Effect of an Anti-Stigma Program on Self-Stigma for Chinese Individuals With Schizophrenia: A Pilot Study With a Quasi-Experimental Design.

The current study explored the effectiveness of an anti-stigma group program for people with schizophrenia. Thirty-four participants recruited from a psychiatric day hospital were allocated to the experimental group (EG) or control group (CG). The Internalized Stigma of Mental Illness Scale (ISMIS), Perceived Psychiatric Stigma Scale (PPSS), and Beck Depression Inventory-II (BDI-II) were used to measure outcomes, which were evaluated at baseline, immediately post program, and 3-month follow up. Generalized estimating equations showed that the EG attained a greater reduction in the stigma resistance subscale of the ISMIS than the CG at posttest and 3-month follow up. Scores on the self-deprecation subscales (p = 0.025) and concerns about marital preclusion (p = 0.037) on the PPSS and BDI-II (p = 0.027) in the EG showed significant improvement over those of the CG at 3-month follow up. The anti-stigma group program seems to be effective in reducing self-stigma and depressive symptoms in people with schizophrenia. [Journal of Psychosocial Nursing and Mental Health Services, 62(2), 37-45.].

The role of vocabulary and grammar in the listening text comprehension of school-age Cantonese-speaking children with developmental language disorder.

The current study examined the role of vocabulary and grammar in the listening comprehension of school-age Cantonese-speaking children with developmental language disorder in Hong Kong. Participants were 692 typically developing children (TD) and 53 children with developmental language disorder (DLD) and they were tested with a standardized test of oral Cantonese, which includes measures on listening comprehension, receptive and expressive grammar, expressive vocabulary, word definition and lexical relations. The results from multiple regression analysis revealed that listening comprehension of the TD group was explained by receptive grammar, expressive vocabulary, and lexical relationships. However, children of the DLD group mainly relied on a subset of their vocabulary knowledge, as measured in a lexical relation task on antonym, in understanding the text under the constraint of a limited grammatical knowledge.

Epigenetic regulator RNF20 underlies temporal hierarchy of gene expression to regulate postnatal cardiomyocyte polarization.

Differentiated cardiomyocytes (CMs) must undergo diverse morphological and functional changes during postnatal development. However, the mechanisms underlying initiation and coordination of these changes remain unclear. Here, we delineate an integrated, time-ordered transcriptional network that begins with expression of genes for cell-cell connections and leads to a sequence of structural, cell-cycle, functional, and metabolic transitions in mouse postnatal hearts. Depletion of histone H2B ubiquitin ligase RNF20 disrupts this gene network and impairs CM polarization. Subsequently, assay for transposase-accessible chromatin using sequencing (ATAC-seq) analysis confirmed that RNF20 contributes to chromatin accessibility in this context. As such, RNF20 is likely to facilitate binding of transcription factors at the promoters of genes involved in cell-cell connections and actin organization, which are crucial for CM polarization and functional integration. These results suggest that CM polarization is one of the earliest events during postnatal heart development and provide insights into how RNF20 regulates CM polarity and the postnatal gene program.

The impact of the COVID-19 pandemic on emergency care of acute myocardial infarction: findings from the Taiwan Clinical Performance Indicator.

Acute myocardial infarction (AMI) treatment requires timely diagnosis and treatment for optimal health outcomes. The Coronavirus Disease (COVID-19) pandemic has caused changes in health-care delivery and utilization; therefore, the present study explored the changes in emergency care quality indicators for patients with AMI before and during different periods of government response to the COVID-19 outbreak in Taiwan. The Taiwan Clinical Performance Indicators database was used to evaluate the impact of COVID-19 on acute care quality indicators for patients with AMI during four periods: before the COVID-19 outbreak (Period I-1 January to 31 December 2019) and during three periods in which the central government imposed different levels of epidemic prevention and response alerts (Period II-1 January 2020 to 30 April 2021; Period III-1 May to 31 July 2021; and Period IV-1 August to 31 December 2021). A 15.9% decrease in monthly emergency department admission for patients with AMI occurred during Period III. The hospital 'door-to-electrocardiogram time being <10 min' indicator attainment was significantly lower during Periods III and IV. The attainment of 'dual antiplatelet therapy received within 6 hr of emergency department arrival' indicator improved in Period IV, whereas 'the primary percutaneous coronary intervention being received within 90 min of hospital arrival' indicator significantly decreased during Periods III and IV. The indicator 'in-hospital mortality' was unchanged within the study duration. Overall, the quality of care for patients with AMI was mildly influenced during the assessed pandemic periods, especially in terms of door-to-electrocardiogram time of <10 min and primary percutaneous coronary intervention received within 90 min of hospital arrival (Period III). Using our study results, hospitals can develop strategies regarding care delivery for patients with AMI during a COVID-19 outbreak on the basis of central government alert levels, even during the height of the pandemic.

