A cross-sectional study on behavioural and psychological symptoms of dementia in elderly and its impact on quality of life in a tertiary care hospital

Background: Historically, the word dementia was derived from Latin word ‘dementatus’, which means ‘out of one’s mind’. There were 24.3 million people with dementia in the world and 4.6 million are being added every year. Present study was done to evaluate the behavioral and psychological symptoms of dementia in elderly patients and its impact on their quality of life.Methods: It was a hospital based descriptive, cross-sectional study. 100 cognitively impaired patients in the age group of 60 years and above were enrolled. The socio-demographic profile, severity of dementia on MMSE; behavioral disturbances on BPSD; psychiatric illness on NPI; agitation on CMAI and their impact on quality of life, and disability were assessed on WHOQOL-Bref and WHO DAS 2.0 scales, respectively.Results: Out of 110 patients that were screened, 100 participated in the study (response rate 91%). Majority of subjects (53%) were illiterate and belongs to rural background (57%). Mean dementia severity score was 17.01±4.439 SD which was of mild to moderate level. Overall mean age was 68.16±8.16 SD and negatively related (r= -0.652; F=27.044, p<0.001) but weakly associated to severity of dementia. There was a statistically significant increase in the NPI scores with increase in dementia severity (Item score F=91.754, p<0.001 and distress score F=81.647, p<0.001). There was significant increase in agitation/aggression (CMAI) with an increase in severity of dementia. BPSD on NPI item score was weakly related (r=0.757) and caused increase in disability but decrease in quality of life. Dementia severity as per MMSE score was negatively related to WHO DAS disability (r= -0.863), BPSD on NPI item (r= -0.797) and agitation/aggression on CMAI (r= -0.587). WHOQOL-Bref decreases with increase in severity of dementia and disability.Conclusions: Dementia severity was of mild to moderate level and it increased with age. Most common psychiatric symptom was agitation/aggression (76%) and least common was hallucinations (12%). BPSD causes significant decrease in quality of life and an increase in severity of disability.

Determinación de los niveles séricos de vitamina D en los pacientes diagnosticados con Esclerosis múltiple y su relación con la severidad y el comportamiento de la enfermedad en el "Hospital Metropolitano de Quito" y en el "Hospital Carlos Andrade Marín" / Determination of vitamin D serum levels in patients diagnosed with multiple sclerosis and their relationship with the severity and illness behavior in the Metropolitan Hospital in Quito and Carlos Andrade Marín Hospital

Introducción: El estudio pretende relacionar los niveles séricos de vitamina D, en pacientes con Esclerosis Múltiple (EM), con la severidad y el comportamiento de la enfermedad. Materiales y Métodos: Reclutamos 81 pacientes con EM, de los cuales se obtuvo una muestra de 50 pacientes para compararlos con 50 sujetos sanos, pareados por edad, sexo y color de la piel. La severidad de la enfermedad se evaluó con la escala de Kurtzke, número de recaídas, exposición solar, etc. Resultados: La concentración sérica de vitamina D en pacientes con EM (M=31.9 SD=12.3 ng/ml) fue similar a la de los controles (M=30.3 SD= 8.0 ng/ml; p=0.53). La prevalencia de insuficiencia de vitamina D fue del 42% (n=21) entre los casos y 46% (n=23) entre los controles, p>0.05). Se calculó la relación entre los niveles óptimos de Vitamina D (> 40, ng/ml) con un bajo grado de discapacidad, definida como un valor en la escala de Kurtzke < 3.5 [χ2(1, N=100)= 3.13 p=0.3]. El promedio de vitamina D en los pacientes con más de una recaída fue de 31.0 ng /ml y con menos de una recaída, 32.5 ng/ml fue similar (p=0.66). Discusión: No hubo diferencia significativa en las concentraciones séricas de vitamina D en pacientes con EM y sujetos sanos, pareados por género, edad y color de la piel. No hubo correlación entre el nivel de vitamina D y el grado de discapacidad medido por la escala de Kurtzke ni con el número de recaídas.

