Chinese culture permeation in the treatment of Parkinson disease: a cross-sectional study in four regions of China.

BACKGROUND: Little is known about the clinical features and treatment of Chinese patients with Parkinson disease (PD). METHODS: A large cross-sectional survey of clinical features, medication use, and motor complications was conducted in 901 consecutive PD patients, from 42 randomly selected university-affiliated hospitals in four urban economic regions of China, between December 2006 and May 2007. RESULTS: The 901 PD patients had age range 30 to 88, and median disease duration 50 months. Most (737, 81.8%) used L-dopa (median 375 mg/day), and often added low doses of other antiparkinsonian agents. Among L-dopa-treated patients, the prevalence of motor complications was low (dyskinesias: 8.5%; motor fluctuations: 18.6%), even among patients with disease duration ≥11 years (dyskinesias: 18.1%; motor fluctuations: 42.2%). Higher L-dopa use was associated with higher occurrence of dyskinesias (OR 2.44; 95% CI 1.20-5.13) and motor fluctuations (OR 2.48; 95% CI 1.49-4.14). Initiating PD treatment with L-dopa alone (OR 0.46; 95% CI 0.22-0.95) or in combination with other medications (OR 0.41; 95% CI 0.19-0.87) was associated with less dyskinesia than treatment initiated with non-L-dopa medication. CONCLUSIONS: Many Chinese PD patients are treated with low-dose L-dopa and added low-dose antiparkinsonian agents, with a low prevalence of motor complications, which might be influenced by Chinese culture.

Birth measurements, family history, and environmental factors associated with later-life hypertensive status.

BACKGROUND: This birth cohort study was conducted to investigate the contribution of prenatal and antenatal environmental exposures to later-life hypertensive status. METHODS: Two thousand five hundred and three individuals born in 1921-1954 at the Peking Union Medical College Hospital (PUMCH) were targeted; 2,081 (83.1%) participated. Clinical examinations included an interview, blood pressure (BP) measurements, and laboratory assays. Statistical analyses were performed using ordinal regression models with later-life hypertensive status as the dependent variable. Similar analyses were for subpopulations divided by family history of hypertension. RESULTS: In the 2,081 subjects, 449 were normotensive, 531 were prehypertensive, and 1,101 had hypertension. Three hundred and forty two hypertensive patients were classified as high-risk (BP ≥180/110 mm Hg, or accompanied with diabetes or three well-established cardiovascular risk factors); the other 759 patients were at mid-to-low risks. Lower birth weight (<2,500 g: odds ratio (OR) = 1.67, P = 0.02; 2,500- <3,000 g: OR = 1.64, P < 0.01; 3,000- <3,500 g, OR = 1.40, P = 0.01), family history of hypertension (OR = 1.73, P < 0.01), poor education (OR = 1.76, P < 0.01), and alcoholism (OR = 3.05, P < 0.01) significantly predicted later-life high-risk hypertension. For participants with hypertensive family history (57.7%), the association with birth weight became nonsignificant, but poor education (OR = 2.33, P < 0.01) and alcoholism (OR = 3.10, P = 0.01) remained important. For participants without hypertensive family history (42.3%), the effects of lower birth weight (<2,500 g: OR = 2.26, P = 0.02; 2,500- <3,000 g: OR = 1.91, P = 0.01; 3,000- <3,500 g, OR = 1.78, P = 0.01) and alcoholism (OR = 3.23, P < 0.01) remained significant. CONCLUSION: Low birth weight, low education, alcoholism, and hypertensive family history are linked to later-life hypertensive status. Low birth weight is also partly associated with one's genetic background; whereas the association with education and alcoholism are independent from hypertensive family history.

Epidemiology and clinical phenomenology for Parkinson's disease with pain and fatigue.

