Determinants of Perceived Physical Environment Barriers among Community-Dwelling Elderly in Taiwan.

OBJECTIVES: To test the hypothesis that mobility, activities of daily living, and the interaction between them can play a key role in determining perceived physical environment barriers among community-dwelling elderly. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: One hundred and ninety-seven community-dwelling elderly with more than 7 points on the Short Portable Mental State Questionnaire and less than 7 points on the Geriatric Depression Scale (15 items). INTERVENTION: None. MEASUREMENTS: Time Get-up and Go test (TUG), the subscales of basic activity of daily living (BADL)/instrumental activities of daily living (IADL) of the Hierarchy of Care Required (HCR), and the physical/structural subscale of the Craig Hospital Inventory of Environmental Factors in Community-dwelling Elderly in Taiwan were used to measure mobility, activities of daily living and perceived physical environment barriers, respectively. Hierarchical linear regression analyses were used to test the study hypothesis. RESULTS: Significant and positive relations were found to exist between perceived physical environment barriers and (1) the TUG time (ß=.300, p<.05), and (2) the IADL score for the HCR (ß=.322, p<.05), respectively. A significant and negative relation existed between perceived physical environment barriers and the interaction term (the TUG time and the IADL score for the HCR) (ß=-.211, p<.05). CONCLUSION: Mobility, IADL and the interaction between them are found to be significant determinants of perceived physical environment barriers in the community-dwelling elderly under consideration. Strategies targeting the enhancement of mobility among community-dwelling elderly are suggested to lead to improvements in the degree to which physical environment barriers are perceived. This beneficial effect could be greater in the case of elderly individuals with better IADL function.

Working memory of school-aged children with a history of febrile convulsions: a population study.

OBJECTIVE: A prospective, population-based, case-control study was performed to ascertain whether febrile convulsion (FC) in early childhood is associated with specific working memory characteristics in school age. METHODS: From a population survey of 4,340 live-birth newborns in Tainan City, Taiwan, 103 children with confirmed FC by age 3 years were followed-up until they were at least 6 years old. Three analogous searching tasks dissociating the mnemonic and executive aspects of performances were administered to 87 of these school-aged children and to 87 randomly selected age-matched control subjects to assess the learning, spatial, and sequential working memory. RESULTS: The FC group performed significantly and consistently better than control subjects on all but one working memory measure, jumping errors. Multivariate analysis using linear regression revealed that the onset of FC before age 1 year was the only significant risk factor for deficits in mnemonic function. Prior neurodevelopmental delay was the only significant risk factor for deficits in executive function. Factors such as socioeconomic status, family predisposition for seizures, complex FC, recurrent FC, and subsequent unprovoked seizures were not risk factors for working memory deficits. CONCLUSION: The authors found that school-aged children with a history of FC demonstrated significantly better mnemonic capacity, more flexible mental processing, and higher impulsivity than their age-matched control subjects. The underlying mechanism for the facilitated working memory function in children with a history of FC needs further delineation.

Effect of prenatal exposure to polychlorinated biphenyls on cognitive development in children: a longitudinal study in Taiwan.

BACKGROUND: From 1978 to 1979, a group of people in Taiwan were exposed to high levels of heat-degraded polychlorinated biphenyls (PCBs) owing to accidental ingestion of contaminated rice oil. Children born to mothers following the exposure ('Yucheng' children) were known to have hyperpigmented skin and other dysmorphology after birth. AIMS: To determine the effect of prenatal exposure to PCBs on cognitive development in Yucheng children. METHOD: One hundred and eighteen Yucheng children prenatally exposed to PCBs and degradation products, and community-matched control children who were exposed to background levels only, were followed from 1985 to 1998. The Bayley Scale for Infant Development, Chinese version of the Stanford-Binet IQ Test, Raven's Coloured Progressive Matrices and Raven's Standardised Progressive Matrices were used to assess the cognitive development of these children. RESULTS: The Yucheng children scored lower than control children on each of these methods of measurement between the ages of 2 and 12 years. CONCLUSIONS: Prenatal exposure to PCBs and their derivatives has long-term adverse effects on cognitive development in humans.

Neurocognitive attention and behavior outcome of school-age children with a history of febrile convulsions: a population study.

PURPOSE: A prospective population-based case-control study was performed to ascertain whether febrile convulsion (FC) in early childhood is associated with neurocognitive attention deficits in school age. METHODS: A total of 103 children, confirmed to have FC by age 3 years from a population survey of 4,340 live-birth newborns in Tainan City, Taiwan, was followed up until at least age 6 years. An achievement test, behavioral ratings, and computerized neurocognitive battery assessing various subcomponents of attention were given to 87 FC children (FC group) and 87 randomly selected population-matched control (CC group). RESULTS: Compared with the CC group, the FC group did not have scholastic performance or behavioral outcome disadvantage. Overall FC group performance was distinguished by significantly higher scores in the achievement test and fewer missing errors (p < 0.005) and commission errors (p < 0. 05), less variability in reaction time (p < 0.005), and a nonsignificant trend of impulsivity. Attention performance of the FC and CC groups were comparable. Within the FC group, age at onset, complex FC, recurrence of FC, development of unprovoked seizures, or prior use of phenobarbital had no adverse effects on neurocognitive attention outcome. CONCLUSIONS: This population study suggests that FC in early childhood does not have adverse effects on behavior, scholastic performance, and neurocognitive attention. On the contrary, the FC group demonstrated significantly better control of distractibility and attention at school age.

