Parkinsonian signs are associated with subtle functional deterioration in community-dwelling Chinese older persons

Objective: To report the prevalence of mild parkinsonian signs and their association with functional impairment in a population-based study of clinically non-demented Chinese persons. Participants and Methods: A random sample of 765 Chinese older persons from a thematic household survey was recruited. There were 389 normal elderly controls (Clinical Dementia Rating = 0), 291 with mild cognitive impairment, and 85 with very mild dementia. The prevalence of mild parkinsonian signs and its association with everyday functional performance were investigated. Results: Mild parkinsonian signs were defined as a score of 2 or more in the Unified Parkinson's Disease Rating Scale-motor section. The prevalence of mild parkinsonian signs was 16.5%, 33.0% and 49.4% in the normal controls, those with mild cognitive impairment and very mild dementia, respectively. In each group, subjects with mild parkinsonian signs had lower functional scores than those without such signs, even after adjusting for the effect of age, sex, and education. Abnormality in axial function, bradykinesia, and rigidity were associated with lower scores for Instrumental Activities of Daily Living, and rigidity was associated with lower Basic Activities of Daily Living scores. Conclusion: The prevalence of mild parkinsonian signs increased with the severity of cognitive impairment in clinically non-demented older persons. Such signs were associated with functional impairment in older persons with mild cognitive impairment and very mild dementia. © 2008 Hong Kong College of Psychiatrists.link_to_subscribed_fulltex

Clinical correlates of functional performance in community-dwelling Chinese older persons with mild cognitive impairment

Background: Increasing evidence suggests that functional impairment can be detected in older persons with mild cognitive impairment (MCI). This study explores the functional profiles and the clinical correlates of a population-based sample of Chinese older persons with MCI in Hong Kong. Methods: A random sample of 765 Chinese elderly subjects without dementia was recruited, of which 389 were elderly normal controls (Clinical Dementia Rating = 0), and 376 had questionable dementia (CDR = 0.5). The latter were categorized into an MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Their functional performances were measured and compared with the normal controls (NC). Multiple regression analyses investigated the associations between functional scores (Disability Assessment in Dementia) and clinical correlates (cognitive test scores, neuropsychiatric symptoms and motor signs) in the NC subjects and cognitively impaired subjects. Results: Subjects with MCI had intermediate functional performance between the NC and those with VMD. Regression analyses revealed that lower scores of cognitive tests (delayed recall and categorical verbal fluency tests), apathy, aberrant motor symptoms and parkinsonism features were associated with lower functional scores in clinically non-demented subjects. Functional scores had no correlation with age, education and medical illness burden. Conclusion: Neuropsychiatric symptoms and parkinsonism features were associated with functional impairment in the clinically non-demented elderly in the community. Assessment of these should be incorporated in the evaluation of older persons for early cognitive impairment. © 2008 International Psychogeriatric Association.link_to_subscribed_fulltex

Clinical correlates of Parkinsonian signs in community-dwelling Chinese older persons: A population based study

Background and objective: This study examined the clinical correlates of parkinsonian signs including neuropsychiatric symptoms, cognitive impairment and medical illness burden in the community-dwelling non-demented Chinese elderly. Methods: A random sample of 765 Chinese elderly subjects from a thematic household survey was recruited. There were 389 normal elderly controls (Clinical Dementia Rating [CDR] 0) (NC) and 376 subjects with questionable dementia (CDR 0.5). The subjects with questionable dementia (CDR 0.5) were categorized into two groups: a MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Parkinsonian signs were measured by Unified Parkinson Disease Rating Scale-motor scale (UPDRS). The clinical correlates were investigated in each group. Results: UPDRS motor score was associated with age, cumulative medical illness burden and cerebrovascular accidents in the normal control and MCI groups. It correlated negatively with MMSE scores in the NC group. It was associated with presence of soft signs in the NC and MCI groups; and apathy in the VMD group. Conclusion: Neuropsychiatric symptoms, cognitive impairment and vascular risk factors had different patterns of associations with parkinsonian signs in the older persons with different degree of cognitive impairment. Copyright © 2008 John Wiley & Sons, Ltd.link_to_subscribed_fulltex

Sonographic appearance of thyroid glands in patients treated with intensity-modulated radiotherapy or conventional radiotherapy for nasopharyngeal carcinoma

