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1.
Hong Kong Med J ; 20(1): 59-62, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24473687

ABSTRACT

With Hong Kong's rapidly ageing population, increasing numbers of people now have some form of cognitive impairment. Enduring power of attorney is a legal instrument that can allow individuals to manage their financial matters if they subsequently become mentally incapacitated. The law requires that the mental capacity of the individual making an enduring power of attorney should be certified by a registered medical practitioner and a solicitor. This paper discusses the principles involved in the assessment of mental capacity for making an enduring power of attorney and uses this example to illustrate various important considerations in the formal assessment of mental capacity.


Subject(s)
Decision Making , Mental Competency , Aged , Hong Kong , Humans , Male , Mental Competency/legislation & jurisprudence
2.
J Geriatr Psychiatry Neurol ; 26(2): 69-77, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23504307

ABSTRACT

Previous studies suggested that patients with mild cognitive impairment (MCI) or dementia can have impaired and declining financial skills and abilities. The purpose of this study is to test a clinically applicable method, based on the contemporary legal standard, to examine directly the mental capacity to make financial decisions and its component decision-making abilities among patients with MCI and early dementia. A total of 90 patients with mild Alzheimer disease (AD), 92 participants with MCI, and 93 cognitively normal control participants were recruited for this study. Their mental capacity to make everyday financial decisions was assessed by clinician ratings and the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED). Based on the clinician ratings, only 53.5% were found to be mentally competent in the AD group, compared with 94.6% in the MCI group. However, participants with MCI had mild but significant impairment in understanding, appreciating, and reasoning abilities as measured by the ACED. The ACED provided a reliable and clinically applicable structured framework for assessment of mental capacity to make financial decisions.


Subject(s)
Alzheimer Disease/psychology , Cognitive Dysfunction/psychology , Decision Making , Mental Competency/psychology , Aged , Alzheimer Disease/diagnosis , Cognitive Dysfunction/diagnosis , Female , Financing, Personal , Hong Kong , Humans , Male , Neuropsychological Tests , Severity of Illness Index
3.
Int J Geriatr Psychiatry ; 26(7): 733-40, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21495078

ABSTRACT

OBJECTIVES: We reported the interim findings of a randomized controlled trial (RCT) to examine the effects of a mind body physical exercise (Tai Chi) on cognitive function in Chinese subjects at risk of cognitive decline. SUBJECTS: 389 Chinese older persons with either a Clinical Dementia Rating (CDR 0.5) or amnestic-MCI participated in an exercise program. The exercise intervention lasted for 1 year; 171 subjects were trained with 24 forms simplified Tai Chi (Intervention, I) and 218 were trained with stretching and toning exercise (Control, C). The exercise comprised of advised exercise sessions of at least three times per week. RESULTS: At 5th months (2 months after completion of training), both I and C subjects showed an improvement in global cognitive function, delayed recall and subjective cognitive complaints (paired t-tests, p < 0.05). Improvements in visual spans and CDR sum of boxes scores were observed in I group (paired t-tests, p < 0.001). Three (2.2%) and 21(10.8%) subjects from the I and C groups progressed to dementia (Pearson chi square = 8.71, OR = 5.34, 95% CI 1.56-18.29). Logistic regression analysis controlled for baseline group differences in education and cognitive function suggested I group was associated with stable CDR (OR = 0.14, 95%CI = 0.03-0.71, p = 0.02). CONCLUSIONS: Our interim findings showed that Chinese style mind body (Tai Chi) exercise may offer specific benefits to cognition, potential clinical interests should be further explored with longer observation period.