Introduction: The study seeks to relate vitamin D serum levels in Multiple Sclerosis (MS) patients with disease severity and its progression. Methods: From eighty one MS patients enrolled, fifty were selected to compare to healthy subjects, paired according to age, gender and skin color. Disease severity was assessed using the Kurtzke severity scale, relapses number, solar exposure. Results: The mean vitamin D serum concentration in MS patients (M= 31.9 SD=12.3 ng/ml) was similar to controls' (M=30.31 SD=8.0 ng/ml; p=0.53). The prevalence of vitamin D insufficiency was 42% (n=22) among cases and 46% (n=23) among controls (p=0.91). The relationship between an optimal vitamin D serum concentration (>40 ng/ml) and a low grade of disability, using a cutoff point in the Kurtzke scale < 3.5, was assessed and a non-significant correlation was found [χ2(1, N=100)= 3.13 p=0.3]. The mean vitamin D level among patients with more than one relapse (M=31.0 ng/ml) was similar to those with less than one relapse (M=32.49, p=0.66). Discusion: There was no difference of vitamin D serum levels between MS patients and the general population. A weak and not significant correlation was found with the degree of disability, measured by the Kurtzke severity scale, and also with the number of relapses.

Clinical Observation of Different Needling Methods for Ischemic Stroke / 上海针灸杂志

ObjectiveToinvestigate the effect of different needling methods on ischemic stroke, for seeking the effective treatment for stroke.MethodBy following the randomized controlled principle, the sixty enrolled patients were randomized into an electroacupuncture groupand an acupuncture group, 30 cases in each group. The two groups were both intervened by needling treatment in addition to the conventional internal medicine management, electroacupuncture for the electroacupuncture group,and ordinary acupuncture for theacupuncture group. The Neuropathy Disability Scale (NDS), Fugl-Meyer Assessment (FMA), and Barthel Index (BI) were adopted for evaluation and comparison.ResultThe NDS, FMA, and BI scores were significantly changed after treatment in both groups (P<0.01); there were significant differencesin comparing FMA and BI scores between the two groups (P<0.05).ConclusionElectroacupuncture can produce a more significant efficacy in treating ischemic stroke compared with ordinary acupuncture, electroacupunctureis also better than ordinary acupuncture in improving the neural deficit.

Surgical Outcomes and Correlation of the Copenhagen Neck Functional Disability Scale and Modified Japanese Orthopedic Association Assessment Scales in Patients with Cervical Spondylotic Myelopathy

STUDY DESIGN: Cross-sectional. PURPOSE: Clinical outcome study comparing the Copenhagen Neck Functional Disability Scale (CNFDS) and modified Japanese orthopedic association (mJOA) assessment scales in patients with cervical spondylotic myelopathy (CSM). OVERVIEW OF LITERATURE: Comparison of instruments that measure patient-reported outcomes is needed. METHODS: A cross-sectional analysis was conducted. Ninety five patients with CSM were entered into the study and completed the CNFDS and the mJOA preoperatively and postoperatively. Correlation between the CNFDS and the mJOA was evaluated preoperatively and at the end of follow-up. Responsiveness to change of CNFDS and mJOA was also assessed. Clinical outcomes were also measured with the recovery rate of mJOA score at end of follow-up. RESULTS: The mean age of patients was 58.2 (standard deviation, SD=8.7) years. Mean follow-up was 2.1 years (range, 1 to 4 years). The mJOA correlated strongly with the CNFDS score preoperatively and postoperatively (r=-0.81 and -0.82, respectively; p<0.001). The CNFDS and the mJOA were able to detect changes after the surgery (p<0.001). The mean mJOA recovery rate was 51.8% (SD=13.1%). CONCLUSIONS: Surgery for the treatment of patients with CSM is an efficacious procedure. CNFDS and mJOA scores have a strong correlation in measuring disability among CSM patients.

