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Hi everyone , my name is ching hong. I am an assistant professor of psychology at the school of social sciences at ntu i also hold a joint appointment at the lkc school of medicine. I am a cognitive neuroscientist by training and my research interests are in understanding the complex interplay of bi...

Hi everyone , my name is ching hong. I am an assistant professor of psychology at the school of social sciences at ntu i also hold a joint appointment at the lkc school of medicine. I am a cognitive neuroscientist by training and my research interests are in understanding the complex interplay of biological and psychological factors in the process of healthy and pathological brain and cognitive aging today , in this brief lecture for cc zero zero zero seven : science and technology for humanity , i will be bringing our focus towards two important psychological factors in depression and social isolation. We will be discussing the role that they play in brain aging specifically in the context of alzheimer's disease. Let us begin with a brief introduction to alzheimer's disease. Aging is the biggest risk factor for alzheimer's disease and related dement with an aging population , the number of individuals living with dementia is expected to rise dramatically not just in singapore , but all over the world. The alzheimer's disease , or ad continuum can be classified broadly into three phases. A preclinical phase , with no symptoms but with possible biological changes are already detectable in brain. This is followed by a more cognitive impairment or mci phase , with mild symptoms that may not yet disrupt our ability to engage in everyday activities. The last phase is dementia that has three different stages of severity more moderate and severe. Here , even though the arrows are of equal size , the duration of each phase or stage may differ between different individuals. Our current state of understanding is that the preclinical phase can be quite long , lasting more than twenty or thirty years before the overt sentence starts to surface , suggesting that in this earlier phase of the disease we have a substantial long runway for designing and implementation of intervention programs in order to tackle alzheimer's disease. A large amount of funding has been invested and dedicated to the discovery of drugs and therapeutics to treat and cure alzheimer's disease. You can see from this graph in red that from the year nineteen ninety five to twenty twenty one , an estimated forty two point five billion us dollars has been spent on research and development of biological therapeutic this disease task force. All these six drugs have been approved in the us. They are predominantly only able to treat symptoms of alzheimer's disease and are not considered to be disease modifying they can also be costly and patients may experience side effects. This graph shows the percentage changes in selected cases of death from the year two thousand to twenty nineteen although these data are from the us , i think it illustrates the point quite well that we have had very limited success in stemming the tide of ad related mortality , especially in comparison with other diseases such as heart disease , stroke and especially hiv. While the increase in mortality represents a huge challenge in our lifetime , it also represents a great opportunity where a lot of good contribution to society and humanity can be achieved. We do know a lot about the biology of it. There are a great number of efforts they have been dedicated to developing biological treatments for ad , but it is also important for us to enlarge the spotlight beyond therapeutics to further understand the multifaceted nature of the ad process. After all , it is the case that many individuals with biological disposition and family history of ad do not actually go on to develop ad in their lifetime. It is also the case that many individuals without strong biological disposition or family history develop in old age. In order to understand this complex alzheimer's disease process , we must leave no stone unturned and we need to investigate more deeply other factors , particularly psychological factors , that are implicated in the alzheimer's disease process. In this figure , we can see a broad overview of the known risk factors for dementia across the lifespan from early life in green on the left , to midlife in blue and lastly later life in purple. The numerical percentage in each of the circle represents the percentage reduction in dementia prevalence if the particular risk factor is eliminated. For example , the provision of adequate length of education , perhaps universal education , in early life , is associated with a seven percent reduction in dementia prevalence there are also a slew of other factors that you should have encountered already in the earlier parts of the course , and they should not be unfamiliar with all of you , such as physical inactivity and diet associated factors such as obesity and diabetes. What we will focus on in the next few slides are two important psychological factors in late life , namely depression and social isolation that contributes a total of eight percent to dementia prevalence before we do so , however , it should be noted that our knowledge of risk factors is incomplete and sixty percent of unknown risk remains. What could they be ? Perhaps some of these unknown risks may also be related to more psychological aspects of the human condition beyond depression and social isolation. It is also important that i make the point here that these factors may be intertwined and health related behaviors and choices may be influenced by a complex interplay of social , psychological and biological variables. For example , smoking behavior may be influenced by psychological related factors of social pressure , need for belonging , stress , anxiety or biological responses to addiction. I hope that you are able to see the need for an interdisciplinary approach and understanding of the multitude of factors that can influence dementia incidence now let's dive a little into the scientific literature on the relationship between depression and dementia incidence when we think about alzheimer's disease , we most commonly associated with the presence of memory deficits but alzheimer's disease not only affects cognition it is also associated with many neuro psychiatric symptoms such as apathy agitation hallucinations delusions motor disturbances and , of course , depression , all of which may become more severe in later part of the disease , in particular for depression. A meta