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Ting SKS, Saffari SE, Hameed S, Chiew HJ, Ng KP, Ng AS. Clinical characteristics of pathological confirmed prodromal dementia with Lewy bodies. J Neurol Sci 2023; 453:120815. [PMID: 37757638 PMCID: PMC10591830 DOI: 10.1016/j.jns.2023.120815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Misdiagnosis rate of Dementia with Lewy Bodies (DLB) remains high despite being second most common cause of neurodegenerative dementia. To date, understanding of clinical profile of pathologically confirmed prodromal DLB remains limited. The main objective of this study was to describe and compare it with pathologically confirmed Alzheimer's disease (AD). METHODS We accessed the National Alzheimer's Coordinating Center database from 2005 to December 2022 data freeze and included 111 and 501 prodromal DLB and AD patients respectively. First visit data was analyzed. RESULTS Clinician-determined memory impairment is common in prodromal DLB (>70%) but associated with higher risk for AD diagnosis (OR 0.355, p = 0.0003). DLB had a higher proportion of non-amnestic mild cognitive impairment (MCI) diagnoses but statistically insignificance in differentiating the two. Inattention (OR 2.273, p = 0.0015), and neuropsychiatric features, such as visual hallucinations (OR 11.98, p < 0.0001), depressed mood (OR1.709, p = 0.0292), apathy (1.824, p = 0.0345), and night/REM sleep behaviors, are associated with DLB diagnosis. Hallucinations are infrequent (7-11%). Motor symptoms, particularly gait disorders (OR 4.570, p < 0.001), falls (OR3.939, p = 0.0003), tremors (OR2.237, p = 0.0154), slowness (OR3.573, p < 0.0001), and parkinsonism signs (OR2.443, p < 0.0001), are common. 32% showed no parkinsonism during initial presentation. Neuropsychological examination revealed less impaired memory and language but impaired executive function in DLB. CONCLUSION In clinical practice, it is important to note that memory symptoms although being higher risk associated with AD diagnosis, are prominent in prodromal DLB. Psychosis is infrequent, and non-amnestic MCI is not necessarily associated with higher risk of DLB diagnosis. A careful clinical approach is key to improve the diagnosis of prodromal DLB.
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Affiliation(s)
- Simon Kang Seng Ting
- Department of Neurology, Singapore General Hospital, Singapore, Singapore; Department of Neurology, National Neuroscience Institute, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore.
| | - Seyed Ehsan Saffari
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Shahul Hameed
- Department of Neurology, The Queen Elizabeth Hospital, King's Lynn NHS Foundation Trust, United Kingdom
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, Singapore General Hospital, Singapore, Singapore; Department of Neurology, National Neuroscience Institute, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - Adeline Sl Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
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Tan YJ, Yong ACW, Foo JN, Lian MM, Lim WK, Dominguez J, Fong ZH, Narasimhalu K, Chiew HJ, Ng KP, Ting SKS, Kandiah N, Ng ASL. C9orf72 expansions are the most common cause of genetic frontotemporal dementia in a Southeast Asian cohort. Ann Clin Transl Neurol 2023; 10:568-578. [PMID: 36799407 PMCID: PMC10109321 DOI: 10.1002/acn3.51744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Frontotemporal dementia (FTD) encompasses a spectrum of neurodegenerative disorders, including behavioural variant FTD (bvFTD), semantic variant primary progressive aphasia (svPPA) and non-fluent variant PPA (nfvPPA). While a strong genetic component is implicated in FTD, genetic FTD in Asia is less frequently reported. We aimed to investigate the frequency of Southeast Asian FTD patients harbouring known genetic FTD variants. METHODS A total of 60 FTD-spectrum patients (25 familial and 35 sporadic) from Singapore and the Philippines were included. All underwent next-generation sequencing and repeat-primed PCR for C9orf72 expansion testing. Neurofilament light chain (NfL) levels were measured in a subset of patients. RESULTS Overall, 26.6% (16/60 cases) carried pathogenic or likely pathogenic variants in a FTD-related gene, including: MAPT Gln351Arg (n = 1); GRN Cys92Ter (n = 1), Ser301Ter (n = 2), c.462 + 1G > C (n = 1); C9orf72 expansion (35-70 repeats; n = 8); TREM2 Arg47Cys (n = 1); and OPTN frameshift insertion (n = 2). Genetic mutations accounted for 48% (12/25) of patients with familial FTD, and 11.4% (4/35) of patients with sporadic FTD. C9orf72 repeat expansions were the most common genetic mutation (13.3%, 8/60), followed by GRN (6.7%, 4/60) variants. Within mutation carriers, plasma NfL was highest in a C9orf72 expansion carrier, and CSF NfL was highest in a GRN splice variant carrier. INTERPRETATION In our cohort, genetic mutations are present in one-quarter of FTD-spectrum cases, and up to half of those with family history. Our findings highlight the importance of wider implementation of genetic testing in FTD patients from Southeast Asia.
