The Evaluation of Tau Deposition with [18F]PI-2620 by Using a Semiquantitative Method in Cognitively Normal Subjects and Patients with Mild Cognitive Impairment and Alzheimer's Disease.

Background: Some studies have reported the effectiveness of [18F]PI-2620 as an effective tau-binding radiotracer; however, few reports have applied semiquantitative analysis to the tracer. Therefore, this study's aim was to perform a semiquantitative analysis of [18F]PI-2620 in individuals with normal cognition and patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Methods: Twenty-six cognitively normal (CN) subjects, 7 patients with AD, and 36 patients with MCI were enrolled. A dynamic positron emission tomography (PET) scan was performed 30-75 min postinjection. PET and T1-weighted magnetic resonance imaging scans were coregistered. The standardized uptake value ratio (SUVr) was used for semiquantitative analysis. The P-Mod software was applied to create volumes of interest. The ANOVA and post hoc Tukey HSD were used for statistical analysis. Results: In the AD group, the occipital lobe had a significantly higher mean SUVr (1.46 ± 0.57) than in the CN and MCI groups. Compared with the CN group, the AD group showed significantly higher mean SUVr in the fusiform gyrus (1.06 ± 0.09 vs. 1.49 ± 0.86), inferior temporal (1.07 ± 0.07 vs. 1.46 ± 0.08), parietal lobe, lingual gyrus, and precuneus regions. Similarly, the AD group demonstrated a higher mean SUVr than the MCI group in the precuneus, lingual, inferior temporal, fusiform, supramarginal, orbitofrontal, and superior temporal regions. The remaining observed regions, including the striatum, basal ganglia, thalamus, and white matter, showed a low SUVr across all groups with no statistically significant differences. Conclusion: A significantly higher mean SUVr of [18F]PI-2620 was observed in the AD group; a significant area of the brain in the AD group demonstrated tau protein deposit in concordance with Braak Stages III-V, providing useful information to differentiate AD from CN and MCI. Moreover, the low SUVr in the deep striatum and thalamus could be useful for excluding primary tauopathies.

Etiology of Dementia in Thai Patients.

INTRODUCTION: Molecular imaging has been developed and validated in Thai patients, comprising a portion of patients in the dementia registry. This should provide a more accurate diagnosis of the etiology of dementia, which was the focus of this study. METHODS: This was a multicenter dementia study. The baseline characteristics, main presenting symptoms, and results of investigations and cognitive tests of the patients were electronically collected in the registry. Functional imaging and/or molecular imaging were performed in patients with an equivocal diagnosis of the causes of dementia, especially in atypical dementia or young onset dementia (YOD). RESULTS: There were 454 patients in the study. The mean age of the patients was 78 years, with 60% female. Functional imaging and/or molecular imaging were performed in 57 patients (57/454 patients, 13%). The most common cause of dementia was Alzheimer's disease (AD; 50%), followed by vascular dementia (VAD; 24%), dementia with Lewy bodies (6%), Parkinson's disease dementia (6%), frontotemporal dementia (FTD; 2.6%), progressive supranuclear palsy (2%), multiple system atrophy (0.8%), and corticobasal syndrome (0.4%). YOD accounted for 17% (77/454 patients), with a mean age of 58 years. The causes of YOD were early onset amnestic AD (44%), VAD (16%), behavioral variant FTD (8%), posterior cortical atrophy (6.5%), and logopenic variant primary progressive aphasia (5.2%). CONCLUSION: AD was the most common cause of dementia in Thai patients and the distribution of other types of dementia and main presenting symptoms were similar to previous reports in Western patients; however, the proportion of YOD was higher.

The Effect of English Language on Multiple Choice Question Scores of Thai Medical Students.

