic approach by targeting cognitive functioning, prognosis and the psychological and social effects of dementia require rigorous investigation. The well-established benefits of physical activity for cognitive functioning and psychological support in dementia have been observed with dance-movement intervention. There is substantial evidence that dance-movement interventions provide emotional and social advantages. Thus, a randomized controlled trial (RCT) is planned to investigate the positive effects of a dance movement intervention, compared with mild physical exercise, on the physical and psychological well-being of elderly Chinese individuals with early dementia. Methods/Design A 3-arm RCT with waitlist control design will be used in this study. Two hundred and one elderly participants with very mild to mild dementia will be screened and randomized into the following groups: (i) dance movement based intervention, (ii) stretching and exercise intervention and (iii) no intervention waitlist-control group. The two intervention groups will receive a 1-h intervention, twice a week, for 12 weeks. The participants will be assessed four times over the course of 12 months: baseline before randomization, post-intervention (3 months), 6 months from baseline and 12 months from baseline. The primary outcomes will be compared between assessment points and between groups on neuropsychiatric symptoms, psychosocial well-being and cognitive and daily functioning. Secondary outcomes will assess the changes in salivary cortisol levels and their relationships with the primary outcome measures. Discussion This study will provide substantial evidence of the efficacy of a dance-movement-based intervention in slowing down dementia progression, due to its ability to act as a buffer against decline and improve areas affected by dementia. We also anticipate an association between cortisol levels and the outcome measures. The further development of this intervention into a structural program may be warranted for early psychosocial support among elderly populations. Trial registration The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR-IOR-15006541).
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Affiliation(s)
- Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China. .,Department of Social Work and Social Administration, The University of Hong Kong, Room 534, Jockey Club Tower, Centennial Campus, Hong Kong, China. .,Sau Po Centre on Aging, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Jacob Kai Ki Cheung
- Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, 2/F, New Clinical Building, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
| | - Irene Kit Man Cheung
- Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Linda Chiu Wah Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, G/F Multicentre, Tai Po, Hong Kong, China.
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50
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Chan WC, Chow PPL, Lam LCW, Hung SF, Cheung EFC, Dunn ELW, Ng RMK, Fu JCK. Pathway of psychiatric care in Hong Kong. Hong Kong Med J 2015; 21 Suppl 2:41-44. [PMID: 25852102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - P P L Chow
- Department of Old Age Psychiatry, Castle Peak Hospital
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital
| | - E F C Cheung
- Department of General Adult Psychiatry, Castle Peak Hospital
| | - E L W Dunn
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital
| | - R M K Ng
- Department of Psychiatry, Kowloon Hospital
| | - J C K Fu
- Department of General Adult Psychiatry, Castle Peak Hospital
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