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Affiliation(s)
- Yi Jayne Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Alisa C W Yong
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jia Nee Foo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Michelle M Lian
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Weng Khong Lim
- Singhealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,Cancer & Stem Cell Biology Program, Duke-NUS Medical School, Singapore, Singapore
| | | | - Zhi Hui Fong
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kaavya Narasimhalu
- Singhealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Simon K S Ting
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore, Singapore
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Ng KP, Shen JY, Chiew HJ, Ng ASL, Kandiah N, Rosa-Neto P, Gauthier S. White Matter Hyperintensity as a Vascular Contribution to the AT(N) Framework. J Prev Alzheimers Dis 2023; 10:387-400. [PMID: 37357280 DOI: 10.14283/jpad.2023.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
The AT(N) framework enables the classification of an individual within the biological Alzheimer's disease (AD) continuum by pairing the cognitive stage with the biomarker status of amyloid-beta (Aβ, A), tau (T) and neurodegeneration (N). AD is a multifactorial disease that may involve different pathogenic mechanisms such as cerebrovascular disease (CVD). Therefore, biomarkers of these mechanisms can be added to the AT(N) framework to enhance the biomarker characterization of individuals within the AD continuum. In AD, white matter hyperintensities (WMH) which are postulated to develop as a result of chronic ischemia from small vessel CVD are shown to play a role in the aetiology. However, the interplay of WMH with Aβ and tau pathophysiology in AD remains unclear. In this review, we summarized the studies that evaluated the associations between WMH and AD pathophysiology (Aβ and tau). We found that the evidence supporting the association of WMH with Aβ was mixed, and this may be explained by the relative contributions of WMH due to its differential load and anatomical distribution. More studies are also needed to determine the association of WMH with tau pathology. Future longitudinal studies with harmonized methodologies to quantify WMH and account for the anatomical differences of WMH are required to validate the relationship between WMH and AT(N) biomarkers. This will allow a clearer understanding of the utility of WMH as a vascular biomarker in the AT(N) framework. Novel CVD biomarkers will also have the potential to further elucidate the contributions of CVD to the AD pathophysiology.
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Affiliation(s)
- K P Ng
- A/Prof. Ng Kok Pin, Senior Consultant, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Tel: +65 63577153,
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Vipin A, Koh CL, Wong BYX, Zailan FZ, Tan JY, Soo SA, Satish V, Kumar D, Wang BZ, Ng ASL, Chiew HJ, Ng KP, Kandiah N. Amyloid-Tau-Neurodegeneration Profiles and Longitudinal Cognition in Sporadic Young-Onset Dementia. J Alzheimers Dis 2022; 90:543-551. [DOI: 10.3233/jad-220448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined amyloid-tau-neurodegeneration biomarker effects on cognition in a Southeast-Asian cohort of 84 sporadic young-onset dementia (YOD; age-at-onset <65 years) patients. They were stratified into A+N+, A– N+, and A– N– profiles via cerebrospinal fluid amyloid-β1–42 (A), phosphorylated-tau (T), MRI medial temporal atrophy (neurodegeneration– N), and confluent white matter hyperintensities cerebrovascular disease (CVD). A, T, and CVD effects on longitudinal Mini-Mental State Examination (MMSE) were evaluated. A+N+ patients demonstrated steeper MMSE decline than A– N+ (β = 1.53; p = 0.036; CI 0.15:2.92) and A– N– (β = 4.68; p = 0.001; CI 1.98:7.38) over a mean follow-up of 1.24 years. Within A– N+, T– CVD+ patients showed greater MMSE decline compared to T+CVD– patients (β = – 2.37; p = 0.030; CI – 4.41:– 0.39). A+ results in significant cognitive decline, while CVD influences longitudinal cognition in the A– sub-group.
