A Pilot Study of Short-Course Oral Vitamin A and Aerosolised Diffuser Olfactory Training for the Treatment of Smell Loss in Long COVID

Background: Olfactory dysfunction (OD) is a common neurosensory manifestation in long COVID. An effective and safe treatment against COVID-19-related OD is needed. Methods: This pilot trial recruited long COVID patients with persistent OD. Participants were randomly assigned to receive short-course (14 days) oral vitamin A (VitA; 25,000 IU per day) and aerosolised diffuser olfactory training (OT) thrice daily (combination), OT alone (standard care), or observation (control) for 4 weeks. The primary outcome was differences in olfactory function by butanol threshold tests (BTT) between baseline and end-of-treatment. Secondary outcomes included smell identification tests (SIT), structural MRI brain, and serial seed-based functional connectivity (FC) analyses in the olfactory cortical network by resting-state functional MRI (rs-fMRI). Results: A total of 24 participants were randomly assigned to receive either combination treatment (n = 10), standard care (n = 9), or control (n = 5). Median OD duration was 157 days (IQR 127-175). Mean baseline BTT score was 2.3 (SD 1.1). At end-of-treatment, mean BTT scores were significantly higher for the combination group than control (p < 0.001, MD = 4.4, 95% CI 1.7 to 7.2) and standard care (p = 0.009) groups. Interval SIT scores increased significantly (p = 0.009) in the combination group. rs-fMRI showed significantly higher FC in the combination group when compared to other groups. At end-of-treatment, positive correlations were found in the increased FC at left inferior frontal gyrus and clinically significant improvements in measured BTT (r = 0.858, p < 0.001) and SIT (r = 0.548, p = 0.042) scores for the combination group. Conclusions: Short-course oral VitA and aerosolised diffuser OT was effective as a combination treatment for persistent OD in long COVID.

Preterm postnatal complications and risk of attention-deficit/hyperactivity disorder

AIM

To investigate the association between the risk of attention-deficit/hyperactivity disorder (ADHD) and preterm birth and determine how postnatal complications in children born preterm is associated with the risk of ADHD.

METHOD

This population-based cohort study used data from the Hong Kong electronic medical records. We followed 359 614 children (48% female; 6-17 years old, mean 11 years 7 months, SD 3 years 2 months) born in public hospitals in Hong Kong from 1st January 2004 to 31st December 2014 and collected medical records and demographic details for mothers and children until 11th November 2020.

RESULTS

The risk of ADHD was 4.0% in children born at term and 5.1% in children born preterm. The odds ratio for ADHD was 2.08 (95% confidence interval [CI] 1.64-2.64) for children born extremely preterm, 1.64 (95% CI 1.46-1.85) for children born very preterm, and 1.15 (95% CI 1.08-1.23) for children born late preterm. Among preterm postnatal complications, only early respiratory disease, retinopathy of prematurity (ROP), and intraventricular haemorrhage were significant predictors of ADHD after controlling for preterm birth, other risk factors, and sociodemographic variables. The excess risk of ADHD among children born very preterm or late preterm could be partly explained by respiratory disease. ROP partially mediated the risk of ADHD in children born very preterm.

INTERPRETATION

Children born preterm in all subcategories, from extremely preterm to late preterm, have increased risk of ADHD. Early respiratory infection partially mediates the risk of ADHD in children born preterm.

Disrupted daily routines mediate the socioeconomic gradient of depression amid public health crises: A repeated cross-sectional study

OBJECTIVE

There is a socioeconomic gradient to depression risks, with more pronounced inequality amid macroenvironmental potential traumatic events. Between mid-2019 and mid-2020, the Hong Kong population experienced drastic societal changes, including the escalating civil unrest and the COVID-19 pandemic. We examined the change of the socioeconomic gradient in depression and the potential intermediary role of daily routine disruptions.

METHOD

We conducted repeated territory-wide telephone surveys in July 2019 and July 2020 with 1112 and 2034 population-representative Cantonese-speaking Hong Kong citizens above 15 years old, respectively. Stratified by year, we examined the association between socioeconomic indicators (education attainment, household income, employment status and marital status) and probable depression (nine-item Patient Health Questionnaire [PHQ-9] ⩾ 10) using logistic regression. Differences in the socioeconomic gradient between 2019 and 2020 were tested. Finally, we performed a path analysis to test for the mediating role of daily routine disruptions.

