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Zhou J, Liu W, Zhou H, Lau KK, Wong GH, Chan WC, Zhang Q, Knapp M, Wong IC, Luo H. Identifying dementia from cognitive footprints in hospital records among Chinese older adults: a machine-learning study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101060. [PMID: 38638410 PMCID: PMC11025003 DOI: 10.1016/j.lanwpc.2024.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Background By combining theory-driven and data-driven methods, this study aimed to develop dementia predictive algorithms among Chinese older adults guided by the cognitive footprint theory. Methods Electronic medical records from the Clinical Data Analysis and Reporting System in Hong Kong were employed. We included patients with dementia diagnosed at 65+ between 2010 and 2018, and 1:1 matched dementia-free controls. We identified 51 features, comprising exposures to established modifiable factors and other factors before and after 65 years old. The performances of four machine learning models, including LASSO, Multilayer perceptron (MLP), XGBoost, and LightGBM, were compared with logistic regression models, for all patients and subgroups by age. Findings A total of 159,920 individuals (40.5% male; mean age [SD]: 83.97 [7.38]) were included. Compared with the model included established modifiable factors only (area under the curve [AUC] 0.689, 95% CI [0.684, 0.694]), the predictive accuracy substantially improved for models with all factors (0.774, [0.770, 0.778]). Machine learning and logistic regression models performed similarly, with AUC ranged between 0.773 (0.768, 0.777) for LASSO and 0.780 (0.776, 0.784) for MLP. Antipsychotics, education, antidepressants, head injury, and stroke were identified as the most important predictors in the total sample. Age-specific models identified different important features, with cardiovascular and infectious diseases becoming prominent in older ages. Interpretation The models showed satisfactory performances in identifying dementia. These algorithms can be used in clinical practice to assist decision making and allow timely interventions cost-effectively. Funding The Research Grants Council of Hong Kong under the Early Career Scheme 27110519.
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Affiliation(s)
- Jiayi Zhou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Wenlong Liu
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Huiquan Zhou
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gloria H.Y. Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Qingpeng Zhang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong SAR, China
| | - Martin Knapp
- Care Policy and Evaluation Centre (CPEC), The London School of Economics and Political Science, London, UK
| | - Ian C.K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Department of Computer Science, The University of Hong Kong, Hong Kong SAR, China
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Callen EF, Clay T, Alai J, Goodman DW, Adler LA, Faraone SV. The Role of Age in Adult ADHD Quality Care: A Longitudinal Analysis of Electronic Health Record Data. J Atten Disord 2024; 28:913-922. [PMID: 38156704 DOI: 10.1177/10870547231218042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Several studies have shown that Adult ADHD presents differently in younger and older adults. We sought to assess the difference in care between these two groups using previously identified quality measures (QMs). METHODS Using electronic health record data, we matched a younger group of ADHD patients to an older group. We then assessed the achievement of the QMs using probit models with and without interaction terms. RESULTS The majority of QMs shown an increase in achievement for both groups over time. However, significant differences in quality of care between younger and older adult ADHD patients persisted. By the end of the study period, with the exception of three QMs, younger patients achieved the QMs more. CONCLUSION While, in general, the quality of care for adult ADHD increased from 2010 to 2020, there were still differences in care between younger and older adult ADHD patients.
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Affiliation(s)
- Elisabeth F Callen
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Tarin Clay
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - Jillian Alai
- American Academy of Family Physicians, Leawood, KS, USA
- DARTNet Institute, Aurora, CO, USA
| | - David W Goodman
- Johns Hopkins School of Medicine, Baltimore, MD, USA
- SUNY Upstate Medical University, Syracuse, USA
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Kwak K, Kostic E, Kim D. Gait variability-based classification of the stages of the cognitive decline using partial least squares-discriminant analysis. Sci Prog 2023; 106:368504231218604. [PMID: 38115812 PMCID: PMC10734339 DOI: 10.1177/00368504231218604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
The purpose of the present study was to examine the differences in gait variability in terms of spatiotemporal, sub-gait cycle, ground reaction force, and the joint profiles of kinematics and kinetics between older individuals with and without risk of potential cognitive impairment, and to derive the crucial features to discriminating the older adults with future risk cognitive decline by using partial least squares-discriminant analysis. A total of 90 community-dwelling older adults aged over 65 years underwent cognitive function assessment and were divided into three groups depending on cognitive assessment score. The participants' level-walking was analyzed by using three-dimensional instrumented gait analysis. The coefficient of variation was extracted and then comparatively analyzed depending on the stages of the cognitive decline. To identify the most important contributor when differentiating the older adults with a risk of future cognitive decline, partial least squares-discriminant analysis was applied, and the discriminative power of the coefficients confirmed as features of great importance were investigated via the receiver operating characteristic area under the curve. The differences in gait variability were found mainly between the suspected dementia groups and other groups, especially in joint dynamics variables. Through the partial least squares-discriminant analysis, the discriminative features were found as follows: the mid-stance, the moments, and the power in the hip, knee, and ankle joints. In addition, the discrimination model was found to differentiate well between the three groups. The classification accuracy of intact cognition, diminished cognition, and suspected dementia was 0.857, 0.710, and 0.857, respectively. These findings mean that gait variability changes according to continuous cognitive decline, especially in sub-gait cycles and joint biomechanics, and suggest that measures of variation can be used as predictors to identify older individuals with a risk of potential cognitive impairment.
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Affiliation(s)
- Kiyoung Kwak
- Division of Biomedical Engineering, College of Engineering, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Emilija Kostic
- Department of Healthcare Engineering, The Graduate School, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Dongwook Kim
- Division of Biomedical Engineering, College of Engineering, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea
- Research Center for Healthcare & Welfare Instrument for the Aged, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea
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Tang J, Chen A, He F, Shipley M, Nevill A, Coe H, Hu Z, Zhang T, Kan H, Brunner E, Tao X, Chen R. Association of air pollution with dementia: a systematic review with meta-analysis including new cohort data from China. ENVIRONMENTAL RESEARCH 2023; 223:115048. [PMID: 36529331 DOI: 10.1016/j.envres.2022.115048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/25/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
It remains unclear whether a total exposure to air pollution (AP) is associated with an increased risk of dementia. Little is known on the association in low- and middle-income countries. Two cohort studies in China (in Anhui cohort 1402 older adults aged ≥ 60 followed up for 10 years; in Zhejiang cohort 6115 older adults followed up for 5 years) were conducted to examine particulate matter - PM2.5 associated with all dementia and air quality index (AQI) with Alzheimer's disease, respectively. A systematic literature review and meta-analysis was performed following worldwide literature searched until May 20, 2020 to identify 15 population-based cohort studies examining the association of AP with dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI. The cohort studies in China showed a significantly increased relative risk (RR) of dementia in relation to AP exposure; in Anhui cohort the adjusted RR was 2.14 (95% CI 1.00-4.56) in people with PM2.5 exposure at ≥ 64.5 μg/m3 versus <63.5 μg/m3 and in Zhejiang cohort the adjusted RR was 2.28 (1.07-4.87) in AQI>90 versus ≤ 80. The systematic review revealed that all 15 studies were undertaken in high income countries/regions, with inconsistent findings. While they had reasonably good overall quality of studies, seven studies did not adjust smoking in analysis and 13 did not account for depression. Pooling all eligible data demonstrated that dementia risk increased with the total AP exposure (1.13, 1.08-1.19). Data analysis of air pollutants showed that the RR significantly increased with PM2.5 (1.06, 1.03-1.10 in 2nd tertile exposure; 1.13, 1.07-1.19 in 3rd tertile versus 1st tertile), PM10 (1.05, 0.86-1.29; 1.62, 0.60-4.36), carbon monoxide (1.69, 0.72-3.93; 1.52, 1.35-1.71), nitrogen dioxide (1.06, 1.03-1.09; 1.18, 1.10-1.28) and nitrogen oxides (1.09, 1.04-1.15; 1.26, 1.13-1.41), but not ozone. Controlling air pollution and targeting on specific pollutants would reduce dementia globally.
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Affiliation(s)
- Jie Tang
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK; Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Anthony Chen
- Faculty of Sciences and Technology, Middlesex University, UK
| | - Fan He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, UK
| | - Alan Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Hugh Coe
- Centre for Atmospheric Science, University of Manchester, UK
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, China
| | - Tao Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Haidong Kan
- School of Public Health, Fudan University, China
| | - Eric Brunner
- Department of Epidemiology and Public Health, University College London, UK
| | - Xuguang Tao
- Division of Occupational and Environmental Medicine, Johns Hopkins School of Medicine, John Hopkins University, USA
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK; Division of Occupational and Environmental Medicine, Johns Hopkins School of Medicine, John Hopkins University, USA.
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Chen S, Fu J, Lai X, Huang Y, Bao T, Chen X, Shang H. Analyses of hospitalization in Alzheimer's disease and Parkinson's disease in a tertiary hospital. Front Public Health 2023; 11:1159110. [PMID: 37213636 PMCID: PMC10192859 DOI: 10.3389/fpubh.2023.1159110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/07/2023] [Indexed: 05/23/2023] Open
Abstract
Background To characterize the pattern of hospitalization in patients with Alzheimer's disease (AD) or Parkinson's disease (PD), and compare the differences to see whether AD patients and PD patients have a different picture of hospitalization. Methods The clinical features of all consecutive patients from January 2017 to December 2020 were reviewed. We identified AD patients and PD patients from an electronic database in a tertiary medical center. Results The study group comprised 995 AD patients and 2,298 PD patients who were admitted to the hospital for the first time, and re-hospitalized 231 AD patients and 371 PD patients were also included. AD patients were older than PD patients when they were hospitalized (p < 0.001). AD patients had longer lengths of stay, higher re-hospitalization rates, and higher intrahospital mortality rates than PD patients during hospitalization even after adjusting age and gender. PD patients had higher levels of total cost than AD patients due to the cost of the deep brain stimulation (DBS) insertion. Hospitalizations for AD patients occurred most often in the department of geriatrics, while most PD patients were admitted to the department of neurology. Hospitalization due to the presence of comorbid conditions was much higher in AD patients, but a larger proportion of PD patients were hospitalized due to PD disease itself. Conclusions The present study found that AD patients and PD patients have a significantly different picture of hospitalization. It is important to implement different management for hospitalized AD and PD, and different emphasis should be given when establishing primary prevention strategies, informing care needs, and guiding healthcare resource planning.
