The impact of active community-based survey on dementia detection ratio in Taiwan: A cohort study with historical control.

Background: Although early dementia detection is crucial to optimize the treatment outcomes and the management of associated symptoms, the published literature is scarce regarding the effectiveness of active screening protocols in enhancing dementia awareness and increasing the rate of early detection. The present study compared the detection ratio of an active community-based survey for dementia detection with the detection ratio of passive screening during routine clinical practice. Data for passive screening were obtained from the National Health Insurance (NHI) system, which was prospectively collected during the period from 2000 to 2003. Design: A population-based cohort study with historical control. Setting: Taiwan. Participants: A total of 183 participants aged 65 years or older were involved in a community-based survey. Data from 1,921,308 subjects aged 65 years or older were retrieved from the NHI system. Measurements: An adjusted detection ratio, defined as a ratio of dementia prevalence to incidence was used. Results: The results showed that the dementia prevalence during the 2000-2003 period was 2.91% in the elderly population, compared with a prevalence of 6.59% when the active survey was conducted. The incidence of dementia in the active survey cohort was 1.83%. Overall, the dementia detection ratio was higher using active surveys [4.23, 95% confidence interval (CI): 2.68-6.69] than using passive detection (1.45, 95% CI: 1.43-1.47) for those aged 65-79 years. Similar findings were observed for those aged 80 years and older. Conclusion: The implementation of an active community-based survey led to a 3-fold increase in the detection rate of early dementia detection compared to passive screening during routine practice.

Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients.

Aspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96-3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41-0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1-2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.

Low ambient temperature as the only meteorological risk factor of seizure occurrence: A multivariate study.

BACKGROUND: The onset of epileptic seizures is influenced by weather, which is multifactorial. It is unknown which specific weather factors affect the occurrence of seizures. OBJECTIVES: We studied the correlation between the onset of epileptic seizures and multiple weather parameters based on a population-based registry profile. METHODS: We determined the number of patients who visited emergency services in Taiwan diagnosed as having epilepsy. Then we used a linear regression model to analyze the monthly average number of patients who received emergency treatment for epilepsy in relation to temperature, barometric pressure, accumulated precipitation, relative humidity, and hours of sunshine. The Poisson regression model was used to analyze multiple meteorological factors in relation to the number of daily emergency visits because of epilepsy. A receiver operating characteristic curve was used to determine the cutoff temperature for the occurrence of seizures. RESULTS: Temperature appeared to be the robust factor for the onset of epilepsy. For every 1 °C decrease in temperature, there was a relative risk increase of 1.016 in the number of emergency visits as a result of epilepsy. Temperature lower than 18 °C had the best predictive value for seizure. Barometric pressure, accumulated precipitation, relative humidity, and the number of hours of sunshine were not related to the occurrence of seizures. SIGNIFICANCE: Our results suggest that temperature is the only influential meteorological factor that affects seizure occurrence.

Gradient Relationship between Increased Mean Corpuscular Volume and Mortality Associated with Cerebral Ischemic Stroke and Ischemic Heart Disease: A Longitudinal Study on 66,294 Taiwanese.

The gradient relationship between mean corpuscular volume (MCV) and mortality due to ischemic vascular disease has not been researched using a large-scale population-based study. This study evaluated the association between MCV and death attributable to cerebrovascular disease (CVD) and cardiovascular disease (CAD) in a large population- and community-based Taiwanese cohort. A longitudinal study with a 9-year follow-up was conducted to evaluate individuals aged 20 years or older who had participated in the Keelung (the northernmost city in Taiwan) community-based integrated screening (abbreviated as KCIS) program since September 1999. The mortality rates associated with CVD and CAD were classified across a range of different MCV levels. Increased MCV levels were associated with an increased risk of CVD/CAD-related death (adjusted hazard ratio [aHR] = 1.42, trend test P = 0.0119). Marginally statistically significant associations were noted for specific deaths from ischemic heart disease (aHR = 1.44, trend test P = 0.0992) and cerebral ischemic stroke (aHR = 1.66, trend test P = 0.0667), respectively, but no significant gradient relationship was noted for death from cerebral hemorrhage stroke (aHR = 1.23, trend test, P = 0.6278). A gradient relationship between baseline MCV level and CVD/CAD-related death was noted, but whether such gradient relationships existed for two specific deaths and how these relationships may be confounded by extraneous factors that were not considered here should be investigated in the future.