RESULTS

Logistic regression showed that higher education attainment in 2019 and being married in 2020 were protective against probable depression. Interaction analysis showed that the inverse association of higher education attainment with probable depression attenuated in 2020 but that of being married increased. Path analysis showed that the mediated effects through daily routine disruptions accounted for 95.9% of the socioeconomic gradient of probable depression in 2020, compared with 13.1% in 2019.

CONCLUSION

From July 2019 to July 2020, the mediating role of daily routine disruptions in the socioeconomic gradient of depression in Hong Kong increased. It is thus implied that infection control measures should consider the relevant potential mental health impacts accordingly.

Trends of depression and anxiety during massive civil unrest and COVID-19 in Hong Kong, 2019-2020

Both COVID-19 and unrest are posing a significant threat to population mental health across the globe. This study examined trends of probable depression and anxiety during a time of civil unrest and concurrent COVID-19 in Hong Kong. Four random digit dialing telephone surveys were conducted in July 2019 (n = 1112), February-March 2020 (n = 2003), April-May 2020 (n = 2008), and July-August 2020 (n = 2034). The prevalence of probable depression increased from 25.7% (95% CI: 23.2-28.3) in July 2019 to 28.2% (95% CI: 26.2-30.1) in February-March 2020, and then decreased to 15.3% (95% CI: 14.0-17.0) in April-May 2020 and 13.7% (95% CI: 12.2-15.2) in July-August 2020. The prevalence of probable anxiety was 19.2% (95% CI: 17.5-20.9) in February-March 2020 and then stabilized in April-May 2020 and July-August 2020 (14.1%, 95% CI: 12.0-15.8). Probable depression and anxiety were more prevalent among persons with high relative to low daily routine disruptions. Combined high unrest-COVID-19 stress was associated with probable depression and anxiety across all persons; high unrest stress alone was associated with probable mental disorders at high daily routine disruptions. Civil unrest and COVID-19 are jointly associated with depression and anxiety among Hong Kong citizens. While population mental health improved, daily routine disruptions is a risk factor of mental disorders at every time-point.

Greater white matter hyperintensities and the association with executive function in suicide attempters with late-life depression

Late-life depression (LLD) is associated with greater risk of suicide and white matter hyperintensities (WMH), which are also found in suicide attempters regardless of age. Greater periventricular WMH are related to worse cognitive function. We investigated the spatial distribution of WMH in suicide attempters with LLD and its association with cognitive function. We recruited 114 participants with LLD (34 with history of suicide attempt and 80 without) and 47 older adult controls (individuals without LLD or history of suicide attempt). WMH were quantified by an automated segmentation algorithm and were classified into different regions. Suicide attempters with LLD had significantly higher global WMH (F3, 150 = 2.856, p = 0.039) and periventricular WMH (F3, 150 = 3.635, p = 0.014) compared to other groups. Suicide attempters with high WMH had significantly lower executive function, which could be an underlying mechanism for cognitive decline in older adults with suicidality.

Civil unrest, COVID-19 stressors, anxiety, and depression in the acute phase of the pandemic: a population-based study in Hong Kong

PURPOSE

To examine the joint associations of civil unrest and COVID-19 with probable anxiety and depression during the first half of 2020 in Hong Kong. Associations were compared between persons with low or high assets.

METHODS

A population-representative sample of 4011 Hong Kong Chinese residents aged 15 years or older were recruited between February and May 2020. Respondents reported current anxiety and depressive symptoms, unrest stress, COVID-19 stress, assets (savings and home ownership), and demographics.

RESULTS

Stress due to unrest and COVID-19 was associated with higher prevalence of probable anxiety and depression; persons with both stressors had higher prevalence. This pattern was consistent among persons with low or high assets, but the probabilities of mental disorder were substantially higher among persons with fewer assets.

CONCLUSIONS

The effect of stressors on probable anxiety and depression are cumulative: persons with stress due to civil unrest and to COVID-19 reported more mental disorders than persons with stress due to only one, or none of these factors. Overall high assets appear to buffer the consequences of stressors, lowering the risk of mental disorder.

