Wayne Freeman Chong, PhD - Speaker and Scientist in Caregiver Innovation

Multidomain lifestyle interventions have recently demonstrated effectiveness in dementia risk reduction. These interventions target multiple risk factors and typically include physical activity, dietary modifications, vascular management, cognitive training, and social engagement. Studies such as the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability highlight the effectiveness of simultaneous exercise, diet, social engagement, and cognitive training in… Show more

Multidomain lifestyle interventions have recently demonstrated effectiveness in dementia risk reduction. These interventions target multiple risk factors and typically include physical activity, dietary modifications, vascular management, cognitive training, and social engagement. Studies such as the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability highlight the effectiveness of simultaneous exercise, diet, social engagement, and cognitive training in maintaining daily functioning among older adults at risk of cognitive decline. Comparable results have been reported in the Prevention of Dementia by Intensive Vascular Care Trial, Multidomain Alzheimer Preventive Trial, and other trials. Unfortunately, scaling these interventions involves complex challenges, primarily due to the individualized nature of these interventions and the need for substantial resources and coordination.

Given the current lack of safe disease-modifying interventions for patients with dementia of various types, emerging research has focused on the prevention and delay of dementia. In this article, we discuss two established and two novel approaches to personalize multidomain lifestyle interventions for individuals at risk of cognitive decline. Show less

Background:
Multidomain lifestyle interventions for dementia risk reduction have been developed and trialled because reversible lifestyle factors have been shown to contribute to the onset and progression of dementia. A recent review and meta-analysis confirmed small beneficial effects of such interventions on cognitive performance. To enhance the effectiveness of these interventions, we have developed and incorporated personalisation approaches. This study aims to investigate the… Show more

Background:
Multidomain lifestyle interventions for dementia risk reduction have been developed and trialled because reversible lifestyle factors have been shown to contribute to the onset and progression of dementia. A recent review and meta-analysis confirmed small beneficial effects of such interventions on cognitive performance. To enhance the effectiveness of these interventions, we have developed and incorporated personalisation approaches. This study aims to investigate the effectiveness of a personalised multidomain lifestyle intervention programme in slowing cognitive decline.

Result:
Global cognition at 24 weeks and at 1-, 3- and 6-month follow-up will be compared with baseline global cognition for each participant. Data aggregation could uncover response characteristics across individuals (Figure B).

Conclusion:
Meta-analyses would provide high quality evidence of the intervention’s effectiveness at the individual and the population levels. Show less

Background:
The Test of Practical Judgement (TOP-J) in its 9-item (TOPJ9) and 15-item (TOPJ15) versions (Rabin et el., 2007), validated for assessing practical judgement, encompasses day-to-day scenarios in medical, financial, safety, and social/ethical domains. This study seeks to evaluate its utility in distinguishing cognitively unimpaired (CU) individuals from those with Mild Cognitive Impairment (MCI) within a Southeast Asian population. This investigation aims to contribute insights… Show more

Background:
The Test of Practical Judgement (TOP-J) in its 9-item (TOPJ9) and 15-item (TOPJ15) versions (Rabin et el., 2007), validated for assessing practical judgement, encompasses day-to-day scenarios in medical, financial, safety, and social/ethical domains. This study seeks to evaluate its utility in distinguishing cognitively unimpaired (CU) individuals from those with Mild Cognitive Impairment (MCI) within a Southeast Asian population. This investigation aims to contribute insights into the cross-cultural applicability of TOP-J in assessing practical judgement across varying cognitive states in the Southeast Asian context.

Result:
The mean age of the 126 participants were 60.34 years ± 9.64, 38% male, mean education of 15.16 years ± 3.11, and 82% Chinese ethnicity. Significant mean differences between groups were observed for each test (p<0.05) (Table 1). ROC Analysis indicated optimal cut-offs for MCI identification were determined for TOPJ9 (<16.5, AUC=0.76, Sn=0.71, Sp=0.7, PPV=0.57, NPV=0.81) and TOPJ15 (<25.5, AUC=0.79, Sn=0.55, Sp=0.9, PPV=0.75, NPV=0.78). Discriminative properties with story delayed and RAVLT delayed are detailed in Table 2.

