Prevalence of dementia in Chinese elderly in Hong Kong

Trends in prevalence and mortality of dementia in elderly Hong Kong population: projections, disease burden, and implications for long-term care

Background. We describe the trends in prevalence and mortality of dementia among older people in Hong Kong over time. Projections of the number of older people with dementia through 2039 and estimation of the disease burden are also included. Methods. Prevalence data were extracted from previous studies in Hong Kong. Mortality data were obtained from the Department of Health of Hong Kong. Projections of the number of people with dementia were calculated by applying the prevalence rates of dementia obtained from previous studies to Hong Kong population projections. The burden of dementia was measured by Disability-Adjusted Life Years (DALYs). Results. The number of people aged 60 and above with dementia is projected to increase by 222%, from 103,433 in 2009 to 332,688 in 2039, with a large proportion of those living in institutions. The number of deaths due to dementia among people aged 60 and above has more than doubled between 2001 and 2009. Mortality rates for dementia have also risen. In 2006, about 286,313 DALYS were lost due to dementia. Conclusions. The information presented may be used to formulate a long-term care strategy for dementia of the ageing population in Hong Kong.

Capacity to make decisions on medication management in Chinese older persons with mild cognitive impairment and mild Alzheimer's disease

BACKGROUND

This study aimed to assess if decisional capacity and the four decision-making abilities related to decisions concerning medication management were impaired among community-dwelling Chinese older persons in Hong Kong with amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), as compared with cognitively normal older adults.

METHODS

Two hundred and ninety-one Chinese community-dwelling older adults were recruited. The four decision-making abilities and decisional capacity were assessed by using the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED) and independent clinician ratings based on the definition in the UK Mental Capacity Act 2005, respectively.

RESULTS

Ninety-nine participants (34%) were diagnosed with MCI and ninety-five (33%) with mild AD. Although almost all (96%) of the participants in the MCI group were found to be mentally competent to make decisions on medication management in clinician ratings, their decision-making abilities as measured by the ACED were significantly lower than those of the cognitively normal controls.

CONCLUSIONS

Results from this study suggest that abilities related to decisions on medication management are impaired before the clinical diagnosis of dementia is made. Use of specific and structured assessment of the relevant decisional abilities may enhance clinical judgment.

Prevalence of dementia and major dementia subtypes in the Chinese populations: a meta-analysis of dementia prevalence surveys, 1980-2010

The aim of this study was to determine the prevalence of dementia and its major subtypes in China. Forty-eight eligible studies were included in this review. The pooled prevalence for the population aged 60 years and older of Alzheimer's disease (AD) was 1.9%, vascular dementia (VaD) was 0.9%, and total dementia was 3.0%. The prevalence of VaD was significantly higher in Northern China than in Southern China. The prevalence of VaD was significantly higher in urban compared to rural areas. The prevalence of dementia and prevalence of AD increased with age in both males and females, and a higher prevalence of AD than VaD was observed in all age groups. AD has become more common than VaD in China since 1990. The current prevalence of dementia in China may be similar to that of developed countries.

MISSING OLDER PERSONS WITH DEMENTIA — A HONG KONG VIEW

This paper reviews missing person incidents that occurred in older persons with dementia reported in local newspapers from 1 January 1999 to 1 May 2002. Ten relevant incidents, two of which happened to the same person, were found in WiseNews, an electronic database of 21 local newspapers. There were four (44%) males and five (56%) females with a mean age of 77 (standard deviation=5). In six (60%) cases, the missing persons eloped from home and four (40%) outside of home. Nine (90%) of the cases required less than a day to three days to locate the missing person. Six (60%) cases resulted in injuries or death due to falls or traffic accidents. It is not uncommon for dementia patients to get lost. Public awareness and understanding of the phenomenon is very important because the survival of missing persons depends on the implementation of timely and effective search and rescue. This analysis confirms the need for a prospective study to further examine the characteristics of missing older adults and missing incidents, as well as the search strategies adopted by caregivers.

这篇文章旨在回顾由一九九九年一月一日至二零零二年五月一日以来在本地报章上报导过的有关老年痴呆症患者走失的个案。WiseNews是一个包含二十一份本地报章的电子资料库。我们通过WiseNews搜索到十宗有关的报导，其中两宗个案发生在同一个患者身上。走失患者当中有四名男性，五名女性，年龄由七十到八十六岁［平均数：七十七］。在六宗［六成］走失个案当中，患者是从居所走失的，而另外四宗［四成］则发生在居所以外的地方。九宗［九成］个案需要少於一天至三天的时间去寻回走失患者。六宗［六成］个案涉及受伤或死亡。走失现象在老年痴呆症患者当中颇为普遍，走失患者的安危取决於及时和有效率的搜索及拯救策略。因此，大众需要对这现象有更多的了解。本文的分析显示本地需要对此问题作前瞻性的调查，使本地社会及健康服务从业员能掌握走失痴呆症患者的特徵，一般走失的情况及照顾者面对这问题的策略，从而提供合宜的协助。

Bidirectional encroachment of collagen into the tunica media in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

Arteries in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are susceptible to smooth muscle loss and fibrosis, but the molecular components underlying these dramatic vascular changes are not well characterized. The purpose of this study was to investigate the distribution of collagen isoforms in the cerebral vessels of North American CADASIL patients with classical NOTCH3 mutations. Expression of types I-VI collagen in brains obtained at autopsy from six CADASIL patients with cysteine-altering mutations in NOTCH3 was compared to control brain expression. We identified a consistent increase of types I, III, IV, and VI collagen in CADASIL brains. Strong accumulation of types I, III, IV and VI collagen was noted in all calibers of vessels, including small and medium-sized leptomeningeal arteries, small penetrating white matter arteries, and capillaries. Within leptomeningeal arteries, where we could define the three tunicae of each vessel, we found distinct collagen subtype distribution patterns in CADASIL. Types I and III collagen were largely found in either adventitial/medial or transmural locations. Type IV collagen was strictly intimal/medial. Type VI collagen was adventitial or adventitial/medial. Within the thickened penetrating arteries of CADASIL patients, all four collagens extended through most of the arterial wall. We observed increased staining of capillaries in CADASIL for types I, IV, and VI collagen. In conclusion, brain vascular collagen subtypes are increased in CADASIL in multiple layers of all sizes of arteries, with disease-specific changes most prominent in the tunica media and thickened small penetrating vessels. In diseased arteries, types I, III, and VI collagen spreads from an external location (adventitia) into the vascular media, while type IV collagen accumulates in an internal pattern (intima and media). These observations are consistent with a pathological role for collagen accumulation in the vascular media in CADASIL.