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Affiliation(s)
- Sihui Chen
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiajia Fu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohui Lai
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Huang
- Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Bao
- Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueping Chen
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Xueping Chen
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Preclinical Alzheimer's dementia: a useful concept or another dead end? Eur J Ageing 2022; 19:997-1004. [PMID: 36692779 PMCID: PMC9729660 DOI: 10.1007/s10433-022-00735-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 02/01/2023] Open
Abstract
The term, preclinical dementia, was introduced in 2011 when new guidelines for the diagnosis of Alzheimer's dementia (AD) were published. In the intervening 11 years, many studies have appeared in the literature focusing on this early stage. A search conducted in English on Google Scholar on 06.23.2022 using the term "preclinical (Alzheimer's) dementia" produced 121, 000 results. However, the label is arguably more relevant for research purposes, and it is possible that the knowledge gained may lead to a cure for AD. The term has not been widely adopted by clinical practitioners. Furthermore, it is still not possible to predict who, after a diagnosis of preclinical dementia, will go on to develop AD, and if so, what the risk factors (modifiable and non-modifiable) might be. This Review/Theoretical article will focus on preclinical Alzheimer's dementia (hereafter called preclinical AD). We outline how preclinical AD is currently defined, explain how it is diagnosed and explore why this is problematic at a number of different levels. We also ask the question: Is the concept 'preclinical AD' useful in clinical practice or is it just another dead end in the Holy Grail to find a treatment for AD? Specific recommendations for research and clinical practice are provided.
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Ser SE. Letter to the editors in response to "Gender-specific clinical risk scores incorporating blood pressure variability for predicting incident dementia". J Am Med Inform Assoc 2022; 29:1823-1824. [PMID: 35869952 PMCID: PMC9471706 DOI: 10.1093/jamia/ocac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/06/2022] [Indexed: 07/25/2023] Open
Affiliation(s)
- Sarah E Ser
- Corresponding Author: Sarah E. Ser, MS, Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL 32610, USA;
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Kong D, Chen A, Zhang J, Xiang X, Lou WQV, Kwok T, Wu B. Public Discourse and Sentiment Toward Dementia on Chinese Social Media: Machine Learning Analysis of Weibo Posts. J Med Internet Res 2022; 24:e39805. [PMID: 36053565 PMCID: PMC9482068 DOI: 10.2196/39805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 07/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dementia is a global public health priority due to rapid growth of the aging population. As China has the world's largest population with dementia, this debilitating disease has created tremendous challenges for older adults, family caregivers, and health care systems on the mainland nationwide. However, public awareness and knowledge of the disease remain limited in Chinese society. OBJECTIVE This study examines online public discourse and sentiment toward dementia among the Chinese public on a leading Chinese social media platform Weibo. Specifically, this study aims to (1) assess and examine public discourse and sentiment toward dementia among the Chinese public, (2) determine the extent to which dementia-related discourse and sentiment vary among different user groups (ie, government, journalists/news media, scientists/experts, and the general public), and (3) characterize temporal trends in public discourse and sentiment toward dementia among different user groups in China over the past decade. METHODS In total, 983,039 original dementia-related posts published by 347,599 unique users between 2010 and 2021, together with their user information, were analyzed. Machine learning analytical techniques, including topic modeling, sentiment analysis, and semantic network analyses, were used to identify salient themes/topics and their variations across different user groups (ie, government, journalists/news media, scientists/experts, and the general public). RESULTS Topic modeling results revealed that symptoms, prevention, and social support are the most prevalent dementia-related themes on Weibo. Posts about dementia policy/advocacy have been increasing in volume since 2018. Raising awareness is the least discussed topic over time. Sentiment analysis indicated that Weibo users generally attach negative attitudes/emotions to dementia, with the general public holding a more negative attitude than other user groups. CONCLUSIONS Overall, dementia has received greater public attention on social media since 2018. In particular, discussions related to dementia advocacy and policy are gaining momentum in China. However, disparaging language is still used to describe dementia in China; therefore, a nationwide initiative is needed to alter the public discourse on dementia. The results contribute to previous research by providing a macrolevel understanding of the Chinese public's discourse and attitudes toward dementia, which is essential for building national education and policy initiatives to create a dementia-friendly society. Our findings indicate that dementia is associated with negative sentiments, and symptoms and prevention dominate public discourse. The development of strategies to address unfavorable perceptions of dementia requires policy and public health attention. The results further reveal that an urgent need exists to increase public knowledge about dementia. Social media platforms potentially could be leveraged for future dementia education interventions to increase dementia awareness and promote positive attitudes.
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Affiliation(s)
- Dexia Kong
- Department of Social Work, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anfan Chen
- School of Journalism and Communication, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jingwen Zhang
- Department of Communication, University of California, Davis, Davis, CA, United States.,Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - W Q Vivian Lou
- Department of Social Work & Social Administration, Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, Hong Kong
| | - Timothy Kwok
- Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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Gao J, Zhu D, Deal JA, Lin FR, He P. Hearing impairment, family financial support, and depressive symptoms among Chinese middle-aged and older adults. Int J Geriatr Psychiatry 2022; 37. [PMID: 36004947 DOI: 10.1002/gps.5788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/11/2022] [Indexed: 11/07/2022]
Abstract
AIMS Hearing impairment (HI) is prevalent among middle-aged and older adults, but few studies have examined its mental health consequences in China. This study investigated the association of HI with depressive symptoms and whether family financial support moderated the association among adults aged 45 in China. METHODS Data were obtained from three waves of the China Health and Retirement Longitudinal Study (2011, 2013 and 2015). Hearing impairment was defined as a self-reported hearing problem in one or both ears. Depressive symptoms were measured with CESD-10. Associations between HI and depressive symptoms were modeled using fixed-effect models. RESULTS People with self-reported hearing loss were more likely than those without hearing loss to have depressive symptoms, with an odds ratio of 1.25 [1.07-1.47]. The association remained significant after adjusting for socio-demographic characteristics, lifestyle behaviors, and health conditions. Family financial support moderated this association. Among those with HI, adults with a higher level of family financial support tend to have better performance on symptoms of depression. CONCLUSIONS HI was positively associated with depressive symptoms among adults aged ≥45 in China, and family financial support played a buffering role in the relationship between HI and depressive symptoms.
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Affiliation(s)
- Jiamin Gao
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank R Lin
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Johns Hopkins Bloomberg School of Public Health, Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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Paul SS, Schröder-Butterfill E. The Psychological and Economic Impacts of Caregiving on Family Carers for People with Probable Dementia in Rural South India. J Cross Cult Gerontol 2022; 37:201-219. [PMID: 35779164 DOI: 10.1007/s10823-022-09455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Informal carers play a vital role in the care and well-being of older people with dementia. This article examines the psychological and economic impacts caregiving has on carers of people with suspected dementia and the mechanisms by which they cope with challenges. A mixed-method design was adopted. A baseline survey of 123 older people was undertaken in a resource-poor setting in Kerala, India, using Addenbrooke's Cognitive Examination - Malayalam Version (ACE-m) to identify those with probable dementia. This was followed by in-depth interviews with ten carers of those identified as having cognitive impairment. The data were later transcribed and thematically analysed using N-Vivo to identify main concepts and themes. Analysis of the in-depth interviews with carers revealed that dementia was often interpreted as a 'second childhood', but that this conceptualisation aided carers to cope better. Anger and irritation were the commonly expressed psychological reactions which got accentuated by lack of reciprocation of emotion on the part of care recipient. Government support through social security measures and medical care, along with traditional social practises, helped carers to tide over care expenses. These support systems lessened the psychological and economic impacts of caring. Misconstruction of the disease nature, for example by considering it a normal part of ageing, also seem inadvertently to have helped in coping with care requirements, although this comes at a cost of lower than optimal healthcare access for older people with cognitive impairment.
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Affiliation(s)
- Sherin S Paul
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India, 689101.
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Huang Y, Li X, Liu Z, Huo J, Guo J, Chen Y, Chen Y, Chen R. Projections of the economic burden of care for individuals with dementia in mainland China from 2010 to 2050. PLoS One 2022; 17:e0263077. [PMID: 35113895 PMCID: PMC8812891 DOI: 10.1371/journal.pone.0263077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China has stepped into an era of aging society, where the impending considerable economic burden attributed to high prevalence of dementia in the elderly appears to be one of the most important health and social issues to deal with for the country. However, population-based quantification and projections for the economic burden of dementia in China are lacking for further health action and policy making. OBJECTIVE To estimate and predict the costs of managing dementia in the elderly population aged 60 and above from 2010 to 2050 in China. METHODS Data were collected from a six-province study (n = 7072) and other multiple sources for calculation of the economic burden of dementia. With the convincing data from published studies, we quantified and projected the costs attributed to dementia in China from 2010 to 2050. RESULTS The national cost of dementia in 2010 was estimated to be US$22.8 billion by the opportunity cost method and US$26.4 billion by the proxy method. In 2050, the costs would increase to US$372.3 billion by the opportunity cost method and US$430.6 billion by the proxy method, consuming 0.53% and 0.61% of China's total GDP, respectively. A series of sensitivity analyses showed that the changes in the proportions of informal caregiving led to the most robust changes in the total burden of care for dementia in China. CONCLUSION Dementia represents an enormous burden on China's population health and economy. Due to the changes in policies and population structure, policymakers should give priority to dementia care.