Conclusion:
Both TOP-J 9 and 15 items are useful for the detection of MCI in a Southeast Asian population. They exhibit comparable efficacy with other neuropsychological tests for MCI detection in Southeast Asian participants. Further validation through a longitudinal study is essential to solidify their diagnostic utility in this population. Show less

Background:
Visual Cognitive Assessment Test(VCAT) is a visual-based cognitive evaluation tool which can be administered to multilingual populations without translation. VCAT has shown to be effective in differentiating mild cognitive impairment(MCI) from cognitively normal and useful for diagnosing MCI and mild AD(Kandiah et al., 2016). However, whether VCAT is also useful for differentiating between vascular and non-vascular MCI remains to be explored.

Results:
Participant… Show more

Background:
Visual Cognitive Assessment Test(VCAT) is a visual-based cognitive evaluation tool which can be administered to multilingual populations without translation. VCAT has shown to be effective in differentiating mild cognitive impairment(MCI) from cognitively normal and useful for diagnosing MCI and mild AD(Kandiah et al., 2016). However, whether VCAT is also useful for differentiating between vascular and non-vascular MCI remains to be explored.

Results:
Participant demographics included a mean age of 60.34 years±10.76, Male 44%, and mean education years of 14.44 years±3.71. After adjusting for age and education years, mean of neuropsychological test, perfusion scores were significantly different between the three groups(p < 0.05). Tukey HSD post-hoc test showed pairwise differences between all groups, except for perfusion scores (Table 1). ROC analysis was conducted to explore the discriminative performance of VCAT in differentiating between CN and V-MCI. The analysis indicated an AUC of 0.74 with the optimal VCAT cut-off for differentiating between CN and V-MCI as 25.5 with specificity 0.85 and sensitivity 0.48. In an additional ROC analysis, we compared the discriminative properties of VCAT, RAVLT Delayed, CT2 and Perfusion.

Conclusion:
The results of our study suggest that VCAT is useful in discriminating between CN and V-MCI, especially in comparison to other neuropsychological tests and perfusion. Future longitudinal studies are needed for further investigation. Show less

Background:
Astrocyte reactivity marked by elevations in Glial Fibrillary Acidic Protein(GFAP), was found to increase Phosphorylated Tau181(pTau181) induced neurodegenerative effects in Alzheimer’s Disease(Bellaver et al., 2023). Nevertheless, the effect of the GFAP- pTau181 axis in vascular/mixed dementias has yet to be completely elucidated. In this study, we investigated the effect of GFAP-pTau181 on cognition in a Southeast Asian cohort having high burden of cerebrovascular… Show more

Background:
Astrocyte reactivity marked by elevations in Glial Fibrillary Acidic Protein(GFAP), was found to increase Phosphorylated Tau181(pTau181) induced neurodegenerative effects in Alzheimer’s Disease(Bellaver et al., 2023). Nevertheless, the effect of the GFAP- pTau181 axis in vascular/mixed dementias has yet to be completely elucidated. In this study, we investigated the effect of GFAP-pTau181 on cognition in a Southeast Asian cohort having high burden of cerebrovascular disease.

Results:
Findings indicate that, WMH volume positively correlated to GFAP and pTau181(Figure 1A and 1B). Information processing speed and VCAT negatively correlated to WMH volume. GFAP negatively correlated to Aβ42/Aβ40 ratio(Figure 2A). pTau181 demonstrated a negative correlative trend with Aβ42/Aβ40 ratio(Figure 2B) and a positive correlative trend with GFAP(Figure 2C). Moderation analysis revealed that GFAP and pTau181 independently influenced the relationship between cognitive measures and WMH volume, such that increasing WMH volume and GFAP/pTau181 levels related to deteriorating processing speed and VCAT scores(Figure 3A and 3B).