Depression Scale Prediction with Cross-Sample Entropy and Deep Learning

A two-stage deep learning-based scheme is presented to predict the Hamilton Depression Scale (HAM-D) in this study. First, the cross-sample entropy (CSE) that allows assessing the degree of similarity of two data series are evaluated for the 90 brain regions of interest partitioned according to Automated Anatomical Labeling. The obtained CSE maps are then converted to 3D CSE volumes to serve as the inputs to the deep learning network models for the HAM-D scale level classification and prediction. The efficacy of the proposed scheme was illustrated by the resting-state functional magnetic resonance imaging data from 38 patients. From the results, the root mean square errors for the HAM-D scale prediction obtained during training, validation, and testing were 2.73, 2.66, and 2.18, which were less than those of a scheme having only a regression stage.

Cognitive Reserve Moderates Effects of White Matter Hyperintensity on Depressive Symptoms and Cognitive Function in Late-Life Depression

INTRODUCTION

White matter hyperintensity (WMH) has been regarded as one of the major contributor of the vascular hypothesis of late-life depression (LLD) and cognitive decline in the elderly. On the other hand, cognitive reserve (CR) has long been hypothesized to provide resilience and adaptability against age- and disease-related insults. This study examined the role of CR, using proxy of education, in moderating the association between WMH and clinical LLD expression.

METHODS

A total of 54 elderly diagnosed with major depressive disorder and 38 matched healthy controls participated in this study. They received MRI scanning and a battery of neuropsychological tests. WMH was quantified by an automated segmentation algorithm. Linear regression analyses were conducted separately in the LLD and control groups to examine the effects of WMH, education and their interaction in depression severity and various cognitive domains.

RESULTS

WMH was significantly and negatively associated with executive function only in the healthy controls. In patients with LLD, we observed a significant interactive effect in education on the association between WMH and depression severity and language domain (category fluency task). Specifically, those with high education showed less depressive symptoms and cognitive decline as WMH increased.

CONCLUSION

WMH is associated with lower cognitive function. However, in patients with LLD, high education attenuates the deleterious effect of WMH on mood and cognition. Therefore, CR appears to exert a protective effect on neurocognitive functioning in people with LLD.

Safety and efficacy of Cerebrolysin in acute brain injury and neurorecovery: CAPTAIN I-a randomized, placebo-controlled, double-blind, Asian-Pacific trial

OBJECTIVE

To evaluate the safety and efficacy of Cerebrolysin as an add-on therapy to local standard treatment protocol in patients after moderate-to-severe traumatic brain injury.

METHODS

The patients received the study medication in addition to standard care (50 mL of Cerebrolysin or physiological saline solution daily for 10 days, followed by two additional treatment cycles with 10 mL daily for 10 days) in a prospective, randomized, double-blind, placebo-controlled, parallel-group, multi-centre phase IIIb/IV trial. The primary endpoint was a multidimensional ensemble of 14 outcome scales pooled to be analyzed by means of the multivariate, correlation-sensitive Wei-Lachin procedure.

RESULTS

In 46 enrolled TBI patients (Cerebrolysin 22, placebo 24), three single outcomes showed stand-alone statistically significant superiority of Cerebrolysin [Stroop Word/Dots Interference (p = 0.0415, Mann-Whitney(MW) = 0.6816, 95% CI 0.51-0.86); Color Trails Tests 1 and 2 (p = 0.0223/0.0170, MW = 0.72/0.73, 95% CI 0.53-0.90/0.54-0.91), both effect sizes lying above the benchmark for "large" superiority (MW > 0.71)]. While for the primary multivariate ensemble, statistical significance was just missed in the intention-to-treat population (p_Wei-Lachin < 0.1, MW_combined = 0.63, 95% CI 0.48-0.77, derived standardized mean difference (SMD) 0.45, 95% CI -0.07 to 1.04, derived OR 2.1, 95% CI 0.89-5.95), the per-protocol analysis showed a statistical significant superiority of Cerebrolysin (p_Wei-Lachin = 0.0240, MW_combined = 0.69, 95% CI 0.53 to 0.85, derived SMD 0.69, 95% CI 0.09 to 1.47, derived OR 3.2, 95% CI 1.16 to 12.8), with effect sizes of six single outcomes lying above the benchmark for "large" superiority. Safety aspects were comparable to placebo.

CONCLUSION

Our trial suggests beneficial effects of Cerebrolysin on outcome after TBI. Results should be confirmed by a larger RCT with a comparable multidimensional approach.