Modeling Rapid Guessing Behaviors in Computer-Based Testlet Items.

In traditional test models, test items are independent, and test-takers slowly and thoughtfully respond to each test item. However, some test items have a common stimulus (dependent test items in a testlet), and sometimes test-takers lack motivation, knowledge, or time (speededness), so they perform rapid guessing (RG). Ignoring the dependence in responses to testlet items can negatively bias standard errors of measurement, and ignoring RG by fitting a simpler item response theory (IRT) model can bias the results. Because computer-based testing captures response times on testlet responses, we propose a mixture testlet IRT model with item responses and response time to model RG behaviors in computer-based testlet items. Two simulation studies with Markov chain Monte Carlo estimation using the JAGS program showed (a) good recovery of the item and person parameters in this new model and (b) the harmful consequences of ignoring RG (biased parameter estimates: overestimated item difficulties, underestimated time intensities, underestimated respondent latent speed parameters, and overestimated precision of respondent latent estimates). The application of IRT models with and without RG to data from a computer-based language test showed parameter differences resembling those in the simulations.

Assessing Emotions of Teaching Assistants in Inclusive Education.

Although there are an increasing number of studies on assessing teacher emotions in mainstream education, there is a lack of appropriate measurement tools to evaluate the emotions of teaching assistants (TAs) who need to take care of students with a range of special educational needs (SEN). This study tested the generalizability of the 24-item teacher emotion inventory (TEI), among 204 TAs from 122 secondary schools with inclusive education in Hong Kong. We conducted both confirmatory factor analysis (CFA) and Rasch analysis to test the within-network validity of the TEI. For the between-network validity, we examined the relationships between TAs' emotions and their attitude toward inclusive education. The Rasch analysis supported the scale's dimensionality and item fit statistics. The CFA supported the five-factor solution of the TEI. The results also showed statistically significant correlations between positive emotions (joy and love) and TAs' attitudes toward inclusive education. TAs' negative emotions (anxiety, anger, and stress) appeared to be negatively correlated with their attitude toward inclusive education. The results supported that TEI is a useful tool to assess the emotions of TAs that play a pivotal role in assisting both school teachers and SEN students, who are more likely to face increased emotional challenges than those not needing to educate SEN students. Implications of this study to enrich the current scope of research on understanding teacher emotions across educational levels and settings are discussed.

Reducing the Misclassification Costs of Cognitive Diagnosis Computerized Adaptive Testing: Item Selection With Minimum Expected Risk.

Cognitive diagnosis computerized adaptive testing (CD-CAT) aims to identify each examinee's strengths and weaknesses on latent attributes for appropriate classification into an attribute profile. As the cost of a CD-CAT misclassification differs across user needs (e.g., remedial program vs. scholarship eligibilities), item selection can incorporate such costs to improve measurement efficiency. This study proposes such a method, minimum expected risk (MER), based on Bayesian decision theory. According to simulations, using MER to identify examinees with no mastery (MER-U0) or full mastery (MER-U1) showed greater classification accuracy and efficiency than other methods for these attribute profiles, especially for shorter tests or low quality item banks. For other attribute profiles, regardless of item quality or termination criterion, MER methods, modified posterior-weighted Kullback-Leibler information (MPWKL), posterior-weighted CDM discrimination index (PWCDI), and Shannon entropy (SHE) performed similarly and outperformed posterior-weighted attribute-level CDM discrimination index (PWACDI) in classification accuracy and test efficiency, especially on short tests. MER with a zero-one loss function, MER-U0, MER-U1, and PWACDI utilized item banks more effectively than the other methods. Overall, these results show the feasibility of using MER in CD-CAT to increase the accuracy for specific attribute profiles to address different user needs.

