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Previous research on art therapy (AT) in cognitive aging has been lacking. AT can potentially engender significant cognitive gains, due to its rigorous cognitive involvement, making it useful to tackle age-related cognitive decline. Along with these cognitive gains, associated neuroplastic changes are hypothesized to arise from AT as well. The current intervention examined the effects of an AT intervention on cognitive outcomes and cortical thickness (CT) among participants with mild cognitive impairment.
Participants were assigned to AT (n = 22) and an active control group (n = 27). In both, weekly 45-min sessions were carried out across 3 months. Cognitive assessments and structural magnetic resonance imaging scans were carried out at baseline and 3-month follow-up. Whole brain analyses on CT were carried out. Cognitive outcomes were analyzed using hierarchical linear models.
Significant gains in immediate memory and working memory span were observed in the AT group, relative to the control group. Significantly increased CT in the AT group, relative to controls, was observed in a right middle frontal gyrus (MFG) cluster. Furthermore, CT changes in this cluster were significantly and positively correlated with changes in immediate memory.
These findings highlighted the role of MFG neuroplasticity in enhancing certain cognitive functions in AT. AT is a neuroplastic intervention capable of engendering significant cognitive gains and associated cortical changes in the context of age-related cognitive decline, even when executed as a low-intensity intervention across 3 months. Given the preliminary nature of these findings, future larger sampled studies are needed.
Previous cross-lagged studies on depression and memory impairment among the elderly have revealed conflicting findings relating to the direction of influence between depression and memory impairment. The current study aims to clarify this direction of influence by examining the cross-lagged relationships between memory impairment and depression in an Asian sample of elderly community dwellers, as well as synthesizing previous relevant cross-lagged findings via a meta-analysis.
A total of 160 participants (Mage = 68.14, s.d. = 5.34) were assessed across two time points (average of 1.9 years apart) on measures of memory and depressive symptoms. The data were then fitted to a structural equation model to examine two cross-lagged effects (i.e. depressive symptoms→memory; memory→depressive symptoms). A total of 14 effect-sizes for each of the two cross-lagged directions were extracted from six studies (including the present; total N = 8324). These effects were then meta-analyzed using a three-level mixed effects model.
In the current sample, lower memory ability at baseline was associated with worse depressive symptoms levels at follow-up, after controlling for baseline depressive symptoms. However, the reverse effect was not significant; baseline depressive symptoms did not predict subsequent memory ability after controlling for baseline memory. The results of the meta-analysis revealed the same pattern of relationship between memory and depressive symptoms.
These results provide robust evidence that the relationship between memory impairment and depressive symptoms is unidirectional; memory impairment predicts subsequent depressive symptoms but not vice-versa. The implications of these findings are discussed
This article summarises the development of mental health legislation in Singapore in three distinctive periods: pre-1965; 1965–2007 and 2007 onwards. It highlights the origin of mental health legislation and the relationship between mental health services and legislation in Singapore. The Mental Health (Care and Treatment) Act 2008 and Mental Capacity Act 2008 are described in detail.
Depression in the elderly is often associated with coexisting medical illnesses. We investigated the individual and combined impacts of depression and medical illnesses on disability and quality of life among community-living older persons.
Cross-sectional and longitudinal analyses of data from 1,844 participants aged 55 and above of the Singapore Longitudinal Aging Study (SLAS-1). Baseline depressive symptoms (Geriatric Depressive Scale, GDS≥5) and chronic medical comorbidity (≥2) from self-reports were related to baseline and 2-year follow up instrumental and basic activities of daily living (IADL-BADL), and quality of life (Medical Outcomes Study 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) scores.
The prevalence of depressive symptoms was 11.4%. In main effect analyses of cross-sectional and longitudinal relationships, depression and medical comorbidity were individually associated with higher risk of IADL-BADL disability and lower PCS and MCS scores of quality of life, and only medical comorbidity was associated with increased risk of hospitalization. Significant interactive effects of depression and medical comorbidity were observed in longitudinal relationships with IADL-BADL disability (p = 0.03), PCS (p < 0.01), and MCS (p < 0.01) scores at follow up. The associations of medical comorbidity with increased odds of IADL-BADL disability and decreased SF-12 PCS and MCS scores were at least threefolds stronger among depressed than nondepressed individuals.
