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Winser SJ, Chan AYY, Whitney SL, Chen CH, Pang MYC. Effectiveness and cost of integrated cognitive and balance training for balance and falls in cerebellar ataxia: a blinded two-arm parallel group RCT. Front Neurol 2024; 14:1267099. [PMID: 38313407 PMCID: PMC10834731 DOI: 10.3389/fneur.2023.1267099] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024] Open
Abstract
Background In patients with cerebellar ataxia (CA), dual-tasking deteriorates the performance of one or both tasks. Objective Evaluate the effects of 4 weeks of cognitive-coupled intensive balance training (CIBT) on dual-task cost, dynamic balance, disease severity, number of falls, quality of life, cognition and cost among patients with CA. Methods This RCT compared CIBT (Group 1) to single-task training (Group 2) among 32 patients with CA. The intervention included either dual-task (CIBT) or single-task training for 4 weeks followed by 6 months of unsupervised home exercises. Dual-task timed up-and-go test (D-TUG) assessed dual-task cost of the physical and cognitive tasks. Assessment time points included baseline 1 (Week 0:T1), baseline 2 (Week 6:T2), post-intervention (Week 10:T3), and follow-up (Week 34:T4). Results Compared to single-task training CIBT improved the dual-task cost of physical task [MD -8.36 95% CI (-14.47 to -2.36, p < 0.01), dual-tasking ability [-6.93 (-13.16 to -0.70); p = 0.03] assessed using D-TUG, balance assessed using the scale for the assessment and rating of ataxia (SARAbal) [-2.03 (-4.04 to -0.19); p = 0.04], visual scores of the SOT (SOT-VIS) [-18.53 (-25.81 to -11.24, p ≤ 0.01] and maximal excursion [13.84 (4.65 to 23.03; p ≤ 0.01] of the Limits of Stability (LOS) in the forward direction and reaction time in both forward [-1.11 (-1.42 to -0.78); p < 0.01] and right [-0.18 (0.05 to 0.31); p < 0.01] directions following 4 weeks of training. CIBT did not have any additional benefits in reducing the number of falls, or improving disease severity, quality of life and cognition. The mean cost of intervention and healthcare costs for 7 months was HKD 33,380 for CIBT group and HKD 38,571 for single-task training group. Conclusion We found some evidence to support the use of CIBT for improving the dual-tasking ability, dual-task cost of physical task and dynamic balance in CA. Future large fully-powered studies are needed to confirm this claim. Clinical trial registration https://clinicaltrials.gov/study/NCT04648501, identifier [Ref: NCT04648501].
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Affiliation(s)
- Stanley J. Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Anne Y. Y. Chan
- Division of Neurology, Prince of Wales Hospital and Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Susan L. Whitney
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cynthia H. Chen
- Saw Swee Hock School of Public Health (Primary), National University of Singapore, Singapore, Singapore
| | - Marco Y. C. Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Winser S, Chan AYY, Chung R, Whitney S, Kannan P. Validity of balance measures in cerebellar ataxia: A prospective study with 12-month follow-up. PM R 2022. [PMID: 35474301 DOI: 10.1002/pmrj.12826] [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] [Received: 10/04/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Balance deficits are common in cerebellar ataxia. Determining which balance outcome measures are psychometrically strong for this population remains an unmet need. OBJECTIVE Evaluate the validity and responsiveness of two clinic-based balance measures [Berg Balance Scale (BBS) and balance sub-component of the Scale for the Assessment and Rating of Ataxia (SARA-bal)] and two laboratory-based balance measures [Sensory Organization Test (SOT) and Limits of Stability (LOS)] in cerebellar ataxia. DESIGN Prospective cohort study. SETTING Institutional study assessing 40 participants with cerebellar ataxia at baseline, 6, and 12 months. MAIN OUTCOME MEASURES Balance was assessed using the BBS, SARA-bal, SOT, and LOS; disease severity was assessed using the SARA; and Patients' Global Impression of Change (PGIC) was used to estimate responsiveness to disease progress at 6 and 12 months. RESULTS BBS and SARA-bal (Spearman's correlation coefficient, ρS = -0.89, p < 0.01) demonstrated strong criterion validity. Convergent validity was moderate to high (ρS range:-0.75 to 0.92) and external validity was low (ρS range:-0.75 to 0.11). Composite SOT scores (SOT-COM; ρS=0.29, p<0.01) and maximal excursion (MXE-LOS) in the forward (F) and right (R) directions of the LOS (ρS = 0.18, p < 0.01) demonstrated moderate to low criterion and convergent validity. The area under the receiver operating characteristic curve (AUCROC ) and its effect size (standard response mean [SRM]) for categorizing 'stable' and 'worsened' patients at 6 and 12 months were satisfactory for the BBS (AUCROC :0.75; SRM-Stable:1.06; SRM-Worsened:1.16), SARA-bal (AUCROC :0.76; SRM-Stable:0.86; SRM-Worsened:0.85), and MXE-LOS(R) (AUCROC :0.29; SRM-Stable:0.41; SRM-Worsened:1.39). CONCLUSION BBS and SARA-bal have moderate to strong criterion and convergent validity and adequate responsiveness to balance changes. Both laboratory-based measures (SOT and LOS) demonstrated a high floor effect. The SOT-COM and MXE-LOS(R) demonstrated moderate to low criterion validity, with only the MXE-LOS(R) displaying adequate responsiveness to balance changes after 6 and 12 months. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stanley Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Anne Y Y Chan
- Division of Neurology, Prince of Wales Hospital and Dept. of Medicine and Therapeutics, Chinese University of Hong Kong
| | - Raymond Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Susan Whitney
- School of Health and Rehabilitation Sciences, University of Pittsburgh, USA.,Rehabilitation Research Chair at King Saud University, Saudi Arabia
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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Shi M, Leng X, Li Y, Chen Z, Cao Y, Chung T, Ip BY, Ip VH, Soo YO, Fan FS, Ma SH, Ma K, Chan AYY, Au LW, Leung H, Lau AY, Mok VC, Choy KW, Dong Z, Leung TW. Genome sequencing reveals the role of rare genomic variants in Chinese patients with symptomatic intracranial atherosclerotic disease. Stroke Vasc Neurol 2021; 7:182-189. [PMID: 34880113 PMCID: PMC9240611 DOI: 10.1136/svn-2021-001157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Objectives The predisposition of intracranial atherosclerotic disease (ICAD) to East Asians over Caucasians infers a genetic basis which, however, remains largely unknown. Higher prevalence of vascular risk factors (VRFs) in Chinese over Caucasian patients who had a stroke, and shared risk factors of ICAD with other stroke subtypes indicate genes related to VRFs and/or other stroke subtypes may also contribute to ICAD. Methods Unrelated symptomatic patients with ICAD were recruited for genome sequencing (GS, 60-fold). Rare and potentially deleterious single-nucleotide variants (SNVs) and small insertions/deletions (InDels) were detected in genome-wide and correlated to genes related to VRFs and/or other stroke subtypes. Rare aneuploidies, copy number variants (CNVs) and chromosomal structural rearrangements were also investigated. Lastly, candidate genes were used for pathway and gene ontology enrichment analysis. Results Among 92 patients (mean age at stroke onset 61.0±9.3 years), GS identified likely ICAD-associated rare genomic variants in 54.3% (50/92) of patients. Forty-eight patients (52.2%, 48/92) had 59 rare SNVs/InDels reported or predicted to be deleterious in genes related to VRFs and/or other stroke subtypes. None of the 59 rare variants were identified in local subjects without ICAD (n=126). 31 SNVs/InDels were related to conventional VRFs, and 28 were discovered in genes related to other stroke subtypes. Our study also showed that rare CNVs (n=7) and structural rearrangement (a balanced translocation) were potentially related to ICAD in 8.7% (8/92) of patients. Lastly, candidate genes were significantly enriched in pathways related to lipoprotein metabolism and cellular lipid catabolic process. Conclusions Our GS study suggests a role of rare genomic variants with various variant types contributing to the development of ICAD in Chinese patients.
