Brain matters: How sharper minds bring happier lives

Human higher-level cognition is probably what makes Homo sapiens special. While we do share some similar mental functions with animals, capacities such as language, reasoning and social cognition are unique to humans. The human mind is so powerful that it is the root of civilisation, making developments like knowledge, economy, science and technology, law, culture, etc., possible. Human cognition is a captivating topic in the fields of psychology, philosophy and neuroscience, attracting researchers and theorists who seek to unveil the complexity of human mind.

To rehabilitation scientists, understanding how the brain works is more of a practical concern, with huge implications for human health and well-being. Our knowledge of the impacts of brain injuries, ageing, and environments on our mental functions helps inform approaches to delaying dementia, improving memory, and restoring movement and language functions.

At PolyU, Prof. David SHUM Ho-keung—Yeung Tsang Wing Yee and Tsang Wing Hing Professor in Neuropsychology, Chair Professor of Neuropsychology and Dean of the Faculty of Health and Social Sciences—has been probing the human brain throughout his entire career. With over 30 years of experience, the world-renowned researcher studies human memory, as well as the assessment and rehabilitation of higher-level cognitive functions in normal and brain-injured persons. At PAIR, he is the Associate Director of the Research Institute for Smart Ageing (RISA) and Member of the Mental Health Research Centre (MHRC).

“Forgetting to remember”: When prospective memory declines

A major area of Prof. Shum’s research is human memory—a faculty of the mind that encodes, preserves and recovers information. To date, scientists have dissected memories into different categories based on duration (e.g., sensory, short-term, long-term memories), functions (e.g., episodic, semantic, procedural memories) and other features. Prof’s Shum’s memory research focuses on prospective memory (PM)—the ability to remember to carry out planned actions or intentions, and to do things in the future.

“Remembering to remember” is a very important executive function, helping us to perform daily tasks safely and effectively. If PM fails, we may “forget to remember” things like turning off a stove, settling a payment, restocking household items and many “to-do” items which we had intended to accomplish. PM functions are impaired in early stages of dementia-related disorders. PM seems to decline with age, according to the research literature. But there is hope. Scientists have been trying to understand the condition better. Even more importantly, they are looking for ways to slow it down or even reverse it.

Building clinical evidence for memory rehabilitation

Prof. Shum has been working on interventions and practices targeted at PM training and assessment for various populations, including older adults, stroke survivors and schizophrenia patients. He and his teammates from PolyU and abroad seek to establish solid evidence of the efficacy of these trainings, and develop novel interventions aimed at specific aspects of PM. The researchers concluded in a systematic review that PM performance in older adults can be significantly and immediately improved by PM training.

The uses of technology and gaming for PM assessment have also been explored. In one study on stroke survivors, Prof. Shum and his team designed a Virtual Reality Prospective Memory Shopping Task (VRPMST), a videogame-like task which requires participants to perform shopping-related tasks (e.g., purchasing food items, collecting a receipt) in a virtual shopping centre. The application was found to be sensitive in measuring PM impairments in participants, highlighting the role of VR technology in rehabilitation science. In another study focusing on persons with traumatic brain injury (TBI), a board game activity with embedded PM tasks was found effective in improving participants’ awareness of their PM functions. Self-awareness, i.e., an accurate appraisal of one’s actual PM ability following brain trauma, is an integral step in TBI rehabilitation. To improve PM, a patient needs to know how good his/her PM is.

Schizophrenia impairs the ability not only to recall important events in the past (retrospective memory), but also to carry out scheduled actions in the future (PM). Implementation intention, i.e., the translation of goals into actions (“if …, then …”), is a pathway through which PM performance is affected, although the underlying neuroscience remains unclear. In this regard, Prof. Shum and his teammates have located the brain activation patterns associated with implementation intention, and have demonstrated that focused training can bring lasting PM improvements in patients with schizophrenia.

The neuroscience of sadness and loneliness: Mind-body connection built into human brain

Well-being, particularly in young people and older adults, is another major area of Prof. Shum’s work. His neurological approach to understanding mental health is very “focused”—identifying the neural correlates of negative emotions (e.g., depression, anxiety, loneliness) and deciphering the links among mind, body and environment. Prof. Shum is now leading intervention projects at the Mental Health Research Centre (MHRC) and the Research Institute for Smart Ageing (RISA) that focus on specific domains of human cognitive functions. He is interested in the neuronal underpinnings of mood problems among older adults in particular.