Lower intake of vegetables and legumes associated with cognitive decline among illiterate elderly Chinese: a 3-year cohort study

BACKGROUND

Despite many studies on cognitive function and its influential factors among old population, relatively little research has been designed to study the relationship between dietary intake and cognitive function in elderly.

OBJECTIVE

We conducted a population-based, prospective nested case-control study to investigate the association between dietary habits and declines in cognitive function over three years among Chinese illiterate elderly.

DESIGN AND METHODS

This study was part of the Chinese Longitudinal Health Longevity Study (CLHLS). Six thousand nine hundred and eleven illiterate residents aged 65 or older were investigated. Socio-demographic and dietary habits data were collected at baseline. The cognitive function of illiterate elderly persons was assessed using Chinese revised Mini Mental State Examination (MMSE-r) in 2002 and 2005. Cognitive decline was defined as MMSE-r score dropped to less than 18 at follow-up among those with normal cognitive function (MMSE-r≥18 at baseline). Odds ratios (OR) were calculated via logistic regression models.

RESULTS

Five thousand six hundred and ninety one elderly were included in the current analysis. In bivariate analysis, cognitive decline was associated with gender, marital status ,financial status, smoking, drinking alcohol, drinking tea, eating fruits, vegetables, legumes, fishes, meat, egg and sugar. Multivariate logistic regression analysis found that always eating vegetable (Adjusted OR: 0.66; 95% confidence intervals, CI: 0.58, 0.75), always consuming legumes (AOR:0.78; 95% CI: 0.64, 0.96) were inversely associated with cognitive decline.

CONCLUSIONS

Lower intakes of vegetables and legumes were associated with cognitive decline among illiterate elderly Chinese. Dietary factors may be important for prevention cognitive decline.

High prevalence of mild cognitive impairment and Alzheimer's disease in arabic villages in northern Israel: impact of gender and education

The prevalence of mild cognitive impairment (MCI) and Alzheimer's disease (AD) have not been well been studied in Arab populations. In a door-to-door study of all residents aged ≥ 65 years in Wadi-Ara, an Arab community in northern Israel, we estimated the prevalence of AD, MCI, and the risk of conversion to AD. Subjects were classified as cognitively normal, MCI, AD, or other based on neurological and cognitive examination (in Arabic). MCI subjects were re-examined (interval ≥ 1 year) to determine conversion to AD and contributions of age, gender, and education to the probability of conversion. Of the 944 participants (96.6% of those approached; 49.4% men), 92 (9.8%) had AD. An unusually high prevalence of MCI (n = 303, 32.1%) was observed. Since the majority of women (77.2%) had no schooling, we estimated the effect of gender on the risk of AD and MCI among subjects without schooling and of school years among men. Among subjects with no schooling (n = 452), age (p = 0.02) and female gender (p < 0.0001) were significant predictors of AD, whereas risk of MCI increased only with age (p = 0.0001). Among men (n = 318), age increased the risk (p < 0.0001), school years reduced the risk of AD (p = 0.039) and similarly for MCI [age (p = 0.0001); school years (p = 0.0007)]. Age (p = 0.013), but not gender or school years, was a significant predictor of conversion from MCI to AD (annual rate 5.7%). The prevalence of MCI and AD are unusually high in Wadi Ara, while the rate of conversion from MCI to AD is low. Yet unidentified genetic factors might underlie this observation.

Cognitive impairment using education-based cutoff points for CMMSE scores in elderly Chinese people of agricultural and rural Shanghai China

OBJECTIVES

To evaluate cognitive impairment (CI) in rural China using the Chinese version of the Mini-Mental Status Examination (CMMSE) and compare the prevalence of CI using two different cutoff points.

MATERIALS & METHODS

A population-based survey was conducted of 2809 people aged 60 years and above in a community of two towns (Huaxin and Xujing) in the Qingpu district, located in the western suburb of Shanghai. Face-to-face interviews were carried out to collect relevant information with questionnaires. The Chinese version of the Mini-Mental State Examination with either a 23/24 cutoff point or a cutoff point varying according to education level (AEL) was used to screen subjects for CI.

RESULTS

Among these subjects, the mean age was 70.6 years (SD = 6.6) and ranged from 60 to 92 years and included 1010 (36.0%) men and 1799 (64.0%) women. The mean age was 70.7 years (SD = 6.4) for men and 70.5 years (SD = 6.7) for women. Of the 2809 subjects, 2010 (71.5%) had no formal education, 607 (21.6%) completed 1-6 years of education, and 173 (6.2%) completed more than 6 years of school education. The prevalence of CI was 35.6% (95% CI: 33.8-37.4) for both genders when the cutoff point of 23/24 was used. However, when the cutoff point was altered with respect to different education levels, the prevalence of CI was 7.0%. For each item of the CMMSE, increased years of education correlated with a higher item score, with the exception of the 'Naming' item score.

CONCLUSIONS

This study demonstrates that screening of CI using the AEL cutoff scores is feasible in a low-education population. Determining whether the 23/24 cutoff point is suitable for the Chinese people requires future prospective studies in a large Chinese population.

Effects of age, education and gender in the Consortium to Establish a Registry for the Alzheimer's Disease (CERAD)-Neuropsychological Assessment Battery for Cantonese-speaking Chinese elders

BACKGROUND

The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-NAB) offers information on the clinical diagnosis of Alzheimer's disease (AD) and gives a profile of cognitive functioning. This study explores the effects of age, education and gender on participants' performance on eight subtests in the Chinese-Cantonese version of the CERAD-NAB.