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Affiliation(s)
- Mengmeng Shi
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China.,Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ying Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China.,Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Zihan Chen
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China.,Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Ye Cao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China.,Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Tiffany Chung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Bonaventure Ym Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Vincent Hl Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yannie Oy Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Florence Sy Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sze Ho Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Karen Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Lisa Wc Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Howan Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alexander Y Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Vincent Ct Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China.,Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,The Chinese University of Hong Kong-Baylor College of Medicine Joint Center For Medical Genetics, The Chinese University of Hong Kong, Hong Kong, China
| | - Zirui Dong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China .,Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Foo JN, Chew EGY, Chung SJ, Peng R, Blauwendraat C, Nalls MA, Mok KY, Satake W, Toda T, Chao Y, Tan LCS, Tandiono M, Lian MM, Ng EY, Prakash KM, Au WL, Meah WY, Mok SQ, Annuar AA, Chan AYY, Chen L, Chen Y, Jeon BS, Jiang L, Lim JL, Lin JJ, Liu C, Mao C, Mok V, Pei Z, Shang HF, Shi CH, Song K, Tan AH, Wu YR, Xu YM, Xu R, Yan Y, Yang J, Zhang B, Koh WP, Lim SY, Khor CC, Liu J, Tan EK. Identification of Risk Loci for Parkinson Disease in Asians and Comparison of Risk Between Asians and Europeans: A Genome-Wide Association Study. JAMA Neurol 2020; 77:746-754. [PMID: 32310270 PMCID: PMC7171584 DOI: 10.1001/jamaneurol.2020.0428] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/03/2020] [Indexed: 02/05/2023]
Abstract
Importance Large-scale genome-wide association studies in the European population have identified 90 risk variants associated with Parkinson disease (PD); however, there are limited studies in the largest population worldwide (ie, Asian). Objectives To identify novel genome-wide significant loci for PD in Asian individuals and to compare genetic risk between Asian and European cohorts. Design Setting, and Participants Genome-wide association data generated from PD cases and controls in an Asian population (ie, Singapore/Malaysia, Hong Kong, Taiwan, mainland China, and South Korea) were collected from January 1, 2016, to December 31, 2018, as part of an ongoing study. Results were combined with inverse variance meta-analysis, and replication of top loci in European and Japanese samples was performed. Discovery samples of 31 575 individuals passing quality control of 35 994 recruited were used, with a greater than 90% participation rate. A replication cohort of 1 926 361 European-ancestry and 3509 Japanese samples was analyzed. Parkinson disease was diagnosed using UK Parkinson's Disease Society Brain Bank Criteria. Main Outcomes and Measures Genotypes of common variants, association with disease status, and polygenic risk scores. Results Of 31 575 samples identified, 6724 PD cases (mean [SD] age, 64.3 [10] years; age at onset, 58.8 [10.6] years; 3472 [53.2%] men) and 24 851 controls (age, 59.4 [11.4] years; 11 030 [45.0%] men) were analyzed in the discovery study. Eleven genome-wide significant loci were identified; 2 of these loci were novel (SV2C and WBSCR17) and 9 were previously found in Europeans. Replication in European-ancestry and Japanese samples showed robust association for SV2C (rs246814; odds ratio, 1.16; 95% CI, 1.11-1.21; P = 1.17 × 10-10 in meta-analysis of discovery and replication samples) but showed potential genetic heterogeneity at WBSCR17 (rs9638616; I2=67.1%; P = 3.40 × 10-3 for hetereogeneity). Polygenic risk score models including variants at these 11 loci were associated with a significant improvement in area under the curve over the model based on 78 European loci alone (63.1% vs 60.2%; P = 6.81 × 10-12). Conclusions and Relevance This study identified 2 apparently novel gene loci and found 9 previously identified European loci to be associated with PD in this large, meta-genome-wide association study in a worldwide population of Asian individuals and reports similarities and differences in genetic risk factors between Asian and European individuals in the risk for PD. These findings may lead to improved stratification of Asian patients and controls based on polygenic risk scores. Our findings have potential academic and clinical importance for risk stratification and precision medicine in Asia.
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Affiliation(s)
- Jia Nee Foo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Elaine Guo Yan Chew
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Rong Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Mike A. Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
- Data Tecnica International LLC, Glen Echo, Maryland
| | - Kin Y. Mok
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Wataru Satake
- Division of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Department of Neurology, The University of Tokyo Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, The University of Tokyo Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Yinxia Chao
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Louis C. S. Tan
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Moses Tandiono
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 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, Singapore
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Ebonne Y. Ng
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Kumar-M. Prakash
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Wee-Yang Meah
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Shi Qi Mok
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Azlina Ahmad Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Y. Y. Chan
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Prince of Wales Hospital, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, PR China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Beom S. Jeon
- Department of Neurology, Seoul National University Hospital, Jongno-gu, Seoul, South Korea
| | - Lulu Jiang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Jia Lun Lim
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Juei-Jueng Lin
- Department of Neurology, Chushang Show-Chwan Hospital, Zhushan District, Nantou, Taiwan
| | - Chunfeng Liu
- Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Chengjie Mao
- Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Vincent Mok
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Prince of Wales Hospital, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, PR China
| | - Zhong Pei
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Chang-He Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Kyuyoung Song
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ai Huey Tan
- Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yu-ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Renshi Xu
- Department of Neurology, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Yaping Yan
- Second Affiliated Hospital, Department of Neurology, Zhejiang University College of Medicine, Hangzhou, Zhejiang Province, PR China
| | - Jing Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - BaoRong Zhang
- Second Affiliated Hospital, Department of Neurology, Zhejiang University College of Medicine, Hangzhou, Zhejiang Province, PR China
| | - Woon-Puay Koh
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Shen-Yang Lim
- Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiea Chuen Khor
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
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Affiliation(s)
- Lisa W C Au
- From Lui Che Woo Institute of Innovative Medicine, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Chinese University of Hong Kong.
| | - Anne Y Y Chan
- From Lui Che Woo Institute of Innovative Medicine, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Chinese University of Hong Kong
| | - Vincent C T Mok
- From Lui Che Woo Institute of Innovative Medicine, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Chinese University of Hong Kong
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Winser S, Pang MYC, Rauszen JS, Chan AYY, Chen CH, Whitney SL. Does integrated cognitive and balance (dual-task) training improve balance and reduce falls risk in individuals with cerebellar ataxia? Med Hypotheses 2019; 126:149-153. [PMID: 31010491 DOI: 10.1016/j.mehy.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/04/2019] [Indexed: 12/24/2022]
Abstract
Frequent falls in people with cerebellar ataxia (CA) is a significant problem Therefore, an intervention that could improve balance and reduce the number of falls is of paramount importance from the patients' perspective. Combining cognitive training with physical training to improve balance is a new approach for reducing the risk of falls in patient populations who are at risk for falls. To determine if adding structured cognitive demands to conventional balance and coordination training we designed the Cognitive-coupled Intensive Balance Training (CIBT) program. We found that the more intensive and focused CIBT intervention reduced dual-task cost, improved balance, and reduced the number of falls in a sample of individuals with CA. We hypothesize that (1) CIBT will improve balance and reduce falls; and (2) CIBT will be a cost-effective treatment option for improving balance and reduce falls. To test these hypotheses, we propose conducting a randomized controlled trial (RCT) with economic evaluation . This paper reports the findings of our study testing the feasibility of the CIBT program, rationale for testing our hypothesis and an overview of our future study design to test the effectiveness and cost-effectiveness of the CIBT program.
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Affiliation(s)
- Stanley Winser
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong.