Subject(s)
Cognition Disorders/therapy , Cognition/physiology , Muscle Stretching Exercises/methods , Tai Ji/methods , Aged , Aged, 80 and over , Cognition Disorders/psychology , Dementia/psychology , Dementia/therapy , Disease Progression , Female , Health Promotion/methods , Humans , Male , Psychiatric Status Rating Scales
4.
Age Ageing ; 40(1): 30-5, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21106558

ABSTRACT

BACKGROUND: studies have suggested that neuropsychiatric (NP) symptoms influence the development of dementia among older adults. But, the results are inconsistent and there is limited information about NP symptoms in population-based samples. OBJECTIVE: to explore the association between NP symptoms and risk of cognitive decline in Chinese older persons residing in the community. DESIGN: prospective study. SETTING: community sample. SUBJECTS: a total of 321 community-dwelling Chinese older persons aged 60 or over with mild cognitive impairment participated in the study. METHODS: at baseline, each subject was assessed with Clinical Dementia Rating (CDR), Mini-Mental State Examination, list learning and delayed recall, and Category Verbal Fluency Test. Severity of NP symptoms was evaluated with Neuropsychiatric Inventory (NPI). Global cognitive status at the end of 2-year study period was determined by CDR. RESULTS: at baseline, 40.5% of participants exhibited one or more NP symptoms (NPI total score ≥ 1). Night-time behaviours (22.1%), depression (16.8%), apathy (14.0%) and anxiety (12.8%) were the most common NP symptoms. At the end of 2-year follow-up, 27.5% of participants with depression at baseline developed dementia, compared with 14.8% of those without depression (χ² = 4.90, P= 0.03). Aberrant motor behaviour was also significantly associated with deterioration in cognition (χ² = 5.84, P= 0.02), although it was an infrequent occurrence. On logistic regression analysis, only depression at baseline was shown to be a risk factor for progression to dementia (OR= 2.40, 95% CI 1.05-5.46, P= 0.04). CONCLUSION: depression in non-demented older persons may represent an independent dimension reflecting early neuronal degeneration. Further studies should be conducted to assess whether effective management of NP symptoms exerts beneficial effects on cognitive function.


Subject(s)
Cognition Disorders/complications , Cognition Disorders/ethnology , Dementia/epidemiology , Depression/complications , Depression/ethnology , Disease Progression , Aged , Aged, 80 and over , China , Cognition Disorders/diagnosis , Depression/diagnosis , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Nerve Degeneration/complications , Nerve Degeneration/diagnosis , Nerve Degeneration/ethnology , Neuropsychological Tests , Prognosis , Prospective Studies , Regression Analysis , Risk Factors
5.
Aging Ment Health ; 14(8): 994-9, 2010 Nov.
Article in English | MEDLINE | ID: mdl-21069605

ABSTRACT

BACKGROUND: With increasing longevity, there is an increasing need for medical professionals to face situations in which explanation for decision on life-sustaining treatment (LST) would be required. OBJECTIVES: As advance decision making for LST in case of severe medical illness may be unfamiliar for most of the Chinese elders, we aim to explore if procedures adopted to enhance the exposure to the issue concerned would bring about improvement in knowledge toward decision for LST. METHOD: This was a cross-sectional study. The design was divided into three sections: (i) a pre-scenario knowledge assessment, (ii) scenario exposure (relating issues of LST using case vignettes), and (iii) a post-scenario assessment. The pre- and post-scenario assessment comprises 10 questions, exploring the understanding toward basic issues related to LST. The scenario exposure comprises two hypothetical case vignettes describing situations demanding decisions for LST. The knowledge level toward LST was assessed and compared before and after the presentation of the two vignettes. RESULTS: One-hundred community dwelling older persons (aged over 60 years) were recruited. The scenario exposure improved the knowledge level of participants (paired samples t-test, p < 0.05). Participants who were younger and better educated were more likely to perform better in the knowledge test (bivariate correlation and logistic regression, p < 0.05). CONCLUSIONS: The results demonstrated that hypothetical scenarios may help to enhance and facilitate the understanding of LST. The study should be carried forward to explore the applicability of enhancement procedure to facilitate the decision making for advance directives and LST in the older community.


