Discontinuation Rate of Newly Prescribed Donepezil in Alzheimer’s Disease Patients in Asia

Background@#and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. @*Methods@#This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). @*Results@#Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. @*Conclusions@#In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Discontinuation Rate of Newly Prescribed Donepezil in Alzheimer’s Disease Patients in Asia

Background@#and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. @*Methods@#This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). @*Results@#Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. @*Conclusions@#In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Cerebrospinal Fluid Biomarkers in Dementia Patients with Cerebral Amyloid Angiopathy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To study the changes of biomarkers in cerebrospinal fluid (CSF) in cerebral amyloid angiopathy (CAA) dementia and Alzheimer(')s disease.</p><p><b>METHODS</b>Levels of amyloid protein β (Aβ42, Aβ40) and phosphorylated Tau-protein (P-tau) in CSF and ratio of Aβ42/Aβ40 were tested in 5 cases with CAA dementia and 20 cases with Alzheimer's disease collected at Peking Union Medical College Hospital from December 2001 to March 2011.</p><p><b>RESULTS</b>The levels of Aβ42, Aβ40, and P-tau in CSF and ratio of Aβ42/Aβ40 were (660.4 ± 265.2) ng/L, (7111.0 ± 1033.4) ng/L, (71.8 ± 51.5) ng/L, and 0.077 ± 0.033, respectively in CAA dementia and (663.6 ± 365.6) ng/L, (5115.0 ± 2931.1) ng/L, (47.7 ± 38.8) ng/L, and 0.192 ± 0.140, respectively in Alzheimer's disease patients. There were no statistically significant differences between CAA dementia and Alzheimer's disease in terms of these CSF biomarkers (all P>0.05).</p><p><b>CONCLUSION</b>Measurements of CSF biomarkers may not be helpful in differential diagnosis of CAA and Alzheimer's disease.</p>

Positive Association Between Type 2 Diabetes Risk Alleles Near CDKAL1 and Reduced Birthweight in Chinese Han Individuals / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Fetal insulin hypothesis was proposed that the association between low birth weight and type 2 diabetes is principally genetically mediated. The aim of this study was to investigate whether common variants in genes CDKAL1, HHEX, ADCY5, SRR, PTPRD that predisposed to type 2 diabetes were also associated with reduced birthweight in Chinese Han population.</p><p><b>METHODS</b>Twelve single nucleotide polymorphisms (rs7756992/rs10946398 in CDKAL1, rs1111875 in HHEX, rs391300 in SRR, rs17584499 in PTPRD, rs1170806/rs9883204/rs4678017/rs9881942/rs7641344/rs6777397/rs6226243 in ADCY5) were genotyped in 1174 unrelated individuals born in Peking Union Medical College Hospital from 1921 to 1954 by TaqMan allelic discrimination assays, of which 645 had normal glucose tolerance, 181 had developed type 2 diabetes and 348 impaired glucose regulation. Associations of these 12 genetic variants with birthweight and glucose metabolism in later life were analyzed.</p><p><b>RESULTS</b>Birthweight was inversely associated with CDKAL1-rs10946398 (β = -41 g [95% confidence interval [CI]: -80, -3], P = 0.034), common variants both associated with increased risk of impaired glucose metabolism and decreased insulin secretion index later in life. After adjusting for sex, gestational weeks, parity and maternal age, the risk allele of CDKAL1-rs7756992 was associated with reduced birthweight (β = -36 g [95% CI: -72, -0.2], P = 0.048). The risk allele in SRR showed a trend toward a reduction of birthweight (P = 0.085).</p><p><b>CONCLUSIONS</b>This study identified the association between type 2 diabetes risk variants in CDKAL1 and birthweight in Chinese Han individuals, and the carrier of risk allele within SRR had the trend of reduced birthweight. This demonstrates that there is a clear overlap between the genetics of type 2 diabetes and fetal growth, which proposes that lower birth weight and type 2 diabetes may be two phenotypes of one genotype.</p>