Increased brain entropy of resting-state fMRI mediates the relationship between depression severity and mental health-related quality of life in late-life depressed elderly

BACKGROUND

Entropy analysis is a computational method used to quantify the complexity in a system, and loss of brain complexity is hypothesized to be related to mental disorders. Here, we applied entropy analysis to the resting-state functional magnetic resonance imaging (rs-fMRI) signal in subjects with late-life depression (LLD), an illness combined with emotion dysregulation and aging effect.

METHODS

A total of 35 unremitted depressed elderly and 22 control subjects were recruited. Multiscale entropy (MSE) analysis was performed in the entire brain, 90 automated anatomical labeling-parcellated ROIs, and five resting networks in each study participant.

LIMITATIONS

Due to ethical concerns, all the participants were under medication during the study.

RESULTS

Regionally, subjects with LLD showed decreased entropy only in the right posterior cingulate gyrus but had universally increased entropy in affective processing (putamen and thalamus), sensory, motor, and temporal nodes across different time scales. We also found higher entropy in the left frontoparietal network (FPN), which partially mediated the negative correlation between depression severity and mental components of the quality of life, reflecting the possible neural compensation during depression treatment.

CONCLUSION

MSE provides a novel and complementary approach in rs-fMRI analysis. The temporal-spatial complexity in the resting brain may provide the adaptive variability beneficial for the elderly with depression.

Comparing the Effects of Mindfulness-Based Cognitive Therapy and Sleep Psycho-Education with Exercise on Chronic Insomnia: A Randomised Controlled Trial

BACKGROUND

Mindfulness-based cognitive therapy (MBCT) is a potential treatment for chronic insomnia. We evaluated the efficacy of MBCT for insomnia (MBCT-I) by comparing it with a sleep psycho-education with exercise control (PEEC) group.

METHODS

Adults with chronic primary insomnia (n = 216) were randomly allocated to the MBCT-I or PEEC group. The MBCT-I included mindfulness and psycho-education with cognitive and behavioural components under cognitive behavioural therapy for insomnia. PEEC included psycho-education of sleep hygiene and stimulus control, and exercises. Any change in insomnia severity was measured by the Insomnia Severity Index (ISI). Secondary outcomes included sleep parameters measured by a sleep diary, health service utilisation, absence from work and mindfulness measured by the Five Facet Mindfulness Questionnaire.

RESULTS

The ISI score significantly decreased in the MBCT-I group compared with the PEEC group at 2 months (i.e., post-intervention) (p = 0.023, effect size [95% CI] -0.360 [-0.675, -0.046]) but not at 5 or 8 months. Treatment response rates and remission rates based on the ISI cut-off scores were not significantly different between groups. Wake time after sleep onset (WASO) was less in the MBCT-I group at 2 and 5 months. At 8 months, both groups showed a reduced ISI score, sleep onset latency and WASO, and increased sleep efficiency and total sleep time; however, no group differences were seen. Other outcome measures did not significantly improve in either group.

CONCLUSIONS

Long-term benefits were not seen in MBCT-I when compared with PEEC, although short-term benefits were seen.

Parental restriction reduces the harmful effects of in-bedroom electronic devices

OBJECTIVE

To investigate whether school readiness could be affected by placing electronic devices (EDs) in children's bedroom and whether the relationship was moderated by parental restriction and family socioeconomic status (SES).

DESIGN

This is a cross-sectional study with bedroom ED placement and parental restriction reported by parents. Multiple linear regressions were used to test the relationship between school readiness and ED placement. Multiple regression with interaction terms were used to test whether the effect was consistent with and without parental restriction.

SETTING

Kindergartens randomly selected from two districts of different socioeconomic backgrounds in Hong Kong, China.

PATIENTS

556 young children attending the third year of kindergarten.

MAIN OUTCOME MEASURES

Children's school readiness was rated by teachers using the Chinese Early Development Instrument.

RESULTS

556 preschoolers (mean age 5.46; 51.8% girls) from 20 kindergartens participated in this study. About 30% of parents placed at least one ED in their children's bedroom. After controlling for sex and SES, the placement of television in the bedroom was associated with lower overall school readiness (β -1.11, 95% CI -1.80 to -0.42) and the placement of game console was associated with lower social competence (β-0.94, 95% CI -1.74 to -0.15). Such harmful effect was more prominent among lower SES families and could be partially alleviated with parental restriction.