Subject(s)
Advance Directives , Decision Making , Health Knowledge, Attitudes, Practice , Life Support Care/psychology , Aged , Aged, 80 and over , Asian People/psychology , Comprehension , Cross-Sectional Studies , Dementia/psychology , Female , Humans , Logistic Models , Male , Middle Aged , Socioeconomic Factors , Surveys and Questionnaires , Withholding Treatment
6.
Alzheimer Dis Assoc Disord ; 24(4): 343-7, 2010.
Article in English | MEDLINE | ID: mdl-20693868

ABSTRACT

Mild Cognitive Impairment (MCI) is a recognized risk condition for clinical dementia. This paper attempted to explore the applicability of a combined cognitive and clinical approach to identify older Chinese adults at-risk of cognitive decline. Seven hundred forty randomly recruited community dwelling participants (aged 60 or over) were assessed at baseline and 2 years with Clinical Dementia Rating (CDR) and a cognitive battery. Baseline MCI groups were categorized by CDR-MCI, cognitive function (Cog-MCI), and a combined CDR-Cog approach. The cognitive approach adopted the Mayo clinic criteria. For the combined approach, nonamnestic MCI combined CDR 0.5 plus nonmemory cognitive deficits. The overall concordance between CDR and Cognitive test ratings were 65.3% (χ2 = 256.4, P<0.001, κ=0.44). With a combined approach, 424 (57%) participants were classified as normal. CDR-MCI group had higher cognitive scores compared with MCI groups by other criteria (1 way analysis of variance or ANOVA). At 2 years, the combined CDR-Cog MCI group identified all dementia (N=24) converters although group differences were not significant. Cognitive function and CDR identified participants potentially at-risk for furthermore decline, but exhibited some differences in detection profiles. A combined approach may be more practical in screening for MCI participants with diverse educational and cultural background.


Subject(s)
Cognitive Dysfunction/diagnosis , Aged , Cognition , Cognitive Dysfunction/psychology , Disease Progression , Female , Hong Kong/epidemiology , Humans , Male , Neuropsychological Tests
7.
Int Psychogeriatr ; 22(1): 2-13, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19785918

ABSTRACT

BACKGROUND: Growing evidence suggests that participation in late-life leisure activity may have beneficial effects on cognitive function. The objective of the study was to evaluate the association between leisure activity participation and cognitive function in an elderly population of community-dwelling Hong Kong Chinese. METHODS: 512 participants were assessed in the follow-up study of a population-based community survey of the prevalence of cognitive impairment among Hong Kong Chinese aged 60 years and over. Leisure activities were classified into four categories (physical, intellectual, social and recreational). Information regarding leisure activity participation, cognitive function and other variables was collected. Multivariate linear regression analyses were performed to examine the association between leisure activity participation and cognitive function. RESULTS: A higher level of late-life leisure activity participation, particularly in intellectual activities, was significantly associated with better cognitive function in the elderly, as reflected by the results of the Cantonese Mini-mental State Examination (p = 0.007, 0.029 and 0.005), the Category Verbal Fluency Test (p = 0.027, 0.003 and 0.005) and digit backward span (p = 0.031, 0.002 and 0.009), as measured by the total frequency, total hours per week and total number of subtypes, respectively; the Chinese Alzheimer's Disease Assessment Scale-Cognitive Subscale (p = 0.045) and word list learning (p = 0.003), as measured by the total number of subtypes; and digit forward span (p = 0.007 and 0.015), as measured by the total hours per week and total number of subtypes, respectively. CONCLUSION: Late-life intellectual activity participation was associated with better cognitive function among community-dwelling Hong Kong elderly Chinese.


Subject(s)
Asian People/statistics & numerical data , Cognition Disorders/diagnosis , Cognition Disorders/epidemiology , Leisure Activities , Residence Characteristics , Age Factors , Aged , Female , Hong Kong/epidemiology , Humans , Male , Middle Aged , Mind-Body Therapies , Neuropsychological Tests , Recreation , Social Behavior
8.
Int J Geriatr Psychiatry ; 25(2): 133-41, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19582757