METHODS

The original English version of the CERAD-NAB was translated and content-validated into a Chinese-Cantonese version to suit the Hong Kong Chinese population. The battery was administered to 187 healthy volunteers aged 60 to 94 years. Participants were excluded if they had neurological, medical or psychiatric disorders (including dementia). Stepwise multiple linear regression analyses were performed to assess the relative contribution of the demographic variables to the scores on each subtest.

RESULTS

The Cantonese version of CERAD-NAB was shown to have good content validity and excellent inter-rater reliability. Stepwise multiple regression analyses revealed that performances on seven and four out of eight subtests in the CERAD-NAB were significantly influenced by education level and age, respectively. Age and education had significant effects on participants' performance on many tests. Gender also showed a significant effect on one subtest.

CONCLUSIONS

The preliminary data will serve as an initial phase for clinical interpretation of the CERAD-NAB for Cantonese-speaking Chinese elders.

Interim follow-up of a randomized controlled trial comparing Chinese style mind body (Tai Chi) and stretching exercises on cognitive function in subjects at risk of progressive cognitive decline

OBJECTIVES

We reported the interim findings of a randomized controlled trial (RCT) to examine the effects of a mind body physical exercise (Tai Chi) on cognitive function in Chinese subjects at risk of cognitive decline.

SUBJECTS

389 Chinese older persons with either a Clinical Dementia Rating (CDR 0.5) or amnestic-MCI participated in an exercise program. The exercise intervention lasted for 1 year; 171 subjects were trained with 24 forms simplified Tai Chi (Intervention, I) and 218 were trained with stretching and toning exercise (Control, C). The exercise comprised of advised exercise sessions of at least three times per week.

RESULTS

At 5th months (2 months after completion of training), both I and C subjects showed an improvement in global cognitive function, delayed recall and subjective cognitive complaints (paired t-tests, p < 0.05). Improvements in visual spans and CDR sum of boxes scores were observed in I group (paired t-tests, p < 0.001). Three (2.2%) and 21(10.8%) subjects from the I and C groups progressed to dementia (Pearson chi square = 8.71, OR = 5.34, 95% CI 1.56-18.29). Logistic regression analysis controlled for baseline group differences in education and cognitive function suggested I group was associated with stable CDR (OR = 0.14, 95%CI = 0.03-0.71, p = 0.02).

CONCLUSIONS

Our interim findings showed that Chinese style mind body (Tai Chi) exercise may offer specific benefits to cognition, potential clinical interests should be further explored with longer observation period.

Culture, gender and health care stigma: Practitioners' response to facial masking experienced by people with Parkinson's disease

Facial masking in Parkinson's disease is the reduction of automatic and controlled expressive movement of facial musculature, creating an appearance of apathy, social disengagement or compromised cognitive status. Research in western cultures demonstrates that practitioners form negatively biased impressions associated with patient masking. Socio-cultural norms about facial expressivity vary according to culture and gender, yet little research has studied the effect of these factors on practitioners' responses toward patients who vary in facial expressivity. This study evaluated the effect of masking, culture and gender on practitioners' impressions of patient psychological attributes. Practitioners (N = 284) in the United States and Taiwan judged 12 Caucasian American and 12 Asian Taiwanese women and men patients in video clips from interviews. Half of each patient group had a moderate degree of facial masking and the other half had near-normal expressivity. Practitioners in both countries judged patients with higher masking to be more depressed and less sociable, less socially supportive, and less cognitively competent than patients with lower masking. Practitioners were more biased by masking when judging the sociability of the American patients, and American practitioners' judgments of patient sociability were more negatively biased in response to masking than were those of Taiwanese practitioners. Practitioners were more biased by masking when judging the cognitive competence and social supportiveness of the Taiwanese patients, and Taiwanese practitioners' judgments of patient cognitive competence were more negatively biased in response to masking than were those of American practitioners. The negative response to higher masking was stronger in practitioner judgments of women than men patients, particularly American patients. The findings suggest local cultural values as well as ethnic and gender stereotypes operate on practitioners' use of facial expressivity in clinical impression formation.

Cerebral microbleeds and symptom severity of post-stroke depression: a magnetic resonance imaging study

BACKGROUND

Cerebral microbleeds (CMBs) are common in stroke survivors, although their clinical significance in the development of psychiatric conditions following stroke remains unknown. This study examines the association between post-stroke depression (PSD) symptom severity and CMBs.

METHODS

Amongst the 4088 patients with acute ischemic stroke who had been admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong, between December 2004 and May 2009, 994 patients were recruited. A psychiatrist administered the Structural Clinical Interview for DSM-IV to all 994 patients and made a diagnosis of PSD three months after the index stroke. PSD symptom severity was assessed with the 15-item Geriatric Depression Scale (GDS). Seventy-eight patients were found to have PSD. The presence and location of CMBs were evaluated with magnetic resonance imaging (MRI).

RESULTS

Seventy-eight patients (7.8%) had PSD. CMBs were identified in 20 PSD patients. Relative to the no-CMB group, the mean GDS score of patients with lobar CMBs was significantly higher (12.6±2.6 versus 10.4±2.5, p=0.01 after adjusting for age, sex, global cognitive functions, neurological deficits and white matter hyperintensities).

LIMITATIONS

Patients with more severe stroke, those who died before the three-month follow-up and those who became depressed later were excluded, as were those unable to give their consent due to dementia or aphasia. These selection biases may limit the generalizability of the findings.

CONCLUSIONS

The results suggest that lobar CMBs may contribute to PSD symptom severity. The importance of CMBs in the pathogenesis of other psychiatric disorders in stroke survivors and other patient populations warrants further investigation.

Elopement among community-dwelling older adults with dementia

BACKGROUND

Adverse consequences following elopement among older people with dementia have been widely reported but the phenomenon of elopement has been under-researched. This study aimed to examine patterns of elopement incidents, search processes and subsequent prevention strategies and to explore factors that predict elopement among community-dwellers with dementia.

METHODS

Twenty subjects with a recent history of elopement and 25 subjects without any history of elopement completed the study. Their cognitive status, dementia severity and behavioral manifestations were evaluated. Family informants were interviewed to gather data on demographic characteristics, clinical conditions, caring patterns, lifestyle, history of elopement, and information about any elopement incidents.

