Most questionnaires designed to assess cognitive impairment among elderly people are constructed in the West, where literacy is high. However, such questionnaires may not be applicable in developing countries because of cultural differences or low literacy. The Elderly Cognitive Assessment Questionnaire (ECAQ) is derived from items in the Mini-Mental State Examination and Geriatric Mental State Schedule. It is a satisfactory scale for quantitative assessment of cognitive impairment among elderly people living in developing countries. This 10-item questionnaire shows a sensitivity of 85.3%, specificity 91.5%, positive predictive value 82.8% and overall miscalculation rate 10.5%. In a sample of 105 elderly subjects from 2 day centres and a psychiatric outpatient clinic in Singapore, the ECAQ was compared with Kahn's Mental Status Questionnaire. The sensitivity of the scales was found to be similar but the ECAQ had a higher specificity and positive predictive value, and lower overall miscalculation rate.

A random sample of 612 elderly Chinese aged 65 and over living in the community in Singapore was assessed with the community version of the Geriatric Mental State (GMS) and the data analysed by the AGECAT program to provide computerised diagnoses. The prevalence of organic disorder (dementia) was 2.3%, depression 5.7%, neuroses 1.5% and paranoid disorder 0.5%. The results were generally lower compared to the study of elderly people in Liverpool using the GMS-AGECAT package. Concordance between AGECAT and the psychiatrist's diagnoses for organic disorder, depression, neuroses and paranoid disorder achieved kappa values of 0.87, 0.88, 0.58 and 1.0 respectively.

Few randomized controlled trials investigated the effects of mindfulness intervention on older adults diagnosed with mild cognitive impairment (MCI). Furthermore, there have been hypotheses and theoretical mechanisms on the benefits of mindfulness intervention on biomarkers of stress, inflammation, and neuroplasticity implicated in MCI that warrant empirical evidence. We conducted a pilot randomized controlled trial to examine whether Mindful Awareness Practice (MAP) improved biomarker levels in older adults with MCI. Fifty-five community-dwelling older adults aged 60 and above were randomized into either the treatment arm, MAP, or the active control arm, the health education program (HEP). Researchers who were blinded to treatment allocation assessed the outcomes at baseline, 3-month, and 9-month follow-ups. Linear-mixed models were used to examine the effect of MAP on biomarker levels. MAP participants had significantly decreased high-sensitivity c-reactive protein (hs-CRP) levels at 9-month (β = −0.307, 95% CI = −0.559 to −0.054 P = 0.018). Exploratory sub-group analyses by sex showed significantly decreased hs-CRP in females only (β = −0.445, 95% CI = −0.700 to −0.189, P = 0.001), while stratification by MCI subtype showed hs-CRP decreased only in amnestic-MCI (aMCI) (β = −0.569, 95% CI = −1.000 to −0.133, P = 0.012). Although total sample analyses were not significant, males had significantly decreased interleukin (IL)−6 (β = −1.001, 95% CI = −1.761 to −0253, P = 0.011) and IL-1β (β = −0.607, 95% CI = −1.116 to −0.100, P = 0.021) levels at 3-month and non-significant improvements at 9-month time-point. MAP improved inflammatory biomarkers in sex- and MCI subtype-specific manners. These preliminary findings suggest the potential of mindfulness intervention as a self-directed and low-cost preventive intervention in improving pathophysiology implicated in MCI.

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