ABSTRACT

OBJECTIVES: We reported the findings of a randomized controlled trial (RCT) to examine the effects of an individualized functional enhancement program (FEP) on functional skills and mood symptoms in mild and moderate dementia. SUBJECTS & METHODS: 74 Chinese older persons with dementia were recruited into a skills training program by occupational therapists (OT). Thirty seven subjects were trained with an individualized selection of daily activities (FEP Intervention, I); 37 were trained with general occupational therapy (Control, C). The FEP comprised of twice weekly group sessions of skills training and problem solving using cognitive behavioral approach. RESULTS: At 1 month after completion of program, both I and C subjects showed an improvement in process skills of the assessment of motor and process skills (AMPS)(paired t-tests, p < 0.05). At 4 months post-program, the I group showed a further reduction of cornell scale for depression in dementia (CSDD) scores (paired t-test, p = 0.02); Apathy improved at 1 month post-training (p = 0.04), but deteriorated at 4 months (p = 0.01). Group differences in changes of mood and functional scores were not significant (ANVOCA, p > 0.05). CONCLUSIONS: The findings suggested a potential benefit for individualized occupational therapy. It should be tailor made with individual needs and continued for sustained effectiveness.


Subject(s)
Cognitive Behavioral Therapy , Dementia/psychology , Dementia/rehabilitation , Mood Disorders/diagnosis , Activities of Daily Living/psychology , Aged , Aged, 80 and over , Analysis of Variance , Apathy , Cognition Disorders/diagnosis , Cognition Disorders/rehabilitation , Depressive Disorder/diagnosis , Depressive Disorder/rehabilitation , Disability Evaluation , Female , Humans , Male , Mood Disorders/rehabilitation , Motor Skills/physiology , Neuropsychological Tests , Program Evaluation , Psychomotor Performance
9.
Int Psychogeriatr ; 21(5): 977-86, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19586561

ABSTRACT

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative disease with a higher prevalence in women. Expression of estrogen receptor 1 (ESR1) gene has been identified throughout the brain. Owing to the putative neuroprotective effects of estrogen, estrogen receptor gene is a potential candidate modulating the development of AD. Preliminary associations between two polymorphisms of ESR1 (PvuII and XbaI) gene and AD have been reported. METHODS: In this study, 16 single nucleotide polymorphisms (SNPs) of the ESR1 gene (including four commonly studied ESR1 SNPs and 12 other tagging SNPs selected from the HapMap database) were investigated to further evaluate the association between ESR1 polymorphisms and the risk of AD in the Chinese population. RESULTS: A total of 233 Chinese AD patients and 245 age-matched elderly control subjects were recruited. Genetic associations were analyzed by chi-square test and interaction effect was analysed by logistic regression analysis. Five SNPs (clustered between intron 3 and intron 7) were associated with the risk of AD (p-value ranges from 0.001 to 0.035); another two SNPs (located on exon 2 and intron 2) were shown to modulate the age-at-onset (AAO) in AD (p-value = 0.036 and 0.011). CONCLUSIONS: ESR1 gene polymorphisms may be associated with the AAO in AD. The present results provided information for possible associations between certain polymorphisms of ESR1 gene and the risk of AD.


Subject(s)
Alleles , Alzheimer Disease/genetics , Asian People/genetics , Cross-Cultural Comparison , Estrogen Receptor alpha/genetics , Polymorphism, Single Nucleotide/genetics , Age of Onset , Aged , Aged, 80 and over , Alzheimer Disease/ethnology , Female , Genetic Predisposition to Disease/genetics , Genotype , Haplotypes/genetics , Hong Kong , Humans , Introns/genetics , Linkage Disequilibrium , Male , Risk , Risk Factors , White People/genetics
10.
Am J Geriatr Psychiatry ; 17(5): 428-36, 2009 May.
Article in English | MEDLINE | ID: mdl-19390300