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Jessica S Rauszen
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Anne Y Y Chan
- Division of Neurology, Prince of Wales Hospital and Honorary Clinical Assistant Professor Dept. of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | - Cynthia Huijun Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Susan L Whitney
- School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
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Chew EGY, Liany H, Tan LCS, Au WL, Prakash KM, Annuar AA, Chan AYY, Lim SY, Mok V, Chung SJ, Song K, Liu J, Foo JN, Tan EK. Evaluation of novel Parkinson's disease candidate genes in the Chinese population. Neurobiol Aging 2018; 74:235.e1-235.e4. [PMID: 30337193 DOI: 10.1016/j.neurobiolaging.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 11/30/2022]
Abstract
Recent whole-exome sequencing studies in European patients with Parkinson's disease (PD) have identified potential risk variants across 33 novel PD candidate genes. We aim to determine if these reported candidate genes are similarly implicated in Asians by assessing common, rare, and novel nonsynonymous coding variants by sequencing all 33 genes in 198 Chinese samples and genotyping coding variants in an independent set of 9756 Chinese samples. We carried out further targeted sequencing of CD36 in an additional 576 Chinese and Korean samples. We found that only 8 of 43 reported risk variants were polymorphic in our Chinese samples. We identified several heterozygotes for rare loss-of-function mutations, including the reported CD36 p.Gln74Ter variant, in both cases and controls. We also observed 2 potential compound heterozygotes among PD cases for rare loss-of-function mutations in CD36 and SSPO. The other reported variants were common in East Asians and not associated with PD, completely absent, or only found in controls. Therefore, the 33 reported candidate genes and associated variants are unlikely to confer significant PD risk in the East Asian population.
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Affiliation(s)
| | - Herty Liany
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kumar-M Prakash
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Azlina Ahmad Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Y Y Chan
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong SAR, China
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vincent Mok
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong SAR, China
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyuyoung Song
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Jia Nee Foo
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore.
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8
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Wong A, Black SE, Yiu SYP, Au LWC, Lau AYL, Soo YOY, Chan AYY, Leung TWH, Wong LKS, Kwok TCY, Cheung TCK, Leung KT, Lam BYK, Kwan JSK, Mok VCT. Converting MMSE to MoCA and MoCA 5-minute protocol in an educationally heterogeneous sample with stroke or transient ischemic attack. Int J Geriatr Psychiatry 2018; 33:729-734. [PMID: 29292529 DOI: 10.1002/gps.4846] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/21/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is psychometrically superior over the Mini-mental State Examination (MMSE) for cognitive screening in stroke or transient ischemic attack (TIA). It is free for clinical and research use. The objective of this study is to convert scores from the MMSE to MoCA and MoCA-5-minute protocol (MoCA-5 min) and to examine the ability of the converted scores in detecting cognitive impairment after stroke or TIA. METHODS A total of 904 patients were randomly divided into training (n = 623) and validation (n = 281) samples matched for demography and cognition. MMSE scores were converted to MoCA and MoCA-5 min using (1) equipercentile method with log-linear smoothing and (2) Poisson regression adjusting for age and education. Receiver operating characteristics curve analysis was used to examine the ability of the converted scores in differentiating patients with cognitive impairment. RESULTS The mean education was 5.8 (SD = 4.6; ranged 0-20) years. The entire spectrum of MMSE scores was converted to MoCA and MoCA-5 min using equipercentile method. Relationship between MMSE and MoCA scores was confounded by age and education, and a conversion equation with adjustment for age and education was derived. In the validation sample, the converted scores differentiated cognitively impaired patients with area under receiver operating characteristics curve 0.826 to 0.859. CONCLUSION We provided 2 methods to convert scores from the MMSE to MoCA and MoCA-5 min based on a large sample of patients with stroke or TIA having a wide range of education and cognitive levels. The converted scores differentiated patients with cognitive impairment after stroke or TIA with high accuracy.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong
| | | | - Stanley Y P Yiu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Lisa W C Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong.,Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Alexander Y L Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Thomas W H Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong
| | - Theodore C K Cheung
- Department of Clinical Psychology, Haven of Hope Hospital, Hong Kong.,Department of Psychology, University of Toronto at Scarborough, Canada
| | - Kam-Tat Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Bonnie Y K Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Joseph S K Kwan
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong.,Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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9
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Wong A, Lau AYL, Yang J, Wang Z, Liu W, Lam BYK, Au L, Shi L, Wang D, Chu WCW, Xiong YY, Lo ESK, Law LSN, Leung TWH, Lam LCW, Chan AYY, Soo YOY, Leung EYL, Wong LKS, Mok VCT. Neuropsychiatric Symptom Clusters in Stroke and Transient Ischemic Attack by Cognitive Status and Stroke Subtype: Frequency and Relationships with Vascular Lesions, Brain Atrophy and Amyloid. PLoS One 2016; 11:e0162846. [PMID: 27632159 PMCID: PMC5025073 DOI: 10.1371/journal.pone.0162846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/29/2016] [Indexed: 02/01/2023] Open
Abstract
Background The objectives of this study are 1) to examine the frequencies of neuropsychiatric symptom clusters in patients with stroke or transient ischemic attack (TIA) by cognitive level and stroke subtype; and 2) to evaluate effect of demographic, clinical, and neuroimaging measures of chronic brain changes and amyloid upon neuropsychiatric symptom clusters. Methods Hospital-based, cross-sectional study. 518 patients were administered the Neuropsychiatric Inventory (NPI) 3–6 months post index admission. NPI symptoms were classified into four symptom clusters (Behavioral Problems, Psychosis, Mood Disturbance & Euphoria) derived from a confirmatory factor analysis of the 12 NPI items. Multivariable logistic regression was used to determine independent associations between demographic, clinical and neuroimaging measures of chronic brain changes (white matter changes, old infarcts, whole brain atrophy, medial temporal lobe atrophy [MTLA] and frontal lobe atrophy [FLA]) with the presence of NPI symptoms and all symptom clusters except euphoria. 11C-Pittsburg Compound B Positron Emission Tomography (11C-PiB PET) was performed in 24 patients to measure amyloid retention for Alzheimer’s Disease (AD) pathology. Results 50.6% of the whole sample, including 28.7% cognitively normal and 66.7% of patients with mild cognitive symptoms, had ≥1 NPI symptoms. Frequencies of symptom clusters were largely similar between stroke subtypes. Compared to patients with cardioembolic stroke and intracranial haemorrhage, those with TIA had less frequent mood disturbance. Stroke severity at admission and MTLA were the most robust correlates of symptoms. FLA was associated with behavioral problems cluster only. Frequency of symptom clusters did not differ between patients with and without significant amyloid retention. Conclusion Frequency of neuropsychiatric symptoms increased with level of cognitive impairment but was largely similar between stroke subtypes. Stroke severity and MTLA were associated with neuropsychiatric symptoms. AD pathology appeared to be unrelated to neuropsychiatric manifestations but further studies with larger sample size are required to substantiate this finding.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Y. L. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Yang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, 510260, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bonnie Y. K. Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun-yun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Eugene S. K. Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lorraine S. N. Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W. H. Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Linda C. W. Lam
- Department of Psychiatry, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Anne Y. Y. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie O. Y. Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Eric Y. L. Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Lawrence K. S. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C. T. Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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10
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Wong A, Lau AYL, Lo E, Tang M, Wang Z, Liu W, Tanner N, Chau N, Law L, Shi L, Chu WCW, Yang J, Xiong YY, Lam BYK, Au L, Chan AYY, Soo Y, Leung TWH, Wong LKS, Lam LCW, Mok VCT. Relations between Recent Past Leisure Activities with Risks of Dementia and Cognitive Functions after Stroke. PLoS One 2016; 11:e0159952. [PMID: 27454124 PMCID: PMC4959678 DOI: 10.1371/journal.pone.0159952] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/11/2016] [Indexed: 11/22/2022] Open
Abstract
Background Leisure activity participation has been shown to lower risks of cognitive decline in non-stroke populations. However, effects of leisure activities participation upon cognitive functions and risk of dementia after stroke are unclear. The purpose of this study is to examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke. Methods Hospital-based, retrospective cohort study. 88 of 1,013 patients with stroke or TIA having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3–6 months after stroke. Regular participation (≥3 times per week) in intellectual, recreational, social and physical activities over the year before the index stroke was retrospectively recorded at 3–6 months after stroke. Results Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20–0.63) and stretching & toning physical exercise (0.37, 0.21–0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r = 0.41, p<0.01) and in intellectual (r = 0.40, p<0.01), recreational (r = 0.24, p<0.01), strenuous aerobic (r = 0.23, p<0.01) and mind-body (r = 0.10, p<0.01) activities was associated with higher poststroke Mini-mental State Examination scores in models adjusted for prestroke cognitive decline. Conclusions Regular participation in intellectual activities and stretching & toning exercise was associated with a significantly reduced short-term risk of PSD in patients with and without recurrent strokes. Participation in greater number of recent past leisure activities was associated with better poststroke cognitive performance. Findings of this retrospective cohort study call for studies of activity intervention for prevention of cognitive decline in individuals at elevated risk of stroke.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Y. L. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Eugene Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael Tang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Nicole Tanner