Evaluation of skeletal and dentoalveolar changes in class II division I pediatric patients receiving myofunctional appliance therapy: A preliminary study.

BACKGROUND/PURPOSE: The treatment effect of myofunctional appliance therapy has remained debated. The aim of this study was to evaluate the skeletal and dentoalveolar effects in class II division I pediatric patients receiving Education Fonctionnelle (EF) myofunctional appliance therapy. METHODS: Thirteen patients undergoing EF appliance treatment (9 boys and 4 girls；average 9.3years old) met the inclusion criteria and 13 untreated patients (9 boys and 4 girls；average 9.9 years old) served as controls. Initial and one-year follow-up lateral cephalometric measurement was used to assess skeletal and dentoalveolar changes. Gender ratio was analyzed using Chi-square test. Age and cephalometric measurement changes within and between the two groups were analyzed using Mann-Whitney U test and Wilcoxon signed rank test and Benjamini - Hochberg procedure. RESULTS: There were no significant differences in age, gender ratio, and initial cephalometric measurement data between the two groups. One-year follow-up skeletal findings revealed no significant differences between the two groups. Regarding the dentoalveolar changes, only the values of the upper incisor angle related parameters revealed significances between the two group (with adjusted p value). CONCLUSION: In this preliminary small sample size study, the EF group demonstrated significant upper incisor angle decrease, lower incisor angle increase, and lower incisor tip to mandibular plane distance decrease in comparison to the values measured in the control group. However, only the upper incisor angle changes were statistically significant after p-value adjustment. The skeletal effect of the EF appliance could not be verified in one-year follow-up of cephalometric data.

The Impacts of COVID-19 on Healthcare Quality in Tertiary Medical Centers-A Retrospective Study on Data from Taiwan Clinical Performance Indicators System.

To date, COVID-19 is by far the most impactful contagious disease of the 21st century and it has had a devastating effect on public health in countries around the globe. Elective medical services have declined markedly since the outbreak of the COVID-19 pandemic. Few studies have compared changes in healthcare quality before and during the outbreak of COVID-19 in Eastern Asian countries. We aimed to explore the impacts of COVID-19 on healthcare quality among medical centers in Taiwan. This was a retrospective study that collected anonymized data from the Taiwan Clinical Performance Indicator system, which was founded by the Joint Commission of Taiwan, an organization to promote, execute, and certify the nation's healthcare quality policies. We explored quality indicators reported by more than three-quarters of medical centers in Taiwan from January 2019 to December 2020. The year 2019 was defined as the baseline period and 2020 was defined as the period after the start of the outbreak of COVID-19. Quality indicators from different regions were analyzed. Unscheduled returns of emergency patients within 72 h of their discharge, unscheduled returns of hospitalized patients within 14 days of their discharge, and unscheduled returns of surgical patients to the operating room during hospitalization all declined during the COVID-19 outbreak. Interestingly, the proportion of acute ischemic stroke patients receiving intravenous tissue-type plasminogen activator (IV-tPA) increased during outbreak of COVID-19. There were significant regional variations in healthcare quality indicators among medical centers in northern and middle/southern Taiwan. The outbreak of COVID-19 changed different patterns of healthcare systems. Although healthcare quality seemed to improve, further investigation is warranted to better understand whether those who were in need of returning to the emergency room or hospital were reluctant or were prevented from travel by the shelter-in-place policy.

H3K4 Methylation in Aging and Metabolism.

During the process of aging, extensive epigenetic alterations are made in response to both exogenous and endogenous stimuli. Here, we summarize the current state of knowledge regarding one such alteration, H3K4 methylation (H3K4me), as it relates to aging in different species. We especially highlight emerging evidence that links this modification with metabolic pathways, which may provide a mechanistic link to explain its role in aging. H3K4me is a widely recognized marker of active transcription, and it appears to play an evolutionarily conserved role in determining organism longevity, though its influence is context specific and requires further clarification. Interestingly, the modulation of H3K4me dynamics may occur as a result of nutritional status, such as methionine restriction. Methionine status appears to influence H3K4me via changes in the level of S-adenosyl methionine (SAM, the universal methyl donor) or the regulation of H3K4-modifying enzyme activities. Since methionine restriction is widely known to extend lifespan, the mechanistic link between methionine metabolic flux, the sensing of methionine concentrations and H3K4me status may provide a cogent explanation for several seemingly disparate observations in aging organisms, including age-dependent H3K4me dynamics, gene expression changes, and physiological aberrations. These connections are not yet entirely understood, especially at a molecular level, and will require further elucidation. To conclude, we discuss some potential H3K4me-mediated molecular mechanisms that may link metabolic status to the aging process.

