Cross-cultural dementia screening using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis.

OBJECTIVES: To quantitatively synthesize data on the accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) in different sociocultural settings and compare its performance to other brief screening instruments for the detection of dementia. DESIGN: Systematic review and meta-analysis. Literature searches were performed in PubMed, EMBASE, and CINAHL from January 1, 2004 until September 1, 2019. SETTING: Community, outpatient clinic, and hospital settings in high-, and low- and middle-income countries. PARTICIPANTS: Twenty-six studies reporting diagnostic accuracy of the RUDAS were included with almost 4000 participants, including approximately 1700 patients with dementia. MEASUREMENTS: Procedures for translation and cultural adaption of the RUDAS, and influence of demographic variables on diagnostic accuracy, were compared across studies. Bivariate random-effects models were used to pool sensitivity and specificity results, and diagnostic odds-ratios and the area under the hierarchical summary receiver operator characteristic curve were used to present the overall performance. RESULTS: The pooled sensitivity and specificity for the detection of dementia were .82 (95% CI, .78-.86) and .83 (95% CI, .78-.87), respectively, with an area under the curve of .89. Subgroup analyses revealed that the RUDAS had comparable diagnostic performances across high-, and low- and middle-income settings (z = .63, P = .53) and in samples with a lower and higher proportion of participants with no formal education (z = -.15, P = .88). In 11 studies making direct comparison, the diagnostic performance of the RUDAS was comparable to that of the Mini-Mental State Examination (z = -.82, P = .41), with areas under the curve of .88 and .84, respectively. CONCLUSIONS: The RUDAS has good diagnostic performance for detecting dementia in different sociocultural settings. Compared to other brief screening instruments, advantages of the RUDAS include its limited bias in people with limited or no formal education and a minimal need for cultural or language adaptation.

Establishing a community-wide DNA barcode library as a new tool for arctic research.

DNA sequences offer powerful tools for describing the members and interactions of natural communities. In this study, we establish the to-date most comprehensive library of DNA barcodes for a terrestrial site, including all known macroscopic animals and vascular plants of an intensively studied area of the High Arctic, the Zackenberg Valley in Northeast Greenland. To demonstrate its utility, we apply the library to identify nearly 20 000 arthropod individuals from two Malaise traps, each operated for two summers. Drawing on this material, we estimate the coverage of previous morphology-based species inventories, derive a snapshot of faunal turnover in space and time and describe the abundance and phenology of species in the rapidly changing arctic environment. Overall, 403 terrestrial animal and 160 vascular plant species were recorded by morphology-based techniques. DNA barcodes (CO1) offered high resolution in discriminating among the local animal taxa, with 92% of morphologically distinguishable taxa assigned to unique Barcode Index Numbers (BINs) and 93% to monophyletic clusters. For vascular plants, resolution was lower, with 54% of species forming monophyletic clusters based on barcode regions rbcLa and ITS2. Malaise catches revealed 122 BINs not detected by previous sampling and DNA barcoding. The insect community was dominated by a few highly abundant taxa. Even closely related taxa differed in phenology, emphasizing the need for species-level resolution when describing ongoing shifts in arctic communities and ecosystems. The DNA barcode library now established for Zackenberg offers new scope for such explorations, and for the detailed dissection of interspecific interactions throughout the community.

Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia.

OBJECTIVES: Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance. METHODS: A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs. RESULTS: At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis. CONCLUSION: The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.

Overdiagnosis of dementia in young patients - a nationwide register-based study.

BACKGROUND: Little is known about the quality of the diagnostic evaluation and the validity of dementia diagnoses in young patients established in routine clinical practice. The aim of this study was to investigate the validity of the diagnosis of dementia registered in the Danish nationwide hospital registers in young patients. METHODS: Two hundred patients were randomly selected from 891 patients <65 years registered with a dementia diagnosis for the first time in 2008. The patients' medical records were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and current clinical criteria for specific dementia subtypes. RESULTS: A registered diagnosis was found to be correct in only 59%. A misdiagnosis of dementia occurred primarily in patients with depression or alcohol abuse. CONCLUSION: Our results suggest that dementia is overregistered and overdiagnosed in young patients. This may be due to a different symptom profile of dementia in young patients, lack of knowledge among clinical physicians and the wide range of conditions which may be misinterpreted as dementia.