We conducted a cross-sectional analysis with 901 Parkinson's disease (PD) patients in China to understand the epidemiological characteristics of PD pain among Chinese patients. In addition, we searched PubMed and the China Hospital Knowledge Database for epidemiological studies of pain and fatigue among PD patients from 1999 to 2011 to understand the prevalence of these symptoms around the world and associated clinical features. The 901 PD cases were recruited from 42 university affiliated hospitals randomly selected from seven provincial capitals across four economic regions of China. We documented motor and non-motor symptoms via clinical examinations and questionnaire surveys. Using logistic regression models, we evaluated factors that were associated with PD pain among these Chinese patients. Of the 901 Chinese patients, 269 (29.9%) had PD-related pain. After adjusting for confounders, only dyskinesias (OR = 2.66) and depression (OR = 2.88) were independently associated with PD pain. The literature search identified a total of 16 eligible studies on PD-pain and 19 on PD fatigue with various tools for symptom assessment. The data suggest a crude prevalence of 33.7% for PD pain in Asia and 79.4% in Northern Europe; the prevalence for PD fatigue was 35.4% in Northern Europe and 59.1% in Western Europe. Interestingly, Northern-European PD patients reported the highest prevalence of pain, but the lowest prevalence of fatigue. These studies suggest that motor complications and depression are likely key predictors for PD pain, while disease severity, depression and sleep disturbance are associated with PD fatigue. More studies with standardized methods would be needed to better understand the prevalence of PD pain and fatigue across various regions of the world.

[Local injection of gentamycin for female urethral syndrome: a clinical study].

OBJECTIVE: To observe the therapeutic effect of local antibiotic injection into the female prostate on female urethral syndrome (FUS), and search for an effective treatment for this disease. METHODS: This study included 163 FUS patients treated in the out-patient department between July 2009 and December 2010. According to the visiting order, the patients were randomly assigned to Groups A (n = 58), B (n = 55) and C (n = 50). All underwent routine treatment. Inaddition Group A received local injection of 2 ml of 80 000 U gentamycin + 2 ml of lidocaine, and Group B 2 ml of normal saline + 2 ml of lidocaine, both injected into the distal segment of the urethral back wall where the female prostate is located, twice a week for 3 weeks. The therapeutic effects were evaluated according to the changes of the patients' independent symptom scores at 2 and 4 weeks after the treatment. Disappearance of the symptoms was considered as "curative" , > 1/2 reduction in the symptom score as "obviously effective", 1/2 - > 1/4 reduction in the symptom score as "effective", and < 1/4 reduction or increase in the symptom score as "ineffective". RESULTS: At 2 weeks after the treatment, the total effectiveness rate was significantly higher in Group A (77.5%) than in B (67.3%) and C (68.0%) (P < 0.05), but with no statistically significant difference between B and C (P > 0.05). At 4 weeks, the total effectiveness rate of Group A was slightly decreased, but still remarkably higher than that of group B or C (P < 0.05). CONCLUSION: Local injection of gentamycin into the female prostate is effective for the treatment of female urethral syndrome.

[The application of Montreal cognitive assessment in urban Chinese residents of Beijing].

OBJECTIVE: To study the distribution of Montreal cognitive assessment (MoCA) scores in terms of age and educational level in Chinese residents aged 50 years and over and to offer a benchmark for a cutoff score. METHODS: A total of 281 residents aged 50 years or older was drawn randomly in the urban areas of Beijing, including 215 healthy elderly controls (NC) and 66 patients meeting the clinical criteria of mild cognitive impairment (MCI). The final scores for MoCA were given in the form of mean percentage distributions specific for age, sex and educational level so as to compare the validity of MMSE mini-mental state examination and MoCA in detecting MCI. By a fitting multiple regression model the influence of the factors on MMSE and MoCA was assessed. RESULTS: Using a cutoff score of 26, MMSE had a sensitivity of 24.2% to detect MCI, whereas MoCA detected 92.4% of the MCI subjects. We found a bivariate correlation between MoCA scores and both the factors of age and educational level (P < 0.001). CONCLUSIONS: MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing normally on MMSE. Our adjustment in the cutoff scores would improve the detection of MCI and Alzheimer's disease by reducing the number of false negatives. MoCA scores should be used to identify current cognitive difficulties but not to make formal diagnoses.