CONCLUSION

ED placement in children's bedroom was associated with lower school readiness, particularly among lower SES families. Parental restriction might help to alleviate the harm.

Complexity analysis of resting state fMRI signals in depressive patients

Analysis of brain signal complexity reveals the intrinsic network dynamics and is widely utilized in the investigation of mechanisms in mental disorders. In this study, the complexity of resting-state functional magnetic resonance imaging (fMRI) signals was explored in patients with depression using multiscale entropy (MSE). Thirty-five patients diagnosed with depression and 22 age- and gender-matched healthy controls were considered. The MSE profiles in five brain networks of the two participant groups were evaluated and analyzed. The results showed that depressive patients exhibited higher complexity in the left frontoparietal network than that seen in healthy controls, which is known to be critical for executive control functions. Through this study, the efficacy of MSE in identifying and understanding the mental disorders was also demonstrated.

Loneliness in late-life depression: structural and functional connectivity during affective processing

BACKGROUND

Late-life depression (LLD) in the elderly was reported to present with emotion dysregulation accompanied by high perceived loneliness. Previous research has suggested that LLD is a disorder of connectivity and is associated with aberrant network properties. On the other hand, perceived loneliness is found to adversely affect the brain, but little is known about its neurobiological basis in LLD. The current study investigated the relationships between the structural connectivity, functional connectivity during affective processing, and perceived loneliness in LLD.

METHOD

The current study included 54 participants aged >60 years of whom 31 were diagnosed with LLD. Diffusion tensor imaging (DTI) data and task-based functional magnetic resonance imaging (fMRI) data of an affective processing task were collected. Network-based statistics and graph theory techniques were applied, and the participants' perceived loneliness and depression level were measured. The affective processing task included viewing affective stimuli.

RESULTS

Structurally, a loneliness-related sub-network was identified across all subjects. Functionally, perceived loneliness was related to connectivity differently in LLD than that in controls when they were processing negative stimuli, with aberrant networking in subcortical area.

CONCLUSIONS

Perceived loneliness was identified to have a unique role in relation to the negative affective processing in LLD at the functional brain connectional and network levels. The findings increas our understanding of LLD and provide initial evidence of the neurobiological mechanisms of loneliness in LLD. Loneliness might be a potential intervention target in depressive patients.

Neural mediator of the schizotypy-antisocial behavior relationship

Prior studies have established that schizotypal personality traits (schizotypy) were associated with antisocial behavior (crime), but it is unclear what neural factors mediate this relationship. This study assessed the mediating effect that sub-regional prefrontal gray, specifically the orbitofrontal gray matter volume, has on the schizotypy-antisocial behavior relationship. Five prefrontal sub-regional (superior, middle, inferior, orbitofrontal and rectal gyral) gray matter volumes were assessed using structural magnetic resonance imaging in 90 adults from the community, together with schizotypy and antisocial behavior. Among all five prefrontal sub-regions, the orbitofrontal cortex (OFC) was the major region-of-interest in the present study. Mediation analyses showed that orbitofrontal gray fully mediated the association between schizotypy and antisocial behavior. After having controlled the sex, age, socio-economic statuses, whole brain volumes and substance abuse/dependence of test subjects, the orbitofrontal gray still significantly mediated the effect of schizotypy on antisocial behavior by 53.5%. These findings are the first that document a neural mediator of the schizotypy-antisocial behavior relationship. Findings also suggest that functions subserved by the OFC, including impulse control and inhibition, emotion processing and decision-making, may contribute to the above comorbidity.

Heroin abuse accelerates biological aging: a novel insight from telomerase and brain imaging interaction