Histone dynamics during DNA replication stress.

Accurate and complete replication of the genome is essential not only for genome stability but also for cell viability. However, cells face constant threats to the replication process, such as spontaneous DNA modifications and DNA lesions from endogenous and external sources. Any obstacle that slows down replication forks or perturbs replication dynamics is generally considered to be a form of replication stress, and the past decade has seen numerous advances in our understanding of how cells respond to and resolve such challenges. Furthermore, recent studies have also uncovered links between defects in replication stress responses and genome instability or various diseases, such as cancer. Because replication stress takes place in the context of chromatin, histone dynamics play key roles in modulating fork progression and replication stress responses. Here, we summarize the current understanding of histone dynamics in replication stress, highlighting recent advances in the characterization of fork-protective mechanisms.

The relationship of the occurrence between three-rooted deciduous mandibular second molars and three-rooted permanent mandibular first molars in children.

BACKGROUND/PURPOSE: This study aimed to determine the correlation between the occurrence of three-rooted deciduous mandibular second molars and three-rooted permanent mandibular first molars in children. MATERIALS AND METHODS: Orthopantograms (n = 977) obtained from August 2008 to December 2010 were retrospectively screened and examined. Among the 977 orthopantograms, those of 591 participants (314 boys and 277 girls; mean age, 8.7 years) with bilateral deciduous mandibular second molars and permanent mandibular first molars were studied. The gender predilection and prevalence of three-rooted mandibular molars were assessed, and the pattern of concurrence was investigated. RESULTS: The prevalence of three roots were 28.4% and 27.6% in the deciduous mandibular second molars and permanent mandibular first molars, respectively. Bilateral occurrence of three-rooted mandibular molars was almost 60% for both deciduous and permanent molars. There was a significantly greater prevalence of three-rooted mandibular molars on the right side of the mandible than that on the left side. CONCLUSION: Deciduous and permanent molars show a similar prevalence of three roots. The presence of three-rooted deciduous mandibular second molar can strongly predict the possibility of three roots in permanent mandibular first molar.

Cognitive Diagnostic Models for Random Guessing Behaviors.

Many test-takers do not carefully answer every test question; instead they sometimes quickly answer without thoughtful consideration (rapid guessing, RG). Researchers have not modeled RG when assessing student learning with cognitive diagnostic models (CDMs) to personalize feedback on a set of fine-grained skills (or attributes). Therefore, this study proposes to enhance cognitive diagnosis by modeling RG via an advanced CDM with item response and response time. This study tests the parameter recovery of this new CDM with a series of simulations via Markov chain Monte Carlo methods in JAGS. Also, this study tests the degree to which the standard and proposed CDMs fit the student response data for the Programme for International Student Assessment (PISA) 2015 computer-based mathematics test. This new CDM outperformed the simpler CDM that ignored RG; the new CDM showed less bias and greater precision for both item and person estimates, and greater classification accuracy of test results. Meanwhile, the empirical study showed different levels of student RG across test items and confirmed the findings in the simulations.

Multidimensional Computerized Adaptive Testing Using Non-Compensatory Item Response Theory Models.

Current use of multidimensional computerized adaptive testing (MCAT) has been developed in conjunction with compensatory multidimensional item response theory (MIRT) models rather than with non-compensatory ones. In recognition of the usefulness of MCAT and the complications associated with non-compensatory data, this study aimed to develop MCAT algorithms using non-compensatory MIRT models and to evaluate their performance. For the purpose of the study, three item selection methods were adapted and compared, namely, the Fisher information method, the mutual information method, and the Kullback-Leibler information method. The results of a series of simulations showed that the Fisher information and mutual information methods performed similarly, and both outperformed the Kullback-Leibler information method. In addition, it was found that the more stringent the termination criterion and the higher the correlation between the latent traits, the higher the resulting measurement precision and test reliability. Test reliability was very similar across the dimensions, regardless of the correlation between the latent traits and termination criterion. On average, the difficulties of the administered items were found to be at a lower level than the examinees' abilities, which shed light on item bank construction for non-compensatory items.