Cognitive testing in non-demented Turkish immigrants--comparison of the RUDAS and the MMSE.

Methods for culturally and linguistically appropriate cognitive testing of elderly minority populations are lacking in Europe. The aim of this study was to compare performance on the Rowland Universal Dementia Assessment Scale (RUDAS) and the Mini Mental State Examination (MMSE) in Turkish immigrants in Denmark and determine the impact of demographic and health-related variables on test performance. A sample of non-demented community-dwelling Turkish immigrants was recruited from the greater Copenhagen area. All participants completed a structured interview regarding demographic, physical and mental health status, as well as measures of depression and acculturation, and cognitive testing with the RUDAS and the MMSE. A total of 76 non-demented participants aged 50 or more were included in the study. The mean performance on the RUDAS and the MMSE was 26.8 (SD 2.4) and 23.7 (SD 4.3), respectively. In group comparisons, correlation analyses and regression analyses, level of schooling represented a more significant variable for RUDAS and MMSE performance than any other variable. However, the impact of schooling was considerably more pronounced on the MMSE and the test was not found to be a valid measure of general cognitive function in subjects with less than five years of schooling. Although not entirely free of educational bias, the RUDAS can be a valuable supplement to the MMSE for assessment of general cognitive function in Turkish minority populations.

Liver fat content investigated by magnetic resonance spectroscopy in obese children and youths included in multidisciplinary treatment.

UNLABELLED: What is already known about this subject • Investigations of non-alcoholic fatty liver disease (NAFLD) by non-invasive imaging procedures have limited evidence. • Thirty percent of obese children are estimated to have NAFLD and implications for future morbidity are uncertain. What this study adds • Many obese children and youths exhibit a high liver fat content as examined by magnetic resonance spectroscopy. • Associations between liver fat content, anthropometry, abdominal adipose tissue distribution and liver enzymes are illustrated. SUMMARY: The study aims to investigate the degree of hepatic steatosis and associations with the amount of abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), anthropometric data and biochemical measures of liver enzymes in children and youths included in obesity treatment. The study included 164 patients, aged 6-20 years, with a body mass index (BMI) above the 90th percentile for sex and age. Liver fat content was measured by magnetic resonance spectroscopy (MRS). SAT and VAT were measured by magnetic resonance imaging. Hepatic steatosis was defined as liver fat content >5% (steatosis-5%) and 9% (steatosis-9%), respectively. Data on waist circumference (WC) and blood samples were available in 124 patients. Steatosis-5% and steatosis-9% were identified in 45% and 27% of the patients, respectively. These patients had increased SAT, VAT, BMI standard deviation score, WC/height ratio, alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels. GGT, ALT and VAT were found to be independent risk factors of hepatic steatosis. In this study, a substantial proportion of obese children and youths have hepatic steatosis. Therefore, it is important to examine these subjects for the degree of fat in their liver. Future studies focusing on hepatic steatosis should consider the use of MRS in addition to blood samples.

Over- and under-diagnosis of dementia in ethnic minorities: a nationwide register-based study.

OBJECTIVE: Among dementia professionals in several European countries, it is believed that dementia is under-diagnosed and under-treated to a greater extent among ethnic minorities than in the native population. It is unknown whether this belief holds true. The objective of this study was to compare the prevalence of register-based dementia diagnoses in the largest ethnic minority groups in Denmark with the prevalence of register-based dementia diagnoses in the general Danish population. METHODS: By linking the Danish hospital registers with the Danish Civil Registration System, nationwide dementia cases for three main ethnic minorities were identified. Age- and gender-specific prevalence rates for dementia were calculated and compared to previously published data for the general population. RESULTS: The study population consisted of 68 219 persons aged 20 and older. A total of 174 dementia cases were identified. The mean age at diagnosis was 57.7 years (SD = 16.2). Compared to the general population, there was a higher prevalence of dementia among those younger than 60 years, and a markedly lower prevalence of dementia among those 60 years and older. CONCLUSIONS: Dementia is under-diagnosed to a greater extent among ethnic minorities in the age group 60 years and older but is over-diagnosed in the age group younger than 60 years. Several factors may contribute to this pattern, including cultural differences in help-seeking behaviour, and problems in navigating the health-care system. Furthermore, cross-cultural assessment of dementia can be difficult because of language barriers and cultural differences.

