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To investigate (1) the effects of indoor incense burning upon cognition over 3 years; (2) the associations between indoor incense burning with the brain’s structure and functional connectivity of the default mode network (DMN); and (3) the interactions between indoor incense burning and vascular disease markers upon cognitive functions. Community older adults without stroke or dementia were recruited (n = 515). Indoor incense use was self-reported as having burnt incense at home ≥ weekly basis over the past 5 years. Detailed neuropsychological battery was administered at baseline (n = 227) and the Montreal Cognitive Assessment at baseline and year 3 (n = 515). MRI structural measures and functional connectivity of the DMN were recorded at baseline. Demographic and vascular risk factors and levels of outdoor pollutants were treated as covariates. Indoor incense burning was associated with reduced performance across multiple cognitive domains at baseline and year 3 as well as decreased connectivity in the DMN. It interacted with diabetes mellitus, hyperlipidemia and white matter hyperintensities to predict poorer cognitive performance. Indoor incense burning is (1) associated with poorer cognitive performance over 3 years; (2) related to decreased brain connectivity; and (3) it interacts with vascular disease to predispose poor cognitive performance.

Only two studies investigated the associations between peak width of skeletonized mean diffusivity (PSMD) and age-related cognitive alterations, whereas none of the studies investigated the association with vascular risk factors. We evaluated 801 stroke- and dementia-free elderlies with baseline and 3-year follow-up assessments. Regression analyses were used to assess the association between age-related cognitive functions and PSMD. Simple mediation models were used to study the mediation effect of PSMD between vascular risk factors and age-related cognitive outcomes. PSMD was negatively associated with processing speed at baseline and negatively associated with processing and memory scores at 3-year follow-up. The association between vascular risk factors and age-related cognition was mediated by PSMD, as well as other diffusion tensor imaging markers. PSMD is preferred over other diffusion tensor imaging markers as it is sensitive to age-related cognitive alterations and calculation is fully automated. PSMD is proposed as a research tool to monitor age-related cognitive alterations.

Introduction The benefit and risk of aerobic exercise among older people harboring advanced cerebral small vessel disease (CSVD) upon cognition, mood, and motor functions are unknown. Methods This rater‐blind randomized trial examined effects of a 24‐week aerobic exercise training (60 min/session, twice/week) upon clinical (cognition, mood, motor functions) and hemodynamic (pulse pressure [PP], blood pressure [BP], pulsatility index) measures in older people harboring moderate to severe CSVD, as evidenced by confluent white matter hyperintensity and/or ≥2 lacunes on magnetic resonance imaging. We further investigated interactions between treatment conditions and hemodynamics measures. Results Fifty‐three and 54 subjects were randomized into the active and control group, respectively. There was no between‐group difference in any of the clinical outcomes. The active group had a greater between‐group reduction in systolic BP and PP than the control group. Within‐group comparison showed that global cognition of the active group remained similar at end of the study compared to baseline, whereas it declined significantly in the control group. We observed “diverging” interaction effects in that greater reduction in systolic BP/PP was associated with greater improvement in memory functions and global cognition but worsening in processing speed in the active group. Side effects were comparable between the two groups. Discussion Future study should investigate the mechanisms of the diverging impacts of aerobic exercise upon different cognitive domains so that the benefit–risk ratio of aerobic exercise in older people harboring more advanced CSVD can be better defined.

