Early-onset dementia in Chinese: Demographic and etiologic characteristics

@#Objective: Data on early-onset dementia in Chinese is limited. This study aimed to report the diagnostic profiles and characteristics of patients with early-onset dementia in a university-affiliated cognitive disorder clinic in Hong Kong. Methods: We prospectively collected data of consecutive patients who were referred between January 2012 and December 2018. All patients were referred for diagnostic evaluation of cognitive symptoms. Patients with symptom-onset at age 65 or before were recruited. We excluded patients with (1) cognitive deficits referable to an isolated event or toxin and (2) significant mood disorders. Results: Of the 93 patients included, four patients had temporal lobe epilepsy mimicking dementia. Three patients had cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), one patient had Niemann-Pick disease type C and two patients had undetermined aetiology. The remaining 83 patients had primary degenerative dementia. The most frequent diagnosis wasAlzheimer’s disease (AD) (70%), followed by frontotemporal dementia (FTD) (22%) and parkinsonian disorders (8%). The mean age of symptom onset was 57.8 ± 5.8 years.Ten (17%) AD patients had non-amnestic presentation. Fifteen FTD patients consented for mutation screening in the GRN (progranulin), MAPT (microtubule-associated protein tau) and C9orf72 genes, none were positive. Conclusions: Early-onset dementia had a broader differential diagnoses than late-onset dementia, and includes a number of rare hereditary diseases. Patients with suspected early-onset dementia should be thoroughly evaluated to identify any treatable causes.

Molecular basis of von Hippel-Lindau syndrome in Chinese patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Von Hippel-Lindau (VHL) syndrome is an autosomal dominant familial cancer syndrome predisposing the affected individuals to multiple tumours in various organs. The genetic basis of VHL in Southern Chinese is largely unknown. In this study, we characterized the mutation spectrum of VHL in nine unrelated Southern Chinese families.</p><p><b>METHODS</b>Nine probands with clinical features of VHL, two symptomatic and eight asymptomatic family members were included in this study. Prenatal diagnosis was performed twice for one proband. Two probands had only isolated bilateral phaeochromocytoma. The VHL gene was screened for mutations by polymerase chain reaction, direct sequencing and multiplex ligation-dependent probe amplification (MLPA).</p><p><b>RESULTS</b>The nine probands and the two symptomatic family members carried heterozygous germline mutations. Eight different VHL mutations were identified in the nine probands. One splicing mutation, NM_000551.2: c.463+1G > T, was novel. The other seven VHL mutations, c.233A > G [p.Asn78Ser], c.239G > T [p.Ser80Ile], c.319C > G [p.Arg107Gly], c.481C > T [p.Arg161X], c.482G > A [p.Arg161Gln], c.499C > T [p.Arg167Trp] and an exon 2 deletion, had been previously reported. Three asymptomatic family members were positive for the mutation and the other five tested negative. In prenatal diagnosis, the fetuses were positive for the mutation.</p><p><b>CONCLUSIONS</b>Genetic analysis could accurately confirm VHL syndrome in patients with isolated tumours such as sporadic phaeochromocytoma or epididymal papillary cystadenoma. Mutation detection in asymptomatic family members allows regular tumour surveillance and early intervention to improve their prognosis. DNA-based diagnosis can have an important impact on clinical management for VHL families.</p>

Analysis of inborn errors of metabolism: disease spectrum for expanded newborn screening in Hong Kong / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Data of classical inborn errors of metabolism (IEM) of amino acids, organic acids and fatty acid oxidation are largely lacking in Hong Kong, where mass spectrometry-based expanded newborn screening for IEM has not been initiated. The current study aimed to evaluate the approximate incidence, spectrum and other characteristics of classical IEM in Hong Kong, which would be important in developing an expanded newborn screening program for the local area.</p><p><b>METHODS</b>The laboratory records of plasma amino acids, plasma acylcarnitines and urine organic acids analyses from year 2005 to 2009 inclusive in three regional chemical pathology laboratories providing biochemical and genetic diagnostic services for IEM were retrospectively reviewed.</p><p><b>RESULTS</b>Among the cohort, 43 patients were diagnosed of IEM, including 30 cases (69%) of amino acidemias (predominantly citrin deficiency, hyperphenylalaninemia due to 6-pyruvoyl-tetrahydropterin synthase deficiency and tyrosinemia type I), 5 cases (12%) of organic acidemias (predominantly holocarboxylase synthetase deficiency) and 8 cases (19%) of fatty acid oxidation defects (predominantly carnitine-acylcarnitine translocase deficiency). The incidence of classical IEM in Hong Kong was roughly estimated to be at least 1 case per 4122 lives births, or 0.243 cases per 1000 live births. This incidence is similar to those reported worldwide, including the mainland of China. The estimated incidence of hyperphenylalaninemia was 1 in 29 542 live births.</p><p><b>CONCLUSIONS</b>Our data indicate that it is indisputable for the introduction of expanded newborn screening program in Hong Kong. Since Hong Kong is a metropolitan city, a comprehensive expanded newborn screening program and referral system should be available to serve the neonates born in the area.</p>