ABSTRACT

OBJECTIVES: This study aims at assessing mental competence in Chinese patients with mild and very mild dementia with a semistructured assessment method and the impact of repeated presentations of information on patients' mental competence. DESIGN: Subjects with mild and very mild dementia were compared with cognitively intact subjects. SETTING: Chinese subjects were recruited from local social centers and residential hostels for the elderly in Hong Kong. PARTICIPANTS: Sixty-six Chinese community-dwelling older adults (aged from 65 to 87 years) were recruited. MEASUREMENTS: Clinical diagnosis was made by experienced geriatric psychiatrists. Subjects were assessed with the Mini-Mental State Examination and the Clinical Dementia Rating (CDR). Mental capacity to consent to treatment was assessed by using the Chinese version of the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and independent clinician ratings based on the definition in the Mental Capacity Act 2005 of the United Kingdom. RESULTS: Thirty-three (50%) participants were diagnosed with very mild or mild dementia (CDR = 0.5 or 1). In this group, 15 (45.5%) subjects were rated as mentally incompetent in clinician ratings. In the assessment of interrater reliability, the intraclass correlation coefficient of MacCAT-T summary scores among three raters ranged from 0.64 to 0.83. The MacCAT-T summary scores correlated significantly with clinician ratings, years of education, Mini-Mental State Examination score, and CDR. In contrast to the nonimpaired group, repeated presentation of information did not significantly improve capacity in the demented group. CONCLUSION: Results from this study suggest that even patients with very mild dementia in this population can show substantial deficits in decision-making capacity, and that improved capacity is not likely to result from repeated disclosure of information.


Subject(s)
Alzheimer Disease/psychology , Decision Making , Dementia/psychology , Informed Consent/psychology , Mental Competency/psychology , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Asian People , Dementia/diagnosis , Dementia/epidemiology , Female , Hong Kong/epidemiology , Humans , Male , Neuropsychological Tests , Psychiatric Status Rating Scales , Psychometrics
11.
Int J Geriatr Psychiatry ; 24(1): 48-53, 2009 Jan.
Article in English | MEDLINE | ID: mdl-18615844

ABSTRACT

OBJECTIVE: We reported the association between modality of Physical Exercise and cognitive function in 782 older Chinese adults assessed in the second phase of a population survey for dementia in Hong Kong. METHODS: Profiles of physical exercise was measured by a questionnaire (no exercise, stretching, aerobic and mind-body exercise). Cognitive Assessments included the CMMSE, ADAS-Cog, and Category Verbal Fluency Test (CVFT). RESULTS: The aerobic and mind body exercise groups with longer exercise habits (>5 years) had higher scores in most cognitive tests (Kruskal Wallis tests, p < 0.01). Beneficial effects were more significant in the young old group from 65- 75 years. CONCLUSIONS: Possible age related specific effects of aerobic and mind body exercise on cognitive reserve are worthy of further exploration.


Subject(s)
Aging/psychology , Cognition/physiology , Exercise/physiology , Aged , Aged, 80 and over , Analysis of Variance , Asian People , Female , Geriatric Assessment , Humans , Male , Mind-Body Therapies , Physical Fitness , Statistics, Nonparametric
12.
Alzheimer Dis Assoc Disord ; 22(2): 153-7, 2008.
Article in English | MEDLINE | ID: mdl-18525287

ABSTRACT

With increasing demand for dementia care in the Chinese community, there is a pressing need to identify practical and valid assessment tool for early detection of dementia. In a sample of 473 randomly recruited community-dwelling Chinese older persons aged 60 or above, we evaluated the cognitive characteristics of subjects with Clinical Dementia Rating (CDR) of 0.5. The cognitive profiles of CDR 0.5 subjects were compared with standard clinical criteria for mild cognitive impairment. The Alzheimer's disease assessment scale-cognitive subscale and list learning delay recall test scores were between -1 and -2 SD below the cutoff for clinically not-demented subjects (CDR 0). Concordance between CDR 0.5 and mild cognitive impairment classifications were related to educational level of the subjects. A higher agreement was found in subjects having >6 years of education than subjects having

Subject(s)
Cognition Disorders/diagnosis , Dementia/diagnosis , Psychiatric Status Rating Scales , Aged , Aged, 80 and over , Cognition Disorders/epidemiology , Dementia/epidemiology , Hong Kong/epidemiology , Humans , Mass Screening , Middle Aged , Predictive Value of Tests , Reproducibility of Results , Severity of Illness Index
13.
Int Psychogeriatr ; 20(5): 1059-70, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18498668