RESULTS

Two-thirds of subjects had moderate severity of dementia (Clinical Dementia Rating ≥ 2). The elopers did not differ from the non-elopers in demographics, caring arrangements, clinical conditions or lifestyle patterns. Eighty percent of eloped subjects had a prior history of elopement. Logistic regression analyses suggested that manifestation of behavioral symptoms predicted elopement (OR = 1.410). Analysis of the 68 elopement incidents revealed that the vast majority of family caregivers failed to recognize any emotional/behavioral clues prior to elopement. Immediate and multiple search strategies were adopted, with eloped subjects mostly found near the point last seen. Yet, subsequent preventive strategies adopted were largely conventional.

CONCLUSION

Although elopement is difficult to predict, there is a need to enhance and sensitize caregivers' understanding of elopement as related to dementia and more effective preventive strategies. Public education on dementia could also serve to engage lay people more effectively in the search process of eloped persons with dementia.

Neuropsychiatric symptoms are associated with increased risks of progression to dementia: a 2-year prospective study of 321 Chinese older persons with mild cognitive impairment

BACKGROUND

studies have suggested that neuropsychiatric (NP) symptoms influence the development of dementia among older adults. But, the results are inconsistent and there is limited information about NP symptoms in population-based samples.

OBJECTIVE

to explore the association between NP symptoms and risk of cognitive decline in Chinese older persons residing in the community.

DESIGN

prospective study.

SETTING

community sample.

SUBJECTS

a total of 321 community-dwelling Chinese older persons aged 60 or over with mild cognitive impairment participated in the study.

METHODS

at baseline, each subject was assessed with Clinical Dementia Rating (CDR), Mini-Mental State Examination, list learning and delayed recall, and Category Verbal Fluency Test. Severity of NP symptoms was evaluated with Neuropsychiatric Inventory (NPI). Global cognitive status at the end of 2-year study period was determined by CDR.

RESULTS

at baseline, 40.5% of participants exhibited one or more NP symptoms (NPI total score ≥ 1). Night-time behaviours (22.1%), depression (16.8%), apathy (14.0%) and anxiety (12.8%) were the most common NP symptoms. At the end of 2-year follow-up, 27.5% of participants with depression at baseline developed dementia, compared with 14.8% of those without depression (χ² = 4.90, P= 0.03). Aberrant motor behaviour was also significantly associated with deterioration in cognition (χ² = 5.84, P= 0.02), although it was an infrequent occurrence. On logistic regression analysis, only depression at baseline was shown to be a risk factor for progression to dementia (OR= 2.40, 95% CI 1.05-5.46, P= 0.04).

CONCLUSION

depression in non-demented older persons may represent an independent dimension reflecting early neuronal degeneration. Further studies should be conducted to assess whether effective management of NP symptoms exerts beneficial effects on cognitive function.

Association between alcohol consumption and cognitive impairment in Southern Chinese older adults

BACKGROUND

There is limited data on the effects of alcohol consumption on cognitive impairment in Chinese populations.

OBJECTIVES

To investigate the association between alcohol consumption and the risk of cognitive impairment in Southern Chinese older adults in Hong Kong.

METHOD

This was a cross-sectional study of 314 Chinese older participants, aged 65 years or over. Participants' socio-demographic, co-morbid diseases, alcohol drinking habits, and Mini Mental State Examination (MMSE) for cognitive function were obtained by a face-to-face interview. Participants were categorized into normal cognitive and cognitively impaired groups by education-adjusted MMSE cut-off scores.

RESULT

The mean (SD) age of the participants was 79.9 (6.5) years. The average weekly alcohol consumption in the cognitively impaired group was significantly higher than that of the normal cognition group [mean (SD): 861.89 (673.03) versus 241.21 (276.26) grams per week respectively; p < 0.001, t-test]. Drinkers with light to moderate alcohol consumption were associated with higher MMSE scores than non-drinkers and heavy drinkers. Logistic regression analyses showed that heavy drinkers (> 400 g alcohol for men and > 280 g for women) were associated with an increased risk of cognitive impairment (OR = 4.99, 95%CI = 1.8-13.82), while light drinkers and moderated drinkers (< 400 g for men and < 280 g for women) were associated with reduced risks (OR = 0.32, 95%CI = 0.12-0.86; OR = 0.17, 95%CI = 0.06-0.51, respectively). Exercise and age were independent protective and risk factors respectively.

CONCLUSION

Heavy alcohol consumption is associated with an increased risk of cognitive impairment while light to moderate alcohol consumption is associated with reduced risk among Southern Chinese older adults in Hong Kong.

Prevalence of neuropsychiatric symptoms in chinese older persons with mild cognitive impairment-a population-based study

OBJECTIVES

To estimate the point prevalence and correlates of neuropsychiatric (NP) symptoms among older adults with mild cognitive impairment (MCI) and normal cognition (NC) in a Chinese community.

DESIGN

Cross-sectional study derived from a population-based prevalence study of MCI and dementia.

SETTING AND PARTICIPANTS

This survey was conducted in Hong Kong from 2005 to 2006. Seven hundred eighty-eight community-dwelling older adults (450 NC and 338 MCI) were recruited. Cognitive and NP data were obtained.

RESULTS

The point prevalence of at least one NP symptom in NC and MCI were 29% and 36.7%, respectively (logistic regression controlled for age and education, odds ratio = 1.38, 95% confidence interval [CI]: 1.01-1.89, Wald χ = 4.10, df = 1, p = 0.04). Agitation (1.8% versus 5.1%), apathy (7.6% versus 15.2%), and irritability (4.2% versus 8%) were more prevalent in subjects with MCI (p <0.05). Logistic regression analyses showed that apathy score was a significant factor associated with the status of NC or MCI (logistic regression, apathy, p = 0.031, Exp(B) = 1.23, 95% CI: 1.02-1.47; Hosmer and Lemeshow test, χ = 8.6, df = 8, p = 0.38, R = 0.23).

CONCLUSIONS

The authors reported the findings of one of the first population-based studies estimating the point prevalence of NP symptoms in Asian older adults with MCI. Taking into account of its prevalence and magnitude of effects, apathy is a clinically significant symptom in MCI. Its predictive value for conversion to dementia warrants further evaluation.