Surgical Outcomes and Correlation of the Copenhagen Neck Functional Disability Scale and Modified Japanese Orthopedic Association Assessment Scales in Patients with Cervical Spondylotic Myelopathy

STUDY DESIGN: Cross-sectional. PURPOSE: Clinical outcome study comparing the Copenhagen Neck Functional Disability Scale (CNFDS) and modified Japanese orthopedic association (mJOA) assessment scales in patients with cervical spondylotic myelopathy (CSM). OVERVIEW OF LITERATURE: Comparison of instruments that measure patient-reported outcomes is needed. METHODS: A cross-sectional analysis was conducted. Ninety five patients with CSM were entered into the study and completed the CNFDS and the mJOA preoperatively and postoperatively. Correlation between the CNFDS and the mJOA was evaluated preoperatively and at the end of follow-up. Responsiveness to change of CNFDS and mJOA was also assessed. Clinical outcomes were also measured with the recovery rate of mJOA score at end of follow-up. RESULTS: The mean age of patients was 58.2 (standard deviation, SD=8.7) years. Mean follow-up was 2.1 years (range, 1 to 4 years). The mJOA correlated strongly with the CNFDS score preoperatively and postoperatively (r=-0.81 and -0.82, respectively; p<0.001). The CNFDS and the mJOA were able to detect changes after the surgery (p<0.001). The mean mJOA recovery rate was 51.8% (SD=13.1%). CONCLUSIONS: Surgery for the treatment of patients with CSM is an efficacious procedure. CNFDS and mJOA scores have a strong correlation in measuring disability among CSM patients.

Outcome Measures of Functionality, Social Interaction, and Pain in Patients with Cervical Spondylotic Myelopathy: A Validation Study for the Iranian Version of the Copenhagen Neck Functional Disability Scale

STUDY DESIGN: Cross-sectional. PURPOSE: To translate and validate the Iranian version of the Copenhagen Neck Functional Disability Scale (CNFDS). OVERVIEW OF LITERATURE: Instruments measuring patient-reported outcomes should satisfy certain psychometric properties. METHODS: Ninety-three cases of cervical spondylotic myelopathy were entered into the study and completed the CNFDS pre and postoperatively at the 6 month follow-up. The modified Japanese Orthopedic Association Score was also completed. The internal consistency, test-retest, convergent validity, construct validity (item scale correlation), and responsiveness to change were assessed. RESULTS: Mean age of the patients was 54.3 years (standard deviation, 8.9). The Cronbach alpha coefficient was satisfactory (alpha=0.84). Test-retest reliability as assessed by the intraclass correlation coefficient analysis was 0.95 (95% confidence interval, 0.92-0.98). The modified Japanese Orthopedic Association score correlated strongly with the CNFDS score, lending support to its good convergent validity (r=-0.80; p<0.001). Additionally, the correlation of each item with its hypothesized domain on the CNFDS was acceptable, suggesting that the items had a substantial relationship with their own domains. These results also indicate that the instrument was responsive to change (p<0.0001). CONCLUSIONS: The findings suggest that the Iranian version of the CNFDS is a valid measure to assess functionality, social interaction, and pain among patients with cervical spondylotic myelopathy.