Loneliness harms us more than we thought. It affects our bodies—according to existing research, loneliness may increase the risk of a heart attack by more than 40%. It affects our brains, too, increasing the risk of cognitive decline and early-onset dementia. Therefore, at RISA, Prof. Shum and his team have been trying to clarify the relationship between loneliness and the human mind, particularly in relation to specific aspects of executive functions and social cognition functions. They are seeking to identify the underlying mechanisms in order to mitigate cognitive decline.

Feeling sad and anxious increases one’s risk for dementia. Poor emotional self-regulation, which is linked to impaired prefrontal cortex (PFC) function, may underlie subclinical depression and anxiety symptoms and their progression to the clinical level. At MHRC, Prof. Shum and his team are examining the use of neurofeedback training based on electroencephalography (EEG) or functional near-infrared spectroscopy (fNIRS) to teach emotional self-regulation to older adults with subclinical depression and anxiety. Through neurofeedback trainings targeted at the PFC, the team hopes to enhance not only the mood of older adults, but also their cognition.

Holistic health intervention informed by “brain-specific” knowledge

Neuroscience and neuropsychology, which concerns the physiological processes of human behaviour and cognition, may appear to be narrow fields of study. In fact, our “specific” understanding of the mind-body connection helps inform strategies for attaining “holistic” health.

At RISA, Prof. Shum has been leading a project which uses multimodal intervention with three components—psycho-cognitive training, physical exercise, and healthy diet—to improve the overall health of older adults. Elderly adults will be provided with brain-training computer games with educational contents on mental health, emotional regulation and social relationships, a combination of resistance training and aerobic exercises, as well as nutritional advice on a “brain-healthy” diet and follow-up monitoring by professionals. The researchers will look into the changes in all three components of health, before and after the multimodal intervention, and collect relevant neuroimaging data.

Teddy bears are not for kids only; elders need their plush toys, too

Many of us owned teddy bears in our childhoods, and some of us may still have these bears, cuddling them in our sleep. Psychologists have demonstrated that owning stuffed animals increases children’s interest in reading, reduces the level of pain after surgery in children, encourages prosocial behaviour among young adults, and enhances social cohesion and socialisation among older adults living in nursing homes. A research project by Prof. Shum and his team demonstrated the benefit of toys for older people in long-term residential care.

The emotional needs of the elderly in long-term care are often overlooked. For older adults with difficulties in speech and communication, including those affected by dementia, their voices may go unheard, and their needs may be misunderstood. Having trouble in finding the word to express intentions and needs is very frustrating. As a result, the elderly may become unconfident, anxious, depressed, or even withdrawn.

In a ten-week intervention study, Prof. Shum’s team compared the efficacy of a plush toy and PARO for reducing agitation and medication use among older adults diagnosed with dementia in long-term care. PARO is a cute-looking, soft, interactive robotic seal for therapeutic use. The results have provided new insights into the power of soft toys and social robots.

Caring for people

In May 2022, a study by Prof. Shum and his team was published on the BMC Psychiatry journal and came under the spotlight of Hong Kong’s press media. The team had performed a large-scale telephone survey of over 3,000 local residents. They found that more than 10% of the respondents had exhibited post-traumatic stress disorder (PTSD) symptoms during the fourth wave of the COVID-19 pandemic. The figure, according to the researchers, could reach 30–40% in the fifth wave.

After these findings were shared with the public, Prof. Shum appeared on various radio and television programmes, calling for the general public to pay closer attention to changes in their own bodies, feelings, behaviour and socialising activities, as well as to seek help from professionals if such symptoms began to affect daily functioning.

Prof. Shum’s numerous research publications and other public and research engagements, on matters of concern to everyone, underscore his determination to improve lives and to give back to Hong Kong, his hometown.

Going home and giving back

Over the years, Prof. Shum has been awarded over 25 national and international competitive grants by funding bodies in Australia and Hong Kong. He has published 4 books, 1 edited book, 8 book chapters, over 310 refereed journal articles, and 6 encyclopaedia entries. He also serves on the editorial board of international journals including Neuropsychological Rehabilitation, Brain Impairment, and PsyCh Journal.

The year 2018 marked an important turning point in Prof. Shum’s scholarly path. After 30 years of overseas sojourn in Australia, Prof. Shum decided to return to Hong Kong and join PolyU as Dean of the Faculty of Health and Social Sciences. Before that, he had served for five years as Dean (Research) of the Health Group at Griffith University.

Currently, in addition to multiple roles at PolyU, Prof. Shum represents PolyU on the board of the Hospital Authority, contributing to the development of Hong Kong’s healthcare system. In steering PolyU’s strategic developments, he is determined to utilise his knowledge of and experience gained in promoting interdisciplinary collaboration in Australia, and to contribute to the optimisation of the healthcare system and the management of university education, research and services in Hong Kong.