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Affiliation(s)
- Ashwati Vipin
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Chen Ling Koh
- National Neuroscience Institute, Singapore, Singapore
| | | | - Fatin Zahra Zailan
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Jayne Yi Tan
- National Neuroscience Institute, Singapore, Singapore
| | - See Ann Soo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Vaynii Satish
- National Neuroscience Institute, Singapore, Singapore
| | - Dilip Kumar
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | | | - Adeline Su Lyn Ng
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Hui Jin Chiew
- National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Nagaendran Kandiah
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Soo SA, Zailan FZ, Tan JY, Sandhu GK, Wong BYX, Wang BZ, Ng ASL, Chiew HJ, Ng KP, Kandiah N. Safety and Usefulness of Lumbar Puncture for the Diagnosis and Management of Young-Onset Cognitive Disorders. J Alzheimers Dis 2022; 87:479-488. [PMID: 35275537 DOI: 10.3233/jad-215453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Young-onset cognitive disorders (YOCD) often manifests with complex and atypical presentations due to underlying heterogenous pathologies. Therefore, a biomarker-based evaluation will allow for timely diagnosis and definitive management. OBJECTIVE Here, we evaluated the safety and usefulness of cerebrospinal fluid (CSF) sampling through lumbar puncture (LP) in YOCD patients in a tertiary clinical setting. METHODS Patients with mild cognitive impairment (MCI) and mild dementia with age of onset between 45-64 years were evaluated. Patients underwent magnetic resonance imaging and their medial temporal lobe atrophy (MTA) was rated. LP side-effects and the impact of the CSF findings on diagnosis and management were analyzed. RESULTS 142 patients (53 (37.32%) MCI, 51 (35.92%) dementia of the Alzheimer's disease [DAT] type, and 38 (26.76%) non-AD type dementia) who underwent LP between 2015 to 2021 were analyzed. Using post-LP results and MTA ratings, 74 (52.11%) patients met the AT(N) criteria for AD. 56 (39.44%) patients (28 out of 53 (50.0%) MCI, 12 out of 51 (21.43%) DAT, and 16 out of 38 (28.57%) non-AD dementia) had a change in diagnosis following LP. 13 (9.15%) patients developed side-effects post-LP (11 (84.62%) patients had headache, 1 (7.69%) patient had backache, and 1 (7.69%) patient had headache and backache). 32 (22.54%) patients had a change in management post-LP, 24 (75.0%) had medication changes, 10 (31.30%) had referrals to other specialists, and 3 (9.40%) was referred for clinical trial with disease modifying interventions. CONCLUSION LP is well-tolerated in YOCD and can bring about relevant clinical decisions with regards to the diagnosis and management of this complex clinical condition.
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Affiliation(s)
- See Ann Soo
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Jayne Yi Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke NUS Medical School, Singapore.,Lee Kong Chian School of Medicine-NTU, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke NUS Medical School, Singapore.,Lee Kong Chian School of Medicine-NTU, Singapore
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Tu TM, Yi SJ, Koh JS, Saffari SE, Hoe RHM, Chen GJ, Chiew HJ, Tham CH, Seet CYH, Yong MH, Yong KP, Hui ACF, Fan BE, Tan BYQ, Quek AML, Seet RCS, Yeo LLL, Tan K, Thirugnanam UN. Incidence of Cerebral Venous Thrombosis Following SARS-CoV-2 Infection vs mRNA SARS-CoV-2 Vaccination in Singapore. JAMA Netw Open 2022; 5:e222940. [PMID: 35297971 PMCID: PMC8931554 DOI: 10.1001/jamanetworkopen.2022.2940] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Reports of cerebral venous thrombosis (CVT) after messenger RNA (mRNA)-based SARS-CoV-2 vaccination has caused safety concerns, but CVT is also known to occur after SARS-CoV-2 infection. Comparing the relative incidence of CVT after infection vs vaccination may provide a better perspective of this complication. OBJECTIVE To compare the incidence rates and clinical characteristics of CVT following either SARS-CoV-2 infection or mRNA-based SARS-CoV-2 vaccines. DESIGN, SETTING, AND PARTICIPANTS Between January 23, 2020, and August 3, 2021, this observational cohort study was conducted at all public acute hospitals in Singapore, where patients hospitalized with CVT within 6 weeks of SARS-CoV-2 infection or after mRNA-based SARS-CoV-2 vaccination (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) were identified. Diagnosis of SARS-CoV-2 infection was based on quantitative reverse transcription-polymerase chain reaction or positive serology. National SARS-CoV-2 infection data were obtained from the National Centre for Infectious Disease, Singapore, and vaccination data were obtained from the National Immunisation Registry, Singapore. EXPOSURES SARS-CoV-2 infection or mRNA-based SARS-CoV-2 vaccines. MAIN OUTCOMES AND MEASURES Clinical characteristics, crude incidence rate (IR), and