Validity of complex figure test in differentiation of Alzheimer's disease from non-dementia / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the validity of Complex Figure Test(CFT)in differentiating Alzheimer's disease(AD)from non-dementia.</p><p><b>METHODS</b>Using CFT,we tested 183 AD patients(AD group),1283 cognitively intact individuals(normal control group),and 134 individuals suffered from other diseases that could be easily confused with dementia(confused control group).</p><p><b>RESULTS</b>The CFT score was 38.7±0.2 in the normal control group,35.3±0.8 in confused control group,23.7±0.8 in mild AD group,and 13.2±1.1 in moderate AD group after adjusted for educational level,age,and sex(all P<0.05).With the 5(th) percentage of the overall score as cutoff point,this tool showed a sensitivity of 73.8% and a specificity of 93.8% in differentiating AD from non-dementia.</p><p><b>CONCLUSION</b>CFT is a sensitive and specific tool in the differentiation of AD from non-dementia.</p>

Validity of auditory verbal learning test in diagnosis of Alzheimer's disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the validity of World Health Organization-University of California-Los Angeles Auditory Verbal Learning Test (WHO-UCLA AVLT) in the diagnosis of Alzheimer's disease (AD).</p><p><b>METHODS</b>Using WHO-UCLA AVLT, we assessed 183 AD patients (AD group),1283 subjects with normal cognitive status (normal control group), and 134 individuals suffered from other diseases easy to be confused with AD (confused control group).</p><p><b>RESULTS</b>The AVLT score was 40.9∓0.3 in normal control group, 30.7∓0.9 in confused control group, 16.6∓1.0 in mild AD group, and 10.2∓1.2 in moderate AD group after adjustment for educational level, age, sex, and rural/urban residence (all P<0.05). With the 5th percentage of the overall score as the cutoff point, this tool showed a sensitivity of 86.3% and a specificity of 93.3%.</p><p><b>CONCLUSION</b>WHO-UCLA CVLT is highly sensitive and specific in the diagnosis of AD.</p>

Gender specific association of neonatal characteristics and cardiovascular risk factors on carotid intima-media thickness in a Chinese cohort / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Multiple neonatal characteristics and adult cardiovascular risk factors are associated with the development of atherosclerosis, however little conclusive evidence exists characterizing the relative strength of these factors. In a large retrospective study, we investigated the association between both objective neonatal measurements and comprehensive adult cardiovascular risk factors with the development of atherosclerosis, quantified by carotid intima-media thickness (CIMT). Further, we assessed the impact of gender on the relative impact of these risk factors.</p><p><b>METHODS</b>CIMT, a measure of atherosclerosis, was determined by carotid ultrasound on 1568 participants (age 50-85) whose birth records were obtained from Peking Union Medical College Hospital. In addition, each participant was given a physical examination, and completed a medical questionnaire to identify a panel of cardiovascular risk factors. Multiple regression analysis was performed on the population and on the male and female cohorts individually, to identify the relative contribution of these risk factors to increased CIMT.</p><p><b>RESULTS</b>For the total population the Framingham score, renal function, adult abdominal circumference and mother's gestational age were associated with CIMT, accounting for 14.7%, 1.4%, 0.9%, and 0.2% of total variance, respectively. In the male population the Framingham score, renal function, abdominal circumference and hemoglobin were the most significant risk factors for CIMT. Risk in the female population was associated with Framingham score, renal function, insulin resistance and gestational age. No relationship between birth weight or head circumference and CIMT were observed.</p><p><b>CONCLUSIONS</b>Adult cardiovascular risk factors were the most significantly associated with the development of atherosclerosis; however mother's age at birth was associated with CIMT, particularly in the female cohort. The relative contribution of the risk factors analyzed varied between the male and female populations.</p>