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Affiliation(s)
- Yixiang Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Health Economics Association, Guangzhou, China
| | - Xiande Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zifeng Liu
- Department of Clinical Data Center, The 3 Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, The University of Florida, Gainesville, Florida, United States of America
| | - Jianwei Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingying Chen
- Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yanmei Chen
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruoling Chen
- Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing (FEHW), University of Wolverhampton Millennium City Building, Wolverhampton, United Kingdom
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Holm E, Jacobsen KK, Lony TB, Lembeck M, Pedersen H, Andersson C, Johannsen P, Jørgensen TSH, Torp‐Pedersen C. Frequency of missed or delayed diagnosis in dementia is associated with neighborhood socioeconomic status. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12271. [PMID: 35356741 PMCID: PMC8943602 DOI: 10.1002/trc2.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/12/2022]
Abstract
Introduction Underdetection of dementia in areas with low socioeconomic status (SES) may interfere with findings concerning associations between SES and dementia. Methods Using administrative registers we assessed the associations between age‐ and sex‐adjusted dementia incidence and neighborhood socioeconomic status (nSES) in 94 Danish municipalities. Wealth was divided into income quartiles and other nSES variables were dichotomized into high versus low according to the median. Results High population density (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.18–1.24), higher proportion of inhabitants in higher income quartiles (P for trend < .0001), and high educational level (OR 1.19, 95% CI 1.15–1.22) were associated with higher incidence of dementia. High proportion of residents above 65 years was associated with lower age‐adjusted dementia incidence (OR 0.86, 95% CI 0.84–0.89). Discussion Low nSES municipalities have a lower age‐adjusted incidence of dementia diagnosis. These findings corroborate prior concerns that a large number of dementia diagnoses may be missed in municipalities characterized by low SES.
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Affiliation(s)
- Ellen Holm
- Department of Internal Medicine University Hospital Zealand Køge Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Katja Kemp Jacobsen
- Department of Technology Faculty of Health and Technology University College Copenhagen Copenhagen Denmark
| | - Thea Bang Lony
- Geriatric Section Department of Internal Medicine Nykøbing Falster Hospital Nykøbing Falster Denmark
| | - Maurice Lembeck
- Geriatric Section Department of Internal Medicine Nykøbing Falster Hospital Nykøbing Falster Denmark
| | - Hanne Pedersen
- Geriatric Section Department of Internal Medicine in Glostrup Amager Hvidovre Hospital Glostrup Denmark
| | - Charlotte Andersson
- Department of Medicine Section of Cardiovascular Medicine Boston University Medical Center Boston Massachusetts USA
| | - Peter Johannsen
- International Medical Vice President, Medical & Science Clinical Drug Development Novo Nordisk Copenhagen Denmark
| | | | - Christian Torp‐Pedersen
- Department of Cardiology and Clinical Research Nordsjaellands Hospital Hillerød Denmark
- Department of Public Health University of Copenhagen Copenhagen Denmark
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13
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Lutski M, Rasooli I, Sternberg S, Lemberger J, Mery N, Shohat T, Zucker I. Prevalence and Incidence Rates of Dementia: A Nationwide Population-Based Study of Electronic Health Records in Israel1. J Alzheimers Dis 2021; 85:1153-1161. [PMID: 34924379 DOI: 10.3233/jad-215048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data on the rate of dementia is essential for planning and developing appropriate services at the national level. OBJECTIVE We report the prevalence and incidence of dementia, based on electronic health records available for the whole population. METHODS This national dementia dataset was established as a part of the National Program to Address Alzheimer's and Other Types of Dementia. Data from medical health records for all persons aged 45+ in Israel, for 2016, were extracted from the databases of the four health maintenance organizations. Dementia cases were identified based on either recorded dementia diagnosis, through International Classification of Diseases (ICD-9 and ICD-10) or dispensation of anti-dementia drugs. The date of first diagnosis was determined by the earliest recording. RESULTS A total of 65,951 persons with dementia, aged 45+, were identified from electronic health data. Based on both ICD codes and anti-dementia drugs, the prevalence rates of dementia among individuals aged 45+ and 65+ in 2016 were 2.5%and 6.4%, respectively, and the incidence rates were 0.49%and 1.3%, respectively. Based on ICD codes alone, the prevalence rates of dementia among individuals aged 45+ and 65+ in 2016 were 2.1%and 5.4%respectively, and the incidence rates were 0.36%and 0.96%respectively. The rates were higher among females compared to males and paradoxically lower in lower socioeconomic status compared to higher statuses. CONCLUSION This data collection reflects the present access of dementia patients to medical care resources and provides the basis for service planning and future dementia policies.
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Affiliation(s)
- Miri Lutski
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Iris Rasooli
- Geriatric Division, Israel Ministry of Health, Tel-Aviv, Israel
| | | | | | - Nisim Mery
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Tamy Shohat
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Inbar Zucker
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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14
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Chen R, Zhou W, Ma Y, Wan Y, Qin X, Rodney A, Ni J, Thomas E, Gao J, Spira AP, Hu Z, Copeland JRM. Impacts of depression subcase and case on all-cause mortality in older people: The findings from the multi-centre community-based cohort study in China. Int J Geriatr Psychiatry 2021; 36:1931-1941. [PMID: 34390042 DOI: 10.1002/gps.5611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/09/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES It is unclear whether and to what extent depression subcases and cases in older age were associated with all-cause mortality. Little is known about gender differences in the associations. We assess these in older Chinese. METHODS We examined a random sample of 6124 participants aged ≥60 years across five provinces in China. They were interviewed using a standard method of the GMS-AGECAT to diagnose depression subcase and case and record sociodemographic and disease risk factors at baseline, and to follow up their vital status. We employed Cox regression models to determine all-cause mortality in relation to depression subcases and cases, with adjustment for important variables, including social support and co-morbidities. RESULTS Over the 10-year follow-up, 928 deaths occurred. Compared to those without depression at baseline, participants with depression subcase (n = 196) and case (n = 264) had increased risk of mortality; adjusted hazard ratios (HRs) were 1.46 (95% CI 1.07-2.00) and 1.45 (1.10-1.91). The adjusted HRs in men were 1.15 (0.72-1.81) and 1.85 (1.22-2.81), and in women 1.87 (1.22-2.87) and 1.22 (0.83-1.77) respectively. In participants aged ≥65 years, the adjusted HRs were 1.12 (0.68-1.84) and 1.99 (1.28-3.10) in men, and 2.06 (1.32-2.24) and 1.41 (0.94-2.10) in women. Increased HR in depression subcases was higher in women than man (ratio of HRs was 1.84, p = 0.034). CONCLUSIONS Older people with depression subcase could have increased all-cause mortality to a similar extent to those with depression case. More attention should be paid to subcases of depression in women to tackle gender inequalities and improve survival.
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Affiliation(s)
- Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK
| | - Weiju Zhou
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK.,JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Ying Ma
- School of Health Administration, Anhui Medical University, China.,Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - Yuhui Wan
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK.,School of Public Health, Anhui Medical University, China
| | - Xia Qin
- School of Health Administration, Anhui Medical University, China
| | - Amanda Rodney
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK
| | - Jindong Ni
- School of Public Health, Guangdong Medical University, China
| | - Erica Thomas
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK
| | - Jian Gao
- School of Health Administration, Anhui Medical University, China
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, China
| | - John R M Copeland
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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15
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Lv X, Zhao M, Li T, Yuan C, Zhang H, Pu C, Li Z, Zhang N, Yu X, Wang H. Effects of an Enhanced Training on Primary Care Providers Knowledge, Attitudes, Service and Skills of Dementia Detection: A Cluster Randomized Trial. Front Neurol 2021; 12:651826. [PMID: 34367045 PMCID: PMC8342805 DOI: 10.3389/fneur.2021.651826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Effective training programs for primary care providers (PCPs) to support dementia detection are needed, especially in developing countries. This study aimed to investigate the effect of an enhanced training on the competency and service of PCPs for dementia detection. Methods: We conducted a cluster randomized trial in Beijing, China. Community healthcare centers (CHCs) located in Fengtai or Fangshan District were eligible. The enrolled CHCs in each district were randomly assigned to the standard or the enhanced training group at a 1:1 ratio. PCPs serving older adults in enrolled CHCs were eligible to participate. The standard training group received three-hour didactic lectures, three monthly supervisions, 3 months of online support and dementia screening packages. The enhanced training group additionally received three monthly face-to-face supervisions and 3 months of online support. The participants became aware of their group membership at the end of the standard training. The knowledge, attitudes, service, and skills regarding dementia detection were assessed using questionnaires and submitted dementia detection records, respectively. Results: A total of 23 and 21 CHCs were randomly assigned to the standard and the enhanced training group, respectively, and 58 participants from 20 CHCs assigned to the standard training group and 48 from 16 CHCs assigned to the enhanced training group were included in the final analysis (mean age 37.5 years, and 67.0% women). A significant increase in the knowledge score was found in both groups, but the increase was similar in the two groups (P = 0.262). The attitude score remained stable in both groups, and no between-group difference was found. Compared with the baseline, both groups reported an increase in dementia detection service, especially the enhanced training group (24.1% to 31.0% in the standard training group and 14.6% to 45.8% in the enhanced training group). The completion rate and accuracy of submitted dementia detection records in the enhanced training group were both significantly higher than those in the standard training group (both P < 0.001). Conclusion: The enhanced training had similar effect on the knowledge of PCPs comparing with the standard training, but was better on continuous service and skills of PCPs related to dementia detection. Trial registration:www.ClinicalTrials.gov, identifier: NCT02782000. Registration date: May 2016. The trial was completed in July 2017.
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Affiliation(s)
- Xiaozhen Lv
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Mei Zhao
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Tao Li
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Changzheng Yuan
- Department of Big Data in Health Science, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Haifeng Zhang
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Chengcheng Pu
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Zhiying Li
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Na Zhang
- Psychological Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Yu
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Huali Wang
- Beijing Dementia Key Lab, Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Beijing, China
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16
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Huo Z, Lin J, Bat BKK, Chan JYC, Tsoi KKF, Yip BHK. Diagnostic accuracy of dementia screening tools in the Chinese population: a systematic review and meta-analysis of 167 diagnostic studies. Age Ageing 2021; 50:1093-1101. [PMID: 33625478 DOI: 10.1093/ageing/afab005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The rate of undetected dementia is high in China. However, the performance of dementia screening tools may differ in the Chinese population due to the lower education level and cultural diversity. This study aimed to evaluate the diagnostic accuracy of dementia screening tools in the Chinese population. METHODS Eleven electronic databases were searched for studies evaluating the diagnostic accuracy of dementia screening tools in older Chinese adults. The overall diagnostic accuracy was estimated using bivariate random-effects models, and the area under the summary receiver operating characteristic curve was presented. RESULTS One hundred sixty-seven studies including 81 screening tools were identified. Only 134 studies qualified for the meta-analysis. The Mini-Mental State Examination (MMSE) was the most commonly studied tool, with a combined sensitivity (SENS) and specificity (SPEC) of 0.87 (95%CI 0.85-0.90) and 0.89 (95%CI 0.86-0.91), respectively. The Addenbrooke's Cognitive Examination-Revised (ACE-R) (SENS: 0.96, 95%CI 0.89-0.99; SPEC: 0.96, 95%CI 0.89-0.98) and Montreal Cognitive Assessment (MoCA) (SENS: 0.93, 95%CI 0.88-0.96; SPEC: 0.90, 95%CI 0.86-0.93) showed the highest performance. The General Practitioner Assessment of Cognition (GPCOG), Hasegawa's Dementia Scale and Cognitive Abilities Screening Instrument had performances comparable to that of the MMSE. The cut-off scores ranged widely across studies, especially for the MMSE (range: 15-27) and MoCA (range: 14-26). CONCLUSIONS A number of dementia screening tools were validated in the Chinese population after cultural and linguistical adaptations. The ACE-R and MoCA had the best diagnostic accuracy, whereas the GPCOG, with an administration time < 5 minutes, could be considered as a rapid screening tool.