incidence rate ratio (IRR) of CVT after SARS-CoV-2 infection and after mRNA SARS-CoV-2 vaccination. RESULTS Among 62 447 individuals diagnosed with SARS-CoV-2 infections included in this study, 58 989 (94.5%) were male; the median (range) age was 34 (0-102) years; 6 CVT cases were identified (all were male; median [range] age was 33.5 [27-40] years). Among 3 006 662 individuals who received at least 1 dose of mRNA-based SARS-CoV-2 vaccine, 1 626 623 (54.1%) were male; the median (range) age was 50 (12-121) years; 9 CVT cases were identified (7 male individuals [77.8%]; median [range] age: 60 [46-76] years). The crude IR of CVT after SARS-CoV-2 infections was 83.3 per 100 000 person-years (95% CI, 30.6-181.2 per 100 000 person-years) and 2.59 per 100 000 person-years (95% CI, 1.19-4.92 per 100 000 person-years) after mRNA-based SARS-CoV-2 vaccination. Six (66.7%) received BNT162b2 (Pfizer-BioNTech) vaccine and 3 (33.3%) received mRNA-1273 (Moderna) vaccine. The crude IRR of CVT hospitalizations with SARS-CoV-2 infection compared with those who received mRNA SARS-CoV-2 vaccination was 32.1 (95% CI, 9.40-101; P < .001). CONCLUSIONS AND RELEVANCE The incidence rate of CVT after SARS-CoV-2 infection was significantly higher compared with after mRNA-based SARS-CoV-2 vaccination. CVT remained rare after mRNA-based SARS-CoV-2 vaccines, reinforcing its safety.
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Affiliation(s)
- Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Shen Jia Yi
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Seyed Ehsan Saffari
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Ming Hui Yong
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kok Pin Yong
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
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Vipin A, Satish V, Saffari SE, Koh W, Lim L, Silva E, Nyu MM, Choong TM, Chua E, Lim L, Ng ASL, Chiew HJ, Ng KP, Kandiah N. Dementia in Southeast Asia: influence of onset-type, education, and cerebrovascular disease. Alzheimers Res Ther 2021; 13:195. [PMID: 34847922 PMCID: PMC8630908 DOI: 10.1186/s13195-021-00936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Southeast Asia represents 10% of the global population, yet little is known about regional clinical characteristics of dementia and risk factors for dementia progression. This study aims to describe the clinico-demographic profiles of dementia in Southeast Asia and investigate the association of onset-type, education, and cerebrovascular disease (CVD) on dementia progression in a real-world clinic setting.
Methods
In this longitudinal study, participants were consecutive series of 1606 patients with dementia from 2010 to 2019 from a tertiary memory clinic from Singapore. The frequency of dementia subtypes stratified into young-onset (YOD; <65 years age-at-onset) and late-onset dementia (LOD; ≥65 years age-at-onset) was studied. Association of onset-type (YOD or LOD), years of lifespan education, and CVD on the trajectory of cognition was evaluated using linear mixed models. The time to significant cognitive decline was investigated using Kaplan-Meier analysis.
Results
Dementia of the Alzheimer’s type (DAT) was the most common diagnosis (59.8%), followed by vascular dementia (14.9%) and frontotemporal dementia (11.1%). YOD patients accounted for 28.5% of all dementia patients. Patients with higher lifespan education had a steeper decline in global cognition (p<0.001), with this finding being more pronounced in YOD (p=0.0006). Older patients with a moderate-to-severe burden of CVD demonstrated a trend for a faster decline in global cognition compared to those with a mild burden.
Conclusions
There is a high frequency of YOD with DAT being most common in our Southeast Asian memory clinic cohort. YOD patients with higher lifespan education and LOD patients with moderate-to-severe CVD experience a steep decline in cognition.
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Koh PX, Neo SX, Chiew HJ, Singh DR, Saini M, Chen Z. Syphilitic Spinal Disease: An Old Nemesis Revisited. A Case Series and Review of Literature. Sex Transm Dis 2021; 48:e126-e131. [PMID: 33512899 DOI: 10.1097/olq.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Syphilitic spinal disease is a rare condition caused by the spirochete Treponema pallidum, either from direct spirochete involvement of the cord or as a consequence of indirect spirochete involvement of the meninges, blood vessels, or the vertebral column. After the introduction of penicillin therapy in the 1940s, it has become an increasingly rare condition. We report 3 challenging cases of syphilitic spinal disease presenting as myelopathy-1 with an extra-axial gumma of tertiary syphilis causing cord compression and 2 with tabes dorsalis complicated by tabetic spinal neuroarthropathy-each presenting a diagnostic dilemma to their treating physicians. We also review the literature for updates on modern investigative modalities and discuss pitfalls physicians need to avoid to arrive at the diagnosis.