A digital cognitive test can be a useful and quick tool for the screening of cognitive impairment. Previous studies have shown that the diagnostic performance of digital cognitive tests is comparable with that of conventional paper-and-pencil tests. However, the use of commercially available digital cognitive tests is not common in Hong Kong, which may be due to the high cost of the tests and the language barrier. Thus, we developed a brief and user-friendly digital cognitive test called the Electronic Cognitive Screen (EC-Screen) for the detection of mild cognitive impairment (MCI) and dementia of older adults. The aim of this study was to evaluate the performance of the EC-Screen for the detection of MCI and dementia in older adults. The EC-Screen is a brief digital cognitive test that has been adapted from the Rapid Cognitive Screen test. The EC-Screen uses a cloud-based platform and runs on a tablet. Participants with MCI, dementia, and cognitively healthy controls were recruited from research clinics and the community. The outcomes were the performance of the EC-Screen in distinguishing participants with MCI and dementia from controls, and in distinguishing participants with dementia from those with MCI and controls. The cohort was randomly split into derivation and validation cohorts based on the participants' disease group. In the derivation cohort, the regression-derived score of the EC-Screen was calculated using binomial logistic regression. Two predictive models were produced. The first model was used to distinguish participants with MCI and dementia from controls, and the second model was used to distinguish participants with dementia from those with MCI and controls. Receiver operating characteristic curves were constructed and the areas under the curves (AUCs) were calculated. The performances of the two predictive models were tested using the validation cohorts. The relationship between the EC-Screen and paper-and-pencil Montreal Cognitive Assessment-Hong Kong version (HK-MoCA) was evaluated by the Pearson correlation coefficient. A total of 126 controls, 54 participants with MCI, and 63 participants with dementia were included in the study. In differentiating participants with MCI and dementia from controls, the AUC of the EC-Screen in the derivation and validation cohorts was 0.87 and 0.84, respectively. The optimal sensitivity and specificity in the derivation cohorts were 0.81 and 0.80, respectively. In differentiating participants with dementia from those with MCI and controls, the AUC of the derivation and validation cohorts was 0.90 and 0.88, respectively. The optimal sensitivity and specificity in the derivation cohort were 0.83 and 0.83, respectively. There was a significant correlation between the EC-Screen and HK-MoCA (r=-0.67, P<.001). The EC-Screen is suggested to be a promising tool for the detection of MCI and dementia. This test can be self-administered or assisted by a nonprofessional staff or family member. Therefore, the EC-Screen can be a useful tool for case finding in primary health care and community settings.

Age-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia. Asia is notable for its large population with a looming dementia epidemic. Yet, the burden of WML and its associated risk factors across different Asian societies are unknown. Subjects from 9 Asian cities (Bangkok, Bandung, Beijing, Bengaluru, Hong Kong, Kaohsiung, Manila, Seoul, and Singapore) were recruited ( n  = 5701) and classified into (i) stroke/transient ischemic attack (TIA), (ii) Alzheimer’s disease (AD)/mild cognitive impairment (MCI), or (iii) control groups. Data on vascular risk factors and cognitive performance were collected. The severity of WML was visually rated on MRI or CT. The prevalence of moderate-to-severe WML was the highest in subjects with stroke/TIA (43.3%). Bandung Indonesia showed the highest prevalence of WML, adjusted for age, sex, education, disease groups, and imaging modality. Hypertension and hyperlipidemia were significant risk factors for WML, and WML was negatively associated with MMSE in all groups. WML is highly prevalent in Asia and is associated with increasing age, hypertension, hyperlipidemia, and worse cognitive performance. Concerted efforts to prevent WML will alleviate the huge dementia burden in the rapidly aging Asian societies.

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Purpose: Recurrent corneal erosion is characterized by recurrent episodes of spontaneous breakdown of the corneal epithelium. Alcohol delamination of the corneal epithelium has a high success rate, but the procedure requires the use of an operating microscope in an operating theater. We present a case series of alcohol assisted epithelial debridement in the clinic setting.Methods: Records of eight consecutive patients aged >18 years who presented to a private ophthalmology practice clinic in Hong Kong between October 2012 and March 2018 with recurrent corneal erosion that did not respond well to conservative or surgical management with persistent symptoms of >3 months were retrospectively reviewed. 75% alcohol was applied directly to the site of abnormal epithelium under slit lamp, followed by debridement of the epithelium using a surgical sponge. A bandage contact lens was then inserted. Patients were followed up until complete healing of the epithelial defect.Results: All eight patients achieved complete healing of the epithelial defect within 2 weeks with no major complication or recurrence.Conclusion: Alcohol-assisted epithelial debridement is simple, safe, and effective for the treatment of recurrent corneal erosion. It can be performed in a clinic setting under slit lamp.

Purpose: Recurrent corneal erosion is characterized by recurrent episodes of spontaneous breakdown of the corneal epithelium. Alcohol delamination of the corneal epithelium has a high success rate, but the procedure requires the use of an operating microscope in an operating theater. We present a case series of alcohol assisted epithelial debridement in the clinic setting. Methods: Records of eight consecutive patients aged >18 years who presented to a private ophthalmology practice clinic in Hong Kong between October 2012 and March 2018 with recurrent corneal erosion that did not respond well to conservative or surgical management with persistent symptoms of >3 months were retrospectively reviewed. 75% alcohol was applied directly to the site of abnormal epithelium under slit lamp, followed by debridement of the epithelium using a surgical sponge. A bandage contact lens was then inserted. Patients were followed up until complete healing of the epithelial defect. Results: All eight patients achieved complete healing of the epithelial defect within 2 weeks with no major complication or recurrence. Conclusion: Alcohol-assisted epithelial debridement is simple, safe, and effective for the treatment of recurrent corneal erosion. It can be performed in a clinic setting under slit lamp.