analysis of thirty two studies. For the overall , the presence of depression almost doubles the odds of incident dementia while depression is clearly implicated in the alzheimer's disease process , we do not yet have a complete understanding of its role. There are some evidence that in early stages , depression may increase risk of dementia but in later stages , dementia may also contribute to depression onset and severity the presence of other neuro psychiatric comorbidities that we have mentioned also complicates the picture. However , it is quite clear that overall depression , or perhaps more broadly mental or psychological health , is important not just for healthy well being across the lifespan but politely plays an important role in preventing and delaying the onset of dementia moving on from depression , social isolation and loneliness are also important psychological risk factors for dementia in this meta analysis of more than fifty studies , researchers found that greater social activity and larger social networks are correlated with better cognition although the effects are modest and there is some heterogeneity they are all statistically significant , although we are unable to infer causality from these results and the underlying mechanisms require further investigation. Overall , the findings point to a beneficial aspect of not being socially isolated and better cognition when we grow older , or perhaps in retirement , we may feel disconnected with our work communities and social communities , or even our family , and become more socially isolated. This may be associated with a loss of a sense of purpose and meaning in life. Well , not as much studies have been conducted in this area. A meta analysis of a few large cohort studies suggests that individuals who reported higher purpose and meaning in life have lower risks of dementia incidents , as represented by a ratio of less than one in the figure. Some of you may be wondering how do we measure and detect social isolation and loss of meaning in life and older adults in the community ? For the measurement of more biological risk factors like the amount of physical activity , blood pressure , education levels are much more easier to quantify the study. The psychological risk factors such as social isolation , social connectedness meaning and purpose in life are much more abstract and consequently more difficult to study. However , it is also the case that these abstract factors , involving our emotions , our thoughts , constitute an important aspect of what it means to be human and a link to cognition and dementia incidence in closing , psychological factors such as depression and social isolation play important roles in brain and cognitive aging although they may be difficult to measure and monitor , there is also less opportunity to leverage on technology and devise ways to target them for intervention , with the ultimate goal of preventing or delaying the onset of alzheimer's disease and dementia so that we can continue to live fulfilling lives even in our age. Hello , my name is hedwig alfred and i'm , a journalism lecturer at the weekly school of communication and information here at ntu in the following minutes , i will talk about the challenges of communicating with seniors in singapore , some missteps and unusual steps that have worked. You would have heard by now , the number of singaporeans aged sixty five years or older has risen significantly and by twenty , thirty , less than eight years from now , this group will account for one in four people here. Think about it. One in four of us will be aged sixty five and into our seventies eighties nineties and beyond. So why highlight communication with this group ? Because there are significant government policies directed at them , because of an unprecedented health crisis , and because it is important to continue to engage this group , which still has much to offer. Most communication textbooks will tell you that to deliver a message well , you need to know your audience , make the purpose of your message clear and choose the right platform to deliver the message. But think about communicating a message to older people in singapore and you are likely to get stuck at step one. In singapore , more so than in other countries , communication challenges involving the elderly include divergent factors such as race , languages spoken , educational levels , work experience and cultural differences. In twenty fourteen , when the government formed the pioneer generation office to reach out to singaporeans sixty five years and older with a message of thanks for their part in nation building and offering a slew of concessions and benefits. Its first task was to figure out how to get the news to the pioneers. The usual method of a press conference followed by coverage in the traditional media would only work for those who read newspapers and watch television. Letters in the mail to inform recipients of the benefits would also be limited to those who could read the four official languages and would understand the information included. So in addition to the use of the media and mailing letters , the pioneer generation office set out to train volunteers who would deliver the information door to door to seniors to be effective , the teams had to include speakers of the official languages and the chinese dialects , and a script was prepared with volunteers prepped to answer possible queries it was a huge undertaking with months of planning and even more months of fieldwork which was mostly well received. The negative feedback , however , included those who were suspicious of the many questions volunteers asked about the senior's well being. Some were even offended by questions about their children and how often they visited. Why so many questions ? The seniors asked ? Why now ? What did the government want in return ? The more educated who read newspapers regularly complained the volunteers talked down to them and said they already knew about the benefits. Some even wondered if the volunteers were part of a scam so while every effort was made to reach the members of the senior group , a one size fits all script did not go down well for some. When the pandemic hit , it became important to be able to pass on good information from the government task force , disease experts and frontline agencies to the public. While the announcements were significant for our day to day living , the messages were not always easy to understand. The government multi ministry task force had regular updates on new steps and regulations to keep singaporeans safe. Medical experts were