Medical comorbidities and depression exert additive and multiplicative effects on functional disability and quality of life. The adverse impact and potential treatment benefits of coexisting mental and physical conditions should be seriously considered in clinical practice.
Worldwide, the number of individuals with dementia is growing in an epidemic manner, with an estimated 35.6 million people affected in 2010 (Prince et al., 2013). With the population aging in Asia, dementia care will become a major public health challenge in this region in the coming decades. Over half of the patients with dementia in the world will live in Asia by 2030. In China alone, a recent review of dementia studies showed that there were 9.2 million dementia patients in 2010 (Chan et al., 2013). These figures are staggering. In many Asian countries, dementia is regarded as a shameful illness, and the local terms for dementia are derogatory. Dementia carries a stigma that may lead to patients’ reluctance in seeking treatment and delay in diagnosis. In addition, local names for dementia frequently conjure up pictures of severe stage of dementia, and may lead to therapeutic nihilism, discouraging mental health professionals from working with elderly patients with dementia. As Asia faces the challenges of a rapidly aging population and provisions of care for growing number of dementia patients, change in local names for dementia has become an issue of attention.
Background: This study examined the use of low doses of antipsychotic medications (300 mg/day CPZeq or less) in older Asian patients with schizophrenia and its demographic and clinical correlates.
Methods: Information on hospitalized patients with schizophrenia, aged 55 years or older, was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001–2009). Data on 1,452 patients in eight Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India, and Malaysia were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.
Results: The prescription frequency for low doses of antipsychotic medications was 40.9% in the pooled sample. Multiple logistic regression analysis of the whole sample showed that patients on low doses of antipsychotic medications were more likely to be female, have an older age, a shorter length of illness, and less positive symptoms. Of patients in the six countries and territories that participated in all the surveys between 2001 and 2009, those in Japan were less likely to receive low doses of antipsychotics.
Conclusion: Low doses of antipsychotic medications were only applied in less than half of older Asian patients with schizophrenia.
The report World Population Ageing 1950–2050 (United Nations, 2002) estimated that in 2005 there were 37.3 million elderly people (i.e. aged 65 years or more) in South-East Asia (a region incorporating Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam). There are only a few epidemiological studies on mental disorders among elderly people in this region and the published data are mainly from Singapore, Malaysia and Thailand. Using Singapore's prevalence rate of 3% for dementia and 5.7% for depression, the numbers of elderly people with dementia in this region would be 1.2 million and with depression 2.12 million (Kua, 1992; Kua & Ko, 1995). However, even in Singapore, we have identified only 10% of all potential cases of dementia and depression — meaning that the large majority of elderly people with mental disorders are not detected, although they may be known, for other reasons, to the health services.
Background: The relationship between depressive symptoms and health service use among older people is not well understood. In this study we examined the two-way relationships between depressive symptoms and hospitalization and/or physician visits by older adults.
Methods: In a one-year follow-up study of 973 community-dwelling older adults in the Singapore Longitudinal Aging Studies (SLAS), depressive symptoms (15-item Geriatric Depression Scale score ≥5) were assessed at baseline and one year later. Information on self-reported physician visits and hospitalization were collected bimonthly over one year.
Results: When demographic characteristics, medical comorbidities, functional status and other covariates were controlled for, baseline depressive symptoms were associated with increased episodes of subsequent physician visits during the one-year follow-up (RR,1.34; 95% CI, 1.05–1.70), but not with subsequent hospitalization(s) during the same period. Conversely, participants with five or more physician visits (versus less than 5) over one year were more likely to be depressed at one year (OR, 10.2; 95% CI, 3.36–31.1); hospitalization during this period was also significantly associated with depressive symptoms at one year (OR = 6.43, 95% CI, 2.48–16.6).
Conclusion: Depressive symptoms and health service use have reciprocal relationships. Health service use for non-mental illnesses may be optimized by efforts at post-hospitalization interventions to recognize and treat depression in older persons.