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Affiliation(s)
- Pei Xuan Koh
- From the Department of Neurology, National Neuroscience Institute, Singapore
| | - Shermyn Xiumin Neo
- From the Department of Neurology, National Neuroscience Institute, Singapore
| | - Hui Jin Chiew
- From the Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Monica Saini
- From the Department of Neurology, National Neuroscience Institute, Singapore
| | - Zhiyong Chen
- From the Department of Neurology, National Neuroscience Institute, Singapore
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Tu TM, Seet CYH, Koh JS, Tham CH, Chiew HJ, De Leon JA, Chua CYK, Hui ACF, Tan SSY, Vasoo SS, Tan BYQ, Umapathi NT, Tambyah PA, Yeo LLL. Acute Ischemic Stroke During the Convalescent Phase of Asymptomatic COVID-2019 Infection in Men. JAMA Netw Open 2021; 4:e217498. [PMID: 33885771 PMCID: PMC8063067 DOI: 10.1001/jamanetworkopen.2021.7498] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Acute ischemic stroke (AIS) is a known neurological complication in patients with respiratory symptoms of COVID-19 infection. However, AIS has not been described as a late sequelae in patients without respiratory symptoms of COVID-19. OBJECTIVE To assess AIS experienced by adults 50 years or younger in the convalescent phase of asymptomatic COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS This case series prospectively identified consecutive male patients who received care for AIS from public health hospitals in Singapore between May 21, 2020, and October 14, 2020. All of these patients had laboratory-confirmed asymptomatic COVID-19 infection based on a positive SARS-CoV-2 serological (antibodies) test result. These patients were individuals from South Asian countries (India and Bangladesh) who were working in Singapore and living in dormitories. The total number of COVID-19 cases (54 485) in the worker dormitory population was the population at risk. Patients with ongoing respiratory symptoms or positive SARS-CoV-2 serological test results confirmed through reverse transcriptase-polymerase chain reaction nasopharyngeal swabs were excluded. MAIN OUTCOMES AND MEASURES Clinical course, imaging, and laboratory findings were retrieved from the electronic medical records of each participating hospital. The incidence rate of AIS in the case series was compared with that of a historical age-, sex-, and ethnicity-matched national cohort. RESULTS A total of 18 male patients, with a median (range) age of 41 (35-50) years and South Asian ethnicity, were included. The median (range) time from a positive serological test result to AIS was 54.5 (0-130) days. The median (range) National Institutes of Health Stroke Scale score was 5 (1-25). Ten patients (56%) presented with a large vessel occlusion, of whom 6 patients underwent intravenous thrombolysis and/or endovascular therapy. Only 3 patients (17%) had a possible cardiac source of embolus. The estimated annual incidence rate of AIS was 82.6 cases per 100 000 people in this study compared with 38.2 cases per 100 000 people in the historical age-, sex-, and ethnicity-matched cohort (rate ratio, 2.16; 95% CI, 1.36-3.48; P < .001). CONCLUSIONS AND RELEVANCE This case series suggests that the risk for AIS is higher in adults 50 years or younger during the convalescent period of a COVID-19 infection without respiratory symptoms. Acute ischemic stroke could be part of the next wave of complications of COVID-19, and stroke units should be on alert and use serological testing, especially in younger patients or in the absence of traditional risk factors.