present to explain the reasons behind the steps and their explanations regularly included jargon special words or terms used by a particular professional group in the pandemic this included words such as rna , ventilator asymptomatic endemic , epidemiology incubation immunocompromised anaphylaxis self isolation and the list goes on. The science speak was difficult for many in the general public , let alone for seniors also , those not reading newspapers or watching tv relied on others to tell them what was happening in an unprecedented health crisis here and globally the volunteers who were still in touch with many older singaporeans had to stop home visits in the lockdown they considered getting on zoom calls or just phone calls to update seniors about the latest restrictions or explain what was happening but found many did not have the devices for such calls. This resulted in further isolation for many seniors who were getting increasingly fearful and a significant number started to believe rumors and half truths about vaccines and side effects. The fake news being circulated among the senior group was significant enough for the government to take steps to curb it. But it was not all lost. After decades of discouraging the use of chinese dialects , the ministry of communication and information started investing in dialect programs on channel eight. The ministry commission programs such as have you eaten and how are you , which included messages in various dialects about health assistance schemes , the silver support scheme , and active aging in the storylines the ministry also tacked on a senior favorite , gati usually a stage performance at hdb estates during the hungry ghost festival or chinese new year. With the covid restrictions , the gut type performers moved their ex onto facebook and youtube. And while the program still focused on singing , the host now weaved in messages about staying home , exercising at home , and staying safe. Seniors here now have no choice but to embrace some form of technology in their everyday lives. We have smartphones and smart tvs and seniors need to learn how to use these devices for their entertainment , to stay in touch with family members , to make appointments at hospitals , to pay bills , to read menus and until recently , to get into shopping malls and supermarkets a church here recently decided to forego hymnals and prayer books in a bid to reduce the risk of infection. So the churchgoers were expected to scan a qr code for the words of the hymns to be sung. The result was a very quiet church , probably because the congregation , many of whom are older adults , is not inclined to whip out their phones in church and read him lyrics in a tiny font. So why do seniors have so much trouble with technological devices ? One , the devices have traditionally been designed by young engineers , targeting young users , and seniors have been forced to adapt or lose out. Two , the accompanying manuals or user guides are not helpful because of the small text font , the small pictures in black and white with tiny captions three seniors don't have the same baseline level as younger people for learning about computers , smartphones websites and apps. Often those who try to teach older adults how to use technology end up being frustrated and wonder why do these older adults not get it ? And for the devices can be difficult for those with age related disabilities such as hearing loss , word retrieval problems and slowing of cognitive function. On the positive side , recommendations are being considered for user guides to be more senior friendly. They include typeface type of the use of color and backgrounds to make reading instructions easier. Clear writing or animation could also help and navigation on a website could be made easier with consistent layouts menus and hyperlinks also in the works are communication devices that recognize speech and can turn it into text , low vision magnifiers electronic page turners and talking books and illustrations. Gps systems will soon not only inform older people how to get somewhere , but also remind them where they are going. Still , the push to digitalize in singapore has come with a price. Seniors with headphones have become the target of scams and they have lost large sums including their life savings , to tricksters pretending to be from banks and government agencies. So now more communication is needed to educate seniors about the dangers lurking in their devices. Seniors in singapore are now healthier and living longer. They are also more educated and want to live active lives , travel and be useful to society. When you think of seniors whom do you think about ? Your grandparents parents , neighbors former teachers ? Cleaning aunties as a community , we would not want to stand by and watch a group feel and become increasingly isolated. So if we agree they are worth engaging the question becomes how low hanging fruit include the absence of this group on social media. So many seniors spend hours online but do not see people like themselves on videos or instagram. In the us , an older group of people have been making tiktok videos of themselves and newspapers have called them influencers and what about traditional media and how they portray seniors during the lockdown there were several stories of older people who were found breaking the rules , eating in hawker centers or not using the trace together app. The media appears to go for the extreme , featuring either a lonely old staring blankly out a window or a fit older tv actor showing off his abs , when in fact most in this group lie somewhere in between. Arguably the most important problem facing the planet now is the climate crisis , and the focus appears to be on the younger generation and steps they can take to stop rising temperatures. But what about the almost one quarter of singaporeans the seniors they too have a role to play. Don't they ? What habits could they change ? How to get the message across to them in a lift ? Inishan i saw a poster to encourage recycling and it showed what items should and should not go into the recycling bins the entire poster was in pictures with green ticks and red crosses. No need for text in english , chinese , malayan tamil. What are some original ideas you can come up with to engage this segment of singaporeans here then , are some takeaways from this session. One , no one platform can reach all sections of the seniors group. Two , solutions for outreach may overturn current thinking. Three , technology can be enhanced to improve the lives of seniors and finally , everyone gains when seniors are engaged.