Correlation between salivary mutans streptococci, lactobacilli and the severity of early childhood caries.

BACKGROUND/PURPOSE: Mutans streptococci (MS) and lactobacilli (LB) are associated with dental caries, but the acquisition of these organisms in young children with early childhood caries (ECC) and severe early childhood caries (S-ECC) has only been partly described. The purpose of this study was to evaluate the salivary MS and LB levels of preschool children with ECC and S-ECC, and the correlation of MS, LB levels with caries severity. MATERIALS AND METHODS: The study population was comprised of children from 3 to 6 years of age who visited the Pediatric Dental clinic of TCVGH. Oral examinations were performed, and whole unstimulated salivary samples were collected for buffer capacity, MS and LB counts by using commercially available diagnostic kits (CRT bacteria kit). The participants were divided into mild (dmft < 6), moderate (dmft:6-9) and severe caries (dmft > 9) groups; the salivary microbiological tests and buffer capacity were compared. RESULTS: A total of 72 children with a mean age of 4.5 years participated in this study. The salivary test showed that the higher the salivary MS level the more severe the caries status in children (P = 0.001). There was also a tendency toward a higher salivary LB level in children with more severe caries, but the difference was not significant (P = 0.088). There was no significant correlation between buffer capacity and caries status. CONCLUSION: The salivary MS level in preschool children was significantly correlated with the severity of early childhood caries.

The effect of professional fluoride application program for preschool children in Taiwan: An analysis using the National Health Insurance Research Database (NHIRD).

BACKGROUND/PURPOSE: Dental caries in primary dentition is a major public health problem in many countries, as well as Taiwan. The service of professional topical fluoride application for children under 5 years of age, performed twice a year by the BNHI in Taiwan through the "Preventive Dental Health Service for Children" plan, began in July 2004. The purpose of this study was to examine the effect and trend of professional topical fluoride application on dental utilization. MATERIALS AND METHODS: The sample subjects were taken from the Normalized Million People File of 2010 in the National Health Insurance Research Database from 2000 to 2012, for the purpose of analyzing the status of the professional topical fluoride program. The main analysis included utilization of professional topical fluoride application, utilization of restorative treatment and utilization of endodontic therapy in children 1-to-5-years of age. The Cochran-Armitage trend test was used for statistical analysis. RESULTS: Professional topical fluoride utilization increased year upon year, particularly after 2012 (P < .001). There was a tendency to reduce the utilization of endodontic therapy (P < .001). The severity of dental caries (number of times receiving dental restoration or endodontic therapy) was decreased after professional topical fluoride application was performed (P < .001). CONCLUSION: Because the dental caries rate for preschool children in Taiwan remains high, it is beneficial to receive professional topical fluoride application for dental care, as this reduces the severity of dental caries and endodontic therapy needs.

Optimal Product Placement.

We model a market, such as an online software market, in which an intermediary connects sellers and buyers by displaying sellers' products. With two vertically-differentiated products, an intermediary can place either: (1) one product, not necessarily the better one, on the first page, and the other hidden on the second page; or (2) both products on the first page. We show that it can be optimal for the intermediary to obfuscate a product-possibly the better one-since this weakens price competition and allows the sellers to extract a greater surplus from buyers; however, it is not socially optimal. The choice of which one to obfuscate depends on the distribution of search costs.

Factors affecting therapeutic response to Rivastigmine in Alzheimer's disease patients in Taiwan.

Rivastigmine has been widely used in mild-to-moderate Alzheimer's disease (AD), but the therapeutic response rate varies from 20 to 60%. A dose-dependent effect has been suggested, but the plasma concentration of rivastigmine and its metabolite, NAP 226-90, were not measured in previous studies. The influencing factors of therapeutic response are complicated and discordant in various studies among different ethnic groups. Hence, we analyzed the therapeutic responses of rivastigmine, measured by neuropsychological assessments, among 63 clinically diagnosed AD patients taking a daily dosage of 6-9 mg in relation to their plasma concentration of rivastigmine and NAP 226-90, apolipoprotein E (APOE) genotype and demographic characteristics. Our reports revealed that 41.3% of recruited AD patients had improvement in cognition, measured by Mini-Mental Status Examination (MMSE), and 63.5% in global status, by Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) score. In cognition, the clinically improving group had a significantly higher rivastigmine concentration [p = 0.049, odds ratio (OR) = 1.029, 95%CI = 1.000-1.058], lower initial MMSE score (p = 0.010, OR = 0.708, 95%CI = 0.546-0.920), and lower initial CDR-SB score (p = 0.003, OR = 0.552, 95%CI = 0.372-0.817). The patients with APOE ε4 allele had worsening cognition (p = 0.037, OR = 3.870, 95%CI = 1.082-13.840). In global status, only higher education (p = 0.043, OR = 1.222, 95%CI = 1.007-1.484) was significantly associated with clinical improvement. In conclusion, high concentrations of rivastigmine may benefit cognitive function of AD patients, especially in APOE ε4 (-) carriers.