Background: This study aimed to investigate the sonographic appearances of the thyroid glands in nasopharyngeal carcinoma (NPC) patients whose cervical lymph nodes were treated with conventional radiotherapy (RT) or intensity-modulated radiotherapy (IMRT). The post-RT sonographic appearances of the thyroid glands in NPC patients were also correlated with the thyroid function. Methods: One hundred and three NPC patients who had completed RT of cervical lymph nodes using the anterior cervical field, 30 NPC patients who had completed RT of cervical lymph nodes using IMRT, and 61 healthy subjects were included in the study. Thyroid glands were sonographically assessed for their size, echogenicity, vascularity, and internal architecture. Thyroid function tests were also performed on each subject. Results: In comparison with the patients with abnormal thyroid function, the thyroid glands of the patients with normal thyroid function tended to be homogeneous and to have greater volume and echogenicity index (p<0.05). Compared with those of the healthy subjects, the thyroid glands of patients previously treated with IMRT and those treated with the anterior cervical field showed significantly lower thyroid volume, lower incidence and number of nodules, and higher vascularity index (p<0.05). Conclusions: The patient's history of previous RT should be taken into consideration in the sonographic examination of the thyroid gland post-RT.Department of Health Technology and Informatic

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

Objectives: To estimate the point prevalence and correlates of neuropsychiatric (NP) symptoms among older adults with mild cognitive impairment (MCI) and normal cognition (NC) in a Chinese community. Design: Cross-sectional study derived from a population-based prevalence study of MCI and dementia. Setting and Participants: This survey was conducted in Hong Kong from 2005 to 2006. Seven hundred eighty-eight community-dwelling older adults (450 NC and 338 MCI) were recruited. Cognitive and NP data were obtained. Results: The point prevalence of at least one NP symptom in NC and MCI were 29% and 36.7%, respectively (logistic regression controlled for age and education, odds ratio = 1.38, 95% confidence interval [CI]: 1.01-1.89, Wald χ = 4.10, df = 1, p = 0.04). Agitation (1.8% versus 5.1%), apathy (7.6% versus 15.2%), and irritability (4.2% versus 8%) were more prevalent in subjects with MCI (p <0.05). Logistic regression analyses showed that apathy score was a significant factor associated with the status of NC or MCI (logistic regression, apathy, p = 0.031, Exp(B) = 1.23, 95% CI: 1.02-1.47; Hosmer and Lemeshow test, χ = 8.6, df = 8, p = 0.38, R = 0.23). Conclusions: The authors reported the findings of one of the first population-based studies estimating the point prevalence of NP symptoms in Asian older adults with MCI. Taking into account of its prevalence and magnitude of effects, apathy is a clinically significant symptom in MCI. Its predictive value for conversion to dementia warrants further evaluation. © 2010 American Association for Geriatric Psychiatry.link_to_subscribed_fulltex

Use of clinical dementia rating in detecting early cognitive deficits in a community-based sample of Chinese older persons in Hong Kong

With increasing demand for dementia care in the Chinese community, there is a pressing need to identify practical and valid assessment tool for early detection of dementia. In a sample of 473 randomly recruited community-dwelling Chinese older persons aged 60 or above, we evaluated the cognitive characteristics of subjects with Clinical Dementia Rating (CDR) of 0.5. The cognitive profiles of CDR 0.5 subjects were compared with standard clinical criteria for mild cognitive impairment. The Alzheimer's disease assessment scale-cognitive subscale and list learning delay recall test scores were between - 1 and - 2 SD below the cutoff for clinically not-demented subjects (CDR 0). Concordance between CDR 0.5 and mild cognitive impairment classifications were related to educational level of the subjects. A higher agreement was found in subjects having > 6 years of education than subjects having ≤ 2 years of education (85.2% vs. 53.8%) (χ 2 = 35.41, df= 2, P < 0.0001). The results suggested that CDR is able to identify mild but significant cognitive impairment in the Chinese community. The use of CDR suggested that attention should be paid to local cultural characteristics. With the use of cognitive evaluation, special adjustments are required to fit the performance of the respondents with different educational background. Copyright © 2008 by Lippincott Williams & Wilkins.link_to_subscribed_fulltex

Combined clinical and cognitive criteria to identify mild cognitive impairment in a southern Chinese community

Mild Cognitive Impairment (MCI) is a recognized risk condition for clinical dementia. This paper attempted to explore the applicability of a combined cognitive and clinical approach to identify older Chinese adults at-risk of cognitive decline. Seven hundred forty randomly recruited community dwelling participants (aged 60 or over) were assessed at baseline and 2 years with Clinical Dementia Rating (CDR) and a cognitive battery. Baseline MCI groups were categorized by CDR-MCI, cognitive function (Cog-MCI), and a combined CDR-Cog approach. The cognitive approach adopted the Mayo clinic criteria. For the combined approach, nonamnestic MCI combined CDR 0.5 plus nonmemory cognitive deficits. The overall concordance between CDR and Cognitive test ratings were 65.3% (χ 2 = 256.4, P<0.001, κ=0.44). With a combined approach, 424(57%) participants were classified as normal. CDR-MCI group had higher cognitive scores compared with MCI groups by other criteria (1 way analysis of variance or ANOVA). At 2 years, the combined CDR-Cog MCI group identified all dementia (N=24) converters although group differences were not significant. Cognitive function and CDR identified participants potentially at-risk for furthermore decline, but exhibited some differences in detection profiles. A combined approach may be more practical in screening for MCI participants with diverse educational and cultural background. Copyright © 2010 by Lippincott Williams & Wilkins.link_to_subscribed_fulltex