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Affiliation(s)
- Zhaohua Huo
- JC School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jiaer Lin
- JC School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Baker K K Bat
- JC School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joyce Y C Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Benjamin H K Yip
- JC School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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17
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Tharmathurai S, Muhammad-Ikmal MK, Razak AA, Che-Hamzah J, Azhany Y, Fazilawati Q, Liza-Sharmini AT. Depression and Severity of Glaucoma Among Older Adults in Urban and Suburban Areas. J Glaucoma 2021; 30:e205-e212. [PMID: 33710066 DOI: 10.1097/ijg.0000000000001830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Depression increases with severity of visual field defect in older adults with primary open-angle glaucoma (POAG). PURPOSE This study aimed to determine the prevalence of depression among patients with POAG and examine the relationship between depression and the severity of POAG in older adults. MATERIALS AND METHODS Three hundred and sixty patients with POAG aged 60 years or above were recruited from 2 tertiary centers located in an urban and suburban area. The participants were stratified according to the severity of their glaucoma based on the scores from the modified Advanced Glaucoma Intervention Study (AGIS) to mild, moderate, severe, and end stage. Face-to-face interviews were performed using the Malay Version Geriatric Depression Scale 14 (mGDS-14) questionnaire. Depression is diagnosed when the score is ≥8. One-way analysis of variance was used to compare the subscores between the groups. Multifactorial analysis of variance was also applied with relevant confounding factors. RESULTS Depression was detected in 16% of older adults with POAG; a higher percentage of depression was seen in those with end stage disease. There was a significant increase in the mean score of mGDS-14 according to the severity of POAG. There was evidence of an association between depression and severity of visual field defect (P<0.001). There was a significant difference in mGDS-14 score between the pairing of severity of POAG [mild-severe (P=0.003), mild-end stage (P<0.001), moderate-severe (P<0.001), and moderate-end stage (P<0.001)] after adjustment to living conditions, systemic disease, and visual acuity. CONCLUSION Ophthalmologists should be aware that older adults with advanced visual field defects in POAG may have depression. The detection of depression is important to ensure adherence and persistence to the treatment of glaucoma.
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Affiliation(s)
- Sangeetha Tharmathurai
- Departments of Ophthalmology
- Eye Clinic, Hospital USM, Health Campus, USM, Kubang Kerian, Kelantan
- Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor
| | - Mohamad K Muhammad-Ikmal
- Departments of Ophthalmology
- Eye Clinic, Hospital USM, Health Campus, USM, Kubang Kerian, Kelantan
- Department of Surgical Based Discipline, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah
| | | | - Jemaima Che-Hamzah
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Yaakub Azhany
- Departments of Ophthalmology
- Eye Clinic, Hospital USM, Health Campus, USM, Kubang Kerian, Kelantan
| | | | - Ahmad T Liza-Sharmini
- Departments of Ophthalmology
- Eye Clinic, Hospital USM, Health Campus, USM, Kubang Kerian, Kelantan
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18
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Zhou W, Hopkins A, Zaman MJ, Tao XG, Rodney A, Yao Y, Cao Z, Ma Y, Hu Z, Copeland JJ, Chen R. Impacts of heart disease, depression and their combination on all-cause mortality in older people: a rural community-based cohort study in China. BMJ Open 2020; 10:e038341. [PMID: 33262187 PMCID: PMC7709510 DOI: 10.1136/bmjopen-2020-038341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the impact of heart disease (HD) combined with depression on all-cause mortality in older people living in the community. DESIGN A population-based cohort study. PARTICIPANTS We examined the data of 1429 participants aged ≥60 years recruited in rural areas in Anhui province, China. Using a standard method of interview, we documented all types of HD diagnosed by doctors and used the validated Geriatric Mental Status-Automated Geriatric Examination for Computer Assisted Taxonomy algorithm to diagnose any depression for each participant at baseline in 2003. The participants were followed up for 8 years to identify vital status. MEASUREMENTS We sought to examine all-cause mortality rates among participants with HD only, depression only and then their combination compared with those without these diseases using multivariate adjusted Cox regression models. RESULTS 385 deaths occurred in the cohort follow-up. Participants with baseline HD (n=91) had a significantly higher mortality (64.9 per 1000 person-years) than those without HD (42.9). In comparison to those without HD and depression, multivariate adjusted HRs for mortality in the groups of participants who had HD only, depression only and both HD and depression were 1.46 (95% CI 0.98 to 2.17), 1.79 (95% CI 1.28 to 2.48) and 2.59 (95% CI 1.12 to 5.98), respectively. CONCLUSION Older people with both HD and depression in China had significantly increased all-cause mortality compared with those with HD or depression only, and without either condition. Psychological interventions should be taken into consideration for older people and those with HD living in the community to improve surviving outcome.
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Affiliation(s)
- Weiju Zhou
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
| | - Alex Hopkins
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
| | - M Justin Zaman
- Department of Cardiology, James Paget University Hospital, Norfolk, UK
| | - Xuguang Grant Tao
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amanda Rodney
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
| | - Yuyou Yao
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
- School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Zhongqiang Cao
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Ma
- School of Health Administration, Anhui Medical University, Hefei, Anhui, China
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, Hefei, Anhui, China
| | - John J Copeland
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, Merseyside, UK
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
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Quail Z, Carter MM, Wei A, Li X. Management of cognitive decline in Alzheimer's disease using a non-pharmacological intervention program: A case report. Medicine (Baltimore) 2020; 99:e20128. [PMID: 32481282 PMCID: PMC7249940 DOI: 10.1097/md.0000000000020128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In China, the over 60 population is estimated to grow from 12% in 2010 to 33% of the overall population by 2050. The escalation in the aging population is projected to result in an Alzheimer's disease prevalence of 27.7 million people in China by 2050 causing substantial health and economic burden. While there are some published studies on multicomponent, non-pharmacological interventions for people with dementia, we have found no published community-based approach to care that encompasses personalized selection of non-pharmacological interventions, active social participation, and dementia education. PATIENT CONCERNS An elderly female living at home alone in urban Beijing presented with significant short-term memory impairment, episodes of confusion, difficulty with language skills, and episodes of wandering. She had become reclusive and disengaged from her previous social networks, and no longer attended any community activities or events. The patient had no significant past medical or psychiatric history. DIAGNOSIS The patient was diagnosed with Alzheimer's disease by a local physician based on clinical features of impaired communication, disorientation, confusion, poor judgement, behavioral changes, and difficulty speaking. Depression was considered a differential diagnosis but is also both a risk factor and symptom of dementia. INTERVENTIONS A novel, community-based, multicomponent social care program for dementia was used to facilitate implementation of non-pharmacological interventions, gradual socialization and provide supportive carer and community education. Non-pharmacological interventions included a combination of validation therapy, music therapy, art therapy, reminiscence therapy, talking therapy, reality orientation, cognitive training, smell therapy, food therapy, sensory stimulation, garden therapy, and physiotherapy. OUTCOMES Improvements in the patient's Geriatric Depression Scale and Mini Mental State Examination scores were noted in association with increased social participation in the community. CONCLUSION The community-based, multicomponent dementia social care program described in this case report has enabled a socially isolated patient with Alzheimer's disease to reduce her social isolation with an associated improvement in her mood and prevention of cognitive decline. Educating the community was an essential part of re-integrating the patient into the social setting. Reducing social isolation and increasing community engagement were essential to maintaining the patient's independence in her own home.
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Affiliation(s)
- Zara Quail
- Care Visions Limited, Stirling, Scotland, UK
| | - Mark Mclean Carter
- Care Visions Limited, Stirling, Scotland, UK
- Care Visions China, Beijing, China
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20
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Niedziela N, Nowak MM, Lis M, Blaszkowska M, Kośmider R, Adamczyk-Sowa M. Atrial fibrillation as an important clinical condition of cognitive decline; diagnosis, comorbidities and severity of symptoms in patients with dementia. Neurol Res 2020; 42:430-438. [DOI: 10.1080/01616412.2020.1738648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Natalia Niedziela
- Faculty of Medical Sciences in Zabrze, Department of Neurology, Medical University of Silesia in Katowice, Poland
| | - Maria Magdalena Nowak
- Faculty of Medical Sciences in Zabrze, Department of Neurology, Medical University of Silesia in Katowice, Poland
| | - Martyna Lis
- Faculty of Medical Sciences in Zabrze, Department of Neurology, Medical University of Silesia in Katowice, Poland
| | - Maria Blaszkowska
- Faculty of Medical Sciences in Zabrze, Department of Neurology, Medical University of Silesia in Katowice, Poland
| | - Rozalia Kośmider
- Faculty of Medical Sciences in Zabrze, Department of Neurology, Medical University of Silesia in Katowice, Poland
| | - Monika Adamczyk-Sowa
- Faculty of Medical Sciences in Zabrze, Department of Neurology, Medical University of Silesia in Katowice, Poland
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21
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Zhou W, Chen R, Hopkins A, Wang Y, Tang J, Chen X, Clifford A, Pan Y, Forthby K, Ni J, Wang D, Brunner E. Association between socioeconomic status and incident stroke in China. J Epidemiol Community Health 2020; 74:519-526. [PMID: 32341052 PMCID: PMC7320795 DOI: 10.1136/jech-2019-213515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/01/2022]
Abstract
Background Little is known about the impact of socioeconomic status (SES) on incidence of stroke in China. This study aimed to examine the association of SES, which was measured by different indicators, with incidence of stroke and gender differences in the association. Methods and results Two prospective cohort studies were conducted including 2852 participants aged ≥60 years in Anhui province and 3016 participants in four other provinces in China. During a median follow-up of 7.1 years, 211 incident stroke cases occurred in the Anhui cohort. The risk of stroke increased with living in rural areas (adjusted HR 2.49, 95% CI 1.19 to 5.22; women 3.64, 95% CI 1.17 to 11.32, men 2.23, 95% CI 0.81 to 6.19), but not significantly with educational level, occupational class, satisfactory income and financial problems (except for women with low education). The four-province cohort had 113 incident stroke cases over the 3.1 years’ follow-up. The five SES indicators were not significantly associated with incident stroke (except for increased risk in men with high occupation), but additional measurement for actual income showed that incident stroke increased in women with low personal income and in men with high family income. Pooled data from the two cohorts demonstrated the impacts of rural living (1.66, 95% CI 1.08 to 2.57) and having high occupational class (1.56, 95% CI 1.01 to 2.38), and gender differences for women with low education (2.26, 95% CI 1.19 to 4.27). Conclusions Rural living and being female with low SES are associated with increased stroke risk in China. Strategies to improve public health in the rural communities and gender-specific targets for health inequality should be an integral component of stroke interventions.