Conclusion:
GFAP, a neuroinflammatory measure moderates the relationship between WMH and cognition and may be a useful biomarker for the detection and prognostication of cognitive impairment among Southeast Asians. The pathobiology could be a result of early upstream astrocyte mediated modulation of Blood-Brain Barrier permeability and resultant perfusion dynamics. pTau181 facilitated effects are likely downstream events of GFAP activation. Further mechanistic validation in a larger longitudinal study is underway. Show less

BACKGROUND: The focus of medicine is shifting from treatment to preventive care. The expression of biomarkers of dementia and Alzheimer’s disease (AD) appear decades before the onset of observable symptoms, and evidence has emerged supporting pharmacological and non-pharmacological interventions to treat modifiable risk factors of dementia. However, there is limited research on the epidemiology, clinical phenotypes, and underlying pathobiology of cognitive diseases in Asian… Show more

BACKGROUND: The focus of medicine is shifting from treatment to preventive care. The expression of biomarkers of dementia and Alzheimer’s disease (AD) appear decades before the onset of observable symptoms, and evidence has emerged supporting pharmacological and non-pharmacological interventions to treat modifiable risk factors of dementia. However, there is limited research on the epidemiology, clinical phenotypes, and underlying pathobiology of cognitive diseases in Asian populations.

OBJECTIVES: The objectives of the Biomarkers and Cognition Study, Singapore(BIOCIS) are to characterize the underlying pathobiology of Cognitive Impairment through a longitudinal
study incorporating fluid biomarker profiles, neuroimaging, neuropsychological and clinical outcomes in a multi-ethnic Southeast Asian population.

DESIGN, SETTING, PARTICIPANTS: BIOCIS is a 5-year longitudinal study where participants are assessed annually. 2500 participants aged 30 to 95 will be recruited from the community in Singapore. To investigate how pathology presents with or without minimal clinical symptoms and vice versa,
cognitively impaired and unimpaired individuals will be recruited. Participants will undergo assessments to characterise biomarkers of dementia through neuroimaging, fluid biomarkers, cognitive assessments, behavioural and lifestyle profiles, retinal scans and microbiome indicators.

CONCLUSION: The BIOCIS cohort will help identify novel biomarkers, pathological trajectories, epidemiology of dementia, and reversible risk factors in a Southeast Asian population. Completion of BIOCIS longitudinal data could provide insights into risk-stratification of Asians populations, and potentially inform public healthcare and precision medicine for better patient outcomes in the prevention of Alzheimer’s disease and dementia. Show less

Background: Mild behavioral impairment (MBI) is one of the earliest observable changes when a person experiences cognitive decline and could be an early manifestation of underlying Alzheimer's disease neuropathology. Limited attention has been given to investigating the clinical applicability of behavioral biomarkers for detection of prodromal dementia.

Objective: This study compared the prevalence of self-reported MBI and vascular risk factors in Southeast Asian adults to identify early… Show more

Background: Mild behavioral impairment (MBI) is one of the earliest observable changes when a person experiences cognitive decline and could be an early manifestation of underlying Alzheimer's disease neuropathology. Limited attention has been given to investigating the clinical applicability of behavioral biomarkers for detection of prodromal dementia.

Objective: This study compared the prevalence of self-reported MBI and vascular risk factors in Southeast Asian adults to identify early indicators of cognitive impairment and dementia.

Methods: This cohort study utilized baseline data from the Biomarkers and Cognition Study, Singapore (BIOCIS). 607 participants were recruited and classified into three groups: cognitively normal (CN), subjective cognitive decline (SCD), and mild cognitive impairment (MCI). Group comparisons of cognitive-behavioral, neuroimaging, and blood biomarkers data were applied using univariate analyses. Multivariate logistic regression analyses were conducted to investigate the association between cerebrovascular disease, vascular profiles, and cognitive impairment.

Results: SCD had significantly higher depression scores and poorer quality of life (QOL) compared to CN. MCI had significantly higher depression scores; total MBI symptoms, MBI-interest, MBI-mood, and MBI-beliefs; poorer sleep quality; and poorer QOL compared to CN. Higher Staals scores, glucose levels, and systolic blood pressure were significantly associated with MCI classification. Fasting glucose levels were significantly correlated with depression, anxiety, MBI-social, and poorer sleep quality.