Effects of erythropoietin administration on cerebral metabolism and exercise capacity in men.

Recombinant human erythropoietin (EPO) increases exercise capacity by stimulating erythropoiesis and subsequently enhancing oxygen delivery to the working muscles. In a large dose, EPO crosses the BBB and may reduce central fatigue and improve cognition. In turn, this would augment exercise capacity independent of erythropoiesis. To test this hypothesis, 15 healthy young men (18-34 years old, 74 + or - 7 kg) received either 3 days of high-dose (30,000 IU/day; n = 7) double-blinded placebo controlled or 3 mo of low-dose (5,000 IU/wk; n = 8) counter-balanced open but controlled administration of EPO. We recorded exercise capacity, transcranial ultrasonography-derived middle cerebral artery blood velocity, and arterial-internal jugular venous concentration differences of glucose and lactate. In addition, cognitive function, ratings of perceived exertion, ventilation, and voluntary activation by transcranial magnetic stimulation-induced twitch force were evaluated. Although EPO in a high dose increased cerebrospinal fluid EPO concentration approximately 20-fold and affected ventilation and cerebral glucose and lactate metabolism (P < 0.05), 3 days of high-dose EPO administration had no effect on cognition, voluntary activation, or exercise capacity, but ratings of perceived exertion increased (P < 0.05). We confirmed that 3 mo of administration of EPO increases exercise capacity, but the improvement could not be accounted for by other mechanisms than enhanced oxygen delivery. In conclusion, EPO does not attenuate central fatigue or change cognitive performance strategy, suggesting that EPO enhances exercise capacity exclusively by increased oxygen delivery to the working muscles.

Non-markovian model of photon-assisted dephasing by electron-phonon interactions in a coupled quantum-dot-cavity system.

We investigate the influence of electron-phonon interactions on the dynamical properties of a quantum-dot-cavity QED system. We show that non-markovian effects in the phonon reservoir lead to strong changes in the dynamics, arising from photon-assisted dephasing processes, not present in markovian treatments. A pronounced consequence is the emergence of a phonon induced spectral asymmetry when detuning the cavity from the quantum-dot resonance. The asymmetry can only be explained when considering the polaritonic quasiparticle nature of the quantum-dot-cavity system. Furthermore, a temperature induced reduction of the light-matter coupling strength is found to be relevant in interpreting experimental data, especially in the strong coupling regime.

Effects of infectious mononucleosis and HLA-DRB1*15 in multiple sclerosis.

BACKGROUND: Both human leukocyte antigen (HLA)-DRB1*15 and Epstein-Barr virus infection presenting as infectious mononucleosis (IM) are recognized as risk factors for multiple sclerosis (MS). However, their combined effect and possible interaction on MS risk is not known. OBJECTIVE: To assess the association between HLA-DRB1*15 and risk of MS in persons with and without IM. METHODS: We compared the prevalence of DRB1*15 in MS patients with (n = 76) and without (n = 1,836) IM with the corresponding distributions in blood donors with (n = 62) and without (n = 484) IM histories. This allowed us to estimate the relative risk of MS associated with DRB1*15 in the presence and absence, respectively, of previous IM. We then estimated the interaction between DRB1*15 and IM as the ratio of the two individual odds ratios. RESULTS: In IM-naïve individuals, DRB1*15 carried a 2.4-fold (95% confidence interval [CI], 2.0-3.0) increased MS risk. In contrast, among persons with IM history, DRB1*15 was associated with a 7.0-fold (95% CI, 3.3-15.4) increased MS risk. Thus, the MS risk conferred by HLA-DRB1*15 was 2.9 (95% CI, 1.3-6.5)-fold stronger in the presence than in the absence of IM. Combined with previous results, this result indicates that DRB1*15-positive persons with a history of IM may be at a 10.0-fold (95% CI, 6.0-17.9) increased risk of MS compared with persons who are DRB1*15 and IM-naïve. CONCLUSION: DRB1*15 and IM may act in synergy causing MS.