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Affiliation(s)
- Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Andrew Che-Fai Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Shaun Shi Yan Tan
- Department of Laboratory Medicine, National University Health System, Singapore
| | - Shawn Sushilan Vasoo
- Department of Infectious Diseases, Tan Tock Seng Hospital and National Centre for Infectious Diseases, Singapore
| | | | | | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
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Koh JS, De Silva DA, Quek AML, Chiew HJ, Tu TM, Seet CYH, Hoe RHM, Saini M, Hui ACF, Angon J, Ker JR, Yong MH, Goh Y, Yu WY, Lim TCC, Tan BYQ, Ng KWP, Yeo LLL, Pang YZ, Prakash KM, Ahmad A, Thomas T, Lye DCB, Tan K, Umapathi T. Corrigendum to 'Neurology of COVID-19 in Singapore' [Journal of the Neurological Sciences Volume 418, 15 November 2020, 117118]. J Neurol Sci 2021; 424:117406. [PMID: 33773769 PMCID: PMC7979574 DOI: 10.1016/j.jns.2021.117406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jasmine Shimin Koh
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore
| | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore; Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore
| | | | - Rebecca Hui Min Hoe
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Monica Saini
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Andrew Che-Fai Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Jasmyn Angon
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore
| | - Justin Ruixin Ker
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Ming Hui Yong
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Wai-Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | | | | | - Kay Wei Ping Ng
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Yu Zhi Pang
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore; Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore
| | - Kumar M Prakash
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore; Department of Neurology, Sengkang General Hospital, Singapore
| | - Aftab Ahmad
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Terrence Thomas
- Department of Paediatrics, Neurology Service, KK Women's and Children's Hospital, Singapore
| | | | - Kevin Tan
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Thirugnanam Umapathi
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore.
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11
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Ng KP, Chiew HJ, Hameed S, Ting SKS, Ng A, Soo SA, Wong BYX, Lim L, Yong ACW, Mok VCT, Rosa‐Neto P, Dominguez J, Kim S, Hsiung GYR, Ikeda M, Miller BL, Gauthier S, Kandiah N. Frontotemporal dementia and COVID-19: Hypothesis generation and roadmap for future research. Alzheimers Dement (N Y) 2021; 6:e12085. [PMID: 33490361 PMCID: PMC7810128 DOI: 10.1002/trc2.12085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 01/21/2023]
Abstract
The COVID-19 pandemic has caused tremendous suffering for patients with dementia and their caregivers. We conducted a survey to study the impact of the pandemic on patients with mild frontotemporal dementia (FTD). Our preliminary findings demonstrate that patients with FTD have significant worsening in behavior and social cognition, as well as suffer greater negative consequences from disruption to health-care services compared to patients with AD. The reduced ability to cope with sudden changes to social environments places patients with FTD at increased vulnerability to COVID-19 infection as well as to poorer clinical and social outcomes. Caregivers of FTD patients also demonstrate high burden during crisis situations. A proportion of patients with FTD benefitted from use of web-based interactive platforms. In this article, we outline the priority areas for research as well as a roadmap for future collaborative research to ensure greatest benefit for patients with FTD and their caregivers.
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Affiliation(s)
- Kok Pin Ng
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Hui Jin Chiew
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Shahul Hameed
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Simon Kang Seng Ting
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - Adeline Ng
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
| | - See Ann Soo
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | | | - Levinia Lim
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Alisa C. W. Yong
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Vincent C. T. Mok
- Gerald Choa Neuroscience CentreLui Che Woo Institute of Innovative MedicineDepartment of Medicine and TherapeuticsPrince of Wales HospitalFaculty of MedicineThe Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina
| | - Pedro Rosa‐Neto
- Translational Neuroimaging LaboratoryMcGill University Research Centre for Studies in AgingAlzheimer’s Disease Research UnitDouglas Research InstituteLe Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest‐de‐l'Île‐de‐MontréalDepartment of Neurology and Neurosurgery, Psychiatry and Pharmacology and TherapeuticsMcGill UniversityMontrealCanada
| | | | - SangYun Kim
- Department of NeurologySeoul National University College of Medicine and Clinical Neuroscience Center of Seoul National University Bundang HospitalSeongnam‐siKorea
| | - G. Y. Robin Hsiung
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Manabu Ikeda
- Department of PsychiatryGraduate School of Medicine, Osaka UniversityOsakaJapan
| | - Bruce L. Miller
- Memory and Aging CenterDepartment of NeurologyUniversity of CaliforniaSan FranciscoSan FranciscoCaliforniaUSA
| | - Serge Gauthier