Conclusions: The results reflect current research that behavioral changes are among the first symptoms noticeable to the person themselves as they begin to experience cognitive decline. Self-reported questionnaires may aid in early diagnoses of prodromal dementia. Behavioral changes and diabetes could be potential targets for preventative healthcare for dementia. Show less

Introduction: Many women in frontline healthcare positions face work demands that are incompatible with their needs and aspirations, resulting in poorer work satisfaction and engagement, and greater probability of leaving their jobs. Proactive career management is associated with elevated well-being and career success but may not be accessible to female health professionals who encounter social, cultural and structural barriers. The complex and diverse nature of proactive career management and… Show more

Introduction: Many women in frontline healthcare positions face work demands that are incompatible with their needs and aspirations, resulting in poorer work satisfaction and engagement, and greater probability of leaving their jobs. Proactive career management is associated with elevated well-being and career success but may not be accessible to female health professionals who encounter social, cultural and structural barriers. The complex and diverse nature of proactive career management and absence of a comprehensive review on the topic necessitates a synthesis of extant literature. This study aims to identify (i) proactive career management behaviours and activities among female health professionals and (ii) outcomes of proactive career management initiatives. This study will contribute to a larger study on encouraging proactive career management behaviours among Singapore female health professionals.

Methods and analyses: Scoping review is used as our method of evidence synthesis to provide a comprehensive overview of all available constructs and markers of interest. This study started in January 2022. Original research, reviews, short reports, letters, methodologies and case studies relevant to our objectives will be examined with guidance from Arksey and O'Malley's framework. The literature contained in scientific databases and grey literature sources will be thoroughly searched. Two independent reviewers will screen citations for eligibility and extract data from the included articles. Extracted data will be narratively synthesised by two independent reviewers using Braun and Clarke's six steps of thematic analysis. We will observe the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews standards in reporting the results. An advisory panel will provide insights on the applicability of the results to negate confirmation bias. Show less

Originating from several disciplines – in particular critical theory, political economy, and social phenomenology – critical gerontology has rapidly developed since the early 1980s as a vibrant and hybridized subfield within gerontology that integrates ideas in humanities and social sciences to broaden aging studies beyond biomedical models and ageist social policies and practice (Katz, 2019).

Objectives: To identify and describe caregiver profiles based on their psychosocial health characteristics
over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at
12 months post-stroke differed by caregiver profile transition patterns, and to investigate if caregiver
profiles at 3 months post-stroke moderate the association of stroke rehabilitation use at 3 months and
12 months post-stroke after accounting for covariates.
Setting… Show more

Objectives: To identify and describe caregiver profiles based on their psychosocial health characteristics
over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at
12 months post-stroke differed by caregiver profile transition patterns, and to investigate if caregiver
profiles at 3 months post-stroke moderate the association of stroke rehabilitation use at 3 months and
12 months post-stroke after accounting for covariates.
Setting and Participants: A total of 149 stroke patient-caregiver dyads from the Singapore Stroke Study.
Methods: Cross-sectional latent profile analyses were conducted on caregiver psychosocial health indicators of burden, depression, health status, quality of relationship with patient, and social support.
Changes in latent profile classification over 3 time points were analyzed.
Results: Two caregiver psychosocial health latent profiles were found across time: nondistressed
and distressed. Most caregivers were classified as nondistressed and remained nondistressed over time.
Distressed caregivers at baseline were 76% likely to become nondistressed at 12 month post-stroke.
Regardless of profile transition patterns, nondistressed caregivers at 12 months post-stroke tended to
have cared for stroke rehabilitation nonusers at 12 months post-stroke. Patient depression explained
profile classification at 3 months and 12 months post-stroke. After accounting for covariates, rehabilitation users at 3 months post-stroke tended to continue using rehabilitation at 12 months post-stroke only when they had nondistressed caregivers at 3 months post-stroke.
Conclusions: Whether caregiver adaptation explains the associations between the latent
profile transition patterns and rehabilitation use at 12 months post-stroke should be examined. Early
psychosocial health assessment and sustained support should be made available to stroke caregivers to
enhance their well-being and patient rehabilitation participation. Show less

Background and objectives
Schema therapy (ST) has become a mainstream therapy for the treatment of psychopathology and has been validated through a series of large scale, international randomized control trials. Among other things, schema therapy emphasizes the meeting of core emotional needs in children by primary caregivers as these unmet needs continue to adversely affect their lives into adulthood. An early intervention parenting program has been developed to help parents meet these core… Show more