Correlations between Epstein-Barr virus antibody levels and risk factors for multiple sclerosis in healthy individuals.

BACKGROUND: Female gender, human leukocyte antigen (HLA) DR2, tobacco smoking and Epstein-Barr virus (EBV) are established risk factors for multiple sclerosis (MS). Their possible interaction however, has been sparsely studied. OBJECTIVES: To investigate possible associations between EBV antibody levels and a range of other recognized MS risk factors. DESIGN, SETTING AND STUDY POPULATION: Cross-sectional study undertaken in Denmark based on 517 healthy individuals selected from the Danish population. METHODS: We measured change in mean log (anti-Epstein-Barr viral capsid antigen (VCA) immune globulin G) using linear regression. RESULTS: Anti-Epstein-Barr VCA immune globulin G levels were positively correlated with female gender and HLA DR2. Furthermore, current smoking and cumulative tobacco consumption were positively associated with EBV antibody levels. CONCLUSION: The association between Epstein-Barr VCA antibody levels and non-viral MS risk factors support the view that EBV is critically involved in the etiology of MS. These non-viral MS risk factors may be linked with MS risk through EBV-specific immune responses.

Meningitis following stapedotomy: a rare and early complication.

Controversy exists concerning stapedotomy for patients with small unilateral air-bone gaps. Surgical treatment of otosclerosis involves an opening to the labyrinth and accordingly, a risk of complications, usually vertigo and sensorineural hearing loss and infrequently anacusis. In this paper we present a 33-year-old woman with a small unilateral air-bone gap, who developed bacterial labyrinthitis with meningitis and anacusis three days after stapes surgery. The patient had a stapedotomy with the small fenestra piston prosthesis technique. Due to the potential for serious complications, patients with unilateral otosclerosis and mild hearing loss should be given the possibility to choose between a hearing aid and surgery. Although stapedotomy in the vast majority of interventions is a highly successful procedure and the best method of treatment for otosclerosis if successful, there is a high price to pay in the event of failure.

[Is the use of surgical microscope justified in thyroid surgery? 10-year experience with thyroid surgery performed by means of microsurgical technique]. / Har operationsmikroskopet sin berettigelse ved thyreoideakirurgi? Ti års erfaring med thyreoideakirurgi udført med mikrokirurgisk teknik.

Paralysis of the recurrent laryngeal nerve is the most disastrous complication following thyroid surgery. In order to minimize this complication, different devices have been used to identify the recurrent laryngeal nerve during surgery. The presently available devices are reviewed and we present our results with the device we used, the surgical microscope. Five hundred and seventy-three patients had thyroid surgery, 451 had benign lesions and 122 malignant. Calculated as nerves at risk, primary surgery in benign/malignant disease resulted in 0.6 per cent/3.5 per cent permanent paralysis and in recurrent and completion surgery this complication rate was 4.5 per cent/2.9 per cent. These results are pleasing but also stress that primary surgery should be radical so as to avoid completion or recurrent surgery.

[A 7-year experience with goiter surgery in an otorhinolaryngologic department. A retrospective study of the the period 1990-1996]. / Syv års erfaring med strumakirurgi i øre-, naese- og halsregi. En retrospektiv undersøgelse fra 1990 til 1996.