- Translational Neuroimaging LaboratoryMcGill University Research Centre for Studies in AgingAlzheimer’s Disease Research UnitDouglas Research InstituteLe Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Ouest‐de‐l'Île‐de‐MontréalDepartment of Neurology and Neurosurgery, Psychiatry and Pharmacology and TherapeuticsMcGill UniversityMontrealCanada
| | - Nagaendran Kandiah
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine – Imperial College LondonNanyang Technological UniversitySingaporeSingapore
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12
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Soo SA, Ng KP, Wong F, Yatawara C, Chiew HJ, Lyn Ng AS, Ismail Z, Kandiah N. Mild Behaviour Impairment Checklist (MBI‐C): Is there a difference in ratings between patient and close informant? Alzheimers Dement 2020. [DOI: 10.1002/alz.039239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- See Ann Soo
- National Neuroscience Institute Singapore Singapore
| | - Kok Pin Ng
- McGill University Research Centre for Studies in Aging Verdun QC Canada
| | - Fennie Wong
- National Neuroscience Institute Singapore Singapore
| | | | | | | | - Zahinoor Ismail
- University of Calgary, Cumming School of Medicine Calgary AB Canada
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13
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Lim L, Wong B, Vipin A, Silva E, Lay Hoon Lim L, Vanessa Chua E, Yuen Oi Choong T, Mei NM, Chiew HJ, Hameed S, Seng Ting SK, Lyn Ng AS, Ng KP, Kandiah N. Posterior cortical atrophy in Southeast Asia: Clinical and biomarker profile. Alzheimers Dement 2020. [DOI: 10.1002/alz.044223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Levinia Lim
- National Neuroscience Institute Singapore Singapore
| | | | | | | | | | | | | | - Nyu Mei Mei
- National Neuroscience Institute Singapore Singapore
| | | | | | | | | | - Kok Pin Ng
- McGill University Research Centre for Studies in Aging Verdun QC Canada
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14
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Koh JS, De Silva DA, Quek AML, Chiew HJ, Tu TM, Seet CYH, Hoe RHM, Saini M, Hui ACF, Angon J, Ker JR, Yong MH, Goh Y, Yu WY, Lim TCC, Tan BYQ, Ng KWP, Yeo LLL, Pang YZ, Prakash KM, Ahmad A, Thomas T, Lye DCB, Tan K, Umapathi T. Neurology of COVID-19 in Singapore. J Neurol Sci 2020; 418:117118. [PMID: 32977228 PMCID: PMC7470792 DOI: 10.1016/j.jns.2020.117118] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To describe the spectrum of COVID-19 neurology in Singapore. METHOD We prospectively studied all microbiologically-confirmed COVID-19 patients in Singapore, who were referred for any neurological complaint within three months of COVID-19 onset. Neurological diagnoses and relationship to COVID-19 was made by consensus guided by contemporaneous literature, refined using recent case definitions. RESULTS 47,572 patients (median age 34 years, 98% males) were diagnosed with COVID-19 in Singapore between 19 March to 19 July 2020. We identified 90 patients (median age 38, 98.9% males) with neurological disorders; 39 with varying certainty of relationship to COVID-19 categorised as: i) Central nervous system syndromes-4 acute disseminated encephalomyelitis (ADEM) and encephalitis, ii) Cerebrovascular disorders-19 acute ischaemic stroke and transient ischaemic attack (AIS/TIA), 4 cerebral venous thrombosis (CVT), 2 intracerebral haemorrhage, iii) Peripheral nervous system-7 mono/polyneuropathies, and a novel group, iv) Autonomic nervous system-4 limited dysautonomic syndromes. Fifty-one other patients had pre/co-existent neurological conditions unrelated to COVID-19. Encephalitis/ADEM is delayed, occurring in critical COVID-19, while CVT and dysautonomia occurred relatively early, and largely in mild infections. AIS/TIA was variable in onset, occurring in patients with differing COVID-19 severity; remarkably 63.2% were asymptomatic. CVT was more frequent than expected and occurred in mild/asymptomatic patients. There were no neurological complications in all 81 paediatric COVID-19 cases. CONCLUSION COVID-19 neurology has a wide spectrum of dysimmune-thrombotic disorders. We encountered relatively few neurological complications, probably because our outbreak involved largely young men with mild/asymptomatic COVID-19. It is also widely perceived that the pandemic did not unduly affect the Singapore healthcare system.
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Affiliation(s)
- Jasmine Shimin Koh
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore
| | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore; Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore
| | | | - Rebecca Hui Min Hoe
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Monica Saini
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Andrew Che-Fai Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Jasmyn Angon
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore
| | - Justin Ruixin Ker
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Ming Hui Yong
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Wai-Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | | | | | - Kay Wei Ping Ng
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Yu Zhi Pang
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore; Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore
| | - Kumar M Prakash
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore; Department of Neurology, Sengkang General Hospital, Singapore
| | - Aftab Ahmad
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Terrence Thomas
- Department of Paediatrics, Neurology Service, KK Women's and Children's Hospital, Singapore
| | | | - Kevin Tan
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Thirugnanam Umapathi
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore.