Total white blood cell count or neutrophil count predict ischemic stroke events among adult Taiwanese: report from a community-based cohort study.

BACKGROUND: Evidence about whether white blood cell (WBC) or its subtypes can act as a biomarker to predict the ischemic stroke events in the general population is scanty, particularly in Asian populations. The aim of this study is to establish the predictive ability of total WBC count or subtypes for long-term ischemic stroke events in the cohort population in Taiwan. METHODS: The Chin-Shan Community Cohort Study began from 1990 to 2007 by recruiting 1782 men and 1814 women of Chinese ethnicity. Following a total of 3416 participants free from ischemic stroke events at baseline for a median of 15.9 years; we documented 187 new incident cases. RESULTS: The multivariate relative risk for the comparison of the participants in the fifth and first WBC count quintiles was 1.67 (95% confidence interval [CI], 1.02-2.73; P for trend=0.03), and the corresponding relative risk for neutrophil count was 1.93 (95% CI, 1.13-3.29; P for trend=0.02). The discriminative ability by WBC and neutrophil counts were similar (area under the receiver operating characteristic curve, 0.600 for adding WBC, 0.610 for adding neutrophils, 0.595 for traditional risk factor model). In addition, the net reclassification improvement (NRI) values between the neutrophil and white blood cell count models were not significant (NRI, =-2.60%, P=0.35), indicating the similar discrimination performance for both WBC and neutrophil counts. CONCLUSIONS: WBC and neutrophil count had a similar ability to predict the long-term ischemic stroke events among Taiwanese.

Noninvasive detection of brainstem and spinal cord axonal degeneration in an amyotrophic lateral sclerosis mouse model.

Degeneration of motor neurons and their associated axons is a hallmark of amyotrophic lateral sclerosis, but reliable noninvasive lesion detection is lacking. In vivo diffusion tensor imaging was performed to evaluate neurodegeneration in the brainstem and cervical spinal cord of wild-type and G93A-SOD1 transgenic mice, an animal model of amyotrophic lateral sclerosis. A statistically significant reduction in the apparent diffusion coefficient was observed in the motor nuclei VII and XII of G93A-SOD1 transgenic mice relative to wild-type mice. No significant difference in diffusion anisotropy was observed in dorsal white or gray matter in cervical and lumbar segments of the spinal cord. In contrast, statistically significant decreases in axial diffusivity (diffusivity parallel to the axis of the spinal cord) and apparent diffusion coefficient were found in the ventrolateral white matter of G93A-SOD1 mice in both the cervical and lumbar spinal cord. The reduction in axial diffusivity, suggestive of axonal injury, in the white matter of the spinal cord of G93A-SOD1 mice was verified by immunostaining with nonphosphorylated neurofilament. The present study demonstrates that in vivo diffusion tensor imaging-derived axial diffusivity may be used to accurately evaluate axonal degeneration in an animal model of amyotrophic lateral sclerosis.

Asymptomatic chronic hepatitis B virus infection does not increase the risk of diabetes mellitus: a ten-year observation.

BACKGROUND AND AIM: Chronic hepatitis C virus infection has been known to increase the risk of diabetes. Whether this association holds true for chronic hepatitis B virus (HBV) infection remains unclear. We thus conducted this study to investigate the influence of asymptomatic chronic HBV infection on the incidence of diabetes in a longitudinal cohort. METHODS: A total of 1233 adults who received health examinations in 1997-1998 and in 2000-2001 were enrolled. Among them, 483 subjects who received a third health examination in 2006-2008 were further sampled. The prevalence and incidence of diabetes between asymptomatic HBV carriers and non-HBV controls were compared using the chi(2)-test and logistic regression. RESULTS: In 1997-1998, the prevalence rates of diabetes (9.49 and 12.0%) and glucose intolerance (28.5 and 25.4%) in HBV carriers and non-HBV controls were comparable (P > 0.05). There was no significant correlation between asymptomatic HBV infection and the presence of diabetes in subjects examined in 1997-1998, 2000-2001, or 2006-2008 when adjusted for age, gender, and body mass index (P > 0.05). In 296 non-diabetic subjects during 1997-1998, the ten-year incidence of diabetes/glucose intolerance was similar between HBV carriers and non-HBV controls (40.0 and 38.7%, P > 0.05). Moreover, no significant correlation was found between asymptomatic HBV infection and the incidence of diabetes/glucose intolerance in 2006-2008 (P = 0.775). CONCLUSIONS: Compared to non-HBV controls, subjects with asymptomatic chronic HBV infection do not have an increased risk of diabetes, and thus HBV itself is not pro-diabetic.

