ObjectiveTo examine the efficacy and safety of combined transcranial direct current stimulation (tDCS) and working memory training (WMT) in enhancing the cognitive functions for individuals with mild neurocognitive disorder due to AD (NCD‐AD).MethodsIn this double‐blind, sham‐controlled randomized clinical trial (RCT), 201 patients with NCD‐AD were randomly assigned for a 4‐week intervention of either a combination of tDCS and WMT, sham tDCS and WMT, or tDCS and control cognitive training (CCT). Global cognition and domain‐specific cognitive function were assessed before and after the intervention with Alzheimer's disease assessment scale‐cognitive subscale (ADAS‐Cog), category verbal fluency test, logical memory, digit, and visual span tests.ResultsStudy participants did not show intervention group differences in baseline demographics, or cognitive characteristics (ANOVA). Cognitive enhancement was found across three groups after 4 weeks intervention. Combined tDCS‐WMT group showed significantly greater improvement compared with single‐modality groups in delayed recall (P = 0.043, η
2 = 0.036) and working memory capacity (P = 0.04, η
2 = 0.038) at 4th week, and logical memory at 12th week (P = 0.042, η
2 = 0.037). Adverse events, including skin lesions (2.2%), were similar between groups.InterpretationtDCS or WMT could be a safe, feasible, and effective intervention for individuals with NCD‐AD. A combination of tDCS and WMT presents greater cognitive enhancement, which may highlight the potential synergistic effects of combined modality intervention on cognition.
A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity.
A high degree of clinical vigilance and multidisciplinary collaboration are required in the management of elderly suicide attempters. The treatment of depression should form a crucial part of the prevention program. Features that distinguish suicide completers from suicide attempters may also carry implications for the secondary prevention of suicide in elderly persons.
Both psychosocial and clinical factors are important in suicides in Hong Kong. They seem to have mediated suicide risk independently. In addition, socio-economic adversities seem to have played a relatively important role in the increasing suicide rate in Hong Kong.
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