Caregiving burden and quality of life of pneumoconiosis caregivers in Hong Kong

OBJECTIVE

Silicosis is the most common type of pneumoconiosis in Hong Kong. This study explored the clinical correlates of the caregiving burden and quality of life (QOL) among pneumoconiosis caregivers in Hong Kong.

METHODS

The study sample included 112 patients with pneumoconiosis and their caregivers. Caregiving burden was measured using the Caregiving Burden Scale (CBS), and caregivers' QOL was assessed using the physical and mental components (PCS and MCS, respectively) of the Medical Outcomes Short Form-36. Pearson's correlation coefficient and Spearman's ρ were calculated to examine the relationship between CBS, PCS, and MCS scores and caregivers' and patients' sociodemographic variables. Stepwise regression analyses were performed to determine the independent correlates of CBS, PCS, and MCS scores.

RESULTS

Caregiving burden was correlated with certain patient characteristics (duration of disease, severity of dyspnea, exercise tolerance, depressive symptoms, daily functioning, and community living skills) and with caregivers' variables (depressive symptoms and availability of family support). Regression analysis showed that patients' daily functioning (β = -.345), caregivers' depressive symptoms (β = .509), and the availability of family support (β = .240) were independent correlates of caregiving burden, explaining 45% of the variance. The independent correlates of PCS included patients' severity of coexisting diseases (β = -.179) and caregivers' depressive symptoms (β = -.521). Both patients' (β = -.155) and caregivers' (β = -.633) depressive symptoms and patients' severity of dyspnea (β = -.183) were independent correlates of the MCS.

CONCLUSION

Caring for pneumoconiosis patients entails a significant caregiving burden for caregivers, and adversely affects their QOL. Caregivers' depressive symptoms are related to both their caregiving burden and QOL.

A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong

OBJECTIVE

To evaluate a case management (CM) model for people with mild dementia, whereby resources within the family and in the community were mobilized and optimally used.

METHOD

Community dwelling psychiatric and geriatrics outpatients with mild dementia were randomized to receive CM by a trained occupational therapist for 4 months (CM group, N = 59) or usual care only (control group, N = 43). Primary outcome indicators included the Zarit Burden Scale (ZBI), General Health Questionnaire (GHQ), and Personal Well-Being Index for Adult (PWI-A) of the family caregivers. Secondary outcome indicators included the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Personal Well-Being Index for Intellectually Disabled (PWI-ID) of the demented subjects as measured at fourth and twelfth months.

RESULT

CSDDis reduced in the CM group at fourth month, but not at twelfth month. The changes in outcome variables of persons with dementia did not differ between the groups (Mann-Whitney U-test, p > 0.05). At follow-up, CM group used more day care and domestic helpers than control group (chi (2), p > 0.05).

CONCLUSION

Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support.

The geriatric depression scale as a screening tool for depression and suicide ideation: a replication and extention

OBJECTIVES

To examine a) whether the Geriatric Depression Scale (GDS) can predict clinician-rated suicide ideation and depression, using the 15-, 5-, and 4-item versions, b) whether an additional suicide-ideation item would improve the performance, and c) whether the results vary by age groups.

METHODS

First-time psychiatric outpatients responded to the GDS. They were subsequently assessed by psychiatrists blind to the GDS, who also indicated whether suicide ideation was present. The performance of the GDS scales was evaluated using receiver operating characteristic curves. Analyses were conducted separately for young-old (aged 60-74 years) and old-old (aged 75 years or older) adults.

RESULTS

Areas under the curves showed that the different GDS versions were comparable in detecting depression and suicide ideation. For identifying depression, thresholds of 7, 2, and 2 for the 15-, 5-, and 4-item versions were optimal, respectively. In terms of detecting suicide ideation, all measures performed better in old-old than in young-old adults. A single, self-report suicide-ideation item performed better than all multiitem GDS measures.

CONCLUSIONS

Both the 4- and the 5-item versions are excellent alternatives to the 15-item version, and all are reasonable tools for detecting the presence of suicide ideation also. However, to improve the effectiveness of screening, brief measures of suicide risk should also be included. Even a 1-item measure of suicide ideation can improve clinical decisions tremendously.

Effectiveness of an individualized functional training program on affective disturbances and functional skills in mild and moderate dementia--a randomized control trial

OBJECTIVES

We reported the findings of a randomized controlled trial (RCT) to examine the effects of an individualized functional enhancement program (FEP) on functional skills and mood symptoms in mild and moderate dementia.

SUBJECTS & METHODS

74 Chinese older persons with dementia were recruited into a skills training program by occupational therapists (OT). Thirty seven subjects were trained with an individualized selection of daily activities (FEP Intervention, I); 37 were trained with general occupational therapy (Control, C). The FEP comprised of twice weekly group sessions of skills training and problem solving using cognitive behavioral approach.

RESULTS

At 1 month after completion of program, both I and C subjects showed an improvement in process skills of the assessment of motor and process skills (AMPS)(paired t-tests, p < 0.05). At 4 months post-program, the I group showed a further reduction of cornell scale for depression in dementia (CSDD) scores (paired t-test, p = 0.02); Apathy improved at 1 month post-training (p = 0.04), but deteriorated at 4 months (p = 0.01). Group differences in changes of mood and functional scores were not significant (ANVOCA, p > 0.05).

CONCLUSIONS

The findings suggested a potential benefit for individualized occupational therapy. It should be tailor made with individual needs and continued for sustained effectiveness.

Validation of Self-administrated Questionnaire for Psychiatric Disorders in Patients with Functional Dyspepsia

Introduction

Psychiatric comorbidity is common in patients with functional dyspepsia (FD) but a good screening tool for psychiatric disorders in gastrointestinal clinical practice is lacking.

Aims

1) Evaluate the performance and optimal cut-off of 12-item General Health Questionnaire (GHQ-12) as a screening tool for psychiatric disorders in FD patients; 2) Compare health-related quality of life (HRQoL) in FD patients with and without psychiatric comorbidities.