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Natalie Chau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lorraine Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Yang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, China
| | - Yun-yun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Bonnie Y. K. Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Anne Y. Y. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W. H. Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lawrence K. S. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Linda C. W. Lam
- Department of Psychiatry, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C. T. Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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11
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Mok VCT, Lam BYK, Wang Z, Liu W, Au L, Leung EYL, Chen S, Yang J, Chu WCW, Lau AYL, Chan AYY, Shi L, Fan F, Ma SH, Ip V, Soo YOY, Leung TWH, Kwok TCY, Ho CL, Wong LKS, Wong A. Delayed-onset dementia after stroke or transient ischemic attack. Alzheimers Dement 2016; 12:1167-1176. [PMID: 27327542 DOI: 10.1016/j.jalz.2016.05.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/11/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Patients surviving stroke without immediate dementia are at high risk of delayed-onset dementia. Mechanisms underlying delayed-onset dementia are complex and may involve vascular and/or neurodegenerative diseases. METHODS Dementia-free patients with stroke and/or transient ischemic attack (TIA; n = 919) were studied for 3 years prospectively, excluding those who developed dementia 3 to 6 months after stroke and/or TIA. RESULTS Forty subjects (4.4%) developed dementia during the study period. Imaging markers of severe small vessel disease (SVD), namely presence of ≥3 lacunes and confluent white matter changes; history of hypertension and diabetes mellitus independently predicted delayed-onset dementia after adjustment for age, gender, and education. Only 6 of 31 (19.4%) subjects with delayed cognitive decline harbored Alzheimer's disease-like Pittsburg compound B (PiB) retention. Most PiB cases (16/25, 64%) had evidence of severe SVD. DISCUSSION Severe SVD contributes importantly to delayed-onset dementia after stroke and/or TIA. Future clinical trials aiming to prevent delayed-onset dementia after stroke and/or TIA should target this high-risk group.
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Affiliation(s)
- Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Bonnie Y K Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eric Y L Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Sirong Chen
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Jie Yang
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexander Y L Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Florence Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sze H Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas W H Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi L Ho
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China.
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12
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Wong A, Wang D, Black SE, Nyenhuis DL, Shi L, Chu WCW, Xiong YY, Au L, Lau A, Chan AYY, Wong LKS, Mok V. Volumetric magnetic resonance imaging correlates of the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment neuropsychology protocols. J Clin Exp Neuropsychol 2016; 37:1004-12. [PMID: 26332179 DOI: 10.1080/13803395.2015.1038983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/17/2022]
Abstract
BACKGROUND Vascular cognitive impairment (VCI) refers to the entire spectrum of cognitive dysfunction attributable to vascular changes in the brain. The objective of this study is to evaluate magnetic resonance imaging (MRI) correlates of performance on the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) VCI neuropsychology protocols. METHOD Fifty ischemic stroke patients and 50 normal elderly persons completed the VCI protocols and MRI. Relationships between the four cognitive domains (executive/activation, language, visuospatial, and memory) and three protocol (60-, 30-, and 5-min) summary scores with MRI measures of volumes of white matter hyperintensities (WMH) and global brain and hippocampal atrophy were assessed using linear regression. RESULTS All cognitive domain scores were associated with WMH volume and, with the exception of language domain, with global atrophy. Additional relationships were found between executive/activation and language domains with left hippocampal volume, visuospatial domain with right hippocampal volume, and memory domain with bilateral hippocampal volumes. All protocol summary scores showed comparable relationships with WMH and hippocampal volumes, with additional relationships found between the 60- and 30-min protocols with global brain volume. CONCLUSIONS Performance on the NINDS-CSN VCI protocols reflects underlying volumetric brain changes implicated in cognitive dysfunctions in VCI.
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Affiliation(s)
- Adrian Wong
- a Department of Medicine and Therapeutics , Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong , Shatin , Hong Kong SAR , China
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13
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Yu RL, Wu RM, Chan AYY, Mok V, Wu YR, Tilley BC, Luo S, Wang L, LaPelle NR, Stebbins GT, Goetz CG. Cross-Cultural Differences of the Non-Motor Symptoms Studied by the Traditional Chinese Version of the International Parkinson and Movement Disorder Society- Unified Parkinson's Disease Rating Scale. Mov Disord Clin Pract 2016; 4:68-77. [PMID: 28345011 DOI: 10.1002/mdc3.12349] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 12/29/2022] Open
Abstract
BACKGROUND Given the importance of ethnic differences in the evaluation of various aspects of symptoms in patients with Parkinson's disease (PD), we present the formal procedure for completing the traditional Chinese translation of the International and Parkinson and Movement Disorder Society/UPDRS (MDS-UPDRS) and highlight the discrepancy in nonmotor symptoms (NMS) between patients in Eastern and Western countries. METHODS A total of 350 native Chinese-speaking PD patients were recruited from multiple hospitals in Eastern countries; they completed the MDS-UPDRS. The translation process was executed and factor analysis was performed to determine the structure of the scale. Chi-squared and t tests were used to compare frequency and severity of PD symptoms between the Chinese-speaking and English-speaking groups (n = 876). RESULTS NMS and motor symptoms were more severe in the Western population (Part I: t(1205) = 5.36, P < 0.0001; and Part III: t(1205) = 7.64, P < 0.0001); however, the prevalence of cognitive dysfunction and impairments in activities of daily living were more frequent in the Eastern patients. The comparative fit index was 0.93 or greater, and the exploratory factor analysis revealed compatible results between the translated scale and the original version. CONCLUSION The traditional Chinese version of the MDS-UPDRS can be designated as an official translation of the original scale, and it is now available for use. Moreover, NMS in PD constitute a major issue worldwide, and the pattern of NMS among the Chinese population is more marked in terms of cognition-based symptoms and activities of daily living.
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Affiliation(s)
- Rwei-Ling Yu
- National Cheng Kung University, Institute of Behavioral Medicine, College of Medicine, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, The Chinese University of Hong Kong, Shatin, China
| | - Vincent Mok
- Department of Medicine and Therapeutics, Hong Kong Special Administrative Region, The Chinese University of Hong Kong, Shatin, China
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital-Linkou branch, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Barbara C Tilley
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sheng Luo
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lu Wang
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nancy R LaPelle
- Division of Preventive and Behavioral Medicine, University of Massachusetts, Worcester, Massachusetts, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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14
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Wong A, Nyenhuis D, Black SE, Law LSN, Lo ESK, Kwan PWL, Au L, Chan AYY, Wong LKS, Nasreddine Z, Mok V. Montreal Cognitive Assessment 5-minute protocol is a brief, valid, reliable, and feasible cognitive screen for telephone administration. Stroke 2015; 46:1059-64. [PMID: 25700290 DOI: 10.1161/strokeaha.114.007253] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization working group proposed a brief cognitive protocol for screening of vascular cognitive impairment. We investigated the validity, reliability, and feasibility of the Montreal Cognitive Assessment 5-minute protocol (MoCA 5-minute protocol) administered over the telephone. METHODS Four items examining attention, verbal learning and memory, executive functions/language, and orientation were extracted from the MoCA to form the MoCA 5-minute protocol. One hundred four patients with stroke or transient ischemic attack, including 53 with normal cognition (Clinical Dementia Rating, 0) and 51 with cognitive impairment (Clinical Dementia Rating, 0.5 or 1), were administered the MoCA in clinic and a month later, the MoCA 5-minute protocol over the telephone. RESULTS Administration of the MoCA 5-minute protocol took 5 minutes over the telephone. Total score of the MoCA 5-minute protocol correlated negatively with age (r=-0.36; P<0.001) and positively with years of education (r=0.41; P<0.001) but not with sex (ρ=0.03; P=0.773). Total scores of the MoCA and MoCA 5-minute protocol were highly correlated (r=0.87; P<0.001). The MoCA 5-minute protocol performed equally well as the MoCA in differentiating patients with cognitive impairment from those without (areas under receiver operating characteristics curve for MoCA 5-minute protocol, 0.78; MoCA=0.74; P>0.05 for difference; Cohen d for group difference, 0.80-1.13). It differentiated cognitively impaired patients with executive domain impairment from those without (areas under receiver operating characteristics curve, 0.89; P<0.001; Cohen d=1.7 for group difference). Thirty-day test-retest reliability was excellent (intraclass correlation coefficient, 0.89). CONCLUSIONS The MoCA 5-minute protocol is a free, valid, and reliable cognitive screen for stroke and transient ischemic attack. It is brief and highly feasible for telephone administration.