Heroin abuse and natural aging exert common influences on immunological cell functioning. This observation led to a recent and untested idea that aging may be accelerated in abusers of heroin. We examined this claim by testing whether heroin use is associated with premature aging at both cellular and brain system levels. A group of abstinent heroin users (n=33) and matched healthy controls (n=30) were recruited and measured on various biological indicators of aging. These measures included peripheral blood telomerase activity, which reflects cellular aging, and both structural and functional measures of brain magnetic resonance imaging. We found that heroin users were characterized by significantly low telomerase activity (0.21 vs 1.78; 88% reduction; t(61)=6.96, P<0.001; 95% confidence interval=1.12-2.02), which interacted with heroin use to affect the structural integrity of gray and white matter of the prefrontal cortex (PFC; AlphaSim corrected P<0.05), a key brain region implicated in aging. Using the PFC location identified from the structural analyses as a 'seed' region, it was further revealed that telomerase activity interacted with heroin use to impact age-sensitive brain functional networks (AlphaSim corrected P<0.05), which correlated with behavioral performance on executive functioning, memory and attentional control (Pearson correlation, all P<0.05). To our knowledge, this study is the first to attempt a direct integration of peripheral molecular, brain system and behavioral measures in the context of substance abuse. The present finding that heroin abuse is associated with accelerated aging at both cellular and brain system levels is novel and forms a unique contribution to our knowledge in how the biological processes of drug abusers may be disrupted.

Increased prospective memory interference in normal and pathological aging: different roles of motor and verbal processing speed

This is a study on prospective memory (PM) and the PM interference effect in normal and pathological aging. One hundred and seven subjects, including 41 healthy young adults, 40 non-demented older adults and 26 patients with mild Alzheimer's disease (AD) participated in this study using a laboratory event-based PM task. PM task performance was comparable between the non-demented older and young adults, but impaired in the AD patients. The PM interference effect increased progressively from the healthy young adults, the non-demented older adults, to the AD patients. Path analysis revealed that the possible mechanism mediating the increased PM interference was the slow motor processing speed in normal aging, while it was the slow verbal speed in pathological aging. It is suggested that different neuropsychological mechanisms may underpin the affected performance of PM task in normal and pathological aging.

Mental imagery for relearning of people after brain injury

OBJECTIVE

This paper reported on the application of mental imagery to the relearning of daily task performance in people with brain injury.

METHOD

The changes in two subjects who had suffered from cerebral infarction shown throughout a 3-week mental imagery programme were described. The subjects' improvement in task performance and other clinical outcomes illustrated the programme's therapeutic effects on skill relearning, maintenance and generalization.

RESULTS

After completing the programme, the subjects showed improvements in performance at both the trained and untrained tasks. Feedback from the patients also suggested its ability to enhance their day-to-day functioning. Clinical assessment results indicated that the subjects experienced an increase in the attention and sequential processing functions but not in the motor and other cognitive functions.

CONCLUSION

Mental imagery appears to be effective at enhancing the task relearning of subjects after brain injury. The skills acquired under this treatment regime can be retained and then generalized to other tasks. Its therapeutic effect is probably mediated by the improved attention and planning and execution functions associated with the rehearsal. Further research should conduct clinical controlled trials to gather evidence on its efficacy at promoting functional regain in people suffering from neurological disorders.

Neural correlates of attention biases of people with major depressive disorder: a voxel-based morphometric study

BACKGROUND

Patients with major depressive disorder are found to show selective attention biases towards mood-congruent information. Although previous studies have identified various structural changes in the brains of these patients, it remains unclear whether the structural abnormalities are associated with these attention biases. In this study, we used voxel-based morphometry (VBM) to explore the structural correlates of attention biases towards depression-related stimuli.

METHOD

Seventeen female patients with major depressive disorder and 17 female healthy controls, matched on age and intelligence, underwent magnetic resonance imaging (MRI). They also performed positive-priming (PP) and negative-priming (NP) tasks involving neutral and negative words that assessed selective attention biases. The reaction time (RT) to a target word that had been attended to or ignored in a preceding trial was measured on the PP and NP tasks respectively. The structural differences between the two groups were correlated with the indexes of attention biases towards the negative words.

RESULTS

The enhanced facilitation of attention to stimuli in the PP task by the negative valence was only found in the depressed patients, not in the healthy controls. Such attention biases towards negative stimuli were found to be associated with reduced gray-matter concentration (GMC) in the right superior frontal gyrus, the right anterior cingulate gyrus and the right fusiform gyrus. No differential effect in inhibition of attention towards negative stimuli in the NP task was found between the depressed patients and the healthy controls.

CONCLUSIONS

Specific structural abnormalities in depression are associated with their attention biases towards mood-congruent information.