Parkinson's disease in China: prevalence in Beijing, Xian, and Shanghai.

A cross-sectional prevalence study of Parkinson's disease in China was undertaken in 1997-98. We assessed 29?454 residents aged > or =55 years from 79 rural and 58 urban communities in Beijing, Xian, and Shanghai, who were selected through stratified, multistage, cluster sampling. With a standardised diagnostic protocol, we identified 277 people with the disease. Prevalence of Parkinson's disease for those aged > or =65 years was 1.7% (95% CI 1.5-1.9). We estimate that 1.7 million people in China have the disease (aged > or =55 years). Our findings suggest that prevalence of Parkinson's disease in China is similar to that in developed countries.

[Comparative study on the clinical features of Alzheimer's disease and vascular dementia].

OBJECTIVE: To investigate the clinical features of Alzheimer's disease (AD) and vascular dementia (VaD), and to find effective methods for differential diagnosis between the two entities. METHODS: Totally 112 AD patients and 92 VaD patients were enrolled in this study, consisted of patients from the memory clinics and patients from the community population visited during the epidemiological survey from 1996 to 2000. Diagnosis of dementia, probable AD and probable VaD were made according to international criteria. Results of specific neuroimaging examination were referred to verify the diagnosis and the final diagnosis of each patient was determined from the discussion between clinical experts and radiological professionals. Analysis on clinical and neuroimaging data was performed, aiming at finding differential points between the two dementia-subtypes. A logistic binary multiple regression analysis was performed to pick out those statistically significant clinical features for differential diagnosis at last. RESULTS: AD and VaD patients have different clinical features in various demented stages, therefore the indexes that differentiate the two dementia subtypes change accordingly. The predominant features of mild AD appear to be deficits of prolonged memory and learning ability, while the major impairment of mild VaD patients is decline of calculating ability. With the progress of dementia, learning ability and attention turn to be the effective indexes for differential diagnosis. In the mild and moderate demented stage, AD patients are inferior to VaD patients in handling finacial affairs and making phone calls, while VaD patients often degenerate in daily activities concerning with both physical ability and intellectual level. Severe VaD patients appears more global degeneration of living ability compared to AD patients. The difference of ADL scores between the two subtypes is significant in moderate to severe demented patients (P < 0.05). Psychological behavior symptoms, such as repeatedly collecting useless things, are the characteristic manifestation to differentiate AD from VaD in all clinical stages. CONCLUSIONS: The results of our study indicate that substantial differences exist between AD and VaD patients. Such differences can be attributed to the differences of lesion nature and distribution, as well as the underlying pathophysiological procedures of each disease.

[Evaluation on the disability weight of Alzheimer's disease and Parkinson's disease in Beijing].

OBJECTIVE: To formulate the classification criteria of disability weight for Alzheimer's disease (AD) and Parkinson's disease (PD) in China and to evaluate the disability weight of AD and PD in population over 60 years old in Beijing. METHODS: Based on the criteria of Global Burden of Disease (GBD), a seven-grade disability classification was used to develop a new disability classification criteria for AD and PD in terms of Delphi method in China. Using the data from epidemiological survey for AD and PD in Beijing in 1997 and new criteria, mean disability weights of AD and PD in population over 60 years old in Beijing were obtained. RESULTS: The mean disability weights of Alzheimer's disease was 0.40 in population over 60 years old who received treatment in Beijing and 0.52 in those without treatment while the mean disability weights of Parkinson's disease were 0.30 in the patient receiving treatment and 0.23 in those without treatment. CONCLUSION: Difference between the result of this study and the data of GBD study in the mean disability weight for AD and PD was noticed.