Methods

Consecutive patients fulfilling Rome III criteria for FD without medical co-morbidities and gastroesophageal reflux disease were recruited in a gastroenterology clinic. The followings were conducted at 4 weeks after index oesophagogastroduodenoscopy: self-administrated questionnaires on socio-demographics, dyspeptic symptom severity (4-point Likert scale), GHQ-12, and 36-item short-form health survey (SF-36). Psychiatric disorders were diagnosed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) by a trained psychiatrist, which served as reference standard.

Results

55 patients underwent psychiatrist-conducted interview and questionnaire assessment. 27 (49.1%) had current psychiatric disorders as determined by SCID (anxiety disorders: 38.2%, depressive disorders: 16.4%). Receiver operating characteristic curve analysis of GHQ-12 revealed an area under curve of 0.825 (95%CI: 0.698-0.914). Cut-off of GHQ-12 at ≥3 gave a sensitivity of 63.0% (95%CI = 42.4-80.6%) and specificity of 92.9% (95%CI = 76.5%-98.9%). Subjects with co-existing psychiatric disorders scored significantly lower in multiple domains of SF-36 (mental component summary, general health, vitality and mental health). By multivariate linear regression analysis, current psychiatric morbidities (Beta = -0.396, p = 0.002) and family history of psychiatric illness (Beta = -0.299, p = 0.015) were independent risk factors for poorer mental component summary in SF-36, while dyspepsia severity was the only independent risk factor for poorer physical component summary (Beta = -0.332, p = 0.027).

Conclusions

Concomitant psychiatric disorders adversely affect HRQoL in FD patients. The use of GHQ-12 as a reliable screening tool for psychiatric disorders allows early intervention and may improve clinical outcomes of these patients.

Lower fluid and fruits/vegetable intake in questionable dementia among older Hong Kong Chinese

OBJECTIVE

Nutrition plays a role in the ageing process of the brain and suboptimal nutrient intake might precede clinical cognitive impairment. A diet high in fruits and vegetables has been recommended while little has been said about the influence of fluid intake in cognitive function. We examine the dietary pattern of community-dwelling older individuals with questionable dementia and compared that with normal individuals.

DESIGN

Cross-sectional.

SETTING

Community.

PARTICIPANTS

285 community-dwellers aged 60 or older.

MEASUREMENTS

Dietary habits were recorded using the Mini-Nutritional Assessment (MNA). Questionable dementia was diagnosed by psychogeriatricians and relevant demographic and dietary factors were examined using univariate then multivariate analyses.

RESULTS

146 questionable dementia and 139 cognitively normal subjects were interviewed. Both groups were not at risk of malnutrition (MNA score 26.1 vs. 26.7 respectively, p = 0.02). The former were older, had fewer years of education, lower MMSE and ADAS-cog as well as lower MNA scores. In univariate analysis, questionable dementia was associated with decline in food intake and appetite, eating less vegetables and fruits, and drinking less fluid. After adjustment for age, gender and education level, eating > 2 servings of vegetables / fruits per day (OR 0.26, 95% CI 0.067, 0.973) and taking > 5 cups of fluids per day (OR 0.4, 95% CI 0.204, 0.792) was associated with a lower prevalence of questionable dementia.

CONCLUSION

Older people with questionable dementia have lower intakes of vegetables, fruits and fluid than those who were cognitively normal. This may pose additional health risks, and increase their chance of progressing into dementia.

Case-control study of suicide attempts in the elderly

BACKGROUND

Prior studies have inadequately explored the relationship between late-life suicidal behavior and subclinical/clinical symptoms. This study aimed to assess the risk associated with subclinical symptoms, mild cognitive impairment and clinical factors among late-life suicide attempters.

METHOD

Forty-three elderly patients aged 60 years and older who sought emergency services in a university-affiliated general hospital for attempting suicide and 43 comparison subjects participated in this study between March 2005 and December 2006. The comparison group was recruited by advertising in the community around the hospital. DSM-IV based diagnostic interview and screening instruments including the GDS, MMSE, BSRS-5 and APGAR were applied. Adjusted odds ratios were measured in the final multiple logistic regression model.

RESULTS

Suicide attempters were more likely to meet a diagnosis of depressive disorder, after adjustments for BSRS-5 score and drinking habit. The adjusted odds of suicide among people with a BSRS-5 score of more than 5 points was 17.8 times higher than those with the BSRS score less than or equal to 5 points.

CONCLUSIONS

Our findings support the significant impact on late-life suicidal behavior from the assessment of subclinical symptoms, including anxiety, depression, hostility, sleep condition and interpersonal symptoms. The assessment of subclinical symptoms by the BSRS-5 may help in the future prevention of late-life suicidal behavior in primary care settings.

A community model of group rehabilitation for older patients with chronic heart failure: A pilot study

PURPOSE

The aim of this study was to develop and evaluate a community-based programme for heart failure patients, with emphasis on exercise and education.

METHOD

In a before-and-after trial, subjects with heart failure underwent a 12-week group programme comprising of exercise, education and mutual support. Outcome measures included subjects' compliance and views of the programme, knowledge related to disease management, physical parameters (symptoms, exercise tolerance, muscle strength) and psychosocial well-being (using generic and disease-specific tools). A focus group was held and participants' feedback noted.

RESULTS

Overall patient compliance and satisfaction rate was high. Significant changes were observed in knowledge, physical performance and psychosocial parameters. Subjects' feedback following the programme was generally positive.

CONCLUSIONS

This pilot study shows that a group programme for heart failure patients is feasible, acceptable and improved physical status and quality of life. It can be a useful model in the management of chronic disease in the community.

Capacity to make treatment decisions in Chinese older persons with very mild dementia and mild Alzheimer disease

OBJECTIVES

This study aims at assessing mental competence in Chinese patients with mild and very mild dementia with a semistructured assessment method and the impact of repeated presentations of information on patients' mental competence.

DESIGN

Subjects with mild and very mild dementia were compared with cognitively intact subjects.

SETTING

Chinese subjects were recruited from local social centers and residential hostels for the elderly in Hong Kong.

PARTICIPANTS

Sixty-six Chinese community-dwelling older adults (aged from 65 to 87 years) were recruited.