Further development in anatomically constrained MR image reconstruction: application to multimodal imaging of mouse stroke.

MR imaging can leverage a wide variety of intrinsic contrast mechanisms to provide detailed information regarding the anatomy, function, physiology, and metabolism of biological tissues. However, because of low sensitivity, many experiments that reveal higher-order structure and function have been limited due to inherent trade-offs between data acquisition time, signal-to-noise ratio, and resolution. This paper describes the further development of a statistical framework for MR image reconstruction which helps to mitigate these effects. Specifically, we advocate the collection of high-resolution multi-modal MR imaging data, and utilize the correlation between features in these different images to reduce noise while maintaining resolution. The proposed approach is illustrated with joint reconstruction of relaxometry and spectroscopic imaging data in a mouse model of stroke.

Location and size of infarct on functional outcome of noncardioembolic ischemic stroke.

PURPOSE: Studies regarding the effects of location and size of infarct on the functional outcome after stroke have yielded inconsistent results. This study aimed to investigate the relationships of neuroimage findings and longitudinal Barthel index (BI) scores in patients with first-ever ischemic stroke. METHOD: The neuroimage findings of enrolled subjects were grouped by anatomical location. The size of infarct was determined by the largest diameter of the lesion. Patients were followed up prospectively at onset, 2 weeks, 1, 2, 4, and 6 months after stroke. Linear mixed model was employed for the repeated measurement analysis of BI at these six time points in each patient. RESULTS: A total of 111 patients were enrolled. The BI increased rapidly during the first two months, and reached plateau after four months. The location and size of the lesion had significant effects on serial measurements of BI. After adjustment for age, sex, treatment mode, and baseline BI score, the posterior cerebral artery infarct group showed the largest improvement in BI. There was a trend that the smaller the lesion size, the more favourable the functional outcome. CONCLUSIONS: Both location and size of lesion in noncardioembolic stroke were significant prognostic factors for functional outcome.

Long-term mortality assessment using biological measures among elderly people. Ten-year follow-up of 597 healthy elderly subjects in Taiwan.

BACKGROUND: Identifying biological measures that are predictive of mortality for elderly people aged over 65 years has not been fully elucidated in oriental studies. OBJECTIVE: The associations between these biological measures and long-term mortality were therefore investigated, and classifications for risk of death were developed among Taiwanese elderly people METHODS: Data used in this study were derived from a total of 597 apparently healthy subjects aged over 65 years identified from a nationwide survey that was conducted between 1989 and 1991 in Taiwan. Each participant received a physical examination and a wide range of biological measures. These 597 apparently healthy subjects were followed to 31 December 1999 to determine the cause of death. The grouping technique using factor analysis was first used to aggregate similar characteristics of biological measures into reduced components. Risk of death for each subject was classified into four groups: good (A), fair (B), modest (C) and poor (D). Hazard ratios for groups B, C, D against A were calculated. RESULTS: The overall 10-year survival rate was 72% [95% confidence interval (CI) 68-76%]. The adjusted hazard ratios for all-cause death in high and mid-level categories of haematological components versus the lowest group were 0.51 (95% CI 0.33-0.80) and 0.56 (95% CI 0.37-0.85), respectively. Group D had a 6-fold risk of death as compared with group A (relative risk = 6.34, 95% CI 3.85-10.52). The corresponding figures were 2.48 (95% CI 1.43-4.29) and 1.60 (95% CI 2.88-6.89) for groups B and C, respectively. CONCLUSIONS: The relationships of biological measures to long-term mortality were elucidated. Information on classification for risk of death may be helpful for elderly people to pay attention to their health status after receiving a health check-up.