ABSTRACT

BACKGROUND: Increasing evidence suggests that functional impairment can be detected in older persons with mild cognitive impairment (MCI). This study explores the functional profiles and the clinical correlates of a population-based sample of Chinese older persons with MCI in Hong Kong. METHODS: A random sample of 765 Chinese elderly subjects without dementia was recruited, of which 389 were elderly normal controls (Clinical Dementia Rating = 0), and 376 had questionable dementia (CDR = 0.5). The latter were categorized into an MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Their functional performances were measured and compared with the normal controls (NC). Multiple regression analyses investigated the associations between functional scores (Disability Assessment in Dementia) and clinical correlates (cognitive test scores, neuropsychiatric symptoms and motor signs) in the NC subjects and cognitively impaired subjects. RESULTS: Subjects with MCI had intermediate functional performance between the NC and those with VMD. Regression analyses revealed that lower scores of cognitive tests (delayed recall and categorical verbal fluency tests), apathy, aberrant motor symptoms and parkinsonism features were associated with lower functional scores in clinically non-demented subjects. Functional scores had no correlation with age, education and medical illness burden. CONCLUSION: Neuropsychiatric symptoms and parkinsonism features were associated with functional impairment in the clinically non-demented elderly in the community. Assessment of these should be incorporated in the evaluation of older persons for early cognitive impairment.


Subject(s)
Aged/statistics & numerical data , Asian People/statistics & numerical data , Cognition Disorders/diagnosis , Data Collection/statistics & numerical data , Activities of Daily Living/classification , Activities of Daily Living/psychology , Age Factors , Asian People/psychology , Cognition Disorders/epidemiology , Cognition Disorders/psychology , Control Groups , Dementia/diagnosis , Dementia/epidemiology , Dementia/psychology , Disability Evaluation , Female , Geriatric Assessment/statistics & numerical data , Hong Kong/epidemiology , Humans , Male , Neuropsychological Tests/statistics & numerical data , Parkinsonian Disorders/diagnosis , Parkinsonian Disorders/psychology , Psychiatric Status Rating Scales , Regression Analysis , Sampling Studies , Severity of Illness Index
14.
Int J Geriatr Psychiatry ; 23(7): 719-25, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18213739

ABSTRACT

BACKGROUND AND OBJECTIVE: This study examined the clinical correlates of parkinsonian signs including neuropsychiatric symptoms, cognitive impairment and medical illness burden in the community-dwelling non-demented Chinese elderly. METHODS: A random sample of 765 Chinese elderly subjects from a thematic household survey was recruited. There were 389 normal elderly controls (Clinical Dementia Rating [CDR] 0) (NC) and 376 subjects with questionable dementia (CDR 0.5). The subjects with questionable dementia (CDR 0.5) were categorized into two groups: a MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Parkinsonian signs were measured by Unified Parkinson Disease Rating Scale- motor scale (UPDRS). The clinical correlates were investigated in each group. RESULTS: UPDRS motor score was associated with age, cumulative medical illness burden and cerebrovascular accidents in the normal control and MCI groups. It correlated negatively with MMSE scores in the NC group. It was associated with presence of soft signs in the NC and MCI groups; and apathy in the VMD group. CONCLUSION: Neuropsychiatric symptoms, cognitive impairment and vascular risk factors had different patterns of associations with parkinsonian signs in the older persons with different degree of cognitive impairment.


Subject(s)
Parkinson Disease, Secondary/etiology , Aged , Aged, 80 and over , Cardiovascular Diseases/etiology , Cognition Disorders/etiology , Dementia/complications , Female , Geriatric Assessment , Health Surveys , Humans , Male , Middle Aged , Neuropsychological Tests , Parkinson Disease, Secondary/psychology , Risk Factors
15.
Neuroepidemiology ; 30(1): 6-12, 2008.
Article in English | MEDLINE | ID: mdl-18204291