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15
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Ng KP, Chiew HJ, Rosa-Neto P, Kandiah N, Ismail Z, Gauthier S. Brain Metabolic Dysfunction in Early Neuropsychiatric Symptoms of Dementia. Front Pharmacol 2019; 10:1398. [PMID: 31824321 PMCID: PMC6882863 DOI: 10.3389/fphar.2019.01398] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) including behavioral and psychiatric symptoms are common in the dementia stages of Alzheimer's disease (AD) and are associated with poorer outcomes in cognition, functional states, quality of life, and accelerated progression to severe dementia or death. NPS are also increasingly observed in the mild cognitive impairment stage of AD and may predict incipient dementia. As such, there is an emerging conceptual framework, which support NPS as early non-cognitive symptoms of dementia. [18F]fluorodeoxyglucosepositron emission tomography is a technique that is sensitive in detecting resting metabolism associated with NPS in neuropsychiatric conditions, and there is a growing body of literature evaluating the role of NPS as early indicators of brain metabolic dysfunctions in AD. In this mini-review, we examine the frequency and associations of NPS with metabolic dysfunction in the AD continuum, including preclinical, prodromal, and dementia stages of AD. We will also present the validated neurobehavioral syndrome, mild behavioral impairment describes the later life emergence of sustained NPS as an at-risk state for incident cognitive decline and dementia, and an early presentation of neurodegenerative diseases in some. Lastly, we will discuss future directions in the field so as to better understand the neurobiological basis of NPS in the early stages of the AD continuum, and their role in predicting AD pathophysiological progression and incident dementia.
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Affiliation(s)
- Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Pedro Rosa-Neto
- The McGill University Research Centre for Studies in Aging, Montreal, QC, Canada
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Serge Gauthier
- The McGill University Research Centre for Studies in Aging, Montreal, QC, Canada
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16
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Ng KP, Chiew HJ, Lim L, Rosa-Neto P, Kandiah N, Gauthier S. The influence of language and culture on cognitive assessment tools in the diagnosis of early cognitive impairment and dementia. Expert Rev Neurother 2018; 18:859-869. [DOI: 10.1080/14737175.2018.1532792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Pedro Rosa-Neto
- Alzheimer’s Disease Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, Canada
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Serge Gauthier
- Alzheimer’s Disease Research Unit, The McGill University Research Centre for Studies in Aging, Montreal, Canada
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17
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Mak A, Cheung MWL, Chiew HJ, Liu Y, Ho RCM. Global trend of survival and damage of systemic lupus erythematosus: meta-analysis and meta-regression of observational studies from the 1950s to 2000s. Semin Arthritis Rheum 2012; 41:830-9. [PMID: 22257558 DOI: 10.1016/j.semarthrit.2011.11.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 10/31/2011] [Accepted: 11/04/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess systemically with meta-analysis the trend of survival and its determinants, which are hindering further improvement of survival of patients with systemic lupus erythematosus (SLE) over the past 5 decades. METHODS Retrospective, cross-sectional, and prospective observational studies addressing survival and damage in SLE patients published between 1 January 1950 and 31 July 2010 were identified in electronic databases. Using the random-effects model, effect size was calculated based on the logit of the overall 5- and 10-year survival rates. The pooled logit and its robust 95% confidence interval were transformed back into the 5- and 10-year survival rates, after adjusting for potential dependence on the data. Potential factors predicting the pooled survival rates were explored by meta-regression. RESULTS Seventy-seven studies involving 18,998 SLE patients were analyzed. Between the 1950s and the 2000s, their overall survival significantly increased, from 74.8% to 94.8% and 63.2% to 91.4% for the overall 5-year and 10-year survival, respectively (P < 0.001). The survival improvement, however, appeared to slow down between 1980 and 1990. Meta-regression revealed that neuropsychiatric and renal damage negatively affected the overall 5-year survival, whereas neuropsychiatric damage remained so for the 10-year survival for the past 50 years. Furthermore, the prevalence of neuropsychiatric damage has been significantly increasing over the past 5 decades. CONCLUSIONS For the past 50 years, damage involving the renal and neuropsychiatric systems has been negatively affecting survival of SLE patients. Early detection and aggressive management of renal and neuropsychiatric involvement may potentially improve further the survival of lupus patients.
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Affiliation(s)
- Anselm Mak
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University of Singapore, Singapore.
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