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Introduction
Hong Kong is a small, densely settled Special Administrative Region of China (the HKSAR). Its 2014 mid-year population of some 7.3 million persons had a median age of 42.8 years, with 14.7% aged 65 and, importantly, 4.4% aged over 80 (Census and Statistics Department, 2015a). These percentages of older persons have increased considerably over the past 30 years, as Hong Kong's population has aged demographically, and the HKSAR now also has one of the lowest fertility rates in the world. It faces its most rapid period of population ageing over the next 20 years, with the age 65-plus group set to comprise almost 23% of the ‘usually resident’ population by 2024 and 30% in 2034, when the median age will be 50. Indeed, United Nations projections indicate that the HKSAR will probably be the sixth oldest territory in the world by 2050, with a median age of almost 53 years (UNDESA, 2015), 10 years older than at present. Clearly, therefore, with a considerable population that is already elderly and the likelihood of very considerable future increase in the proportion of older persons, questions of age-friendliness on all the main domains of the World Health Organization (WHO)'s (2007a, 2007b) age-friendly cities and communities (AFCC) model are of prime consideration as well as certain local additional AFCC characteristics (Wong et al, 2015, 2017). By August 2017, ten HKSAR districts had embarked on the AFCC commitments and received recognition from the WHO by being included in its list of AFCC communities. Hong Kong is also one of 15 countries and territories involved in pilot testing a set of indicators of age-friendliness, under the WHO Kobe Centre for Health Development (WHO, 2015).
Hong Kong is a highly urbanised small territory of only 1,100 square kilometres and, while about 40% of the HKSAR comprises protected country parks, geographical reasons mean that the population is concentrated in only about 25% of the land area. Therefore, overall population density is among the highest in the world, at 6,690 per square kilometer in 2014. In places such as Kwun Tong, the most densely populated district and located in Kowloon, density reaches 57,250 persons per square kilometer (Hong Kong Government, 2015).
The current study presents both longitudinal behavioral data and functional activation data documenting the effects of early focal brain injury on the development of spatial analytic processing in two children, one with prenatal left hemisphere (LH) injury and one with right hemisphere (RH) injury. A substantial body of evidence has shown that adults and children with early, lateralized brain injury show evidence of spatial analytic deficits. LH injury compromises the ability to encode the parts of a spatial pattern, while RH injury impairs pattern integration. The two children described in this report show patterns of deficit consistent with the site of their injury. In the current study, their longitudinal behavioral data spanning the age range from preschool to adolescence are presented in conjunction with data from a functional magnetic resonance imaging (fMRI) study of spatial processing. The activation results provide evidence that alternative profiles of neural organization can arise following early focal brain injury, and document where in the brain spatial functions are carried out when regions that normally mediate them are damaged. In addition, the coupling of the activation with the behavioral data allows us to go beyond the simple mapping of functional sites, to ask questions about how those sites may have come to mediate the spatial functions. (JINS, 2003, 9, 604–622.)
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