MEASUREMENTS

Clinical diagnosis was made by experienced geriatric psychiatrists. Subjects were assessed with the Mini-Mental State Examination and the Clinical Dementia Rating (CDR). Mental capacity to consent to treatment was assessed by using the Chinese version of the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and independent clinician ratings based on the definition in the Mental Capacity Act 2005 of the United Kingdom.

RESULTS

Thirty-three (50%) participants were diagnosed with very mild or mild dementia (CDR = 0.5 or 1). In this group, 15 (45.5%) subjects were rated as mentally incompetent in clinician ratings. In the assessment of interrater reliability, the intraclass correlation coefficient of MacCAT-T summary scores among three raters ranged from 0.64 to 0.83. The MacCAT-T summary scores correlated significantly with clinician ratings, years of education, Mini-Mental State Examination score, and CDR. In contrast to the nonimpaired group, repeated presentation of information did not significantly improve capacity in the demented group.

CONCLUSION

Results from this study suggest that even patients with very mild dementia in this population can show substantial deficits in decision-making capacity, and that improved capacity is not likely to result from repeated disclosure of information.

Characteristics and diagnostic profile of patients seeking dementia care in a memory clinic in Hong Kong

BACKGROUND

Seeking medical advice for dementia involves an understanding of norms, values and attitudes towards care-giving and inter-dependency, which are culturally bounded. We hypothesize that local culture and socioeconomic structure affect our Chinese patients who present with forgetfulness to our memory clinic.

METHODS

A retrospective case notes review was undertaken on 454 consecutive patients referred to the memory clinic at Princess Margaret Hospital, Hong Kong.

RESULTS

385 patients were diagnosed with dementia and 27 had mild cognitive impairment. Reversible dementia was identified in 24 patients and normal cognition in 18. In patients with dementia, 55.8% had Alzheimer's disease, 26.2% had vascular dementia, 6.0% had other irreversible dementia, 5.2% had dementia with Lewy bodies, 4.9% had undetermined dementia and 1.8% had frontotemporal dementia. The median duration from symptom onset to medical consultation was two years; 66.5% had advanced disease with initial Mini-mental State Examination scores < or = 17. On their first visit, 85% of patients were living in the community; after two years this proportion had fallen to 63%.

CONCLUSIONS

Dementia patients in Hong Kong apparently enjoy a long subclinical period and only seek medical attention at late stages. Local Chinese culture and socioeconomic backgrounds could be the main reasons that underlie these observations.

Validation of Fuld object memory evaluation for the detection of dementia in nursing home residents

OBJECTIVES

To examine the psychometric properties of the Fuld Object Memory Evaluation (FOME) as an instrument to detect dementia in nursing home residents.

METHOD

Ninety-six elderly participants were recruited into a dementia group (n = 30) and a normal control group (n = 66). Forty participants (12 dementia, 28 normal controls) had visual impairment.

RESULTS

The test-retest reliability and parallel-form reliability of FOME were excellent, with intraclass correlation coefficients of 0.92 and 0.96, respectively. Satisfactory convergent validity of FOME was established with the Cantonese version of Mini-Mental State Examination, and the Memory subscale and the Initiation/Perseveration subscale of the Chinese version of Dementia Rating Scale (r = 0.43 - 0.68; p < 0.01). The FOME total retrieval (TR) score and delayed recall (DR) score showed good discriminative power to screen for dementia. Optimal cutoff scores for TR and DR were suggested as 33 (93% sensitivity, 82% specificity) and 7 (87% sensitivity, 76% specificity) respectively. The performance of FOME was not influenced by age, educational level and visual impairment.

CONCLUSION

The findings suggest that FOME is a valid assessment to screen for dementia in older nursing home residents and can be used with older individuals with limited education and those with visual impairments.

Clinical validity of Fuld Object Memory Evaluation to screen for dementia in a Chinese society

OBJECTIVES

Fuld Object Memory Evaluation (FOME) evaluates the episodic memory functions of encoding, storage, and recall across five recall trials and a delayed recall trial. This study examined the clinical validity of FOME as a screening tool for dementia in older Chinese adults.

METHOD

The psychometric properties and the discriminative power of FOME were examined in a convenience sample of 192 community-dwelling older individuals, of which 57 were diagnosed with dementia. The influence of age and education on the FOME performance was also estimated.

RESULTS

The test-retest reliability and parallel-form reliability of FOME were excellent, with Intraclass Correlation Coefficients ranging from 0.91-0.96. Good convergent validity of FOME was established with Mini-Mental State Examination (r(p) = 0.69-0.74), and the Memory subscale and the Initiation/Perseveration subscale of Dementia Rating Scale (r(p) = 0.63-0.74). The FOME total retrieval (TR) score and delayed recall (DR) score demonstrated good discriminative power in differentiating dementia from normal cognitive functioning, with area under the curve values of 0.97 and 0.93 respectively. The optimal cut-off scores suggested for TR and DR were 31 (93% sensitivity, 90 specificity) and 7 (91% sensitivity, 82% specificity), respectively. The performance of the FOME was not influenced by the educational level.

CONCLUSIONS

The results suggest that the FOME is a reliable and valid instrument to screen for dementia in older community-dwelling Chinese adults. The absence of the effects of education on the assessment performance makes FOME a clinically useful instrument for older adults with limited education.

Ethnic differences in Singapore's dementia prevalence: the stroke, Parkinson's disease, epilepsy, and dementia in Singapore study

OBJECTIVES

To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians.

DESIGN

A two-phase, cross-sectional study of randomly selected population from central Singapore with disproportionate race stratification.

SETTING

Community-based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers.

PARTICIPANTS

Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate).

MEASUREMENTS

The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders-Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively.

RESULTS

The overall age- and race-standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10-1.45). Prevalence (in 5-year age bands) was 0.08% (50-54), 0.08% (55-59), 0.44% (60-64), 1.16% (65-69), 1.84% (70-74), 3.26% (75-79), 8.35% (80-84), and 16.42% (>/=85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese.

CONCLUSION

Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.