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Affiliation(s)
- Adrian Wong
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - David Nyenhuis
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Sandra E Black
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Lorraine S N Law
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Eugene S K Lo
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Pauline W L Kwan
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Lisa Au
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Anne Y Y Chan
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Lawrence K S Wong
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Ziad Nasreddine
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Vincent Mok
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
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15
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Leung TW, Wang L, Soo YOY, Ip VHL, Chan AYY, Au LWC, Fan FSY, Lau AYL, Leung H, Abrigo J, Wong A, Mok VCT, Ng PW, Tsoi TH, Li SH, Man CBL, Fong WC, Wong KS, Yu SCH. Evolution of intracranial atherosclerotic disease under modern medical therapy. Ann Neurol 2015; 77:478-86. [PMID: 25557926 DOI: 10.1002/ana.24340] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/26/2014] [Accepted: 12/07/2014] [Indexed: 01/05/2023]
Affiliation(s)
- Thomas W. Leung
- Division of Neurology, Department of Medicine and Therapeutics
| | - Lily Wang
- Division of Neurology, Department of Medicine and Therapeutics
| | | | | | - Anne Y. Y. Chan
- Division of Neurology, Department of Medicine and Therapeutics
| | - Lisa W. C. Au
- Division of Neurology, Department of Medicine and Therapeutics
| | | | - Alex Y. L. Lau
- Division of Neurology, Department of Medicine and Therapeutics
| | - Howan Leung
- Division of Neurology, Department of Medicine and Therapeutics
| | - Jill Abrigo
- Department of Diagnostic and Interventional Radiology; Prince of Wales Hospital, Chinese University of Hong Kong
| | - Adrian Wong
- Division of Neurology, Department of Medicine and Therapeutics
| | | | - Ping Wing Ng
- Department of Medicine and Geriatrics; United Christian Hospital
| | - Tak Hong Tsoi
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital
| | - Siu Hung Li
- Department of Medicine; North District Hospital
| | | | - Wing Chi Fong
- Department of Medicine; Queen Elizabeth Hospital; Hong Kong
| | - Ka Sing Wong
- Division of Neurology, Department of Medicine and Therapeutics
| | - Simon C. H. Yu
- Department of Diagnostic and Interventional Radiology; Prince of Wales Hospital, Chinese University of Hong Kong
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16
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Wong A, Cheng ST, Lo ESK, Kwan PWL, Law LSN, Chan AYY, Wong LKS, Mok V. Validity and reliability of the neuropsychiatric inventory questionnaire version in patients with stroke or transient ischemic attack having cognitive impairment. J Geriatr Psychiatry Neurol 2014; 27:247-52. [PMID: 24763069 DOI: 10.1177/0891988714532017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study examined the validity and reliability of the Neuropsychiatric Inventory Questionnaire version (NPI-Q), a proxy-reported format of the interview-based NPI, in assessing neuropsychiatric symptoms in 173 patients with stroke or transient ischemic attack (TIA) having cognitive impairment. The NPI-Q was validated against the NPI as a gold standard. Informants took approximately 7 minutes to complete the NPI-Q. Bland-Altman analysis revealed a bias of 0.7 points, with 95% limits of agreement between -8.6 and 10.0 between the total symptom scores of the NPI and NPI-Q. The NPI-Q correlated significantly with the NPI in individual and total symptom scores and caregiver distress scores. In predicting presence of symptoms on the NPI, the NPI-Q yielded, on average, sensitivity of 74.1% and specificity of 79.5%. On the NPI-Q, informants tended to overreport symptoms in patients with less severe symptoms but underreport with increasing symptom severity. Internal consistency of the NPI-Q was acceptable (Cronbach's α = 0.756). One-week test-retest reliability of the NPI-Q was excellent (intraclass correlation coefficient = .990). The NPI-Q is a valid and reliable instrument for screening neuropsychiatric symptoms in patients with stroke and TIA.
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Affiliation(s)
- Adrian Wong
- Department of Psychological Studies, The Hong Kong Institute of Education, Tai-po, Hong Kong SAR, China Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Tai-po, Hong Kong SAR, China
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, The Hong Kong Institute of Education, Tai-po, Hong Kong SAR, China
| | - Eugene S K Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Pauline W L Kwan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lorraine S N Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lawrence Ka-Sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vincent Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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17
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Chan AYY, Yeung JHM, Mok VCT, Ip VHL, Wong A, Kuo SH, Chan DTM, Zhu XL, Wong E, Lau CKY, Wong RKM, Tang V, Lau C, Poon WS. Subthalamic nucleus deep brain stimulation for Parkinson's disease: evidence for effectiveness and limitations from 12 years' experience. Hong Kong Med J 2014; 20:474-80. [PMID: 25345997 DOI: 10.12809/hkmj144242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/05/2022] Open
Abstract
OBJECTIVE To present the result and experience of subthalamic nucleus deep brain stimulation for Parkinson's disease. DESIGN Case series. SETTING Prince of Wales Hospital, Hong Kong. PATIENTS A cohort of patients with Parkinson's disease received subthalamic nucleus deep brain stimulation from September 1998 to January 2010. Patient assessment data before and after the operation were collected prospectively. RESULTS Forty-one patients (21 male and 20 female) with Parkinson's disease underwent bilateral subthalamic nucleus deep brain stimulation and were followed up for a median interval of 12 months. For the whole group, the mean improvements of Unified Parkinson's Disease Rating Scale (UPDRS) parts II and III were 32.5% and 31.5%, respectively (P<0.001). Throughout the years, a multidisciplinary team was gradually built. The deep brain stimulation protocol evolved and was substantiated by updated patient selection criteria and outcome assessment, integrated imaging and neurophysiological targeting, refinement of surgical technique as well as the accumulation of experience in deep brain stimulation programming. Most of the structural improvement occurred before mid-2005. Patients receiving the operation before June 2005 (19 cases) and after (22 cases) were compared; the improvements in UPDRS part III were 13.2% and 55.2%, respectively (P<0.001). There were three operative complications (one lead migration, one cerebral haematoma, and one infection) in the group operated on before 2005. There was no operative mortality. CONCLUSIONS The functional state of Parkinson's disease patients with motor disabilities refractory to best medical treatment improved significantly after subthalamic nucleus deep brain stimulation. A dedicated multidisciplinary team building, refined protocol for patient selection and assessment, improvement of targeting methods, meticulous surgical technique, and experience in programming are the key factors contributing to the improved outcome.