ABSTRACT

OBJECTIVE: To develop a short cognitive test for screening mild cognitive impairment (MCI) in Hong Kong Chinese older adults. METHODS: The Chinese Abbreviated MCI (CAMCI) test was developed with a multistage process. In phase 1, a short version of the cognitive test comprising a 1-min animal fluency test and a 10-min delayed word list recall was developed and tested in 578 volunteers (community-dwelling active elderly persons). In phase 2, the CAMCI test was validated in an independent and randomly recruited sample of 459 participants in a community survey. Additionally, the predictive significance of the CAMCI test was evaluated in a group of 196 subjects assessed in phase 1 for conversion to clinical dementia at 20 months' follow-up. The discriminating power of the CAMCI test in differentiating MCI from normal control (NC) and mildly demented subjects was compared with Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscales. RESULTS: The CAMCI test was found to have high discriminating power in differentiating NC from MCI and mildly demented subjects in the phase 1 volunteer sample. The receiver operating characteristics (ROC) revealed an area under the curve (AUC) of 0.91. The ROC were further validated in the phase 2 sample. The AUC of the CAMCI test was compared with MMSE and ADAS-Cog subscales. The short MCI test was comparable to the ADAS-Cog subscale in discriminating NC from MCI and demented subjects (chi(2) test, p = n.s.). Logistic regression analysis was carried out to determine significant baseline predictors for conversion to dementia at phase 3 follow-up. Both ADAS-Cog total [Exp(B) = 1.115, p = 0.028] and CAMCI [Exp(B) = 0.88, p = 0.045] scores were significant predictors for dementia status at follow-up. CONCLUSION: The CAMCI test is able to discriminate NC from MCI and mild dementia in Hong Kong Chinese older adults. Its potential for large-scale community screening for early detection of cognitive impairment in late life should be emphasized and explored.


Subject(s)
Cognition Disorders/diagnosis , Geriatric Assessment/methods , Mass Screening/methods , Neuropsychological Tests/standards , Aged , Aged, 80 and over , Area Under Curve , Cognition Disorders/epidemiology , Dementia/diagnosis , Dementia/epidemiology , Diagnosis, Differential , Female , Follow-Up Studies , Geriatric Assessment/statistics & numerical data , Hong Kong/epidemiology , Humans , Male , Mental Recall , Neuropsychological Tests/statistics & numerical data , Predictive Value of Tests , ROC Curve , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness Index , Task Performance and Analysis
16.
Int J Geriatr Psychiatry ; 23(6): 611-7, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18041794

ABSTRACT

BACKGROUND: Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis. METHOD: A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-2006. In the first phase, 6,100 randomly selected community dwelling elders were assessed with Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC). Two thousand and seventy-three subjects were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject. RESULTS: 1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms (>or= 8 on CSDD). Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms. CONCLUSIONS: In our sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.


Subject(s)
Cognition Disorders/epidemiology , Dementia/epidemiology , Depression/epidemiology , Aged , Cognition Disorders/etiology , Dementia/diagnosis , Dementia/psychology , Depression/etiology , Epidemiologic Methods , Female , Hong Kong/epidemiology , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Residence Characteristics , Sex Factors , Time Factors
17.
Int Psychogeriatr ; 20(1): 135-48, 2008 Feb.
Article in English | MEDLINE | ID: mdl-17892609

ABSTRACT

INTRODUCTION: In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong. METHODS: The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1. RESULTS: The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4-9.6) and 8.9% (95%CI: 7.8-10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia. CONCLUSIONS: A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity.


Subject(s)
Asian People/psychology , Cognition Disorders/diagnosis , Dementia/diagnosis , Memory Disorders/diagnosis , Age Distribution , Aged , Asian People/statistics & numerical data , Cognition Disorders/epidemiology , Cognition Disorders/psychology , Data Collection , Dementia/epidemiology , Dementia/psychology , Diagnostic and Statistical Manual of Mental Disorders , Educational Status , Exercise , Female , Hong Kong/epidemiology , Humans , Logistic Models , Male , Memory Disorders/epidemiology , Memory Disorders/psychology , Middle Aged , Prevalence , Psychiatric Status Rating Scales/statistics & numerical data , Risk Factors , Severity of Illness Index
18.
Pharmacol Res ; 56(6): 509-14, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17951067