[Applicability of the screening test for the Luria-Nebraska Neuropsychological Battery in Taiwan].

The study was to examine the applicability of the screening test for the Luria-Nebraska Neuropsychological Battery in Taiwan. This screening test contains 15 items. It could be used at the first stage of neuropsychological assessment process and served as a screening tool for brain-damaged patients. In this study, 50 brain-damaged patients, 50 normal controls receiving physical examination, and 100 normal controls from local communities were sampled and administered with the screening test. Based on test results, item analysis and factor analysis were performed, reliability and validity data were established, and temporary local norm and subgroup norm were also developed. It also investigated the effects of age and educational level on test performance. Further factor analysis with total subjects showed that three factors were extracted. Factor 1 was number concept and simple calculation. Factor 2 was higher cortical function. Factor 3 was motor control and rhythm. These three factors accounted for sixty percent of total variance. In addition, cut-off scores were set for low and high education groups.

Prevalence and subtypes of dementia in Taiwan: a community survey of 5297 individuals.

OBJECTIVE: To study the prevalence rate of dementia in Taiwan, the relative frequencies of its subtypes, and its associations with age, education, gender, and residence location. PARTICIPANTS: A total of 2753 men and 2544 women from four urban and four rural communities participated. Their age ranged from 41 to 88 years; 28% of them were at least 65 years old. Their education ranged from 0 to 20 years; 27% of them had less than 1 year of formal schooling. DESIGN: Phase I was a screening survey by trained nurses who administered a Chinese version of the Mini-Mental State Examination, the MMSE-T1, to all participants. Phase II involved the assessment for dementia by neurologists on the 1521 individuals who had scored less than 24 on the 30-point MMSE-T1. MAIN RESULTS: Thirty-one cases of dementia were identified by the DSM-III-R criteria, including 18 cases of Alzheimer's disease, 10 cases of vascular dementia, and three cases of other dementias. The prevalence rate in individuals aged 65 and over was 2.0%. Aging and illiteracy were associated with higher rates of dementia; gender and residence location made no difference. CONCLUSIONS: The prevalence rate of dementia was low in this Chinese population. Consistent with common findings from other parts of the world, a high rate of dementia was associated with older age and illiteracy, and Alzheimer's disease was the most frequent cause.

Performance on a dementia screening test in relation to demographic variables. Study of 5297 community residents in Taiwan.

OBJECTIVE: To examine the relation between performance on a dementia screening test and the demographic variables of age, education, gender, and urban vs rural residency. DESIGN: Community survey with cluster sampling. SETTING: One urban and one rural community from each of four geographic regions in Taiwan, Republic of China. PARTICIPANTS: A total of 5265 nondemented individuals approximately equally divided between men and women and between urban and rural residency with a range in age from 41 to 88 years and in education from 0 to 20 years. MAIN OUTCOME MEASURE: Score on a Chinese adaptation of the Mini-Mental State Examination. RESULTS: Lower test scores were associated with older age and less education. The decrease in score with age was faster among participants who had never attended school. Better performance by men and by urban residents was found only among participants with fewer than 6 years of schooling. In this group, the magnitudes of sex and residency differences were comparable among those subjects aged 41 to 64 years and those aged 65 to 88 years. Women who had never worked outside of the home performed poorer than those who had worked outside of the home. CONCLUSIONS: The influence of educational background on test performance is most evident in individuals with less education. Commonly used dementia screening tests may be unfair to poorly educated individuals, especially women and rural residents. Efforts should be made to develop ecologically relevant cognitive tests for the intended study populations. To help distinguish test bias from different rates of cognitive decline, the study populations should include individuals in predementia age ranges.

[The performances of attention deficit/hyperactivity disorder on neuropsychological tests of children].

The purpose of this study was to investigate the Attention Deficit/Hyperactivity Disorder (ADHD) by neuropsychological tests of children. There were two groups of subjects; one group was 23 ADHD children, the other group was 33 normal children. All of the subjects were 5 to 8 years old (mean = 7.05). The social economic status differences were nonsignificant between the two groups (chi-square = 0.52, p > 0.05). The instruments were WISC-R, Tests of Psycholinguistic Abilities, Diagnostic Arithmetic Test, and Reitan-Indiana Neuropsychological test for yound children. The findings were: (1) For all IQs (verbal, performance, full), the ADHD group was significantly lower than the normal group, and there were 8 (34.8%) ADHD children who were mental retards, 3 (13.0%) ADHD children were borderline mental retards, and there was just one (3.0%) normal child who was a borderline mental retard. (2) For academic abilities (Tests of Psycholinguistic Abilities, and Diagnostic Arithmetic Tests), the ADHD group was significantly (p < 0.05) lower than the normal group, and the higher the grade, the larger the difference. (3) For neuropsychological tests, if cut-off points of performance level (0, 1, 2, 3) were percentile 5, 10, and 25 for all of the subjects, then there 12 variable criteria were lower than the Reitan's, 3 variable criteria were higher than the Reitan's, 29 variable criteria were similar with Reitan's, and 8 variables were indiscriminate between individuals. (4) The motor functions and higher cognitive abilities of the ADHD group were worse than those of the normal group.