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Affiliation(s)
- Weiju Zhou
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
| | - Alex Hopkins
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, China
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiangyan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Angela Clifford
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ken Forthby
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Jindong Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Eric Brunner
- Department of Public Health and Epidemiology, University College London, London, UK
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22
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Ura C, Okamura T, Inagaki H, Ogawa M, Niikawa H, Edahiro A, Sugiyama M, Miyamae F, Sakuma N, Furuta K, Hatakeyama A, Ogisawa F, Konno M, Suzuki T, Awata S. Characteristics of detected and undetected dementia among community‐dwelling older people in Metropolitan Tokyo. Geriatr Gerontol Int 2020; 20:564-570. [DOI: 10.1111/ggi.13924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Chiaki Ura
- Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | | | | | - Madoka Ogawa
- Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | | | - Ayako Edahiro
- Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Mika Sugiyama
- Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | | | - Naoko Sakuma
- Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - Ko Furuta
- Tokyo Metropolitan Geriatric Hospital Tokyo Japan
| | | | | | | | | | - Shuichi Awata
- Tokyo Metropolitan Institute of Gerontology Tokyo Japan
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23
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Wang H, Xie H, Qu Q, Chen W, Sun Y, Zhang N, Liu Y, Li T, Chan KY, Gauthier S, Yu X. The continuum of care for dementia: needs, resources and practice in China. J Glob Health 2020; 9:020321. [PMID: 31893030 PMCID: PMC6925963 DOI: 10.7189/jogh.09.020321] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, NHC Key Laboratory of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Beijing, China
| | - Hengge Xie
- Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China
| | - Qiumin Qu
- Department of Neurology, Xi'an Jiaotong University First Affiliated Hospital, Xi'an, China
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Nan Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, China
| | - Tao Li
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, NHC Key Laboratory of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Beijing, China
| | - Kit Yee Chan
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Serge Gauthier
- McGill Center for Studies in Aging, McGill University, Montreal, Canada
| | - Xin Yu
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, NHC Key Laboratory of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Beijing, China
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24
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Abstract
In China, the ageing population and the prevalence of dementia are projected to escalate significantly by 2050 resulting in a substantial increase in health and economic burden on caregivers, healthcare facilities, healthcare providers and communities. There is no published national dementia policy or strategy in China. This case report describes significant barriers contributing to diagnostic problems and inadequate care of dementia through the case of an older female in rural China, whose condition deteriorated due to neuropsychiatric and functional symptoms of undiagnosed dementia. Intersectoral collaboration between care organisations facilitated delivery of a non-pharmacological intervention programme which was associated with improvements in the patient’s functional and neuropsychiatric symptoms. The case demonstrates that recruitment and training of a wider range of health and care professionals and caregivers in a systematic approach to non-pharmacological interventions could help overcome barriers to the specialised care needs of people with dementia where resources are lacking.
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Affiliation(s)
- Zara Quail
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, Scotland, UK
| | - Angelina Wei
- Care Visions Dementia Services, Care Visions China, Beijing, China
| | - Vicky Fan Zhang
- Care Visions Dementia Services, Care Visions China, Beijing, China
| | - Mark McLean Carter
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, Scotland, UK .,Care Visions Dementia Services, Care Visions China, Beijing, China
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25
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Rahman MS, Rahman MA, Ali M, Rahman MS, Maniruzzaman M, Yeasmin MA, Ahmed NAMF, Abedin MM, Islam SMS. Determinants of depressive symptoms among older people in Bangladesh. J Affect Disord 2020; 264:157-162. [PMID: 32056745 DOI: 10.1016/j.jad.2019.12.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/08/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Depressive symptoms are common among older people which are associated with disability, morbidity and mortality. The aim of this study was to determine the associated risk factors for depressive symptoms among older people in Bangladesh. METHODS A cross-sectional survey was conducted among 400 people aged ≥65 years from the Meherpur district in Bangladesh. Depressive symptoms were measured by the 15-item Geriatric Depression Scale and categorized into: no depressive symptoms, mild, moderate and severe depressive symptoms. Information was also collected on socio-economic and demographic characteristics, health problems, feeling of loneliness, history of falls and concern about falling. Chi-square test of association and multinomial logistic regression was performed to reveal the determinants of depressive symptoms. RESULTS Just over half of the sample were female, aged 70+ years, and lived in rural areas. The prevalence of depressive symptoms was 55.5%, and 23.0% mild, 19.0% moderate, and 13.5% having severe levels of depressive symptoms. Older age, sex, residence, marital status, presence of co-morbidities, visual impairment, previous falls, loneliness, and fear of falling were the significant determinants for developing depressive symptoms. LIMITATIONS A convenience sampling method was used for data collection among older people from selected communities in a district of Bangladesh. The results do not represent the entire population of Bangladesh. Besides, it was a cross-sectional study, and causality cannot be determined. CONCLUSION Depressive symptoms among older people in Bangladesh is prevalent, and needs to be addressed. Public health programs and strategies are needed to reduce depressive symptoms among older adults in Bangladesh.
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Affiliation(s)
| | - Md Ashfikur Rahman
- Development Studies Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Mohammad Ali
- Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh.
| | - Md Saidur Rahman
- Department of Management, Islamic University, Kustia, 7003, Bangladesh
| | - Md Maniruzzaman
- Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Mst Anamika Yeasmin
- Department of Clinical Psychology, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | | | | | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Victoria, 3125, Australia
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26
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Clay E, Zhou J, Yi ZM, Zhai S, Toumi M. Economic burden for Alzheimer's disease in China from 2010 to 2050: a modelling study. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1667195. [PMID: 31595183 PMCID: PMC6764338 DOI: 10.1080/20016689.2019.1667195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
Objectives: We aimed to conduct a modelling study to estimate and predict the economic burden of AD to support the healthcare management of AD in China. Methods: The economic burden of AD was estimated with an evaluation of the prevalence of AD patients and a simulation of annual resource use and cost per AD patient in China using a published model. Percentage of AD patients being treated was assumed to be 5% from 2010 to 2050, with three scenarios testing the value of this parameter of 10%, 20% and 40% throughout 2020 to 2050. Results: The costs of AD were estimated to be from around 91 billion RMB in 2010 to 332 billion in 2050. Most of the current burden was related to private caregivers paid by families. With the percentage of patients being treated changing from 5% to 40%, costs were estimated to double. This was related to more hospitalisations and more use of care facilities, while the burden for families would decrease. Conclusion: A high economic burden related to AD is predicted. The burden would be driven mainly by indirect costs related to the social support of the patients. Investment in improving awareness and care of AD patients is needed and worth it.
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Affiliation(s)
- Emilie Clay
- Health Economics and Outcomes Research Department, Creativ-Ceutical, Paris, France
| | - Junwen Zhou
- Public Health Department – Research Unit EA 3279, Aix-Marseille University, Marseille, France
| | - Zhan-Miao Yi
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University Health Science Center, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Mondher Toumi
- Public Health Department – Research Unit EA 3279, Aix-Marseille University, Marseille, France
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27
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Xu M, Chen R, Liu B, Chai Y, Boer DD, Hu P, Hu Z. Psychosocial determinants of depression in the community of the elderly with cardiovascular disease. Psychiatry Res 2018; 268:123-130. [PMID: 30025282 DOI: 10.1016/j.psychres.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/27/2018] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
The co-morbidity of cardiovascular disease (CVD) and depression is quite frequent in old people, and some potential biological and behavioural mechanisms linking them have been reported. Yet the impact of psychosocial factors on depression in the elderly with CVD remains unclear. This study aimed to analyze the psychosocial determinants of depression in the elderly with CVD. Using the Geriatric Mental Status-Automated Geriatric Examination for Computer Assisted Taxonomy, a community-based household survey was performed in 2,199 elderly people from the Anhui cohort third-wave survey from 2007 to 2009 and an extended study in Hubei from 2010 to 2011. Multiple logistic regression analyses were employed to assess the influence of psychosocial factors on depression. Among them, the prevalence of depression was 4.77%. Three factors were associated with depression in elderly in the community: self-assessed physical health status, anything else severely upsetting and unpleasantness with relatives, friends, or neighbors. In particular, associations of psychosocial factors with depression were more evident in individuals with CVD. This study confirms several psychosocial determinants of depression and the impact of CVD on the associations among the elderly, which provides some clues for interventional strategies of late-life depression.
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Affiliation(s)
- Man Xu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ruoling Chen
- Center for Health and Social Care Improvement (CHSCI), University of Wolverhampton, Wolverhampton, United Kingdom
| | - Bing Liu
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yun Chai
- School of Public Health and Health Management, Hubei University of Medicine, Shiyan, Hubei, China
| | - Dorothy D Boer
- English Language Teaching Department, Hubei University of Medicine, Shiyan, Hubei, China
| | - Ping Hu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Zhi Hu
- School of Health Administrations, Anhui Medical University, Hefei, China.