ABSTRACT

Studies in animals and a short-term human study have suggested that curcumin, a polyphenolic compound concentrated in the curry spice turmeric, decreases serum cholesterol concentration. However, no controlled human trials have examined the effect of curcumin on cholesterol. This study investigated the effects of consuming curcumin on the serum lipid profile in men and women. Elderly subjects (n=36) consumed 4 g/d curcumin, 1g/d curcumin, or placebo in a 6-month, randomized, double-blind trial. Plasma curcumin and its metabolites were measured at 1 month, and the serum lipid profile was measured at baseline, 1 month, and 6 months. The plasma curcumin concentration reached a mean of 490 nmol/L. The curcumin concentration was greater after capsule than powder administration. Consumption of either dose of curcumin did not significantly affect triacylglycerols, or total, LDL, and HDL cholesterol over 1 month or 6 months. However, the concentrations of plasma curcumin and serum cholesterol were positively and significantly correlated. Curcumin consumption does not appear to have a significant effect on the serum lipid profile, unless the absorbed concentration of curcumin is considered, in which case curcumin may modestly increase cholesterol.


Subject(s)
Alzheimer Disease/blood , Cholesterol/blood , Curcumin/therapeutic use , Triglycerides/blood , Aged , Aged, 80 and over , Alzheimer Disease/drug therapy , Curcumin/adverse effects , Double-Blind Method , Female , Humans , Male , Middle Aged
19.
Am J Alzheimers Dis Other Demen ; 22(3): 211-7, 2007.
Article in English | MEDLINE | ID: mdl-17606530

ABSTRACT

Increasing evidence suggests that performance of the instrumental activities of daily living (IADL) can be impaired at the mild cognitive impairment (MCI) stage. Our study aimed at investigating the profiles of functional impairment in Chinese subjects with MCI. Subjects with MCI were categorized into single-domain amnestic MCI (a-MCI) (n=54) and multiple-domain amnestic MCI (md-MCI) (n=93) groups. Their functional scores of Disability Assessment of Dementia (DAD) were compared with those of cognitively normal elderly controls (NC) (n=78) and those with mild Alzheimer's disease (AD) (n=85). Subjects with md-MCI had intermediate performance in IADL between the NC and those with mild AD. Subjects with a-MCI had functional scores similar to those of normal controls. Age, education, and global cognitive test scores were not associated with functional scores in MCI subjects. Our results demonstrated that Chinese older persons with md-MCI had impairment in IADL, as compared to NC and subjects with a-MCI. This finding suggests that assessment of IADL should be incorporated in the clinical evaluation of MCI.


Subject(s)
Activities of Daily Living , Dementia/complications , Age Factors , Aged , Aged, 80 and over , Asian People , Case-Control Studies , Female , Hong Kong , Humans , Male , Neuropsychological Tests , Severity of Illness Index
20.
Int J Geriatr Psychiatry ; 22(5): 431-7, 2007 May.
Article in English | MEDLINE | ID: mdl-17152120

ABSTRACT

BACKGROUND: The relationships between apathy, depression and functional impairment in questionable dementia (QD) and Alzheimer's disease (AD) are complex. This study aimed to explore the interactions between severity of apathy, depression and functional performance; and to investigate the effects of apathy alone, depression alone and coexistence of apathy and depression on the functional performance in subjects with QD and AD. METHODS: One hundred ninety-five subjects with QD and 96 subjects with mild AD were recruited. Apathy and depression were rated using the Neuropsychiatric Inventory and functional disability was measured using the Disability Assessment for Dementia (DAD). RESULTS: Severity of apathy and depression symptoms were associated with poorer functional performance in QD and apathy was associated with poorer functional performance in AD. In QD, subjects with apathy, depression, or coexistence of apathy and depression had poorer functional performance than those with neither apathy nor depression. The coexistence of apathy and depression did not produce more severe functional disability than apathy alone or depression alone. In AD, subjects with apathy had poorer functional performance than those without apathy. Depression in the absence of apathy was not associated with more severe functional disability. CONCLUSION: Apathy and depression symptoms are common in the early course of AD. Apathy and depression had different effects on functional performances in the subjects with QD from those with AD.


Subject(s)
Activities of Daily Living/psychology , Alzheimer Disease/psychology , Depression/psychology , Motivation , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Comorbidity , Depression/diagnosis , Disability Evaluation , Female , Hong Kong , Humans , Male , Mental Status Schedule , Middle Aged , Statistics as Topic
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