MRI features of olfactory bulb volume in healthy middle and old-aged persons / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the differences of olfactory bulb (OB) volumes between younger and older, male and female, left-side and right-side in healthy middle and old-aged persons by MRI.</p><p><b>METHODS</b>Ninety five healthy middle and old-aged volunteers (male:female = 45:50) were divided into 2 groups, group one included persons aged from 50 to 69, group two included persons elder than 70. The left-side, right-side and both-side volumes of OB, the volumes of brain and the ratio of OB/brain were measured by MRI.</p><p><b>RESULTS</b>(1) The left-side and both-side volumes of OB (x(-) +/- s), the volumes of brain [(39.89 +/- 8.7) mm(3), (81.70 +/- 16.8) mm(3) and (1281.86 +/- 140.2) cm(3)] in 50 - 69 years old group were respectively larger than those in >/= 70 years old group [(34.45 +/- 10.4) mm(3), (72.10 +/- 19.3) mm(3) and (1165.77 +/- 165.3) cm(3)], and the differences reached statistical significance (t were respectively 2.649, 2.449, 3.516, all P < 0.05). There were no significant differences of right-side OB volumes and the ratio of OB/brain between 50 - 69 years old group and >/= 70 years old group (t were respectively 1.904, 0.616, each P > 0.05). (2) The male's OB volumes of left-side, right-side and both-side, the brain volumes and the ratio of OB/brain were respectively larger than females', and the differences reached statistical significance (t were respectively 4.461, 3.630, 4.399, 3.800, 2.400, all P < 0.05). (3) The right-side OB volumes were larger than left-side's and significant differences were found in female group, 50 - 60 years old group and >/= 70 years old group (t were respectively 2.732, 2.117, 3.516, all P < 0.05). There were no significant differences of OB volumes between left-side and right-side in female (t = 2.649, P = 0.110). The ratio of right-side OB/brain were larger than the ratio of left-side's and the differences reached statistical significance (t = 3.183, P = 0.002).</p><p><b>CONCLUSIONS</b>MRI could be used to measure the volume of OB. The older the people, the smaller the OB volumes. There was no influence of age on the ratio OB/brain. The OB volumes of right-side were larger than those of left-side. The OB volumes of male were larger than those of female.</p>

Relationship between perinatal characteristics and later activities of daily living in Chinese elderly people / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are no reports on the association between perinatal characteristics and comprehensive physical function in Chinese elderly people. In this study, we traced 875 subjects who were born at the Peking Union Medical College Hospital (PUMCH) of China from 1921 to 1941. The purpose of this study was to determine the effects of perinatal characteristics on activities of daily living (ADL) function in the geriatric period.</p><p><b>METHODS</b>Birth data of 875 subjects were obtained from obstetric birth records of PUMCH. Adulthood data collection was conducted in the outpatient clinics of PUMCH. During the clinic visits, trained research staff administered physical examinations, activities of daily living scale and a demographic questionnaire. ADLs of all subjects were assessed with the activities of daily living scale.</p><p><b>RESULTS</b>There were 101 subjects whose ADL function was limited and the rate of ADL limitation was 11.5%. Binary logistic regression analyses results showed that the main influencing factors of ADL were age, maternal age at birth, occupation, daily exercise and chronic disease. Subjects whose maternal age at their birth exceeded 35 years were at 2.202 times (1.188 - 4.083) greater risk of ADL limitation when we applied multivariate logistic regression models.</p><p><b>CONCLUSIONS</b>This study validated the relationship between perinatal characteristics and ADL in the geriatric period. An older maternal age at birth could predict a higher ADL limitation rate in the geriatric period.</p>

