Cognitive status in the community dwelling Thai elderly.

OBJECTIVE: To survey the prevalence of cognitive impairment in the elderly and to estimate the prevalence of dementia in the community dwelling Thai population. To assess the psychometric property of Thai Mental State Examination (TMSE). MATERIAL AND METHOD: We conducted a countrywide survey of 3,177 Thai elderly who were 60 years old and over from 1995 to 1997. Medical history and ability to carry out daily activities were taken by trained medical personnel. Thai Mental State Examination (TMSE) was used for cognitive study. Every elderly person involved in this study was examined by either an internist or a neurologist. Blood was taken for haematological and biochemical analysis. SPSS 6.0 was the main statistical analysis of the data. RESULTS: Three thousand one hundred and seventy seven elderly people were enrolled in this study, thirty eight point eight per cent were male and sixty one point two per cent were female. There was correlation between age, education and TMSE (r=-0.345, r=0.473, p<0.001). We found no correlation between TMSE, mean arterial blood pressure (BP), systolic BP, diastolic BP, haematocrit, cholesterol, triglyceride, blood sugar and syphilitic serology. Multiple cut off points of TMSE was proposed to utilise the twenty fifth percentile in each five yearly age interval. Those who were under the 25th percentile of TMSE and had impaired daily activities were diagnosed as dementia. The prevalence of dementia was 9.88 percentiles in our study. CONCLUSION: Dementia is a common problem in the Thai elderly. As treatment has become available for several etiologies of dementia, early detection and assessment of dementia with a cognitive screening test are essential. Public education to distinguish between dementia and old age needs to be emphasised.

Epidemiology of stroke in the elderly in Thailand.

Epidemiology of stroke in the elderly in Thailand was conducted from August 1994 to October 1996. The total of 3,036 Thai elderly were included in this study. They represented the elderly population from four regions; Central Region (615 elderly, Nakhon Pathom Province), Northern Region (840 elderly, Lampang Province), North-Eastern Region (706 elderly, Sakon Nakhon Province), and Southern Region (857 elderly, Ranong Province). All elderly in these selected areas received general physical examinations and complete neurological examinations from neurologists. Demographic data concerning each individual was recorded by specially trained nurses. Data included age, sex, occupation, education, drug usage, alcohol, smoking and pre-existing diseases. Blood was taken from each subject for complete blood count, fasting blood sugar, cholesterol, triglyceride, high density lipoprotein cholesterol and VDRL. Data on physical examinations were recorded with particular attention to blood pressure, carotid bruit, cardiac murmurs, cardiac arrhythmia, speech, posture, gait, frontal lobe releasing signs, Babinski sign and focal neurological deficit. Thirty-four stroke patients were identified from 3,036 elderly (prevalence rate of 1.12 per cent). There were 12 stroke patients from Central Region (prevalence rate of 1.99 per cent), 5 from Northern Region (0.6 per cent), 4 from North-Eastern Region (0.6 per cent) and 13 from Southern Region (1.5 per cent). Hypertension was the main risk factor for stroke in this study whereas diabetes mellitus, smoking, alcohol consumption, hyperlipidemia and underlying heart diseases were insignificant risk factors. The prevalence of hypertension in Thai elderly was ranging from 16.7 to 47.2 per cent (criteria over 140/90 mmHg) or 6.1 to 24.8 per cent (criteria over 160/90 mmHg). Prevalence of smoking and alcohol consumption in Thai elderly ranged from 19.5 per cent (Sakon Nakhon) to 62.1 (Lampang) and 16.75 per cent (Nakhon Pathom) to 33.70 per cent (Lampang) respectively. Data from physical examinations revealed that dysarthria, hemiplegic gait and Babinski sign were the significant signs for diagnosis of stroke in the community setting. The prevalence of carotid bruit, cardiac murmur and cardiac arrhythmia were ranging from 1.3 to 1.8 per cent, 3.1-7.1 per cent and 0.8-1.4 per cent respectively. From this study, it can be concluded that stroke prevention is the best policy for stroke management. Stroke prevention measures should thus be aimed at the high risk elderly group. This is best achieved by identifying risk factors among them and then controlling these risk factors properly.

Clonidine for smoking cessation.

Clonidine was used to reduce withdrawal symptoms of nicotine and increase the success rate of smoking cessation in the smoking cessation clinic of Siriraj Hospital. One hundred and fourteen subjects enrolled in a double-blind, randomised, placebo-controlled trial. Subjects were divided as clonidine group (n = 58) with the mean age of 38 years and placebo group (n = 56) with the mean age of 33 years. Both groups received information about harmful effects of smoking as well as behavioral modification protocol. The dose of clonidine used in this study was 300 micrograms and the duration of the trial was 5 weeks. Both subject groups attended the clinic weekly and received identical counselling. Clonidine did not reduce withdrawal symptoms of nicotine when compared to the placebo and the success rate of smoking cessation at the end of the 5 weeks' period was identical between the two groups (clonidine 50%; placebo 48%, p > 0.05). No significant side effects of clonidine were found. There was no correlation between background educational level, income, amount of cigarettes smoked per day and the success rate in both groups. In conclusion, clonidine did not show any beneficial effect on smoking cessation.

Native valve infective endocarditis at Siriraj Hospital, 1982-1989.

During January 1982 to June 1989, there were 105 evaluable adult cases of native valve infective endocarditis admitted to Department of Medicine, Siriraj Hospital. The incidence was approximately 2.6 per 1,000 admissions. The male to female ratio was 1.4 and the mean age was 31.6 years. Thirty (28.5%) were cases associated with intravenous drug abuse. All non-addicts had pre-existing cardiac lesions susceptible to endocarditis especially rheumatic mitral regurgitation, aortic regurgitation, VSD and PDA. The clinical features of cases without intravenous drug abuse were low grade fever for few weeks, malaise, dyspnea and heart murmur. The addicts with endocarditis presented with acute febrile illness and pulmonary symptoms. Mucocutaneous embolic lesions were detected in one third of the patients. Echocardiography detected vegetations in 50 per cent of the patients. Streptococci were the most common causative agent in 93 per cent of non-addicts whereas the same percentage in addicts were caused by S. aureus. Most of the patients were treated with beta lactams (pen G, ampicillin or cloxacillin) alone or combined with aminoglycosides (streptomycin or gentamicin) for a duration from 10 days to 16 week. Six cases had valve replacement operation due to intractable heart failure and valve ring abscess, 2 had embolectomy of major arteries and 2 had craniotomy due to intracerebral hemorrhage. The overall case fatality rate was 14 per cent. The causes of death were heart failure, cerebral complications and severe pulmonary infections. Clinical response was observed sooner in non-addict patients.

Opsoclonus in malaria: the first report in the literature.

The first report in the literature of opsoclonus in malaria was presented. A 24-year-old woman had a two week history of high fever and lassitude. Physical examination revealed no specific neurological sign on admission. Ring form and gametocytes of Plasmodium falciparum were found in blood smear. Combined treatment of quinine and tetracycline were prescribed. She developed classical abnormal eye movement of opsoclonus and hand tremor on the following day, which gradually subsided on the tenth hospital day. Computed brain tomography and cerebrospinal fluid study were normal. She was discharged home after 3 weeks of admission with some occasional minimal opsoclonus without hand tremor.