Institute of Mental Health

A multi-sector partnership involving the National Healthcare Group and Nanyang Technological University is building voice AI and a community intervention programme to detect an early form of depression among the elderly. The three-year project also engages the NHG Polyclinics and Institute of Mental Health (IMH) and two NTU Singapore schools – Lee Kong Chian School of Medicine (LKCMedicine) and College of Computing and Data Science (CCDS). WHAT IT'S ABOUT The project – dubbed SoundKeepers – will involve more than 600 senior individuals aged 55 and above who are connected to Hougang and Woodlands polyclinics. Voice records of the participants from casual conversation or passage reading will be collected with consent and identified as a representative sample for the AI model. The voice samples will be anonymised and stored in a central storage terminal. The AI, to be jointly developed by NTU Singapore's LKCMedicine and CCDS, will then analyse these sample recordings for their acoustic properties, including pitch, volume, timbre, rhythm, shimmer, jitter, and harmonics-to-noise ratio. "When we use our voice, we are activating and coordinating more than a hundred different muscles and neurobiological processes. A change in speech acoustic features can reveal abnormalities in these neurobiological processes," explained Dr Lee Eng Sing, co-principal project investigator. He is also an assistant professor and the clinical director of NTU LKCMedicine's Primary Care and Family Medicine research programme. Meanwhile, a second component of the project is a 24-week community intervention programme led by the IMH. It will comprise module-based psychoeducation, community activities (such as exercise and recreational activities), and befriending. The programme will be delivered with assistance from social service agencies, Fei Yue Community Services and Club HEAL. Moreover, a randomised controlled trial – to be led by the NHG Polyclinics – will recruit 300 participants with those observed having early depression to compare their levels of loneliness, anxiety, well-being, and depression literacy before and after the intervention programme. These will also be compared to a control group. This cluster-wide project has received S$5.6 million ($4.2 million) in funding from the Lien Foundation. WHY IT MATTERS The NHG-based project targets the condition called subsyndromal depression (SSD), an emergent form of depression observed among seniors. The project partners consider the condition as a "largely unaddressed health risk." In a statement, they claim that SSD is five times more likely to become depression within a year; individuals with this condition are reportedly 12 times at higher risk of dementia. There are five times more people with SSD than those diagnosed with depression over a year, they noted. The condition is also said to affect around 13% of seniors living in community homes, based on self-reported assessments – which may be an underestimation. Additionally, it was observed that seniors with early depression incur more healthcare costs as well as have a higher uptake of outpatient services than those without it. "Currently, SSD is not actively diagnosed or treated," admitted Dr Mythily Subramaniamad, also a co-principal investigator of the SoundKeepers project. She is also the assistant chair of the Research Medical Board at IMH. Their project, Dr Subramaniamad added, will "facilitate the early detection and diagnosis of SSD with a tool that can be easily used in the community setting." "[A]s while previous studies have demonstrated the feasibility of detecting depression through vocal analysis, little work has been done on the more subtle SSD," claimed NTU CDDS professor Guan Cuntai, another co-principal investigator of the project. Once proven effective, SoundKeepers is hoped to be expanded to cover more polyclinics, GP clinics, and participant cohorts. Project partners also see the voice AI-driven project as potentially becoming part of Singapore's national mental health ecosystem through such existing government-funded community programmes as CREST and COMIT. THE LARGER TREND Another social service agency in Singapore, Lion Befrienders, is also leveraging AI and mobile technologies to monitor and improve the mental conditions of community-dwelling seniors. In 2021, it started a two-year pilot with software company Opsis to check the mental state of over 4,000 seniors by capturing and analysing their facial expressions. Last year, the Singapore University of Technology and Design worked with Lion Befrienders to launch a mobile application to prevent dementia among seniors through multilingual instructions. The app, called Ami, has been installed in over a thousand digital tablets used in one of the service's active ageing centres. ON THE RECORD "We need new ways to listen to our seniors. While they may not express their worries through words, we can now try to hear it through their voices," Lien Foundation CEO Lee Poh Wah underscored in a statement.