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Affiliation(s)
| | - Anne Y Y Chan
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jonas H M Yeung
- Division of Neurology, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Vincent H L Ip
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Adrian Wong
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - S H Kuo
- Neurological Institutes of New York, Columbia University, United States
| | - Danny T M Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - X L Zhu
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edith Wong
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Claire K Y Lau
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Rosanna K M Wong
- Department of Occupational Therapy, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Venus Tang
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong
| | - Christine Lau
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - W S Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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18
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Tsoi H, Yu ACS, Chen ZS, Ng NKN, Chan AYY, Yuen LYP, Abrigo JM, Tsang SY, Tsui SKW, Tong TMF, Lo IFM, Lam STS, Mok VCT, Wong LKS, Ngo JCK, Lau KF, Chan TF, Chan HYE. A novel missense mutation in CCDC88C activates the JNK pathway and causes a dominant form of spinocerebellar ataxia. J Med Genet 2014; 51:590-5. [PMID: 25062847 PMCID: PMC4145425 DOI: 10.1136/jmedgenet-2014-102333] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Spinocerebellar ataxias (SCAs) are a group of clinically and genetically diverse and autosomal-dominant disorders characterised by neurological deficits in the cerebellum. At present, there is no cure for SCAs. Of the different distinct subtypes of autosomal-dominant SCAs identified to date, causative genes for only a fraction of them are currently known. In this study, we investigated the cause of an autosomal-dominant SCA phenotype in a family that exhibits cerebellar ataxia and pontocerebellar atrophy along with a global reduction in brain volume. Methods and results Whole-exome analysis revealed a missense mutation c.G1391A (p.R464H) in the coding region of the coiled-coil domain containing 88C (CCDC88C) gene in all affected individuals. Functional studies showed that the mutant form of CCDC88C activates the c-Jun N-terminal kinase (JNK) pathway, induces caspase 3 cleavage and triggers apoptosis. Conclusions This study expands our understanding of the cause of autosomal-dominant SCAs, a group of heterogeneous congenital neurological conditions in humans, and unveils a link between the JNK stress pathway and cerebellar atrophy.
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Affiliation(s)
- Ho Tsoi
- Faculty of Science, Laboratory of Drosophila Research, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Allen C S Yu
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Zhefan S Chen
- Faculty of Science, Laboratory of Drosophila Research, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nelson K N Ng
- Faculty of Science, Laboratory of Drosophila Research, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anne Y Y Chan
- Faculty of Medicine, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Liz Y P Yuen
- Faculty of Medicine, Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jill M Abrigo
- Faculty of Medicine, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Suk Ying Tsang
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Partner State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Hong Kong
| | - Stephen K W Tsui
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tony M F Tong
- Clinical Genetic Service, Department of Health, The Government of Hong Kong, Hong Kong, Hong Kong
| | - Ivan F M Lo
- Clinical Genetic Service, Department of Health, The Government of Hong Kong, Hong Kong, Hong Kong
| | - Stephen T S Lam
- Clinical Genetic Service, Department of Health, The Government of Hong Kong, Hong Kong, Hong Kong
| | - Vincent C T Mok
- Faculty of Medicine, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Lawrence K S Wong
- Faculty of Medicine, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jacky C K Ngo
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kwok-Fai Lau
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ting-Fung Chan
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Partner State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Hong Kong
| | - H Y Edwin Chan
- Faculty of Science, Laboratory of Drosophila Research, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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19
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Yu SCH, Zou WXY, Soo YOY, Wang L, Hui JWY, Chan AYY, Lee KT, Ip VHL, Fan FSY, Chan ALC, Wong LKS, Leung TW. Evaluation of carotid angioplasty and stenting for radiation-induced carotid stenosis. Stroke 2014; 45:1402-7. [PMID: 24699055 DOI: 10.1161/strokeaha.113.003995] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control. METHODS In this 6-year prospective nonrandomized study, we compared the carotid angioplasty and stenting outcome of 65 consecutive patients (84 vessels) with RIS with that of a control group of 129 consecutive patients (150 vessels) with AS. Study end points were 30-day periprocedural stroke or death, ipsilateral ischemic stroke, technical success, procedural characteristics, instent restenosis (ISR; ≥50%) and symptomatic ISR. RESULTS The median follow-up was 47.3 months (95% confidence interval, 26.9-61.6). Imaging assessment was available in 74 vessels (RIS) and 120 vessels (AS) in 2 years. Comparing RIS group with AS group, the rates of periprocedural stroke or death were 1.5% (1/65) versus 1.6% (2/129; P=1); ipsilateral ischemic stroke rates were 4.6% (3/65) versus 4.7% (6/129; P=1); the annual risks of ipsilateral ischemic stroke were 1.2% (3 patient/254.7 patient year) versus 1.2% (6 patient/494.2 patient year; P=0.89); technical success rates were both 100%. Stenting of common carotid artery and the use of multiple stents was more common in the RIS group (P=0 in both cases); ISR rates were 25.7% (19/74) versus 4.2% (5/120; P<0.001); symptomatic ISR rates were 6.8% (5/74) versus 0.8% (1/120; P=0.031). CONCLUSIONS The safety, effectiveness, and technical difficulty of carotid angioplasty and stenting for RIS are comparable with that for AS although it is associated with a higher rate of ISR. CLINICAL TRIAL REGISTRATION This trial was not registered as enrollment started in 2006.
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Affiliation(s)
- Simon C H Yu
- From the Department of Imaging and Interventional Radiology, Prince of Wales Hospital (S.C.H.Y., J.W.Y.H., K.T.L.), Vascular and Interventional Radiology Foundation Clinical Science Center (S.C.H.Y., J.W.Y.H., K.T.L., T.W.L.), and Department of Medicine and Therapeutics, Prince of Wales Hospital (W.X.Y.Z., Y.O.Y.S., L.W., A.Y.Y.C., V.H.L.I., F.S.Y.F., A.L.C.C., L.K.S.W., T.W.L.), The Chinese University of Hong Kong, Hong Kong, China
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20
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Yang J, Wong A, Wang Z, Liu W, Au L, Xiong Y, Chu WWC, Leung EYL, Chen S, Lau C, Chan AYY, Lau AYL, Fan F, Ip V, Soo Y, Leung T, Ho CL, Wong LKS, Mok VCT. Risk factors for incident dementia after stroke and transient ischemic attack. Alzheimers Dement 2014; 11:16-23. [PMID: 24603162 DOI: 10.1016/j.jalz.2014.01.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/29/2013] [Accepted: 01/09/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND We hypothesized that chronic brain changes are important substrates for incident dementia after stroke and transient ischemic attack (TIA). METHODS We compared clinical and imaging features between patients with consecutive stroke/TIA with (n = 88) and without (n = 925) incident dementia at 3 to 6 months after a stroke/TIA. Pittsburg compound B (PiB) positron emission tomography was performed in 50 patients, including those with (n = 37) and without (n = 13) incident dementia. RESULTS Age, history of diabetes mellitus, severity of white matter changes (WMCs), and medial temporal lobe atrophy (MTLA) were associated with incident dementia. Alzheimer's disease (AD)--like PiB retention was found in 29.7% and 7.7% (P = .032) of patients with and without incident dementia, respectively. CONCLUSIONS Chronic brain changes including WMCs, MTLA, and AD pathology are associated with incident dementia after stroke/TIA. Interventions targeting these chronic brain changes may reduce burden of vascular cognitive impairment.
