Impairments of attention and memory are evident in early psychosis, and are associated with functional disability. In a group of stable, medicated women patients, we aimed to determine whether participating in aerobic exercise or yoga improved cognitive impairments and clinical symptoms. A total of 140 female patients were recruited, and 124 received the allocated intervention in a randomized controlled study of 12 weeks of yoga or aerobic exercise compared with a waitlist group. The primary outcomes were cognitive functions including memory and attention. Secondary outcome measures were the severity of psychotic and depressive symptoms, and hippocampal volume. Data from 124 patients were included in the final analysis based on the intention-to-treat principle. Both yoga and aerobic exercise groups demonstrated significant improvements in working memory (P<0.01) with moderate to large effect sizes compared with the waitlist control group. The yoga group showed additional benefits in verbal acquisition (P<0.01) and attention (P=0.01). Both types of exercise improved overall and depressive symptoms (all P⩽0.01) after 12 weeks. Small increases in hippocampal volume were observed in the aerobic exercise group compared with waitlist (P=0.01). Both types of exercise improved working memory in early psychosis patients, with yoga having a larger effect on verbal acquisition and attention than aerobic exercise. The application of yoga and aerobic exercise as adjunctive treatments for early psychosis merits serious consideration. This study was supported by the Small Research Funding of the University of Hong Kong (201007176229), and RGC funding (C00240/762412) by the Authority of Research, Hong Kong.

The accuracy of estimates of usual energy intake derived from food records in participants of a long-term dietary-intervention trial was studied in a subset of 29 women aged 48.7+/-5.0 y and weighing 61.9+/-6.5 kg. This sample was similar to the population in the whole trial (n=715), from which it was selected in terms of age, weight, body mass index (BMI), and reported energy and fat intakes. During the validation study, reported energy intake was derived from 7 consecutive days of food records, and total energy expenditure was measured by the doubly labeled water method over 13 d. Reported energy intake (6.98+/-1.58 MJ/d) was significantly lower than energy expenditure (9.00+/-2.08MJ/d) and represented 79.8+/-17.6% of expenditure. The correlation between reported energy intake and expenditure was 0.46 (P=0.01, 95% CI: 0.15, 0.71). Body weight, BMI, height, length of time in the dietary trial, and percentage of energy from fat and carbohydrate were not significantly associated with the accuracy of reporting. These results indicate that energy intake derived from food records is an imprecise measure that substantially underestimates energy intake in middle-aged women participating in a long-term dietary-intervention trial.

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Homeless and marginally housed individuals constitute a socially impoverished population characterized by high rates of multimorbid illness that includes polysubstance use, viral infection, and psychiatric illness. Their extensive exposure to risk factors is associated with numerous poor outcomes, yet little is known about structural brain integrity and its association with neurocognition in this population. In Study 1, we conducted a cluster analysis to re-construct three previously derived subgroups with distinct neurocognitive profiles in a large sample of socially marginalized persons (N = 299). Cluster 1 (n = 87) was characterized as highest functioning overall, whereas Cluster 3 (n = 103) was the lowest functioning neurocognitively, with a relative strength in decision-making. Cluster 2 (n = 109) fell intermediate to the other subgroups, with a relative weakness in decision-making. Next, we examined the association between complementary fronto-temporal cortical brain measures (gyrification, cortical thickness) and neurocognitive profiles using multinomial logistic regression. Chi-square tests and ANOVAs differentiated subgroups on proxy measures of neurodevelopment and acquired brain insult/risk exposure. We found that greater frontal and temporal gyrification and more proxies of aberrant neurodevelopment were associated with Cluster 3 (lowest functioning subgroup). Further, age moderated the association between orbitofrontal cortical thickness and neurocognition, with positive associations in older adults, and negative associations in younger adults. Finally, greater acquired brain insult/risk exposure was associated with the cluster characterized by selective decisionmaking impairment (Cluster 2), and the higher functioning cluster (Cluster 1). In Study 2, we examined the association between white matter integrity and neurocognitive profiles using multinomial logistic regression and Tract-based Spatial Statistics. We found significantly lower fractional anisotropy (FA), with corresponding increased axial and radial diffusivity (AD, RD) in widespread and bilateral brain regions of Cluster 3.Differences in RD were more prominent compared to AD. Altogether, our findings highlight the unique pathways to neurocognitive impairment in a heterogeneous population and help to clarify the vulnerabilities confronted by different subgroups.