Effects of multiple training modalities in patients with Alzheimer's disease: a pilot study.

OBJECTIVE: This pilot study investigated the effects of multiple training modalities on cognition, neuropsychiatric symptoms, caregivers' burden, and quality of life in patients with Alzheimer's disease (AD). PATIENTS AND METHODS: This intervention study was conducted in 24 patients with AD aged ≥65 years with a Clinical Dementia Rating (CDR) score of 0.5-1. The patients were assigned to receive multiple training modalities (1 hour for each training: Tai Chi, calligraphy, and drawing) over a 6-week period in either the experimental group (n=14) or the comparison group (n=10). A series of neuropsychological tests - namely the Traditional Chinese version Mini-Mental Status Examination, Cognitive Assessment Screening Instrument (CASI), Neuropsychiatric Inventory and the Neuropsychiatric Inventory Caregiver Distress Scale, and the Clinical Dementia Rating Sum of Boxes scale - were conducted at the baseline and after the intervention. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Zarit Caregiver Burden Scale were used to assess the quality of life and caregivers' burden, respectively. Independent sample t-test and paired sample t-test were used to analyze the data. RESULTS: After the intervention, the experimental group reported higher scores in the orientation domain of CASI (P=0.007) and in the psychiatry domain of WHOQOL-BREF (P=0.042) compared with the comparison group. Caregivers' distress was significantly decreased in the experimental group (P=0.035) but not in the comparison group (P=0.430). CONCLUSION: The multiple training modalities improved scores in the orientation domain of CASI and psychiatry domain of WHOQOL-BREF in patients with AD. Moreover, the intervention reduced caregivers' distress.

Early symptoms of Alzheimer's disease in Japan and Taiwan.

AIM: The effects of Alzheimer's disease (AD) are making a major impact on the socioeconomic status of older adults in society. The recognition of early symptoms and clinical presentation are crucial issues to foster early diagnosis and treatment in order to have better therapeutic outcomes. METHODS: We recruited clinically diagnosed AD patients at the very mild stage in the Clinical Dementia Rating scale 0.5 and mild stage Clinical Dementia Rating scale 1.0 in Taiwan and Japan. Psychometrics including the Ascertain Dementia 8 (AD8) questionnaire were administered to collect and compare the differences of the clinical presentation of the participants from the two countries. RESULTS: A total of 1189 participants, 641 from Taiwan and 548 from Japan, were recruited in the present study. In the very mild dementia group with Clinical Dementia Rating scale 0.5, apart from AD8-2: reduced interest in hobbies/activities (P = 0.056) and AD8-4: trouble learning how to use a tool, appliance or gadget (P = 0.224), other AD8 subitems were significantly different between the two countries. Japanese participants had a higher reported frequency of AD8-5: forgetting the correct month or year (82.7%) than that (57.9%) in Taiwanese (P < 0.001). Taiwanese participants had a higher reported frequency in AD8-1: problems with judgment (20.3%), AD8-3: repeats questions, stories or statements (67.5%), AD8-6: difficulty handling complicated financial affairs (32.5%); AD8-7: difficulty remembering appointments (53.8%); and AD8-8: consistent problems with thinking and/or memory (89.3%) than those in Japanese participants. CONCLUSION: Early symptoms of AD in both countries are different. The frequently reported early symptoms are important for primary physicians and the general population so that they can recognize the disease in the early stage so as to have a better therapeutic outcome. Such efforts would increase the awareness of dementia in the general population. Geriatr Gerontol Int 2016; 16: 797-803.