BACKGROUND: Universities in Thailand are preparing for Thailand's integration into the ASEAN Economic Community (AEC) by increasing the number of tests in English language. English language is not the native language of Thailand Differences in English language proficiency may affect scores among test-takers, even when subject knowledge among test-takers is comparable and may falsely represent the knowledge level of the test-taker. OBJECTIVE: To study the impact of English language multiple choice test questions on test scores of medical students. MATERIAL AND METHOD: The final examination of fourth-year medical students completing internal medicine rotation contains 120 multiple choice questions (MCQ). The languages used on the test are Thai and English at a ratio of 3:1. Individual scores of tests taken in both languages were collected and the effect of English language on MCQ was analyzed Individual MCQ scores were then compared with individual student English language proficiency and student grade point average (GPA). RESULTS: Two hundred ninety five fourth-year medical students were enrolled. The mean percentage of MCQ scores in Thai and English were significantly different (65.0 ± 8.4 and 56.5 ± 12.4, respectively, p < 0.001). The correlation between MCQ scores in Thai and English was fair (Spearman's correlation coefficient = 0.41, p < 0.001). Of 295 students, only 73 (24.7%) students scored higher when being tested in English than in Thai language. Students were classified into six grade categories (A, B+, B, C+, C, and D+), which cumulatively measured total internal medicine rotation performance score plus final examination score. MCQ scores from Thai language examination were more closely correlated with total course grades than were the scores from English language examination (Spearman's correlation coefficient = 0.73 (p < 0.001) and 0.53 (p < 0.001), respectively). The gap difference between MCQ scores in both languages was higher in borderline students than in the excellent student group (11.2 ± 11.2 and 7.1 ± 8.2, respectively, p < 0.001). Overall, average student English proficiency score was very high, at 3.71 ± 0.35 from a total of 4.00. Mean student GPA was 3.40 ± 0.33 from a possible 4.00. English language MCQ examination scores were more highly associated with GPA than with English language proficiency. CONCLUSION: The use of English language multiple choice question test may decrease scores of the fourth-year internal medicine post-rotation final examination, especially those of borderline students.

Unrecognized Delirium is Prevalent among Older Patients Admitted to General Medical Wards and Lead to Higher Mortality Rate.

Objective: Delirium is a syndrome associated with high mortality that often goes undetected by healthcare providers. There has been limited evidence regarding the consequences of under-recognition of delirium on patient outcomes. The present study aimed to investigate the rate of under-recognized delirium and explore the effect of unrecognized delirium on patient mortality. Material and Method: A cohort of older patients aged 70 years or more who developed delirium during admittance to general medical wards at Siriraj Hospital between January and March 2009 was retrospectively investigated. A diagnosis of delirium was made by geriatricians applying DSM-IV criteria. Medical records were reviewed to identify recognition of delirium by physicians and nurses. Factors affecting mortality were investigated using univariate and multivariate logistic regression models. Results: Of 110 patients who developed delirium, 57.3% of cases were identified as delirium by physicians, with only 14.5% of cases having their delirium documented in the discharge summary. Rate of delirium recognition among nurses was 61.8%, with a comprehensive nursing care plan developed in only 13.6% of cases. Patients with delirium that went unrecognized by attending physicians had a mortality rate of 38.3%, compared to 15.9% for the recognized delirium group (p = 0.008). In multivariate analysis, unrecognized delirium was identified as an independent risk factor for death with adjusted OR of 5.16 (95% CI 1.45-18.29). Conclusion: Rate of unrecognized delirium by healthcare providers in this study was high, but comparable to previous studies. Moreover, under-recognition of delirium was found to lead to higher mortality. Routine screening for delirium and implementation of a proactive care plan by nurses for older patients admitted to general medical wards might be a strategy for improving this common and preventable medical condition and for lowering delirium-related mortality rates.

A survey of opinions regarding wishes toward the end-of-life among Thai elderly.