Gln192Arg polymorphism in paraoxonase 1 gene is associated with Alzheimer disease in a Chinese Han ethnic population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Oxidative stress such as low-density lipoprotein (LDL) oxidation is thought to be an important mechanism in Alzheimer's disease (AD). Paraoxonase 1 (PON1), an enzyme located on high-density lipoprotein, can prevent LDL from oxidation to some extent. It is also a potent cholinesterase inhibitor and an arylesterase, combating organophosphate poisoning and metabolization of environmental neurotoxins which might be responsible for neurodegeneration with aging. We evaluated the association of Gln192Arg polymorphism in the PON1 gene with AD in a Chinese Han ethnic population.</p><p><b>METHODS</b>Patients and age-matched controls were recruited from outpatient clinics and a population-based epidemiological survey, respectively. Gln192Arg polymorphism in the PON1 gene was detected by allele-specific PCR technique in 521 patients with AD and 578 healthy controls.</p><p><b>RESULTS</b>The presence of at least one of PON1 R alleles (Q/R or R/R) was lower in AD patients than in the controls (82.7% vs 87.4%; chi(2) = 4.68, P = 0.03). PON1 gene R allele frequency was lower in AD patients than in the controls (60.7% vs 64.7%; chi(2) = 3.85, P = 0.05). One-way ANOVA showed that PON1 genotype had no effect on the age of onset for developing AD. Logistic regression analysis demonstrated the age and sex-adjusted odds ratio (OR) for the risk of AD in PON1 of PON1 R allele carriers was 0.71 (P = 0.044, 95% CI, 0.51 - 0.99).</p><p><b>CONCLUSION</b>Our results indicate that Gln192Arg polymorphism in the PON1 gene is associated with AD, and PON1 R allele might be a protective factor for AD in a Chinese Han ethnic population.</p>

Association between interleukin-1 alpha-889 C/T polymorphism and Alzheimer's disease in Chinese Han population / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the possible association between interleukin-1 alpha-889C/T (IL-1 alpha-889 C/T) polymorphism and Alzheimer's disease (AD) in Chinese Han population.</p><p><b>METHODS</b>A total of 520 AD patients and 505 normal controls were enrolled. The polymorphism of IL-1 alpha-889C/T was detected with real-time polymerase chain reaction. Multiple logistic regression and chi square test were performed for statistical analysis.</p><p><b>RESULTS</b>The frequencies of C/C, C/T, and T/T genotypes were 70.96%, 25.77%, and 3.27%, respectively, among AD patients, and 80.59%, 18.22%, and 1.19%, respectively, among non-dementia controls. In multivariate analysis, T/T and C/T genotypes of IL-1 alpha-889, age > or =65 years, and female were risk factors for AD. Adjusted for the age and sex, T/T and C/T genotypes were still associated with AD. The odds ratio for AD were 3.57 and 1.74 for individuals with T/T and C/T genotypes compared with individuals with C/C genotype. P value was 0. 019 and 0. 001, respectively.</p><p><b>CONCLUSION</b>The IL-1 alpha-889 T/T and C/T genotypes are likely to be susceptible factors for the development of AD in Chinese Han population. The susceptibility genotype, female, and age > or =65 years are risk factors for AD.</p>

Analysis on association between the polymorphisms in apolipoprotein E, interleukin-1 alpha genes and Alzheimer's disease in Chengdu area / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the correlation between the polymorphisms of apolipoprotein E(APOE), the interleukin-1 alpha (IL-1 alpha ) genes and the susceptibility to Alzheimer's disease(AD).</p><p><b>METHODS</b>Association study was performed in 114 AD patients and 113 healthy elderly individuals from Chengdu, China. Polymorphisms of APOE and IL-1 alpha genes were analyzed with polymerase chain reaction-restriction fragment length polymorphism.</p><p><b>RESULTS</b>The frequency of APOE-epsilon 4-carrying genotype in moderate to severe AD patients (28.6%) was higher than that of mild patients (18.5%) and the controls (14.2%), and the difference between moderate to severe AD group and the control group was significant (OR=2.4, 95%CI: 1.1-5.5). The frequency of epsilon 4 was also of significant difference between the group of moderate to severe dementia and the control group (OR=2.6, 95%CI: 1.3-5.3). However, no significant difference in distribution of IL-1 alpha polymorphism between AD patients and controls was observed.</p><p><b>CONCLUSION</b>The APOE epsilon 4 allele was associated with moderate to severe AD while no association between the IL-1 alpha gene polymorphism and AD was found.</p>