Assessment of the severity of dementia: validity and reliability of the Chinese (Cantonese) version of the Hierarchic Dementia Scale (CV-HDS)

BACKGROUND

With the rapid growth of the older population, early detection of cognitive deficits is crucial in slowing down functional deterioration of the elderly persons.

OBJECTIVES

To examine the validity and reliability of the Chinese (Cantonese) version of the Hierarchic Dementia Scale (CV-HDS) for Chinese older persons in Hong Kong.

METHODS

The HDS was translated into Cantonese Chinese. The content and cultural validity were evaluated by six expert panel members. Sixty-two participants with diagnosis of dementia were recruited for evaluation. Inter-rater reliability, test-retest reliability, internal consistency and concurrent validity were examined.

RESULTS

The CV-HDS demonstrated satisfactory psychometric properties. inter-rater reliability and test-retest reliability were high (alpha=0.89 and alpha=0.94 respectively). High value of Cronbach's alpha (alpha=0.94) demonstrated good internal consistency. The concurrent validity of CV-HDS, through correlation with its scores with that of the Chinese version of Mini Mental Status Examination, was established (ranged from r=0.58 to r=0.78, p<0.01).

CONCLUSIONS

The CV-HDS is a reliable and valid instrument for assessing severity of cognitive impairment in Cantonese speaking Chinese people with dementia. It facilitates treatment planning to optimize the effects of functional training and rehabilitation.

Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder forms of cognitive impairment in Hong Kong SAR

BACKGROUND

Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis.

METHOD

A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-2006. In the first phase, 6,100 randomly selected community dwelling elders were assessed with Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC). Two thousand and seventy-three subjects were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject.

RESULTS

1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms (>or= 8 on CSDD). Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms.

CONCLUSIONS

In our sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.

Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong

INTRODUCTION

In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong.

METHODS

The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1.

RESULTS

The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4-9.6) and 8.9% (95%CI: 7.8-10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia.

CONCLUSIONS

A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity.

Living with early-stage dementia: the perspective of older Chinese people

AIM

This paper is a report of a study to describe the lived experiences of people with early-stage dementia and their ways of coping with the illness.

BACKGROUND

Emerging models of subjective experience and coping with early dementia have been developed in Western cultures. Understanding how Chinese people with early-stage dementia adjust and cope is an important starting point in developing interventions that can enhance their adaptive coping.

METHOD

A convenience sample of 15 Chinese people in the early stages of dementia were interviewed and observed during home visits. The study involved in-depth transcribed interview data using a phenomenological approach. The data were collected in 2005.

RESULTS

Four themes were identified in the data: attribution of illness, experiencing losses resulting in frustration and uncertainty, adapting to a new role in relationships with family and friends and continuing to live. People with early dementia who adopted a positive outlook did so because they had made sense of and accepted the illness, received understanding and support from family and friends and were being listened to and respected.

CONCLUSION

The themes emerging from the findings could be used as a framework in understanding how people cope with the onset of early dementia. The framework includes specific implications for the provision of intervention services and highlights the importance of understanding people's own constructions of their illness and how they adjust their lives in coping.

Rivastigmine in Chinese patients with subcortical vascular dementia

BACKGROUND

We explored the efficacy and tolerability of rivastigmine among Chinese patients with subcortical vascular dementia.

METHODS

Forty subjects were randomized to either placebo (n = 20) or rivastigmine (n = 20) in a double-blind 26-week trial. Outcome measures were cognition (mini-mental state examination, frontal assessment battery), neuropsychiatric inventory (NPI), instrumental activities of daily living, clinical dementia rating scale, and adverse events.

RESULTS

No statistical significant benefit could be observed in the active group in any of the efficacy measures. A trend favoring active group was observed only in the NPI subscore of irritability (p = 0.066) and aberrant motor behavior (p = 0.068). Withdrawal rate was 30% and 15% in the active and placebo group, respectively.

CONCLUSION

Among Chinese subcortical vascular dementia patients, there was no apparent cognitive benefit associated with use of rivastigmine over the 6 months period. A trend favoring rivastigmine was observed in certain behavioral measures. Rivastigmine was associated with more withdrawals relative to placebo.

Systematic review of dementia prevalence 1994 to 2000

Ageing has occurred in all regions of the world, with impact on neuropsychiatric disorders, particularly dementia. However, previous meta-analysis and reviews have shown high variability in world dementia prevalence rates.

Coexisting Cerebral Infarction in Alzheimer's Disease Is Associated with Fast Dementia Progression: Applying the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences Neuro

OBJECTIVES

To determine whether patients with Alzheimer's disease (AD) and coexisting cerebral infarction (CI) that satisfy the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) neuroimaging criteria for vascular dementia (VaD) progress faster than those who do not satisfy the neuroimaging criteria.

DESIGN

Retrospective cohort study.

SETTING

Multidisciplinary memory clinic in a tertiary hospital.

PARTICIPANTS

One hundred thirty consecutive patients with AD, with or without CI, followed up regularly for more than 1 year.

MEASUREMENTS

The patients were classified according to the distribution and severity of CI as defined according to the NINDS-AIREN neuroimaging criteria into those with AD and no CI (AD-N), those with AD and CI not fulfilling neuroimaging criteria (AD-I), and those with AD and CI fulfilling neuroimaging criteria (AD-V), and their differences in dementia progression were tested. The loss of independence, indicated by institution admission or a clinical dementia rating (CDR) score of 3, was defined as the endpoint for a poor outcome.

RESULTS

The mean age was 75.8, and 68.5% were women. The initial Mini-Mental State Examination (MMSE) score was 15.3+/-0.4, and the average duration of follow up was 30.4 months. Fifty-four patients had reached study endpoint at the time of analysis. AD-V (hazard ratio (HR)=3.1, 95% confidence interval (CI)=1.2-8.2), use of psychotropic drugs (HR=2.7, 95% CI=1.1-6.4), and initial MMSE score (HR=0.9, 95% CI=0.8-1.0) were independent predictors of poor outcome in the Cox regression model.

CONCLUSION

In AD, co-occurrence of CI with distribution and severity as defined in the NINDS-AIREN neuroimaging criteria for VaD is associated with faster dementia progression.