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28
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Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis. Public Health Nutr 2018; 21:1921-1932. [DOI: 10.1017/s136898001800037x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractObjectiveTo assess the association of fish consumption with risk of dementia and its dose–response relationship, and investigate variations in the association among low-, middle- and high-income countries.DesignA new community-based cross-sectional study and a systematic literature review.SettingsUrban and rural communities in China; population-based studies systematically searched from worldwide literature.SubjectsChinese adults aged ≥60 years in six provinces (n 6981) took part in a household health survey of dementia prevalence and risk factors. In addition, 33 964 participants from eleven published and eligible studies were included in the systematic review and meta-analysis.ResultsIn the new study in China, 326 participants were diagnosed with dementia (4·7 %); those who consumed any amount of fish in the past two years v. those who consumed no fish had reduced risk of dementia (adjusted OR=0·73, 95 % CI 0·64, 0·99), but the dose–response relationship was not statistically significant. The meta-analysis of available data from the literature and the new study showed relative risk (RR) of dementia of 0·80 (95 % CI 0·74, 0·87) for people with fish consumption; the impact was similar among countries with different levels of income. Pooled dose–response data revealed RR (95 % CI) of 0·84 (0·72, 0·98), 0·78 (0·68, 0·90) and 0·77 (0·61, 0·98) in people with low, middle and high consumption of fish, respectively. Corresponding figures for Alzheimer’s disease were 0·88 (0·74, 1·04), 0·79 (0·65, 0·96) and 0·67 (0·58, 0·78), respectively.ConclusionsGreater consumption of fish is associated with a lower risk of dementia. Increasing fish consumption may help prevent dementia worldwide regardless of income level.
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29
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Zhang X, Clarke CL, Rhynas SJ. What is the meaning of filial piety for people with dementia and their family caregivers in China under the current social transitions? An interpretative phenomenological analysis. DEMENTIA 2018; 18:2620-2634. [PMID: 29333867 DOI: 10.1177/1471301217753775] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The filial piety model of family centred care has dominated Chinese society for thousands of years. The ways in which filial piety is presented are being modified and modernised as China undergoes social transitions. The study aims to understand the meaning of filial piety for people with dementia and family caregivers. Semi-structured interviews with people with dementia ( n = 10) and family caregivers ( n = 14) were conducted. Data were analysed using interpretative phenomenological analysis. Three themes emerged: (a) ‘Being filial is a cultural continuity and my future investment’. (b) ‘The changed perception and ways of being filial’. (c) ‘Filial responsibility is a social and cultural convention, but not my personal choice’. This study highlights the importance of cultural values in family care decision making and in shaping filial responsibilities. It indicates that filial obligation can be maintained through social support, even though the nature of filial piety has been changed by social transitions.
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Affiliation(s)
- Xiubin Zhang
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Charlotte L Clarke
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Sarah J Rhynas
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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30
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Evaluation of a WeChat-based dementia-specific training program for nurses in primary care settings: A randomized controlled trial. Appl Nurs Res 2017; 38:51-59. [DOI: 10.1016/j.apnr.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/01/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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31
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Han TS, Wang HHX, Wei L, Pan Y, Ma Y, Wang Y, Wang J, Hu Z, Sharma P, Chen R. Impacts of undetected and inadequately treated hypertension on incident stroke in China. BMJ Open 2017; 7:e016581. [PMID: 28993383 PMCID: PMC5640060 DOI: 10.1136/bmjopen-2017-016581] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/11/2017] [Accepted: 08/21/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES China carries the greatest burden of stroke given its largest volume of people with hypertension. This study assessed the impacts of suboptimal controls of hypertension on incident stroke and projected the number of patients with stroke saved after the control of blood pressure improved in population. SETTING Anhui, China. PARTICIPANTS We examined data from the Anhui cohort of 2001-2011, consisting of 3336 participants aged ≥60 years who were randomly recruited from the urban and rural Anhui. 2852 participants (89.2%) had hypertensive status measured and no stroke at baseline, and were followed up until 2011 in three surveys using a standard method of interview. RESULTS At baseline, 1646 participants (57.7%) were identified to have hypertension, among whom 912 (55.4%) were previously undetected, 115 (7.0%) detected but not treated, 452 (27.5%) treated but not controlled and only 127 (7.7%) controlled. During the 10-year follow-up, 211 incident stroke cases (12.8/1000 person-years) occurred. Compared with normotensive individuals at baseline, multivariate adjusted HR for having stroke increased in those with undetected hypertension by 1.63 (95%CI 1.15 to 2.32), untreated by 2.21 (1.26-3.85) and uncontrolled hypertension by 3.34 (2.28-4.88), but did not differ from those with controlled hypertension (1.34; 0.60-2.99). Based on a two-fold increase in the detection and management of current levels of hypertension and algorithms on the current situation in China, approximately 250 000 incident stroke cases could be prevented annually. CONCLUSIONS In China, hypertension is frequently undetected or inadequately treated. With appropriate management of hypertension, a substantial number of people could be saved form stroke.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Surrey, UK
| | - Harry Hao-Xiang Wang
- School of Public Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- General Practice and Primary Care, Institute of Health and Wellbeing, Glasgow University, Glasglow, UK
| | - Li Wei
- Department of Practice and Policy, University College London, London, UK
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Ma
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Yu Wang
- Pojen General Hospital, Taipei, China
| | - Jiaji Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Surrey, UK
- Department of Medicine, Imperial College London NHS Trust, London, UK
| | - Ruoling Chen
- Centre for Health and Social Care Improvement, Faculty of Education, Health and Wellbeing, Wolverhampton University, Wolverhampton, UK
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32
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Zhang H, Loi SM, Zhou S, Zhao M, Lv X, Wang J, Wang X, Lautenschlager N, Yu X, Wang H. Dementia Literacy among Community-Dwelling Older Adults in Urban China: A Cross-sectional Study. Front Public Health 2017. [PMID: 28638820 PMCID: PMC5461251 DOI: 10.3389/fpubh.2017.00124] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Delay in seeking diagnosis of dementia is common in China. Misinformation and poor knowledge about dementia may contribute to it. The study was designed to explore the nationwide dementia literacy among older adults in urban China and to investigate the factors associated with overall dementia literacy. Methods In a cross-sectional study, a convenience sample of 3,439 community-dwelling old adults aged 60 and over was recruited from 34 cities in 20 provinces between June 20 and August 20, 2014. All participants were administered the face-to-face mental health literacy questionnaire, which included the prevalence, symptoms, intention, and options for treatment of dementia. Stepwise multivariate regression analysis was used to explore factors associated with overall dementia literacy. Results The response rate was 87.4%. The overall dementia literacy was 55.5% (SD = 20.9%) among all respondents. The correct response rate was higher for questions on symptoms (58.7–89.6%), but lower for questions on the prevalence (22.2%) and choosing appropriate professional care personnel (22.2%). Being male [OR = 1.256, 95% CI (1.022–1.543)], having lower per capita annual income [OR = 1.314, 95% CI (1.064–1.623)], lower education [OR = 1.462, 95% CI (1.162–1.839)], and suspected depression [OR = 1.248, 95% CI (1.009–1.543)] were negatively associated with overall dementia literacy. Conclusion Dementia literacy among community-dwelling older adults in urban China remains very low, in particular about the impact of dementia and appropriate treatment personnel. Community educational programs aiming to close this knowledge gap are encouraged to focus on those in the population at highest risk of low dementia literacy.
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Affiliation(s)
- Haifeng Zhang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Samantha M Loi
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Aged Persons Mental Health Program, North Western Mental Health, Melbourne Health, Parkville, VIC, Australia
| | - Shu'aijun Zhou
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,Institute of Medical Education, Peking University Health Science Center, Beijing, China
| | - Mei Zhao
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiaozhen Lv
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jing Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Nicola Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Aged Persons Mental Health Program, North Western Mental Health, Melbourne Health, Parkville, VIC, Australia
| | - Xin Yu
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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33
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Lang L, Clifford A, Wei L, Zhang D, Leung D, Augustine G, Danat IM, Zhou W, Copeland JR, Anstey KJ, Chen R. Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis. BMJ Open 2017; 7:e011146. [PMID: 28159845 PMCID: PMC5293981 DOI: 10.1136/bmjopen-2016-011146] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates. METHODS/SETTING/PARTICIPANTS A systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measures of interest were the prevalence and determinants of undetected dementia. RESULTS 23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7% (95% CI 55.0% to 68.0%). The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria. CONCLUSIONS The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.
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Affiliation(s)
- Linda Lang
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
- Post Graduate Academic Institute of Medicine, University of Wolverhampton, Wolverhampton, UK
| | - Angela Clifford
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
| | - Li Wei
- Department of Practice and Policy, University College London, London, UK
| | - Dongmei Zhang
- School of Health Administration, Anhui Medical University, China
| | - Daryl Leung
- New Cross Hospital, The Royal Wolverhampton NHS Trust, UK
| | - Glenda Augustine
- Department of Public Health, Wolverhampton City Council, Wolverhampton, UK
| | - Isaac M Danat
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
| | - Weiju Zhou
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
| | - John R Copeland
- Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Kaarin J Anstey
- Dementia Collaborative Research Centre-Early Diagnosis and Prevention, Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing University of Wolverhampton, Wolverhampton, UK
- Post Graduate Academic Institute of Medicine, University of Wolverhampton, Wolverhampton, UK
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Chen Z, Yang X, Song Y, Song B, Zhang Y, Liu J, Wang Q, Yu J. Challenges of Dementia Care in China. Geriatrics (Basel) 2017; 2:geriatrics2010007. [PMID: 31011017 PMCID: PMC6371088 DOI: 10.3390/geriatrics2010007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/03/2017] [Accepted: 01/13/2017] [Indexed: 11/16/2022] Open
Abstract
Dementia results in brain dysfunction, disability and dependency among affected people, causing an overwhelming burden for caregivers. China has the largest number of people with dementia worldwide and is facing severe challenges with respect to dementia care, including poor awareness of dementia in the public, inadequate knowledge of dementia for medical professionals and caregivers, an underdeveloped dementia service system, and high costs of dementia care. To address these challenges, China is taking action to increase dementia awareness and education among the public and care providers, and develop policies, services and resources for dementia care.