BACKGROUND: Knowledge of wishes toward the end-of-life is crucial for carrying out high quality palliative care. However, advance directive is not commonly available among Thais, particularly for non-cancerous older patients. OBJECTIVE: The present study aimed to explore Thai older person's wishes toward cares needed at the end-of-life. MATERIAL AND METHOD: A convenience sample of 100 older patients, who attended geriatric clinic at a university hospital in Thailand, was recruited. A 3-page questionnaire developed to suit Thai culture was utilized to elicit opinions concerning circumstances around end-of-life period. RESULTS: All participants were Buddhists with mean age of 75.9 (8.2). Toward the end-of-life, the majority wanted to know the truth about their illnesses and to be free from uncomfortable symptoms. Seventy-five percent did not want "prolong-life" treatments when chance of surviving is slim. Age less than 70 and having education of no more than 6 years were factors associated with being unwilling to prolong suffering with OR of 9.88 (1.20-81.57, p = 0.03) and 3.15 (1.11-8.95, p = 0.03), respectively. Interestingly, fifty-six percent of elderly did not want to die at home. Age less than 70 was the only factor significantly associated with being unwilling to die at home with OR of 2.80 (95% CI = 1.05-7.47, p = 0.04). CONCLUSION: The present study illustrated older persons' opinions in relation to cares at the end-of-life from a Thai perspective, which showed some similarities and differences when compared to western countries. These opinions should be crucial for carrying out optimal and qualitative end-of-life care for older people when advanced care planning is not in place for the individual.

Short-term clinical outcomes in delirious older patients: a study at general medical wards in a university hospital in Thailand.

AIM: Delirium, a common disorder in hospitalized older patients, frequently results in unfavorable consequences. Previous studies in different settings have provided conflicting results regarding clinical outcomes and mortality. We aimed to study three clinical outcomes--length of stay (LOS), in-hospital mortality and 3-month mortality--among delirious Thai older patients. METHODS: A prospective observational study was carried out in a university hospital in Thailand. All patients aged older than 70 years admitted to general medical wards were included. Delirium assessments were undertaken within the first 24 h of admission and serially until discharge. Subsequent assessments were carried out at 3 months after discharge. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Factors associated with mortality were determined by using logistic regression models. RESULTS: LOS was significantly longer in the delirium group (10 and 8 days, P = 0.001). Furthermore, the delirium group had higher in-hospital and 3-month mortality (P < 0.001). Factors significantly associated with in-hospital mortality in multivariate analysis were age more than 80 years (AOR 2.74, 95% CI 1.05-7.15), malignancy (AOR 3.11, 95% CI 1.16-8.33), severe illness (AOR 3.75, 95% CI 1.38-10.20) and delirium (AOR 7.34, 95% CI 1.51-35.69). Delirium remained a strong predictor for 3-month mortality in multivariate analysis with AOR of 3.33 (95% CI 1.45-7.62) CONCLUSIONS: Delirium was associated with prolonged hospital-stay and was the strongest predictor for mortality among older hospitalized patients. It requires serious attention from physicians, healthcare administrators and policy makers to implement an appropriate management plan for this high-burden issue.

Prevalence and incidence of delirium in Thai older patients: a study at general medical wards in Siriraj Hospital.