Background and objectives
Schema therapy (ST) has become a mainstream therapy for the treatment of psychopathology and has been validated through a series of large scale, international randomized control trials. Among other things, schema therapy emphasizes the meeting of core emotional needs in children by primary caregivers as these unmet needs continue to adversely affect their lives into adulthood. An early intervention parenting program has been developed to help parents meet these core emotional needs in order to prevent the development of psychopathology in the first place. The program, Good Enough Parenting, is equally focused on reducing problems and strengthening parenting practices, regardless of where the child is on the “disordered to well-being continuum”. This study aims to explore “patient experience” by users of this program. Best clinical research guidelines advocate that participants should be used as collaborators rather than pure recipients; this process should predate large scale trials.

Design
An exploratory qualitative study with 55 parent-participants of Good Enough Parenting was conducted.

Methods
One-to-one interviews were conducted with participants, using critical incident technique and guided by semi-structured interview schedule, to explore their experiences with the program. Transcripts were then analyzed using thematic analysis.

Results
Coding showed a high degree of inter-rater reliability (kappa value of 0.78). The themes that emerged were Cultivating Awareness of Parents’ Own Schemas, Cultivating Intentionality, Working through Developmental Issues, Responses to Challenges at Home, Performing Multiple Roles, and the Learning Process. Participants overwhelmingly reported satisfaction within these key themes.

Conclusions
The results support the development of the program and the choice of “participant reported outcome measures” for use in subsequent randomized controlled trials. Show less

The very rapid ageing of Singapore’s population is placing a huge burden on informal caregivers. I discuss two macroeconomic strategies – strengthening redistributive measures and professionalizing informal caregiving - that may alleviate this burden. A national study on informal caregiving is urgently required to identify specific areas and caregiver segments that will benefit from these strategies.

This thesis aimed to elucidate the role of informal caregiver subjective well-being in explaining formal long-term care service (LTCS) use. A systematic review and meta-analysis of literature found that elevated caregiver burden, caregiver depression, and poorer caregiver health status are associated with increased formal LTCS use. Quantitative analyses of longitudinal data collected from stroke survivors and their caregivers revealed that increased caregiving burden and caregiver depression… Show more

This thesis aimed to elucidate the role of informal caregiver subjective well-being in explaining formal long-term care service (LTCS) use. A systematic review and meta-analysis of literature found that elevated caregiver burden, caregiver depression, and poorer caregiver health status are associated with increased formal LTCS use. Quantitative analyses of longitudinal data collected from stroke survivors and their caregivers revealed that increased caregiving burden and caregiver depression are prospective and concurrent predictors of stroke rehabilitation use at 12-month post-stroke, and that non-distressed caregivers at 3-month post-stroke and 12-month post-stroke are likely to have cared for stroke rehabilitation users at 12-month post-stroke. Show less

This study examines the relationship between caregivers' perception of community-based long-term care (CBLTC) services and the service use. We used first two waves of the longitudinal data set of 1,416 dyads of care recipients and their caregivers in Singapore. Four perceived attributes of LTC services-service quality, convenience, social connectedness, and affordability-were measured on a 5-point scale. Among the four perceived attributes, perceived affordability was significantly associated… Show more

This study examines the relationship between caregivers' perception of community-based long-term care (CBLTC) services and the service use. We used first two waves of the longitudinal data set of 1,416 dyads of care recipients and their caregivers in Singapore. Four perceived attributes of LTC services-service quality, convenience, social connectedness, and affordability-were measured on a 5-point scale. Among the four perceived attributes, perceived affordability was significantly associated with future utilization for all types of CBLTC services. Perceived service quality and convenience was significantly associated with center-based LTC services use. Caregivers are critically involved in the decision of using CBLTC services, and their perception of service characteristics is significantly associated with the uptake of CBLTC services. It is important to incorporate both care recipients' and caregivers' needs and preferences when designing and promoting integrated health care delivery models. © The Author(s) 2015. Show less

Research Objective: As the fastest ageing Asian nation, Singapore expects increasing demand for formal Long-Term Care (LTC) services. However, current utilization rates are relatively low compared to Western contexts. Based on recent studies, we suggest that caregiver characteristics, such as reliance on family support, availability of foreign domestic workers, and caregiver-perceived attractiveness of services, and care recipients’ earlier LTC services utilization influence care recipients’… Show more