The aim of this study was quality assurance and to analyse the frequency of complications following thyroid surgery. The most dreaded surgical complications are permanent injury to the recurrent laryngeal nerve or persistent hypocalcaemia. Our surgical procedure included the use of the surgical microscope in connection with thyroid grand surgery. Our materiel includes 122 patients who underwent surgery for benign thyroid diseases in our department from 1990-1996. In nearly 50% of all cases a lobectomy was performed, reserving resections and subtotal thyroidectomy to special cases. Resections were primarily done in the beginning of the period. The surgical microscope was used as a standard procedure to identify and expose the recurrent laryngeal nerve and the parathyroid glands. Primary thyroid grand surgery in benign disease resulted in permanent unilateral laryngeal nerve palsy in one case or in 0.83% of the patients. When calculated as nerves at risk, the complication rate was reduced to 0.67%. In benign completion surgery the complication rate was 0%. No patient developed persistent hypocalcaemia.

Microsurgical technique in thyroid surgery--a 10-year experience.

OBJECTIVE: To report the results of thyroid surgery in a University department of ENT--head and neck surgery, and to evaluate the benefits of the use of the surgical microscope in thyroid surgery. DESIGN: A retrospective evaluation of the records of all patients who underwent thyroid surgery in the 10-year period 1987-1996. METHODS: In addition to standard surgical principles the Zeiss multi-discipline universal surgical microscope with a 250 mm ocular lens was used in all cases. Total thyroidectomy was performed in all malignant cases, while unilateral lobectomy plus isthmus resection was the standard procedure in benign cases. PATIENTS: There were 573 patients, aged 11-87 years, 444 females and 129 males. Four hundred and fifty-one had benign lesions, 122 malignant. Four hundred and eighty-nine had primary surgery, 84 underwent completion surgery or surgery for recurrent disease. RESULTS: Primary thyroid gland surgery in benign/malignant disease resulted in permanent recurrent laryngeal nerve palsy in 0.6 per cent/3.5 per cent of the patients respectively, when calculated as nerves at risk (NAR). In benign recurrent or malignant completion surgery this complication rate was 4.5 per cent/2.9 per cent respectively. CONCLUSION: Thyroid surgery in our University ENT--Head and Neck Department with the use of the surgical microscope provides pleasing results, especially considering the diversity of surgeons, due to the departments' teaching responsibilities.

[Patient assessment in ambulatory surgery. A questionnaire study]. / Patientevaluering af sammedagskirurgi. En enqueteundersøgelse.

In our department, from the beginning of December 1994 to the end of February 1995, we operated upon a selected group of 199 patients, hospitalized as day surgery patients. Each patient was given a questionnaire to fill in after discharge. We asked them to evaluate day surgery from the consumer's point of view. We did not record any data which could identify the single patient. We received 158 questionnaires (79%) of which 151 were accepted. One hundred and seven patients (71%) found day surgery acceptable and a good alternative to conventional hospitalization, 82% preferred having the same doctor and primary nursing during the treatment. One hundred and sixteen patients were discharged as planned (77%). There were no serious complications. Provided that patients are carefully selected, we find day surgery a highly satisfactory method of management which is safe and efficient.

Mediastinitis-a rare complication of a peritonsillar abscess.

We report a case of mediastinitis, in an otherwise healthy 25-year-old man, resulting from a peritonsillar abscess with extension through the parapharyngeal and retropharyngeal spaces. In our case the patient was primarily treated with needle aspiration, a method described in many publications as a safe alternative to incision and drainage. We emphasize that for peritonsillar abscesses a tonsillectomy or wide incision and drainage, instead of needle aspiration, might prevent the extension of the condition, thus preventing serious complications.

[Extrapulmonary tuberculosis--important differential diagnosis]. / Ekstrapulmonal tuberkulose--en vigtig differentialdiagnose.

In this paper, we present two cases of extrapulmonary tuberculosis, the first case with tuberculosis of the larynx and the second with tuberculosis lymfadenitis. In both cases malignant lesions were primarily proposed. We emphasize that definitive diagnosis requires culture and specification of Mycobacterium tuberculosis. We draw attention to the fact that extrapulmonary tuberculosis is still a differential diagnostic consideration.