A new mobile application in Singapore is taking an innovative approach to communications training for caregivers of people with dementia. The Institute of Mental Health (IMH), a tertiary psychiatric care hospital under the National Healthcare Group in Singapore, has collaborated with Taggle, a connected digital health platform provider, to create the Play2Care app. WHAT IT'S ABOUT Now available on both Android and iOS app stores, Play2Care gamifies the training of dementia caregivers. It features a series of explanatory videos on the T.A.N.G.O. approach in caregiving developed by IMH. The videos show how the techniques can be applied in five commonly encountered scenarios in dementia caregiving. "In the Play2Care app, Taggle used technology to recreate interactive scenarios for caregivers to practice T.A.N.G.O, so that it becomes a natural way for caregivers to react when faced with the real situation," explained Taggle CEO Lee Seng Beo. Additionally, Play2Care has mini-games that caregivers can play with their patients. The app was also designed with adult caregivers in mind, incorporating elements such as a large font size, high-contrast coloured buttons, and reduced speed in voiceover and animations. IMH shared that Play2Care proved to enhance carers' dementia knowledge and comfort level in interacting with persons with dementia in a small pilot involving five participants. WHY IT MATTERS Behavioural changes in people with dementia pose a challenge to caregivers. These changes, which are actual attempts to communicate their unmet needs, can stress out caregivers who lack understanding. Agitation, reversed sleep-wake patterns, refusal to shower, repeated requests for food and growing suspicions are some of the most common behavioural issues that caregivers struggle to understand, according to the IMH. "This knowledge gap of how to communicate effectively with persons with dementia often stems from a lack of understanding of these behaviours and that a different set of communication techniques is required. While we can offer medical advice and treatment, there has to be a more creative way to impart communication techniques that caregivers can apply in their day-to-day routines to alleviate stress. This is why we initiated this app," Dr Yao Fengyuan, a senior consultant and chief of the IMH Department of Geriatric Psychiatry, explained. To manage these behaviours, the IMH offers the T.A.N.G.O. communication strategy, which stands for the following techniques: a tender approach; acknowledging emotions and unmet needs; never challenging behaviours; getting into simple conversations; and optimising the environment to promote comfort and independence. Attending lectures to learn common challenging behaviours and ways to manage them, according to Ong Xin Ling, a senior occupational therapist at IMH, no longer suffices. "We need a supplemental platform beyond the classroom setting for caregivers to practise and implement those communication strategies learnt," she added. THE LARGER TREND As global staff shortages also hit the senior care sector, digital approaches, such as the use of mobile technologies and robotics, have been explored in recent years. In Singapore, a prototype of a mobile app that helps senior folks improve their multilingual thinking to arrest dementia progression was recently rolled out in active ageing centres. A project in Australia called MATCH, which has received $1 million from Google.org, is incorporating into a caregivers' training app a music-based intervention for regulating the mood of individuals with dementia. Also in Australia, startup Andromeda Robotics offers its humanoid robot, Abi, which was built to be an empathetic companion to elderly residents in nursing homes. The deployment of companion robots, such as the AI-driven PIO and Channy, has been a trend among local South Korean governments to keep solo-living seniors company at home.

A team of researchers has uncovered new clues about how chemicals released by brain cells regulate our attention span. A team of researchers from Nanyang Technological University, Singapore (NTU Singapore) has uncovered new clues about how chemicals released by brain cells regulate our attention span. Findings from the study could pave the way for new therapies to treat neurological conditions associated with concentration difficulties, such as depression and attention-deficit hyperactivity disorder (ADHD). To communicate with one another, neurons in the brain and nervous system release chemicals called neurotransmitters that relay messages from one cell to another. Neurotransmitters are crucial for brain function and regulating all bodily functions, ranging from breathing and heart rate to reproduction. These chemicals also coordinate cognitive processes that enable us to focus on important information within the constant barrage of stimuli the brain receives from the external environment, otherwise known as our attention span. Researchers have long thought that our attention span was directed by only one neurotransmitter, acetylcholine, which excites neurons and causes them to fire electrical signals. However, recent work suggests that attention could require another neurotransmitter, gamma-aminobutyric acid (GABA), which inhibits neurons from receiving and sending messages. In their study published in the Proceedings of the National Academy of Sciences (PNAS), the team demonstrated for the first time that GABA works together with acetylcholine in a precise sequence to regulate the transmission of signals from a part of the brain's information processing network, called the claustrum. Hidden deep in the brain, the claustrum is a thin sheet-like structure that receives and processes information from different parts of it. The claustrum helps to regulate concentration, but its exact role remains unknown. Neurotransmitters toggle 'like a switch' to relay information In lab experiments, the NTU scientists investigated how neurons in the claustrum in mice respond to acetylcholine and GABA produced by a part of the brain called the forebrain, that plays a central role in several brain functions. The key technological advance that allowed the researchers to make this discovery is called optogenetics. Optogenetics uses light-sensitive proteins to selectively control the activity of specific types of neurons within the brain. In this case, the neurons within the forebrain that release acetylcholine and GABA were activated by light, allowing the team to measure the response of the claustrum to such a stimulus. They discovered that two types of neurons in the claustrum, which send output signals to different parts of the brain, respond in opposing ways to acetylcholine and GABA. Neurons that extend to structures deep in the brain were excited by acetylcholine while neurons that extend to structures on the surface of the brain were inhibited by GABA. Through this coordinated sequence of opposing actions, the two neurotransmitters toggle the transfer of information between the claustrum and the rest of the brain, like a switch. The study provides evidence that the neurotransmitters regulate a "microcircuit" in the brain, that allows the organ to differentiate important information from noise, helping a person pay attention. The opposing actions of the neurotransmitters (acetylcholine and GABA) on neurons in the claustrum enable brain signals to be encoded efficiently, allowing the brain to pay attention and ignore noise. First author Mr Aditya Nair, former researcher at LKCMedicine and a current Ph.D. student at Caltech, said, "Our study advances our understanding of the claustrum's role in directing attention span. Understanding how the claustrum regulates attention span at the cellular level also provides a window into other areas regulated by similar signalling pathways, such as arousal and learning." Lead investigator and neuroscientist Professor George Augustine from NTU's Lee Kong Chian School of Medicine (LKCMedicine) said, "By understanding how acetylcholine and GABA work together to direct our attention, new and more effective therapies may be developed in the future to improve the attention span of patients with conditions such as ADHD and depression." Commenting as an independent expert, Dr Geoffrey Tan, Consultant (Psychiatry) Clinician-Scientist at the Institute of Mental Health Singapore, said, "Directing attention and multi-tasking are crucial cognitive processes for everyday functioning that require toggling between networks or circuits in the brain. This study identifies a 'switch' in the claustrum that provides a mechanism by which acetylcholine may drive computations such as these. It is timely as we increasingly incorporate brain networks into how we think about cognition, psychiatric conditions and even interventions like mindfulness." The next steps for this project will be to determine how altering the dual-transmitter switch alters attention and brain disorders that affect attention, such as ADHD. It will also be important to determine whether the switch mechanism applies to other brain processes, such as arousal and learning.