Ageing and psychological response during the post-SARS period

We studied the psychological impact of the outbreak of Severe Acute Respiratory Syndrome (SARS) to understand if age and residential location were risk factors associated with post-traumatic disturbance, namely intrusion, avoidance, and hyperarousal. One hundred and forty-six volunteers belonging to four groups classified along the dimensions of age (middle-aged versus older-aged) and location (high SARS-prevalent regions versus low SARS-prevalent regions), participated in this study. After controlling for depression, residents in high SARS-prevalent regions, regardless of age, consistently developed more intense post-traumatic disturbance than residents in low SARS-prevalent regions. Furthermore, the prevalence of probable post-traumatic stress disorder (PTSD) cases was significantly higher in older people and in residents of SARS-prevalent regions. Our findings suggest the importance of mental health aftercare in the post-epidemic period of disease epidemics.

Neural activities associated with emotion recognition observed in men and women

Previous studies have suggested that men and women process emotional stimuli differently. In this study, we examined if there would be any consistency in regions of activation in men and women when processing stimuli portraying happy or sad emotions presented in the form of facial expressions, scenes, and words. A blocked design BOLD functional magnetic resonance imaging paradigm was employed to monitor the neural activities of male and female healthy volunteers while they were presented with the experimental stimuli. The imaging data revealed that the right insula and left thalamus were consistently activated for men, but not women, during emotion recognition of all forms of stimuli studied. To further understand the imaging data acquired, we conducted the protocol analysis method to identify the cognitive processes engaged while the men and women were viewing the emotional stimuli and deciding whether they were happy or sad. The findings suggest that men rely on the recall of past emotional experiences to evaluate current emotional experiences. This may explain why the insula, a structure important for self-induced or internally generated recalled emotions, was consistently activated in men while processing emotional stimuli. Our findings suggest possible gender-related neural responses to emotional stimuli.

Differential age-related change of prose memory in older Hong Kong Chinese of higher and lower education

BACKGROUND

Memory difficulty is one of the most common complaints of older people, with or without psychiatric conditions. It is therefore of utmost important to understand how normal ageing process impacts upon prose memory so as to gain insight into ways to differentiate pathological vs normal age-related changes of the recall of prose observed among older people.

OBJECTIVES

To understand the differential age-related change of prose memory in older Hong Kong Chinese of higher and lower education.

METHOD

Forty-eight normal, healthy Cantonese-speaking Chinese were recruited. Seventeen of them were younger, highly educated participants. Among the 31 older people recruited, 19 of them received education comparable with the younger participants and 12 were older people of low education. A prose passage was constructed to measure the different processes of prose memory, including learning efficiency, rate of forgetting, recall accuracy, accuracy of temporal sequence of information recalled, distortions, and recognition memory.

RESULTS

As expected, ageing affected all the processes of prose memory measured, except the rate of forgetting. Apart from learning efficiency and rate of forgetting, education was observed to modify the effect of ageing on all the processes studied.

CONCLUSIONS

Changes of prose memory associated with ageing and the differential effect of education on prose recall among older people were discussed. The findings seem to suggest that prose memory is a multifaceted construct.

Self-regulatory learning and generalization for people with brain injury

PRIMARY OBJECTIVE

brain injury can result in the loss of previous learnt behaviours that affect an individual's daily functioning. The use of self-regulation helps the individual to relearn the lost behaviours by bringing him/her to self-conscious level through independent and reflective learning derived using a social cognitive perspective. The purpose of this paper is to report on clinical observations made with the use of self-regulation in people with brain injury during the relearning of lost functions.

METHODS AND PROCEDURES

daily tasks were used to assess the relearning ability of the subjects pre- and post-programme.

EXPERIMENTAL INTERVENTION

one-week self-regulatory training on five selected daily tasks.

MAIN OUTCOMES AND RESULTS

these provisory observations would suggest that, with specific guidance for people with different needs, such as with impaired cognitive function and depression, self-regulation is effective in enhancing their relearning.

CONCLUSION

Self-regulatory training is effective in enhancing the relearning of lost functions.

[Factors affecting the cognitive status of people with epilepsy]

INTRODUCTION

Epilepsy is a devastating neurological disorder affecting the neuropsychological functioning of the sufferers.

AIM AND DEVELOPMENT

This paper reviews the crucial factors associated with the cognitive status of people with epilepsy. These factors include seizure type and other medical variables such as age of onset, seizure frequency, and seizure history. The effect of these factors on the cognitive functioning of people with epilepsy is reviewed and discussed. Future directions of studies on this topic are also discussed.