Neuropsychiatric symptoms in dementia and elderly people in the community: results from the Beijing Dementia Cooperative Study / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the prevalence of neuropsychiatric symptoms in dementia and normal elderly people living in the Chinese community of Beijing.</p><p><b>METHODS</b>A cross-sectional study derived from the Beijing Dementia Cooperative Study was carried out a population survey was carried out on a total of 1540 participants aged 65 years and older living in Beijing city and rural areas. All the individuals and 373 demented elderly people completed a series of neuropsychological examination and the Neuropsychiatric Inventory (NPI).</p><p><b>RESULTS</b>Among the dementia participants, 49.33% had exhibited neuropsychiatric symptoms (35.66% rated as clinically significant), in which 80.4% reported 2 or more disturbances, with depression (23.86%), apathy (21.72%) and anxiety (20.38%) being most common. Of the 1540 normal individuals, 18.25% of them exhibited neuropsychiatric symptoms (6.49% rated as clinically significant), in which 53% reported 2 or more disturbances, with sleepless (10%), depression (8.9%) and anxiety (6.97%) being the most common.</p><p><b>CONCLUSION</b>To our knowledge, this was the first multi-center study on neuropsychiatric disturbances in dementia and cognitive normal elderly people. Neuropsychiatric symptoms occurred mainly in persons with dementia and of clinical severity. Though the neuropsychiatric disturbances reported in cognitive normal individuals were lower and less serious compared to dementia, they should not be neglected. These finding suggested that a screening programme focusing on identifying these symptoms should be included in the physician's diagnostic tools for dementia.</p>

Association between Alzheimer's disease and nitric oxide synthase III polymorphism / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the association between Alzheimer's disease (AD) and nitric oxide synthase (NOS) III in Chinese Han population.</p><p><b>METHODS</b>Seventy-five AD and 68 normal controls were genotyped for NOS III G894T polymorphism. Genotyping was carried out by PCR-RFLP methods.</p><p><b>RESULTS</b>There were two genotypes of NOS III, GG and GT, in either AD patients or normal controls. The frequencies of these two genotypes were 78.7% and 21.3% in AD patients and 82.4% and 17.6% in normal controls, respectively. No association was found between AD and NOS III genotype (P > 0.05). There were two alleles, G and T, in AD patients and normal controls. The frequencies of these two alleles were 89.3% and 10.7% in AD patients and 91.2% and 8.8% in normal controls, respectively, indicating that there was no association between AD and NOS III allels (P > 0.05).</p><p><b>CONCLUSIONS</b>There was no association between AD and NOS III G894T polymorphism in Chinese Han population.</p>

A caregiver survey in Beijing, Xi'an, Shanghai and Chengdu: health services status for the elderly with dementia / 中国医学科学院学报

<p><b>OBJECTIVE</b>In order to rationally allocate resources and to improve the quality of life of people with dementia, it is necessary to assess their current health services status.</p><p><b>METHODS</b>A population-based door-to-door caregiver survey was conducted in Beijing, Xi'an, Shanghai and Chengdu in 1998. Totally 1 141 individuals with dementia were found among 34 807 residents aged 55 years and over on the basis of national prevalence study of dementia. Then 428 families with demented patients were randomly selected for questionare interview. Interviews were completed in 405 but refused by 23 families. Measurements included demographic characteristics of patients and their caregivers, perspective of the victim of the disease, current awareness of the disease and medical and welfare services provided.</p><p><b>RESULTS</b>Among 405 cases of dementia (including 298 cases of AD and 81 cases of VaD), mean MMSE scores were 16.3 +/- 5.3 for 157 mild cases, 12.7 +/- 5.4 for 135 moderate cases, and 6.2 +/- 5.8 for 110 severe cases. Most patients (96%) were cared for at home by family members. Among caregivers, 189 (48.8%) considered the impairment of cognition, behavior and daily living activity in demented persons as a result of normal aging. Half of the caregivers spend over 8 hours each day looking after the patient. Whether the caregivers brought their relatives with dementia to a doctor was determined by disease severity, i.e. 8.3% for mild, 13.5% for moderate, and 19.4% for severe in 1996 to approximately 1997 and 14.4%, 25.6% and 33.6%, respectively in 1998-1999. Of those, only 26.9% reported receiving a dementia diagnosis, and only 21.3% received a recommedation to take medication. However, there was no established standard treatment and only 2% patient's used Ache-I.</p><p><b>CONCLUSIONS</b>General education is needed to increase the public awareness of dementia. For patients with dementia, early diagnosis, early treatment and optimal care are important to improve their quality of life.</p>