Screening of mild cognitive impairment in Chinese older adults - A multistage validation of the Chinese abbreviated mild cognitive impairment test

Objective: To develop a short cognitive test for screening mild cognitive impairment (MCI) in Hong Kong Chinese older adults. Methods: The Chinese Abbreviated MCI (CAMCI) test was developed with a multistage process. In phase 1, a short version of the cognitive test comprising a 1-min animal fluency test and a 10-min delayed word list recall was developed and tested in 578 volunteers (community-dwelling active elderly persons). In phase 2, the CAMCI test was validated in an independent and randomly recruited sample of 459 participants in a community survey. Additionally, the predictive significance of the CAMCI test was evaluated in a group of 196 subjects assessed in phase 1 for conversion to clinical dementia at 20 months' follow-up. The discriminating power of the CAMCI test in differentiating MCI from normal control (NC) and mildly demented subjects was compared with Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscales. Results: The CAMCI test was found to have high discriminating power in differentiating NC from MCI and mildly demented subjects in the phase 1 volunteer sample. The receiver operating characteristics (ROC) revealed an area under the curve (AUC) of 0.91. The ROC were further validated in the phase 2 sample. The AUC of the CAMCI test was compared with MMSE and ADAS-Cog subscales. The short MCI test was comparable to the ADAS-Cog subscale in discriminating NC from MCI and demented subjects (χ 2 test, p = n.s.). Logistic regression analysis was carried out to determine significant baseline predictors for conversion to dementia at phase 3 follow-up. Both ADAS-Cog total [Exp(B) = 1.115, p = 0.028] and CAMCI [Exp(B) = 0.88, p = 0.045] scores were significant predictors for dementia status at follow-up. Conclusion: The CAMCI test is able to discriminate NC from MCI and mild dementia in Hong Kong Chinese older adults. Its potential for large-scale community screening for early detection of cognitive impairment in late life should be emphasized and explored. Copyright © 2008 S. Karger AG.link_to_subscribed_fulltex

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

Background: studies have suggested that neuropsychiatric (NP) symptoms influence the development of dementia among older adults. But, the results are inconsistent and there is limited information about NP symptoms in population-based samples. Objective: to explore the association between NP symptoms and risk of cognitive decline in Chinese older persons residing in the community. Design: prospective study. Setting: community sample. Subjects: a total of 321 community-dwelling Chinese older persons aged 60 or over with mild cognitive impairment participated in the study. Methods: at baseline, each subject was assessed with Clinical Dementia Rating (CDR), Mini-Mental State Examination, list learning and delayed recall, and Category Verbal Fluency Test. Severity of NP symptoms was evaluated with Neuropsychiatric Inventory (NPI). Global cognitive status at the end of 2-year study period was determined by CDR. Results: at baseline, 40.5% of participants exhibited one or more NP symptoms (NPI total score ≥1). Night-time behaviours (22.1%), depression (16.8%), apathy (14.0%) and anxiety (12.8%) were the most common NP symptoms. At the end of 2-year follow-up, 27.5% of participants with depression at baseline developed dementia, compared with 14.8% of those without depression (χ 2=4.90, P= 0.03). Aberrant motor behaviour was also significantly associated with deterioration in cognition (χ 2= 5.84, P= 0.02), although it was an infrequent occurrence. On logistic regression analysis, only depression at baseline was shown to be a risk factor for progression to dementia (OR= 2.40, 95% CI 1.05-5.46, P= 0.04). Conclusion: depression in non-demented older persons may represent an independent dimension reflecting early neuronal degeneration. Further studies should be conducted to assess whether effective management of NP symptoms exerts beneficial effects on cognitive function. © The Author 2010. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.link_to_subscribed_fulltex

Modality of physical exercise and cognitive function in Hong Kong older Chinese community

Objective: We reported the association between modality of Physical Exercise and cognitive function in 782 older Chinese adults assessed in the second phase of a population survey for dementia in Hong Kong. Methods: Profiles of physical exercise was measured by a questionnaire (no exercise, stretching, aerobic and mind-body exercise). Cognitive Assessments included the CMMSE, ADAS-Cog, and Category Verbal Fluency Test (CVFT). Results: The aerobic and mind body exercise groups with longer exercise habits (>5 years) had higher scores in most cognitive tests (Kruskal Wallis tests, p<0.01). Beneficial effects were more significant in the young old group from 65-75 years. Conclusions: Possible age related specific effects of aerobic and mind body exercise on cognitive reserve are worthy of further exploration. Copyright © 2008 John Wiley & Sons, Ltd.link_to_subscribed_fulltex