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Affiliation(s)
- Zheng Chen
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Xuan Yang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Yuetao Song
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Binbin Song
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Yi Zhang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Jiawen Liu
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Qing Wang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Jia Yu
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
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Social correlates of mental, neurological, and substance use disorders in China and India: a review. Lancet Psychiatry 2016; 3:882-99. [PMID: 27528098 DOI: 10.1016/s2215-0366(16)30166-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 01/10/2023]
Abstract
Understanding the epidemiological profiles of mental, neurological, and substance use disorders provides opportunities for the identification of high-risk population subgroups and for the development of effective country-specific prevention and intervention strategies. Guided by the Conceptual Framework for Action on the Social Determinants of Health by WHO we reviewed the literature to examine the association between a range of social correlates (eg, sex, age, education, income, urbanicity, marital status, and regional differences) and mental, neurological, and substance use disorders in China and India, the most populous countries in the world. We looked for papers on mental, neurological, and substance use disorders with location identifiers and socioeconomic correlates published between 1990 and 2015 and our search found 65 relevant studies from China and 29 from India. Several association patterns between social correlates and mental, neurological, and substance use disorders were not consistent with those reported in high-income countries, including a high concentration of middle-aged men with alcohol use disorders in China and to a lesser extent in India, and a positive association between being married and depression among women in India. Consistent with previous global reports, low education and poverty were associated with higher occurrence of dementia in both China and India, although there is evidence of an interaction between education and income in the risk for dementia in China. Large variations across regions and ethnic groups were consistently documented in China. These unique correlation patterns for mental, neurological, and substance use disorders identified in China and India emphasise the importance of understanding the local social context when planning targeted strategies to reduce the burden of these disorders. High-quality, up-to-date information about the constantly changing pattern of societal factors correlated with mental, neurological, and substance use disorders is urgently needed to help reduce the large and increasing negative social and economic effects that these conditions are having in China, India, and other low-income and middle-income countries.
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Chen R, Lang L, Clifford A, Chen Y, Hu Z, Han TS. Demographic and socio-economic influences on community-based care and caregivers of people with dementia in China. JRSM Cardiovasc Dis 2016; 5:2048004016652314. [PMID: 27478589 PMCID: PMC4948254 DOI: 10.1177/2048004016652314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/04/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Dementia is a major public health challenge and China has the largest population with dementia in the world. However, dementia care and caregivers for Chinese are less investigated. OBJECTIVES AND DESIGN To evaluate demographic and socio-economic influences on dementia care, management patterns and caregiver burden in a household community-dwelling-based survey, using participants' care receipts and Zarit scale. SETTING AND PARTICIPANTS Rural and urban communities across six provinces of China comprising 4837 residents aged ≥60 years, in whom 398 had dementia and 1312 non-dementia diseases. RESULTS People with dementia were less likely to receive care if they were living in rural compared to urban areas (Odd ratio (OR) = 0.20; 95%CI: 0.10-0.41), having education level below compared to above secondary school (OR = 0.24; 95%CI: 0.08-0.70), manual labourer compared to non-manual workers (OR = 0.27; 95%CI: 0.13-0.55), having personal annual income below RMB 10,000 yuan (£1000) compared to above (OR = 0.37; 95%CI: 0.13-0.74) or having four or more than compared to less four children (OR = 0.52; 95%CI: 0.27-1.00). Caregivers for dementia compared with those for non-dementia diseases were younger and more likely to be patients' children or children in-law, had lower education and spent more caring time. Caregiver burden increased with low education, cutback on work and caring for patients who were younger or living in rural areas, and this caregiver burden was three-fold greater than that for non-dementia diseases. CONCLUSIONS There are a number of inequalities in dementia care and caregiver burden in China. Reducing the socio-economic gap and increasing education may improve community care for people with dementia and preserve caregivers' well-being.
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Affiliation(s)
- Ruoling Chen
- University of Wolverhampton, UK; Guangdong Medical University, China; Anhui Medical University, China
| | | | | | - Yang Chen
- Imperial College NHS Healthcare Trust, St. Mary's Hospital, UK
| | - Zhi Hu
- Anhui Medical University, China
| | - Thang S Han
- University of London (ICR2UL) and Ashford and St Peter's NHS Foundation Trust, UK
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Delayed help seeking behavior in dementia care: preliminary findings from the Clinical Pathway for Alzheimer's Disease in China (CPAD) study. Int Psychogeriatr 2016; 28:211-9. [PMID: 26138923 DOI: 10.1017/s1041610215000940] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prevalence and factors associated with delays in help seeking for people with dementia in China are unknown. METHODS Within 1,010 consecutively registered participants in the Clinical Pathway for Alzheimer's Disease in China (CPAD) study (NCT01779310), 576 persons with dementia (PWDs) and their informants reported the estimated time from symptom onset to first medical visit seeking diagnosis. Univariate analysis of general linear model was used to examine the potential factors associated with the delayed diagnosis seeking. RESULTS The median duration from the first noticeable symptom to the first visit seeking diagnosis or treatment was 1.77 years. Individuals with a positive family history of dementia had longer duration (p = 0.05). Compared with other types of dementia, people with vascular dementia (VaD) were referred for diagnosis earliest, and the sequence for such delays was: VaD < Alzheimer's disease (AD) < frontotemporal dementia (FTD) (p < 0.001). Subtypes of dementia (p < 0.001), family history (p = 0.01), and education level (p = 0.03) were associated with the increased delay in help seeking. CONCLUSIONS In China, seeking diagnosis for PWDs is delayed for approximately 2 years, even in well-established memory clinics. Clinical features, family history, and less education may impede help seeking in dementia care.
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Yu X, Chen S, Chen X, Jia J, Li C, Liu C, Toumi M, Milea D. Clinical management and associated costs for moderate and severe Alzheimer's disease in urban China: a Delphi panel study. Transl Neurodegener 2015; 4:15. [PMID: 26301090 PMCID: PMC4546035 DOI: 10.1186/s40035-015-0038-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare resource utilisation for Alzheimer’s disease (AD) in China is not well understood. This Delphi panel study aimed to describe the clinical management pathways for moderate and severe AD patients in urban China and to define the amount and cost of healthcare resources used. Methods A panel of 11 experts was recruited from urban China to participate in two rounds of preparatory interviews. In the first round, 9 physicians specialised in dementia gave a qualitative description of the clinical management of AD patients. In the second round, 2 hospital administrators were asked about the cost of AD management and care. Results from the interviews were discussed by the experts in a Delphi panel meeting, where consensus was reached on quantitative aspects of AD management, including the rate of healthcare resource utilisation, the respective unit costs and caregiving time. Results Interviewees reported that mild AD is under-recognised in China; most patients are diagnosed with moderate to severe AD. Loss of independence and agitation/aggression are the main drivers for healthcare resource utilisation and contribute to a heavier caregiver burden. It was estimated that 70 % moderate AD patients are independent/non-aggressive at the time of diagnosis, 15 % are independent/aggressive, 10 % are dependent/non-aggressive, and 5 % are dependent/aggressive. Dependent/aggressive AD patients are more likely to be hospitalised (70–90 %) than accepted in a nursing home (0–20 %), while the opposite is true for dependent/non-aggressive patients (5–35 % for hospitalisation vs. 80 % for nursing home). Independent AD patients require 1–3 hours/day of caregiver time, while dependent patients can require up to 12–15 hours/day. Experts agreed that AD complicates the management of age-related comorbidities, found in 70–80 % of all AD patients, increasing the frequency and cost of hospitalisation. Conclusions The Delphi panel approach was an efficient method of gathering data about the amount of healthcare resources used and associated costs for moderate and severe AD patients in urban China. The results of this study provide a useful source of information for decision makers to improve future healthcare policies and resource planning, as well as to perform economic evaluations of AD therapies.
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Affiliation(s)
- Xin Yu
- Institute of Mental Health, Peking University Sixth Hospital, Huayuanbeilu 51, Haidian District, Beijing, 100191 China
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochun Chen
- Fujian Institute of Geriatrics, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Jianjun Jia
- Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China
| | - Chunhou Li
- Medical Services Department, Peking Union Medical College Hospital, Beijing, China
| | - Cong Liu
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Hu Z, Zaman MJ, Wang J, Peacock JL, Chen R. Correlates of Untreated Hypercholesterolemia in Older Adults: A Community-Based Household Survey in China. PLoS One 2015; 10:e0131318. [PMID: 26161751 PMCID: PMC4498884 DOI: 10.1371/journal.pone.0131318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 06/01/2015] [Indexed: 11/18/2022] Open
Abstract
Hypercholesterolemia is common in older adults and less treated, but little is known about correlates of untreated hypercholesterolemia. Using a standard interview method we examined a random sample of 7,572 participants aged ≥60 years in a community-based household survey across 7 provinces of China during 2007–2012, and documented 328 cases of hypercholesterolemia from self-reported doctor diagnosis. Compared to participants with normal cholesterol, older adults with hypercholesterolemia had higher socioeconomic position and larger body mass index. In patients with hypercholesterolemia, 209 were not treated using lipid-lowering medications (63.7%, 95% confidence interval (CI) 58.5%–68.9%). Untreated hypercholesterolemia was significantly associated with female sex (adjusted odds ratio 2.13, 95%CI 1.17–3.89), current smoking (3.48, 1.44–8.44), heavy alcohol drinking (3.13,1.11–8.84), chronic bronchitis (2.37,1.14–4.90) and high level of meat consumptions (2.85,1.22–6.65). Although having coronary heart disease exposed participants for treatment, half of participants with coronary heart disease did not receive lipid-lowering medications. Among hypercholesterolemia participants with stroke, hypertension or diabetes, more than half of them did not receive lipid-lowering medications. The high proportion of untreated hypercholesterolemia in older, high-risk Chinese adults needs to be mitigated through multi-faceted primary and secondary prevention strategies to increase population opportunities of treating hypercholesterolemia.