Comparative study on the clinical features of Alzheimer's disease and vascular dementia / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical features of Alzheimer's disease (AD) and vascular dementia (VaD), and to find effective methods for differential diagnosis between the two entities.</p><p><b>METHODS</b>Totally 112 AD patients and 92 VaD patients were enrolled in this study, consisted of patients from the memory clinics and patients from the community population visited during the epidemiological survey from 1996 to 2000. Diagnosis of dementia, probable AD and probable VaD were made according to international criteria. Results of specific neuroimaging examination were referred to verify the diagnosis and the final diagnosis of each patient was determined from the discussion between clinical experts and radiological professionals. Analysis on clinical and neuroimaging data was performed, aiming at finding differential points between the two dementia-subtypes. A logistic binary multiple regression analysis was performed to pick out those statistically significant clinical features for differential diagnosis at last.</p><p><b>RESULTS</b>AD and VaD patients have different clinical features in various demented stages, therefore the indexes that differentiate the two dementia subtypes change accordingly. The predominant features of mild AD appear to be deficits of prolonged memory and learning ability, while the major impairment of mild VaD patients is decline of calculating ability. With the progress of dementia, learning ability and attention turn to be the effective indexes for differential diagnosis. In the mild and moderate demented stage, AD patients are inferior to VaD patients in handling finacial affairs and making phone calls, while VaD patients often degenerate in daily activities concerning with both physical ability and intellectual level. Severe VaD patients appears more global degeneration of living ability compared to AD patients. The difference of ADL scores between the two subtypes is significant in moderate to severe demented patients (P < 0.05). Psychological behavior symptoms, such as repeatedly collecting useless things, are the characteristic manifestation to differentiate AD from VaD in all clinical stages.</p><p><b>CONCLUSIONS</b>The results of our study indicate that substantial differences exist between AD and VaD patients. Such differences can be attributed to the differences of lesion nature and distribution, as well as the underlying pathophysiological procedures of each disease.</p>

Memory-assessing methods which help the clinical diagnosis of early Alzheimer's disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate distribution and influence factors of logic memory (LM) modified in assessing and scoring method in normal population and Alzheimer's disease (AD) patients, and definite the cut-off point of the modified scale.</p><p><b>METHODS</b>Totally 183 AD patients, including 118 mild and 65 moderate in degree, 1,417 controls, including 1,283 normal individuals and 134 individuals suffered from other diseases, were recruited in this study. Modified LM was conducted.</p><p><b>RESULTS</b>Educational level (F=354.36, STB=0.46, P=0.0001) was the most obvious factor in demographic data to influence total score in normal control group by a fitting of multiple regression models. The total score increased with the rising of educational level in normal controls (P=0.0001) and other diseases controls (P=0.0001), but not in AD cases (P=0.1365). The total scores were significantly different among normal controls (20.2 +/- 0.2), other diseases controls (17.5 +/- 0.5), mild AD patients (9.6 +/- 0.5) and moderate AD patients (7.1 +/- 0.7) (P=0.0001, P=0.0059), after adjusted educational level, age, sex and rural/urban status by multiple analysis covariance. The sensitivity of cut-off points using modified methods to diagnose AD reasonably increased to 71.98%, while the specificity was 94.11%. According to the sum of long-delayed recall and long-delayed recognition, the sensitivity increased with the rising of educational levels. For education levels at illiteracy, elementary school, junior middle school, senior middle school and above senior middle school, the cut-off points for total score of modified method were 6.5, 9.5, 10.8, 13 and 15.8, respectively, and for sum of long-delayed recall and long-delayed recognition the cut-off points were 5, 6, 8, 9, 10.</p><p><b>CONCLUSIONS</b>When modified LM used as a neuropsychological assessment, it is with high specificity, high accuracy and reasonable sensitivity. It is suitable for the diagnosis of AD in early stages, especially for individuals with high educational levels.</p>