Validation of the Korean Version of the Neck Pain and Disability Scale

STUDY DESIGN: A prospective study. PURPOSE: To evaluate the reliability and validity of the adapted Korean version of the Neck Pain and Disability Scale (NPDS). OVERVIEW OF LITERATURE: The validity of Korean version of NPDS has not been completely demonstrated yet. METHODS: Translation/retranslation of the English version of NPDS was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the visual analog scale (VAS) measure of pain, NPDS and the previously validated Short Form-36 (SF-36) were mailed to 91 patients, who had been surgically treated for degenerative cervical disease. Eighty-one patients responded to the first mailing of questionnaires and 69 of the first time responder returned their second survey. Factor analysis and reliability assessment by kappa statistics of agreement for each item, the intraclass correlation coefficient and Cronbach's alpha were conducted. Concurrent and construct validity were also evaluated by comparing the responses of NPDS with the results of VAS and responses of SF-36. RESULTS: Factor analysis extracted 3 factors. All items had a kappa statistics of agreement greater than 0.6. The NPDS showed excellent test/re-test reliability. Internal consistency of Cronbach's alpha was found to be very good. The NPDS was correlated with the VAS. The Korean version of NPDS showed good significant correlation with SF-36 total score and with single SF-36 domains scores. CONCLUSIONS: The adapted Korean version of the NPDS was successfully translated and is considered suitable for outcome assessments in the Korean-speaking patients with neck pain.

Translation, cultural adaptation and reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil

OBJECTIVE: To translate, to perform a cultural adaptation of and to test the reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil. METHODS: First, the Cochin Hand Functional Scale questionnaire was translated into Portuguese and was then back-translated into French. These translations were reviewed by a committee to establish a Brazilian version of the questionnaire to be tested. The validity and reproducibility of the Cochin Hand Functional Scale questionnaire was evaluated. Patients of both sexes, who were aged 18 to 60 years and presented with rheumatoid arthritis affecting their hands, were interviewed. The patients were initially interviewed by two observers and were later interviewed by a single rater. First, the Visual Analogue Scale for hand pain, the Arm, Shoulder and Hand Disability questionnaire and the Health Assessment Questionnaire were administered. The third administration of the Cochin Hand Functional Scale was performed fifteen days after the first administration. Ninety patients were assessed in the present study. RESULTS: Two questions were modified as a result of the assessment of cultural equivalence. The Cronbach's alpha value for this assessment was 0.93. The intraclass intraobserver and interobserver correlation coefficients were 0.76 and 0.96, respectively. The Spearman's coefficient indicated that there was a low level of correlation between the Cochin Hand Functional Scale and the Visual Analogue Scale for pain (0.46) and that there was a moderate level of correlation of the Cochin Scale with the Health Assessment Questionnaire (0.66) and with the Disability of the Arm, Shoulder and Hand questionnaire (0.63). The average administration time for the Cochin Scale was three minutes. CONCLUSION: The Brazilian version of the Cochin Hand Functional Scale was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity.

Can Early Ischemic Lesion Recurrence on Diffusion-Weighted MRI Affect Functional Outcome after Acute Ischemic Stroke?

BACKGROUND AND PURPOSE: Ischemic lesion recurrence on diffusion-weighted imaging (DWI-LR) is a frequently observed phenomenon after acute ischemic stroke. However, no study has elucidated the impact of DWI-LR on functional outcome. METHODS: Among a consecutive series of patients who presented with focal symptoms or signs compatible with stroke within 48 hours from the onset over a 50-month period, those who had relevant ischemic lesions on initial DWI and underwent follow-up DWI within 14 days after the onset were enrolled in this study. As outcome variables, the scores on the modified Rankin Disability Scale (mRDS) at 3 months and 1 year were measured prospectively and dichotomized into good (0-2) vs. poor (3-6). When calculating odds ratios (ORs), adjustment was performed for age, previous stroke, initial score on the NIH Stroke Scale, stroke subtype, and IV thrombolysis. RESULTS: Among those 786 patients finally enrolled in this study, 221 (28.1%) had DWI-LR. For a poor outcome at 3 months, the crude ORs of any, symptomatic, and asymptomatic DWI-LR were 2.70 [95% confidence interval (CI), 1.96 to 3.72], 10.03 (95% CI, 4.39 to 22.96), and 2.04 (95% CI, 1.44 to 2.88), respectively. With adjustment, the OR of symptomatic DWI-LR was 6.44 (95% CI, 2.50 to 16.57), whereas those of any and asymptomatic DWI-LR lost their statistical significance: 1.44 (95% CI, 0.94 to 2.20) and 1.04 (95% CI, 0.65 to 1.65), respectively. Analyzing with the 1-year outcome produced similar results. CONCLUSIONS: This study shows that symptomatic early lesion recurrence can affect functional outcome after acute ischemic stroke, whereas an asymptomatic one may not.