Relationship between periventricular lucencies on computed tomographic scans and vascular dementia.

We evaluated 48 consecutive patients with periventricular lucencies (PVL) on CT scan of brain to determine the clinical significance of this finding. Twenty-one (43.7%) patients were demented; 27 (56.3%) patients had no dementia but had various other diseases. PVL were frequently associated with hypertension and previous stroke. We used a PVL scoring system to evaluate the degree of PVL. When the score was greater than 3.5, the sensitivity and specificity in separating vascular dementia from other diseases with PVL were 78% and 67% respectively (Kappa = 0.42). We conclude that although mild PVL may be a frequent but non-specific finding in patients with hypertension or previous stroke, moderate and severe PVL should raise the possibility of vascular dementia.

[Factors affecting stroke patients' motivations for rehabilitation].

Factors correlated to the motivation for rehabilitation in stroke patients were studied. Thirty patients who had had only one stroke were recruited between December 1991 and April 1992 for our study. Several assessment tools including the Motivational scale, the Health Locus of Control scale and a questionnaire were used. According to the results of the assessment, the stroke patients' motivation remained stable when assessed two to three times during the hospital stay, whereas their UE/LE Brunnstrom stage scores and activities of daily living skill (ADL) improved significantly. The motivation of the patients was closely correlated with the degree of education, the internal scores and ADL performance: patients with education level higher than primary school, higher internal scores, or better ADL performance had stronger motivation for rehabilitation. On the other hand, motivational assessments between the nursing staff and the therapists were not completely in agreement. The ADL performance was better correlated with the degree of motivation on the nursing assessment, whereas the Brunnstrom stage scores of UE/LE were more closely correlated with the therapists' assessment. Items on the motivational questionnaire such as "eagerness to recover earlier", "recognition of the effectiveness of rehabilitation", "support of spouse" and "homesickness" were commonly considered to be positive factors. However, the other factors such as "being in bad mood", "lack of family cooperation", "worrying about things other than finances" and "lack of family support" were commonly considered to be negative factors on motivation. In the comparison between high and low motivation groups, the high motivation group payed more attention to the positive factors such as "eagerness to be independent" and such negative factors as "lack of understanding of illness" as well as "poor appetite and fatigue". The low motivation group was considered to be more affected by such negative factors as "worrying about things other than finances", "not good enough facilities" and "homesickness" which resulted in lessening the motivation for rehabilitation.

Evaluation of 110 consecutive patients with dementias: a prospective study.

We prospectively investigated 131 consecutive cases (both in- and outpatients) of suspected dementia to evaluate the relative frequency of different types of dementia in Chinese patients. Dementia was confirmed in 110 cases (84.0%). In contrast to the Western series, vascular dementia (39.1%) was slightly more frequent than the Alzheimer's disease (36.4%). Twelve cases (10.9%) of potentially treatable dementia were found. Careful clinical observation was the most useful part of the evaluation. CT scan of brain was the most useful laboratory test.

Outcome for very low birth-weight infants.

A total of 69 very low birth weight (VLBW = birth weight less than or equal to 1500gm) infants, born at Veterans General Hospital from January 1, 1984 until December 31, 1986, were studied, excluding 4 patients who were discharged before the condition was stabilized and were also lost to follow-up. The incidence of VLBW infants was 7.5 per thousand of 9214 total live birth deliveries; male to female ratio was 34:39. The hospital mortality rate for babies with birth weight less than 1001gm was 65%; for those with birth weight 1001-1500gm was 30.6%; the total mortality at hospital discharge was 40.6%. The corrected ages at final follow-up assessment ranged from eight months to four years. Among the 41 survivors one case was lost to follow-up. Of the remaining 40 cases, 5 cases had major handicap which was manifested with either severe debilitating morbidity or marked developmental delay; the incidence was 12.5%. One of them died at the postnatal age of 18 months due to ventriculo-peritoneal shunt (V-P shunt) obstruction. Six cases (15.0%) had moderate handicap; the remaining 29 cases (72.5%) were considered to be normal or to suffer from transient, mild, resolvable problems. Cases with mortality or major handicap were categorized into "worse" group, otherwise they belonged to the "better" group. Stepwise multiple discriminant function analysis showed that four factors could correctly classify the outcome in 85.1% of infants: pulmonary hemorrhage was the most important factor followed by birth weight, intraventricular hemorrhage, and maternal antepartum hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)