Relationship between the data from MR-diffusion tensor imaging and the clinical cognitive evaluation in Alzheimer's disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To determine the relationship between the extent of the damage and clinical data in Alzheimer's disease (AD).</p><p><b>METHODS</b>Twenty-two patients with AD and twenty-two controls received MR-diffusion tensor scanning. The fractional anisotropy (FA) values of white matter in AD patients were measured respectively in parietal lobe and the genu of corpus callosum. Independent-samples t-test for non-paired data was used to test differences between AD and controls for FA values. Correlation analysis was applied to reveal the correlations between FA values in each region and the MMSE, FOM, RVR, BD and DS scores.</p><p><b>RESULTS</b>Positive correlations were found between FA values in left parietal lobe and FOM/DS, and between FA values in genu of corpus callosum and MMSE scores.</p><p><b>CONCLUSIONS</b>In AD, the MR-DTI can reflect the relationship between the degree of white matter abnormalities and the cognitive impairment.</p>

Evaluation on the disability weight of Alzheimer's disease and Parkinson's disease in Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To formulate the classification criteria of disability weight for Alzheimer's disease (AD) and Parkinson's disease (PD) in China and to evaluate the disability weight of AD and PD in population over 60 years old in Beijing.</p><p><b>METHODS</b>Based on the criteria of Global Burden of Disease (GBD), a seven-grade disability classification was used to develop a new disability classification criteria for AD and PD in terms of Delphi method in China. Using the data from epidemiological survey for AD and PD in Beijing in 1997 and new criteria, mean disability weights of AD and PD in population over 60 years old in Beijing were obtained.</p><p><b>RESULTS</b>The mean disability weights of Alzheimer's disease was 0.40 in population over 60 years old who received treatment in Beijing and 0.52 in those without treatment while the mean disability weights of Parkinson's disease were 0.30 in the patient receiving treatment and 0.23 in those without treatment.</p><p><b>CONCLUSION</b>Difference between the result of this study and the data of GBD study in the mean disability weight for AD and PD was noticed.</p>

Cigarette smoking and Parkinson's disease: a population based case-control study / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the association with cigarette smoking for Parkinson's disease (PD).</p><p><b>METHODS</b>One hundred and fourteen PD cases and 205 controls matched on gender and race were recruited from ongoing PD prevalence survey and identified at the neurological clinic of Peking Union Medical College Hospital. Face to face questionnaire interview was carried out and data on smoking and alcohol consumption were analyzed in a population-based case control study.</p><p><b>RESULTS</b>With never-smokers as the reference category, we observed reduced risk for PD among ever smokers (OR = 0.49, 95% CI: 0.30 - 0.79) current smokers (OR = 0.44, 95% CI: 0.23 - 0.86) and ex-smokers (OR = 0.54, 95% CI: 0.30 - 0.96). When comparing with non-smokers, the ever smokers stratified by years of smoking had an inverse association with those whose smoking history longer than 20 years (OR = 0.35, 95% CI: 0.18 - 0.70) and an mild protective association with those who smoked less than 20 years (OR = 0.61, 95% CI: 0.35 - 1.07). Those who had quitted smoking for more than 20 years were less likely to have the disease than never smokers, and those who had quitted for less than 20 years were least likely to have PD. Those current smokers were still least likely to have the disease. Significant inverse gradient with pack-day smoker (trend P < 0.05), and the inverse association for cigarette smoking and PD were found not bing confounded by alcohol consumption.</p><p><b>CONCLUSION</b>The inverse association between PD and cigarette smoking and history of cessation was found. Further studies need to provide biochemical evidence on the relation between smoking and its protective effect on PD.</p>