Sir: The editorial by George Christodoulou et al (2008) on ‘Psychiatry for the person’ and the response by Jeremy Holmes (2008) have been read with avid interest on this side of the globe. Listening to previous presentations on this topic at Asian meetings of the World Psychiatric Association (WPA), we were often left with a sinking feeling that they resonate well with our work but could be better. For the Institutional Programme on Psychiatry for the Person (IPPP) to succeed, there should be more participation from developing countries. The marketplace of ideas should not be confined to academics in Europe and North America and ignoring the rich experience of clinicians in Chennai, Singapore or Batu Pahat.
Objective: This cross-sectional study examined the clinical significance and impact of subsyndromal depression in a sample of elderly people living in the community in Singapore.
Method: Data were analyzed from a population survey (the Singapore National Mental Health Survey of the Elderly). A total of 1092 respondents from a nationally representative multi-ethnic (Chinese, Malay and Indian) stratified random sample of older adults aged 60 and above were examined for depression using the Geriatric Mental State Examination (GMS). Diagnostic confidence levels of 3–5 indicated a DSM-IV diagnosis of syndromal depression, and 1–2 indicated subsyndromal depression. Other variables included sociodemographic characteristics, psychiatric and medical comorbidities, MMSE, health awareness, health and functional status.
Results: Subjects with subsyndromal depression were more likely to have poor socioeconomic status, cognitive impairment, anxiety, and measures of poor mental, physical and functional status compared with non-depressed subjects, and were similar to or worse than syndromal cases. In multivariate analyses that controlled for age, gender, ethnicity, education and several other sociodemographic factors, both subsyndromal and syndromal depression were significantly associated with higher numbers of medical comorbidities, diagnoses of comorbid dementia and anxiety, lower MMSE scores, self-reported mental health problem, functional disability and poor health status.
Conclusion: In this Asian population, subsydromal depression had the same clinical significance and health impact as syndromal depression, similar to findings in the West.
Background: We evaluated the combined and differential effects of physical, social and productive activities on cognitive decline and whether they were modified by the presence of the APOE-ε4 allele.
Methods: In a prospective cohort study of 1635 community-dwelling Chinese older adults aged 55 or older participating in the ongoing Singapore Longitudinal Aging Study, physical, social and productive leisure activities were assessed at baseline, and cognitive decline (at least one point drop) in MMSE scores between baseline and follow-up after one year.
Results: Cognitive decline was observed in 30% of the respondents. Controlling for age, gender, education and other risk factors, odds ratios (ORs) were significantly reduced in those with medium (OR: 0.60, 95% CI: 0.45–0.79) and high activity levels (OR: 0.62, 95% CI: 0.46–0.84). A stronger association was shown for productive activity (OR = 0.36), than for physical (OR = 0.78) and social activities (OR = 0.85). These associations showed statistically significant interactions with APOE genotype, being more pronounced in those with the APOE-ε4 allele.
Conclusion: Increased leisure activity, especially productive activities more than physical or social activities, was associated with a lowered risk of cognitive decline. APOE-ε4 genotype individuals appeared to be more vulnerable to the effects of low and high levels of leisure activities.
Background: Few studies have investigated the association of psychiatric morbidity with acute hospitalization risk in elderly people.
Method: We examined this association using population-based data for 1092 older adults aged ≥60 years in Singapore, including subjects who reported at least one acute hospitalization from any medical condition(s) in the 12 months prior to interview (N = 136). Psychiatric morbid/comorbid disorders were diagnosed using the Geriatric Mental State examination.
Results: In a multivariate analysis, comorbid psychiatric disorders were inde-pendently associated with hospitalization [adjusted odds ratio 2.76, 95% confidence interval 1.20–6.33], after controlling for age, ethnicity, employment status, number of medical comorbidities, number of activities of daily living limitations, hearing and visual impairment, SF-12 Physical and Mental Component Summary scores, social, productive, fitness and health activities, and regular visits to health-care providers. Neither dementia diagnosis nor cognitive impairment measured by the Mini-mental State Examination was associated with increased hospitalization risk.
Conclusion: Psychiatric morbidity in old age was significantly associated with increased hospitalization risk. This finding underlines the importance of treating psychiatric illness to reduce the risk of acute hospitalization in elderly patients.