BACKGROUND: Delirium, an acute decline in attention and cognition, is found to be a common life-threatening clinical syndrome among hospitalized older patients. However, there has been no study to date regarding prevalence and incidence of delirium in Thai older patients. OBJECTIVE: The authors aimed to determine prevalence and incidence of delirium in older patients admitted to general medical wards in a university hospital in Thailand. MATERIAL AND METHOD: A prospective observational study was conducted in Siriraj Hospital. All patients aged 70 years or older admitted to general medical wards during study period were included. Delirium assessments were undertaken initially within the first 24 hours of admission and serially every 48 hours until patients developed delirium or were discharged. Delirium was diagnosed by experienced geriatricians based on the DSM-IV criteria. Prevalence was based on delirium identified at the first assessment, whereas incidence was defined based on cases developed during hospitalization. RESULTS: Two hundred and twenty five patients were enrolled. The prevalence of delirium was 40.4%, while the incidence of delirium was 8.4%. Therefore, the total occurrence rate of delirium was remarkably high (48.9%). Occurrence rate of delirium significantly increased with age (p = 0.003) and illness severity (p < 0.001). Number of impaired activities of daily living was also associated with occurrence rate of delirium in older patients. CONCLUSION: In conclusion, the prevalence of delirium among older patients admitted to general medical wards in the present study were alarmingly high. Meanwhile, the incidence of delirium was comparable to other studies. Obviously, it requires serious attention from physicians, nurses and hospital administrators. These findings may reflect the importance of delirium detection for proper management. To lower morbidity and mortality in older patients, effective preventive strategies of delirium should be implemented promptly during hospital admission.

Risk factors for developing delirium in older patients admitted to general medical wards.

BACKGROUND: Delirium in older patients is common and leads to poor clinical outcomes. It is, however, preventable if its risk factors are identified and modified accordingly. OBJECTIVE: To determine risk factors associated with delirium in hospitalized older patients admitted to general medical wards at Siriraj Hospital. MATERIAL AND METHOD: A prospective observational study was conducted at general medical wards, Siriraj Hospital. All consecutive patients aged 70 years or older admitted during study period were assessed and followed until discharge. A diagnosis of delirium was made if patients developed symptoms which fulfilled DSM IV criteria. Information regarding demographic data, co-morbid illnesses, preexisting cognitive status and functional status was collected at admission. Factorf associated with delirium were analyzed using logistic regression models. RESULTS: Risk factors associated with developing delirium identified from univariate analysis were female gender, age more than 80 years-old, having 4 or more co-morbidities, azothemia, hyponatremia, presence of infection, severe illness, preexisting dementia, depression, and impaired basic activities of daily living. After adjusted in multivariate analysis; factors those remained statistically significant were preexisting dementia (OR = 5.52, 95% CI = 2.51-12.14), severe illness (OR = 5.18, 95% CI = 2.10-12.76) presence of infection (OR = 2.54, 95% CI = 1.15-5.61) and azothemia (OR = 2.55, 95% CI = 1.205.40). CONCLUSION: Pre-existing dementia and illness severity were strongly associated with developing delirium in older patients in the present study, which is concordant with previous studies. Other factors such as presence of infection and azothemia are modifiable factors that could potentially be important targets, along with other factors identified in the present study, for implementing intervention in order to prevent delirium in this population.

Caregiver burden and needs of dementia caregivers in Thailand: a cross-sectional study.

OBJECTIVE: To identify the burdens of Thai dementia caregivers and to determine the services that could support them in this function. MATERIAL AND METHOD: The authors surveyed 88 dementia caregivers attending "Caregiver Day". The questionnaire contained Caregiver Burden Inventory. The answers range from "not at all descriptive" (zero) to "very descriptive" (4). The authors also explored baseline characteristics of caregivers and care recipients as well as caregiver's needs of a supporting system. RESULTS: There was an 82% response rate. Responses in time-dependence burden distributed almost equally in the five possible scales. In developmental and physical burden, caregivers rate scores mainly from 0-2. The scores in social and emotional burden ranged mainly between 0-1. Dependency in basic activities of daily living correlated with higher caregiver burden (odd ratio 7.48, 95% confidence interval 1.42-39.53, p = 0.02), while sex and kinship did not. The top three caregiver's needs were 1) caregiver education and training, 2) telephone line provided for caregiver consultation and 3) special system in a hospital provided for dementia patients to have rapid access to see a doctor. CONCLUSION: Caring for dementia patients can lead to high caregiver burden, particularly those caring for dependent patients. Physical and developmental burdens are affected more than social and emotional burdens. Culture, relationship quality and resources (coping, outlook on life and social support) might be contributing factors of this difference.