A comparison study of cognitive impairment screening tools: CDT, IQCODE VS MMSE.

Objective: To compare the Clock Drawing Test (CDT), and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Mini Mental State Examination (MMSE) in dementia patients. Methods: The prospective study was carried out in Srithanya hospital from April 2005 to July 2006. There were 106 patients interviewed by one psychiatric nurse. CDT developed by Royall et al (CLOX1) was selected in this study. The Thai version of MMSE was MMSE-Thai 2002. IQCODE was a 1-5 rating scale on 16 items. Pearson’s correlation and cut- off point were analyzed. Results: The age range was 53-85 years and the average age was 67.43 ± 8.2 years. Females were 60.4%. Most had a primary level of education (38.6%). There were 27 demented, 11 physical illness, 8 depression and Parkinson and 60 normal elderly cases. Means of MMSE, CLOX1 and IQCODE were 24.70 ± 4.85, 9.59 ± 4.01, 3.34 ± 0.44 respectively. Both questionnaires were significantly correlated with MMSE. The optimal cut-off point (sensitivity, specificity) of CLOX1 and IQCODE for dementia were < 8 ( 79.7, 85.2%) and ≥ 3.25 (83.5, 81.5%) respectively. Conclusion: These instruments could be used for screening cognitive impairment in clinical practice. Each tool had a different superior aspect regarding context.

Chrono impact versus enteric coated valproate in Thai epileptic patients.

BACKGROUND: Since its first clinical use more than 30 years ago, Valproic acid is still being widely prescribed It has been available in Thailand for more than 20 years. Sodium valproate slow-released (SVSR) form has been used in clinical practice in Thailand since 1990. The objectives of this open study were to access the compliance and satisfaction consequences in the epileptic patients. MATERIAL AND METHOD: In this prospective, multi-center study, the authors compared the compliance and satisfaction consequences in epileptic patients switched from more than two times daily sodium valproate enteric-coated tablet (SVEC) regimen to the same total daily dose of SVSR form given once or twice daily. RESULTS: Eighty-nine of the 100 patients completed the study. 43.8% were male (39 of 89 patients). Mean age was 34.74 +/- 12.67 years. Most common etiology of epilepsy was idiopathic 40.4%. Patients were very/fairly happy with the SVSR form 94.4% compared to the SVEC form 56.2% (p = 0.000). Patients had been experiencing no problem with the SVSR form 67.4% compared to SVEC form 38.2% (p = 0.000) and also never missing taking SVSR. form 77.5% compared to SVEC form 40.4% (p = 0.000). According to convenience, patients preferred to administer SVSR form once a day 92.1% and never over taking dosed the antiepileptic drug 96.6%. SVSR form had fewer side effects than the enteric-coated form interms of memory problem (40.4% vs 48.3%) (p = 0.000), sleepiness (30.3% vs 42.7%) (p = 0.041) and difficulty in thinking clearly (38.2% vs 44.9%) (p = 0.001). The patients were seizure free during the study period comparing SVSR form 76.4% to SVEC form 65.2% (p = 0.011). CONCLUSION: Patients preferred once daily regime. Switching from SVEC to SVSR form increased seizure free, reduced side effects, improved patient's compliance and satisfaction.

Knowledge and attitude towards epilepsy in Thai district physicians.

This study was done in order to survey the knowledge and attitude towards uncomplicated epilepsy of district physicians who participated in an intensive short course on epilepsy held by the Ministry of Public Health from December 2001 to March 2002. A questionnaire was developed by the author and adapted from Davies and Schambler’s study that was designed to collect demographic data and information on general knowledge of epilepsy and the physician’s role and attitude towards epilepsy. There were 30 items in the questionnaire relating to attitude, i.e. personality, emotion, job opportunity and family life of epileptic people. The 1-7 Likert scale was applied. 230 completed copies were analyzed by frequency and percentage. Demographic data indicated that the participants were from the following parts of the country: North, 43 participants (18.9%); Northeast, 97 participants (42.1%); South, 42 participants (18.5%); Central and East, 48 [participants (20.6%). The mean age was 31.40 + 8.26 years. 81.7% had never attended a course on epilepsy. 70% gained experience in epilepsy from medical school. 33.5% thought that knowledge gained from medical school was sufficient for caring of uncomplicated epileptic cases. 57.9% felt confident caring for epileptics. 98% did not have enough knowledge on new anti-epileptic drugs. 60% considered conventional anti-epileptic drugs’ efficacy in generalized tonic-clonic seizure different. 99.1% agreed that guidelines for care of epileptic patients were beneficial. 75% thought that general practitioners (GPs) should pay a role in counseling. Most had a positive view on epileptic peoples. 58.2% felt that epileptic were affected by a public stigma because of their disease. In conclusion, the attitude of district physicians was positive. Continuing medical education for GPs should be further developed and the curriculum for medical student should be revised.