Research Objective: As the fastest ageing Asian nation, Singapore expects increasing demand for formal Long-Term Care (LTC) services. However, current utilization rates are relatively low compared to Western contexts. Based on recent studies, we suggest that caregiver characteristics, such as reliance on family support, availability of foreign domestic workers, and caregiver-perceived attractiveness of services, and care recipients’ earlier LTC services utilization influence care recipients’ LTC services utilization even after controlling for well-established factors of the Andersen Model: socio-economic status, intention to use, referred service type, demographics and care recipients’ needs.

Design: A 12-month prospective survey of care recipients and caregivers dyads with three waves of data collection: baseline, 6-month, and 12-month. Setting: A nationally representative study of patients referred to the Agency for Integrated Care between December 2011 and July 2012 for at least one of six LTC services: nursing home, day rehabilitation, dementia day care, home medical, home nursing, and home therapy.Population Studied: 703 care recipients and 689 caregivers.

Principal Findings: After controlling for the influence of the established factors, caregiver characteristics explained 9.2%, 12.8%, and 16.5% of the variance in the care recipients’ wave-3 utilization of LTC, centre-based and home-based LTC services respectively. Care recipients’ earlier utilization of corresponding services further explained 23.1%, 24.8%, and 11.6% of the variance in their wave-3 utilization of LTC, centre-based and home-based LTC services respectively. Lower wave-3 caregiver-perceived attractiveness of home-based services, care recipients’ wave-1 and -2 LTC services non-utilization were positively associated with care recipients’ wave-3 non-utilization of LTC services. Show less

Use of long-term care (LTC) services among older adults in Asia has emerged as an important issue in light of rapidly aging countries and changing family structures. Simply building more LTC facilities will not result in higher usage rates, and more insight is needed on the usage of existing services. Few studies have been conducted among Asian populations outside Western settings on this topic. The multi-ethnic population in Singapore is useful for understanding the factors influencing the use… Show more

Use of long-term care (LTC) services among older adults in Asia has emerged as an important issue in light of rapidly aging countries and changing family structures. Simply building more LTC facilities will not result in higher usage rates, and more insight is needed on the usage of existing services. Few studies have been conducted among Asian populations outside Western settings on this topic. The multi-ethnic population in Singapore is useful for understanding the factors influencing the use of long-term care services in Asia. We present our qualitative findings on long-term care service usage in the older population (50+ years) over time. We highlight caregivers' needs as an important determinant of LTC use. Although preferences of the care recipients were considered, caregiver needs, the availability of formal and informal care support, attitudes, perceived control, and social norms surrounding family caregiving governed the use of formal LTC services in Singapore. Show less

The Agency for Integrated Care (AIC) conducted a survey to determine the specific areas in which the agency could work with General Practitioners (GPs) to enhance mental illness management in Singapore. This survey was conducted as part of AIC’s engagement strategy and because the Primary Care Surveys 2010 and 2005 noted that a sizeable number of mental health cases are seen by GPs.

Face-to-face interviews were conducted among a random sample of 849 group and non-group GPs. The GPs… Show more

The Agency for Integrated Care (AIC) conducted a survey to determine the specific areas in which the agency could work with General Practitioners (GPs) to enhance mental illness management in Singapore. This survey was conducted as part of AIC’s engagement strategy and because the Primary Care Surveys 2010 and 2005 noted that a sizeable number of mental health cases are seen by GPs.

Face-to-face interviews were conducted among a random sample of 849 group and non-group GPs. The GPs practise in four geographical districts in Singapore. 500 responses were obtained.

70% of the respondent GPs indicated that they were seeing patients with mental illness. Anxiety and depression were the most commonly seen mental conditions. The lack of available drugs and facilities in the clinic, and unfamiliarity with mental health patient management were the main reasons that GPs do not see patients with mental illness. 39% of the GPs referred patients to a psychologist. 36% of the GPs referred patients to a counsellor. Availability of additional allied health services in the neighbourhood was crucial in encouraging GPs to see more patients with mental illness. General geriatrics, dementia, general mental health and major depression were the areas of interest for further training. Show less