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Affiliation(s)
- Zhi Hu
- School of Health Administrations, Anhui Medical University, Hefei, China
| | - M. Justin Zaman
- James Paget University Hospital, Gorleston-on-Sea, Norfolk, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Jingjing Wang
- School of Health Administrations, Anhui Medical University, Hefei, China
| | - Janet L. Peacock
- Division of Health and Social Care Research, King’s College London, London, United Kingdom
- NIHR Biomedical Resaerch Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Ruoling Chen
- Centre for Health and Social Care Improvement, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
- Post Graduate Academic Institute of Medicine, University of Wolverhampotn, Wolverhampton, United Kingdom
- * E-mail:
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Hu S, Yu X, Chen S, Clay E, Toumi M, Milea D. Memantine for treatment of moderate or severe Alzheimer’s disease patients in urban China: clinical and economic outcomes from a health economic model. Expert Rev Pharmacoecon Outcomes Res 2015; 15:565-78. [DOI: 10.1586/14737167.2015.1065734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chen R, Hu Z, Chen RL, Zhang D, Xu L, Wang J, Wei L. Socioeconomic deprivation and survival after stroke in China: a systematic literature review and a new population-based cohort study. BMJ Open 2015; 5:e005688. [PMID: 25636790 PMCID: PMC4316438 DOI: 10.1136/bmjopen-2014-005688] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To assess the association of socioeconomic deprivation (SED) with survival after stroke in China. DESIGN A systematic literature review and a new population-based cohort study. SETTING AND PARTICIPANTS In urban and rural communities in Anhui, China, 2978 residents aged ≥60 years took part in baseline investigation and were followed up for 5 years; five published studies were identified for a systematic review. PRIMARY AND SECONDARY OUTCOME MEASURES 167 of 2978 participants (5.6%) had doctor-diagnosed stroke at baseline or 1 year later. All-cause mortality in the follow-up. RESULTS In the Anhui cohort follow-up of 167 patients with stroke, 64 (38.3%) died. Multivariate adjusted hazard ratio (HR) of mortality in patients with educational level of less than or equal to primary school was 1.88 (95% CI 1.05 to 3.36) compared to those having more than primary school education. Increased HR of mortality in patients living in a rural area was at borderline significant (1.64, 0.97 to 2.78), but the HR in patients with lower levels of occupation and income was not significant. Published studies showed a significant increase in stroke mortality in relation to some SED indicators. Pooled relative risk (RR) of mortality in patients with low education was 3.07 (1.27 to 7.34), in patients with low income 1.58 (1.50 to 1.65) and in patients living in rural areas 1.47 (1.37 to 1.58). CONCLUSIONS The evidence suggests the presence of a mortality gradient after stroke for material as well as social forms of deprivation in China. Inequalities in survival after stroke persist and need to be taken into account when implementing intervention programmes.
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Affiliation(s)
- Ruoling Chen
- School of Health Administration, Anhui Medical University, Hefei, China
- Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Ruo-Li Chen
- Institute for Science and Technology in Medicine, Keele University, Keele, UK
| | - Dongmei Zhang
- School of Health Administration, Anhui Medical University, Hefei, China
- Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK
| | - Long Xu
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Jingjing Wang
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Li Wei
- Department of Practice and Policy, School of Pharmacy, University College London, UK
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The prevalence of doctor-diagnosed angina in 4314 older adults in China and comparison with the Rose angina questionnaire: The 4 province study. Int J Cardiol 2014; 177:627-8. [DOI: 10.1016/j.ijcard.2014.09.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/23/2014] [Indexed: 11/20/2022]
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Chen R, Hu Z, Wei L, Wilson K. Socioeconomic status and survival among older adults with dementia and depression. Br J Psychiatry 2014; 204:436-40. [PMID: 24526747 DOI: 10.1192/bjp.bp.113.134734] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People from lower socioeconomic groups have a higher risk of mortality. The impact of low socioeconomic status on survival among older adults with dementia and depression remains unclear. AIMS To investigate the association between socioeconomic status and mortality in people with dementia and late-life depression in China. METHOD Using Geriatric Mental Status - Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) we interviewed 2978 people aged ⩾60 years in Anhui, China. We characterised baseline socioeconomic status and risk factors and diagnosed 223 people with dementia and 128 with depression. All-cause mortality was followed up over 5.6 years. RESULTS Individuals with dementia living in rural areas had a three times greater risk of mortality (multivariate adjusted hazard ratio (HR) = 2.96, 95% CI 1.45-6.04) than those in urban areas, and for those with depression the HR was 4.15 (95% CI 1.59-10.83). There were similar mortality rates when comparing people with dementia with low v. high levels of education, occupation and income, but individuals with depression with low v. high levels had non-significant increases in mortality of 11%, 50% and 55% respectively CONCLUSIONS Older adults with dementia and depression living in rural China had a significantly higher risk of mortality than urban counterparts. Interventions should be implemented in rural areas to tackle survival inequality in dementia and depression.
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Affiliation(s)
- Ruoling Chen
- Ruoling Chen, PhD, Division of Health and Social Care Research, King's College London, UK; Zhi Hu, PhD, School of Health Administrations, Anhui Medical University, China; Li Wei, PhD, Department of Practice and Policy, University College London, UK; Kenneth Wilson, MD, Division of Psychiatry, University of Liverpool, UK
| | - Zhi Hu
- Ruoling Chen, PhD, Division of Health and Social Care Research, King's College London, UK; Zhi Hu, PhD, School of Health Administrations, Anhui Medical University, China; Li Wei, PhD, Department of Practice and Policy, University College London, UK; Kenneth Wilson, MD, Division of Psychiatry, University of Liverpool, UK
| | - Li Wei
- Ruoling Chen, PhD, Division of Health and Social Care Research, King's College London, UK; Zhi Hu, PhD, School of Health Administrations, Anhui Medical University, China; Li Wei, PhD, Department of Practice and Policy, University College London, UK; Kenneth Wilson, MD, Division of Psychiatry, University of Liverpool, UK
| | - Kenneth Wilson
- Ruoling Chen, PhD, Division of Health and Social Care Research, King's College London, UK; Zhi Hu, PhD, School of Health Administrations, Anhui Medical University, China; Li Wei, PhD, Department of Practice and Policy, University College London, UK; Kenneth Wilson, MD, Division of Psychiatry, University of Liverpool, UK
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Ghio L, Vaggi M, Amore M, Ferrannini L, Natta W. Unmet needs and research challenges for late-life mood disorders. Aging Clin Exp Res 2014; 26:101-14. [PMID: 24078460 DOI: 10.1007/s40520-013-0149-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
Mood disorders are common and often under-recognised in older people whereby, together with the general ageing of the population, they are becoming a significant and growing public health problem worldwide. However, the need to address the problem of late life mood disorders in a real-world setting is met with a surprising lack of strong evidence in this field. Randomised clinical trials which focus on elderly mood disorders are not very common and the majority of them focus on pharmacological treatment of major depression. The aim of this study was to review first the main unmet needs and research challenges in late-life mood disorders as a basis to then review the state of the art evidence resulting from randomised clinical trials and the main critical aspects of their implementation. Comorbidity as well as polypharmacy, cognitive decline, unpredictable placebo response, and uncertainty on optimal duration of trials are some of the challenges the investigator has to address. Moreover, some methodological limitations of randomised clinical trials reduce the applicability of the results of such studies to common clinical practices and have encouraged some authors to investigate the existence of possible alternative research designs such as pragmatic randomised clinical trials.
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Shi J, Wei M, Tian J, Snowden J, Zhang X, Ni J, Li T, Jian W, Ma C, Tong Y, Liu J, Liu T, Wang P, Wang Y. The Chinese version of story recall: a useful screening tool for mild cognitive impairment and Alzheimer's disease in the elderly. BMC Psychiatry 2014; 14:71. [PMID: 24612772 PMCID: PMC3995883 DOI: 10.1186/1471-244x-14-71] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decline in verbal episodic memory is a core feature of amnestic mild cognitive impairment (aMCI). The delayed story recall (DSR) test from the Adult Memory and Information Processing Battery (AMIPB) discriminates MCI from normal aging and predicts its conversion to Alzheimer's dementia. However, there is no study that validates the Chinese version of the DSR and reports cut-off scores in the Chinese population. METHODS A total of 631 subjects were screened in the memory clinics of Dongzhimen Hospital, Beijing University of Chinese Medicine, China. 249 were considered to have normal cognition (NC), 134 met diagnostic criteria for MCI according to the MCI Working Group of the European Consortium on Alzheimer's Disease, and 97 met criteria for probable Alzheimer's disease (AD) according to the NINCDS/ADRDA criteria, 14 exhibited vascular dementia (VaD), and 50 had a diagnosis of another type of dementia. Receiver operating characteristic (ROC) curve analyses were used to calculate the story recall cutoff score for detecting MCI and AD. Normative data in the NC group were obtained as a function of age and education. RESULTS In this Chinese sample, the normative mean DSR score was 28.10 ± 8.54 in the 50-64 year-old group, 26.22 ± 8.38 in the 65-74 year-old group, and 24.42 ± 8.38 in the 75-85 year-old group. DSR performance was influenced by age and education. The DSR test had high sensitivity (0.899) and specificity (0.799) in the detection of MCI from NC using a cut-off score of 15.5. When the cutoff score was 10.5, the DSR test obtained optimal sensitivity (0.980) and specificity (0.938) in the discrimination of AD from NC. Cutoff scores and diagnostic values were calculated stratified by age and education. CONCLUSIONS The Chinese version of the DSR can be used as a screening tool to detect MCI and AD with high sensitivity and specificity, and it could be used to identify people at high risk of cognitive impairment.
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Affiliation(s)
- Jing Shi
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Mingqing Wei
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Jinzhou Tian
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.
| | - Julie Snowden
- Cerebral Function Unit, Greater Manchester Neuroscience Centre Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
| | - Xuekai Zhang
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Jingnian Ni
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Ting Li
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Wenjia Jian
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Congcong Ma
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yanping Tong
- The 3rd Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Jianping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Tonghua Liu
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Pengwen Wang
- Key Laboratory of Chinese Internal Medicine, Ministry of Education, Beijing University of Chinese Medicine, Beijing, China
| | - Yongyan Wang
- Institute of Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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