Validation of the brazilian version of Guy's neurological disability scale

The Guy's neurological disability scale (GNDS) has recently been introduced as a new measure of disability in multiple sclerosis. It is patient-oriented, multidimensional, and not biased towards any particular disability. The purpose of the present study was to validate the Brazilian version of the GNDS. The adaptation of the scale was based on the translation/back-translation methodology. Sixty-two patients with clinically definite multiple sclerosis (CDMS) according to Poser's criteria were recruited for this study. GNDS was administered individually to each subject. The EDSS and the ambulation index (AI) scores were assigned by a neurologist. The intraclass correlation coefficient and the Cronbach's alpha values of the Brazilian version of GNDS (0.94 and 0.83, respectively) were comparable to the original one (0.98 and 0.79, respectively). Furthermore, the factor analysis of the Brazilian version of GNDS suggested, as the original article, a four-factor solution which accounted for 68.8 percent of the total variance. The Brazilian version of GNDS was found to be clinically relevant as it correlated significantly with the EDSS and AI. In conclusion, the Brazilian version of GNDS can be considered an important tool to evaluate the disability in MS patients, with clinical usefulness and psychometrics soundness.

A Guy's neurological disability scale (GNDS) é uma escala de incapacidade criada recentemente, orientada para o paciente, multidimensional, e que não privilegia nenhum tipo específico de incapacidade. O objetivo deste estudo é validar a GNDS para a língua portuguesa. A adaptação da escala foi feita através do método de tradução e re-tradução. Sessenta e dois pacientes com esclerose múltipla (EM) clinicamente definida de acordo com os critérios de Poser participaram deste estudo. A GNDS foi aplicada individualmente em cada paciente. O EDSS e o índice ambulatorial (IA) foram determinados por neurologista. A correlação intra-classe e o valor de Cronbach's alfa da versão brasileira da GNDS (0.94 e 0.83, respectivamente) foram comparáveis aos do artigo original (0.98 e 0.79, respectivamente). Como no artigo original, a análise fatorial da versão brasileira da GNDS sugeriu uma solução de quatro fatores que explicaria 68.8 por cento da variação total. A versão brasileira da GNDS mostrou-se clinicamente relevante uma vez que se correlacionou com o EDSS e o IA. Em conclusão, a versão brasileira da GNDS pode ser considerada como um importante instrumento de avaliação incapacidade na EM com significado clínico e relevância psicométrica.

Disability Scale for Patients with Spinal Cord Injury: Spinal Cord Independence Measure

OBJECTIVE: The objectives of this study were to evaluate the reliability of the Korean version of Spinal Cord Independence Measure (SCIM) and to compare the sensitivity of the SCIM to functional changes of spinal cord injury (SCI) patients with that of the Functional Independence Measure (FIM). METHOD: Seventeen subjects with SCI were studied. The SCIM was translated and modified to convert as SCIM Korean-version. All patients were evaluated with the SCIM and the FIM by two raters every other week. To determine inter-rater reliability, the relationship between the SCIM scores obtained by two raters was evaluated by Kappa coefficient and linear regression. To determine relative sensitivity of the test to functional changes, changes in the scores on the SCIM and FIM were compared by McNemar test. RESULTS: The Kappa coefficient of the various individual tasks in SCIM ranged between 0.63 and 1.00. High correlations were also found between the total SCIM scores for the paired raters (r=0.99, p<0.01). The SCIM detected all the functional changes detected by FIM total scoring, but in 3 (14%) of 22 sequential test batteries, the FIM missed changes detected by SCIM total scoring. CONCLUSION: These results demonstrated that the SCIM is reliable and more sensitive than the FIM in reflecting the functional changes of SCI patients.