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Affiliation(s)
- Jie Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Adrian Wong
- Department of Psychological Studies, d Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Tai-po, Hong Kong SAR, China; Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Hong Kong SAR, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yunyun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Winnie W C Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Eric Y L Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Sirong Chen
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Christine Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alexander Y L Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Florence Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vincent Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Thomas Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi L Ho
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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21
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Foo JN, Tan LC, Liany H, Koh TH, Irwan ID, Ng YY, Ahmad-Annuar A, Au WL, Aung T, Chan AYY, Chong SA, Chung SJ, Jung Y, Khor CC, Kim J, Lee J, Lim SY, Mok V, Prakash KM, Song K, Tai ES, Vithana EN, Wong TY, Tan EK, Liu J. Analysis of non-synonymous-coding variants of Parkinson's disease-related pathogenic and susceptibility genes in East Asian populations. Hum Mol Genet 2014; 23:3891-7. [PMID: 24565865 DOI: 10.1093/hmg/ddu086] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
To evaluate the contribution of non-synonymous-coding variants of known familial and genome-wide association studies (GWAS)-linked genes for Parkinson's disease (PD) to PD risk in the East Asian population, we sequenced all the coding exons of 39 PD-related disease genes and evaluated the accumulation of rare non-synonymous-coding variants in 375 early-onset PD cases and 399 controls. We also genotyped 782 non-synonymous-coding variants of these genes in 710 late-onset PD cases and 9046 population controls. Significant enrichment of LRRK2 variants was observed in both early- and late-onset PD (odds ratio = 1.58; 95% confidence interval = 1.29-1.93; P = 8.05 × 10(-6)). Moderate enrichment was also observed in FGF20, MCCC1, GBA and ITGA8. Half of the rare variants anticipated to cause loss of function of these genes were present in healthy controls. Overall, non-synonymous-coding variants of known familial and GWAS-linked genes appear to make a limited contribution to PD risk, suggesting that clinical sequencing of these genes will provide limited information for risk prediction and molecular diagnosis.
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Affiliation(s)
- Jia Nee Foo
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore
| | - Louis C Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Herty Liany
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore
| | - Tat Hung Koh
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore
| | - Ishak D Irwan
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore
| | - Yen Yek Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Wing-Lok Au
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anne Y Y Chan
- Neurology Division, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | | | - Sun Ju Chung
- Department of Neurology, Asan Medical Center and
| | - Yusun Jung
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Korea
| | - Chiea Chuen Khor
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore Singapore Eye Research Institute, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Juyeon Kim
- Department of Neurology, Asan Medical Center and
| | - Jimmy Lee
- Institute of Mental Health, Singapore Duke-National University of Singapore Graduate Medical School, Singapore
| | - Shen-Yang Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vincent Mok
- Neurology Division, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kumar-M Prakash
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kyuyoung Song
- Department of Biochemistry and Molecular Biology, University of Ulsan College of Medicine, Seoul, Korea
| | - E-Shyong Tai
- Duke-National University of Singapore Graduate Medical School, Singapore Department of Medicine, Yong Loo Lin School of Medicine and Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Eranga N Vithana
- Singapore Eye Research Institute, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Duke-National University of Singapore Graduate Medical School, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore Duke-National University of Singapore Graduate Medical School, Singapore
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
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Chan AYY, Baum L, Tang NLS, Lau CYK, Ng PW, Hui KF, Mizuno Y, Kwan JY, Mok VCT, Kuo SH. The role of the Ala746Thr variant in the ATP13A2 gene among Chinese patients with Parkinson's disease. J Clin Neurosci 2013; 20:761-2. [PMID: 23522931 DOI: 10.1016/j.jocn.2012.05.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/15/2012] [Accepted: 05/16/2012] [Indexed: 11/16/2022]
Abstract
The association between idiopathic Parkinson's disease (PD) and the ATP13A2 (PARK9) Ala746Thr variant, associated with Kufor-Rakeb syndrome, is controversial. We investigated this association in 69 patients with early onset PD (EOPD; ≦50 years of age), 192 patients with late onset PD (LOPD; >50 years of age), and 180 healthy controls in the Chinese population in Hong Kong. The presence of the Ala746Thr variant in the ATP13A2 locus was examined in all participants. We detected the heterozygous Ala746Thr variant in one healthy control (0.6%), one patient with EOPD (1.4%, p=0.50), and one patient with LOPD (0.5%, p=0.96). We suggest that the ATP13A2 Ala746Thr variant is not a common risk factor for PD in the Chinese population in Hong Kong.
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Affiliation(s)
- Anne Y Y Chan
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
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23
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Zou WXY, Leung TW, Yu SCH, Wong EHC, Leung SF, Soo YOY, Ip VHL, Chan AYY, Lam WWM, Siu DYW, Abrigo J, Lee KT, Liebeskind DS, Wong KS. Angiographic features, collaterals, and infarct topography of symptomatic occlusive radiation vasculopathy: a case-referent study. Stroke 2013; 44:401-6. [PMID: 23306321 DOI: 10.1161/strokeaha.112.674036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Occlusive radiation vasculopathy (ORV) predisposes head-and-neck cancer survivors to ischemic strokes. METHODS We analyzed the digital subtraction angiography acquired in 96 patients who had first-ever transient ischemic attack or ischemic strokes attributed to ORV. Another age-matched 115 patients who had no radiotherapy but symptomatic high-grade (>70%) carotid stenoses were enrolled as referent subjects. Digital subtraction angiography was performed within 2 months from stroke onset and delineated carotid and vertebrobasilar circulations from aortic arch up to intracranial branches. Two reviewers blinded to group assignment recorded all vascular lesions, collateral status, and infarct pattern. RESULTS ORV patients had less atherosclerotic risk factors at presentation. In referent patients, high-grade stenoses were mostly focal at the proximal internal carotid artery. In contrast, high-grade ORV lesions diffusely involved the common carotid artery and internal carotid artery and were more frequently bilateral (54% versus 22%), tandem (23% versus 10%), associated with complete occlusion in one or both carotid arteries (30% versus 9%), vertebral artery (VA) steno-occlusions (28% versus 16%), and external carotid artery stenosis (19% versus 5%) (all P<0.05). With comparable rates of vascular anomaly, ORV patients showed more established collateral circulations through leptomeningeal arteries, anterior communicating artery, posterior communicating artery, suboccipital/costocervical artery, and retrograde flow in ophthalmic artery. In terms of infarct topography, the frequencies of cortical or subcortical watershed infarcts were similar in both groups. CONCLUSIONS ORV angiographic features and corresponding collaterals are distinct from atherosclerotic patterns at initial stroke presentation. Clinical decompensation, despite more extensive collateralization, may precipitate stroke in ORV.
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Affiliation(s)
- Winnie X Y Zou
- Department of Medicine and Therapeutics, Division of Neurology, Prince of Wales Hospital, Shatin, Hong Kong
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Xiong L, Leung HHW, Chen XY, Han JH, Leung TWH, Soo YOY, Chan AYY, Lau AYL, Wong LKS. Comprehensive assessment for autonomic dysfunction in different phases after ischemic stroke. Int J Stroke 2012; 8:645-51. [PMID: 22759410 DOI: 10.1111/j.1747-4949.2012.00829.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Studies mostly use the analysis of heart rate variability to measure cardiovascular autonomic regulation in ischemic stroke. Besides power spectral analysis of heart rate variability, this study sought to determine whether autonomic function was impaired during different phases in ischemic stroke by Ewing's battery of autonomic function tests. METHODS Ninety-four patients with ischemic stroke (34 patients in acute phase and 60 patients in chronic phase, average six-months after stroke onset) and thirty-seven elderly controls were recruited. Ewing's battery autonomic function tests and power spectral analysis of heart rate variability were performed in all the subjects. RESULTS From power spectral analysis of heart rate variability, stroke patients of both acute and chronic phases had significantly lower low frequency power spectral density than controls. From Ewing's battery of autonomic function tests, patients in acute phase showed impairment in two parasympathetic tests (Valsalva ratio: P = 0·002; heart rate response to deep breathing: P < 0·001) and those in chronic phase showed impairment in all parasympathetic tests (all P < 0·05) in comparison with controls. CONCLUSIONS The comprehensive assessment indicates that autonomic dysfunction occurs in acute phase of ischemic stroke and may persist up to six-months after stroke. Parasympathetic dysfunction rather than sympathetic dysfunction is predominant after ischemic stroke.
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Affiliation(s)
- Li Xiong
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China
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25
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Xiong YY, Wong A, Mok VCT, Tang WK, Lam WWM, Kwok TCY, Chu WCW, Chan AYY, Wong LKS. Frequency and predictors of proxy-confirmed post-stroke cognitive complaints in lacunar stroke patients without major depression. Int J Geriatr Psychiatry 2011; 26:1144-51. [PMID: 21184437 DOI: 10.1002/gps.2652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 09/20/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many lacunar stroke patients complained of cognitive decline after stroke. This study aims to investigate the factors underlying post-stroke cognitive complaints in these patients. METHODS Seventy-five consecutive lacunar stroke patients without major depression were recruited for the study. Stroke severity was measured using NIHSS score and MRI was performed during the acute admission period. At 3 months, objective psychometric performance and depressive symptoms were assessed. Post-stroke cognitive complaints were corroborated by a proxy. Using logistic regression we examined the contribution of demographic features, stroke severity, objective psychometric scores, depressive symptoms, and imaging features (white matter lesion volume and infarct measures) to post-stroke cognitive complaints. RESULTS Thirty-two (42.7%) patients had post-stroke cognitive complaints. Patients with post-stroke cognitive complaints had more depressive symptoms and worse psychometric performance than those without. In the multivariate logistic regression model, only the severity of depressive symptoms was independently associated with post-stroke cognitive complaints. CONCLUSIONS This study suggests that post-stroke cognitive complaints are frequent among lacunar stroke patients without major depression and are prominently determined by the subclinical depressive symptomatology.
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Affiliation(s)
- Yun-Yun Xiong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong, China
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Lau AYL, Chan AYY, Mok VCT. Refractory bulbar and respiratory dysfunction in a young Chinese woman with seronegative, muscle-specific tyrosine kinase antibody-positive myasthenia gravis: response to cyclophosphamide and rituximab treatment. Hong Kong Med J 2011; 17:77-79. [PMID: 21282832] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The use of cyclophosphamide and rituximab for patients with refractory myasthenia gravis has shown promising results. We report on a 31-year-old Chinese woman with acetylcholine receptor antibody-negative and muscle-specific tyrosine kinase antibody-positive generalised myasthenia gravis who had refractory bulbar dysfunction and respiratory failure despite immunosuppressive therapy and thymectomy, and partial and sustained responses to cyclophosphamide and rituximab treatment, respectively. Myasthenia crisis was diagnosed when she presented in the third trimester of pregnancy with dysphagia, bilateral ptosis, prominent fatigability, and respiratory failure. She required prolonged intensive care and non-invasive ventilatory support despite several courses of intravenous immunoglobulins and plasmapheresis. Pulse cyclophosphamide 500 mg/m(2) was given monthly for 4 consecutive months with a partial response. Rituximab 500 mg weekly was subsequently given for 4 weeks with a dramatic and sustained response. She remained symptom-free and assumed full maternal care at 1 year. To the authors' knowledge, this is the first report of a Chinese patient with refractory myasthenia gravis who responded to cyclophosphamide and rituximab.
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Affiliation(s)
- A Y L Lau
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
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Mok VCT, Wong A, Wong K, Chu WCW, Xiong Y, Chan AYY, Kwok TCY, Hu X, Lee WK, Tang WK, Wong KSL, Wong S. Executive dysfunction and left frontal white matter hyperintensities are correlated with neuropsychiatric symptoms in stroke patients with confluent white matter hyperintensities. Dement Geriatr Cogn Disord 2011; 30:254-60. [PMID: 20847556 DOI: 10.1159/000318744] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to determine the clinical and neuroimaging correlates of the presence of neuropsychiatric symptoms in stroke patients with age-related confluent white matter hyperintensities (WMH). METHODS The Neuropsychiatric Inventory was utilized to detect the presence of 12 symptoms. Multivariate logistic regression models were used to identify clinical and neuroimaging correlates of the presence of symptoms. RESULTS Seventy-seven stroke patients (mean WMH volume: 39.5 cm(3)) were recruited. Thirty patients (39%) had ≥ 1 neuropsychiatric symptom. Poor executive function was associated with the presence of any symptoms and symptoms other than depression. More severe left frontal WMH was associated with depression. CONCLUSION Executive dysfunction and left frontal WMH are correlated with neuropsychiatric symptoms in these patients.
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Affiliation(s)
- Vincent C T Mok
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, China.
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Lau AYL, Soo YOY, Graham CA, Woo WK, Wong EHC, Leung H, Chan AYY, Au LWC, Ip VHL, Leung CSF, Hui V, Shum WC, Abrigo J, Siu DYW, Yu SCH, Wong LKS, Leung TW. An expedited stroke triage pathway: the key to shortening the door-to-needle time in delivery of thrombolysis. Hong Kong Med J 2010; 16:455-462. [PMID: 21135422] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVES To assess time management of stroke thrombolysis triage and functional outcomes in patients receiving recombinant tissue plasminogen activator for hyperacute stroke, and identify bottlenecks in delivery of the treatment. DESIGN Prospective study. SETTING A university teaching hospital in Hong Kong. PATIENTS Patients with suspected hyperacute stroke referred to the stroke thrombolysis team during October 2008 to September 2009. MAIN OUTCOME MEASURES Time performance records including door-to-stroke team, door-to-needle, and onset-to-thrombolysis times. Functional outcomes by modified Rankin Scale score at 3 months, and thrombolysis-related complications including haemorrhagic transformations and mortality. RESULTS During the 12-month period, 95 thrombolysis calls were received; recombinant tissue plasminogen activator was given intravenously to 17 (18%) of the patients and intra-arterially to 11 (12%). The mean (standard deviation) door-to-stroke team and the door-to-needle times for intravenous recombinant tissue plasminogen activator patients were 33 (25) and 80 (25) minutes, respectively; both were about 20 minutes longer than that recommended by the National Institute of Neurological Disorders and Stroke. The mean National Institute of Health Stroke Scale score for patients received intravenous recombinant tissue plasminogen activator was 16 (standard deviation, 7). The mean (standard deviation) onset-to-treatment time was 144 (42) minutes. Nine (53%) patients who received intravenous recombinant tissue plasminogen activator achieved favourable outcomes at 3 months, with a modified Rankin Scale score of 0 to 1. Symptomatic haemorrhage and mortality occurred in one (6%) patient. CONCLUSION A dedicated stroke triage pathway is essential to ensure efficient and safe delivery of thrombolysis therapy. Improvements in door-to-stroke team time through integration with emergency medicine staff and neuroradiologists may improve thrombolysis eligibility.
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Affiliation(s)
- A Y L Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
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So CC, So ACY, Chan AYY, Tsang STY, Ma ESK, Chan LC. Detection and characterisation of -globin gene cluster deletions in Chinese using multiplex ligation-dependent probe amplification. J Clin Pathol 2009; 62:1107-11. [DOI: 10.1136/jcp.2009.067538] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wong A, Xiong YY, Kwan PWL, Chan AYY, Lam WWM, Wang K, Chu WCW, Nyenhuis DL, Nasreddine Z, Wong LKS, Mok VCT. The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dement Geriatr Cogn Disord 2009; 28:81-7. [PMID: 19672065 DOI: 10.1159/000232589] [Citation(s) in RCA: 203] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the psychometric properties of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease (SVD). METHODS 40 SVD patients and 40 matched controls were recruited. Concurrent and criterion validity, inter-rater and test-retest reliability, internal consistency of the HK-MoCA were examined and clinical observations were made. RESULTS Performance on the HK-MoCA was significantly predicted by both executive (beta = 0.23, p = 0.013) and non-executive (beta = 0.64, p < 0.001) composite scores. It differentiated SVD patients from controls (area under the curve = 0.81, p < 0.001) with an optimal cutoff at 21/22. Reliability, internal consistency and clinical utility were good. CONCLUSION The HK-MoCA is a useful cognitive screening instrument for use in SVD patients.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Abstract
Seven patients of Chinese origin who had haemoglobin (Hb) Q-H disease were studied. They were found to have a similar clinical phenotype to that of patients with deletional Hb H disease, who have a near identical genotypic configuration. The complete absence of Hb A in Hb Q-H disease and the similar clinical phenotype to deletional Hb H disease lends support to the observation that Hb Q-Thailand shares similar functional properties with Hb A.
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