Search

Background: To investigate the characteristics and clinical correlates of transient visual disturbances (TVDs) in patients with migraine without aura (MO). Patients with MO frequently report TVDs, which differ from typical visual aura, but the clinical significance of these TVDs has not been determined. Methods: Patients with MO who attended our headache clinics were enrolled. Structured questionnaires were used to acquire data on participants' headache profiles, disability, comorbidities, and lifetime suicidal ideation and suicide attempts. A semistructured visual phenomenon questionnaire was used to characterize TVDs. Headache specialists interviewed the participants for diagnosis and the verification of questionnaire responses. Results: Patients with MO (n = 7200; female/male ratio = 3.56, mean age 40.1 ± 13.4 years) were divided into two groups based on the presence (n = 2488) or absence (n = 4712) of TVDs. Patients with TVDs had more headache-related disability, psychiatric comorbidities, and photophobia than did those without TVDs. Suicidal ideation and suicide attempts were more common among patients with than among those without TVDs [ideation: odds ratio (OR) = 1.92, 95% confidence interval (CI) 1.71-2.15, p < 0.001; suicide attempt: OR = 2.23, 95% CI 1.80-2.75, p < 0.001]. Conclusion: The presence of TVDs may imply greater migraine-related disability, photophobia, and suicidal ideation/suicide attempt risk in patients with MO. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of information on male dementia caregivers in Asia and, in particular, on the factors relating to caregiver burden. We aimed to identify factors that may be associated with burden among male caregivers of people with dementia (PWD). Methods: Data were collected from a national dementia registration survey. The caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). We analyzed the correlation between ZBI scores and variables, such as demographic data of PWD and their male caregivers, caregivers' monthly income, the relationship between PWD and caregivers, the severity of dementia, physical comorbidities and activities of daily living (ADL) of PWD, and neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI). Results: A total of 509 PWD and their male caregivers were included. The majority of caregivers were sons (72.1%) and husbands (22.0%). Sons had higher ZBI scores than husbands (28.5 ± 15.2 vs 22.0 ± 17.0; p < 0.001). Multivariable linear regression showed that sons as caregivers (ß = 7.44, p = 0.034), ADL (ß = 0.52, p = 0.002), and NPI_severity subscore of apathy (ß = 2.74, p = 0.001) were positively associated with ZBI scores. Conclusion: Poor ADL and apathy in PWD and being a patient's son were associated with higher levels of burden among male dementia caregivers. Effective interventions are needed to assist male caregivers in accomplishing their caregiving role and at the same time to alleviate their caregiver burden. [ABSTRACT FROM AUTHOR]

Artery of Percheron (AOP) infarction, a rare cause of acute altered mental status (AMS), is characterized by bilateral paramedian thalamic infarction. The aim of this study was to review the clinical manifestation, radiological patterns, treatment, and prognosis of patients with AOP infarction. This retrospective case series included patients with AOP infarction from 2009 to 2020 from a medical center in Taiwan. We defined AOP infarction as acute bilateral paramedian thalamic infarction from magnetic resonance imaging, and patients were further categorized by their additional AOP territorial involvements. We determined outcomes with the modified Rankin Scale at discharge. Among the 10 included patients, AMS was the most common presentation (90%). We identified two patients with bilateral vertebral artery (VA), Ave with unilateral posterior cerebral artery (PCA), and one with bilateral PCA occlusion. Atherosclerosis was the most common presumed etiology (60%). Two and eight patients had favorable and unfavorable prognoses, respectively. PCA occlusion, rather than VA and BA occlusion, was common in angiography. Residual symptoms often resulted in significant disability at discharge. Basilar tip syndrome may share indistinguishable thalamic infarct patterns with AOP infarction but could be differentiated by angiography and other infarcted territories. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) exerts significant financial expenses on caregivers, and knowledge of caregivers' support for out-of-pocket payment is of great importance for policymaking on the insurance coverage of future AD medication in Taiwan. We aimed to investigate caregivers' willingness to pay (WTP) for a hypothetical curative AD medication and the effect of different factors on the amount of WTP. Methods: Informal caregivers of patients with AD and informants of patients with amnestic mild cognitive impairment (MCI) were included. An iterative bidding game technique, followed by a dichotomous choice question and a final open-ended question were used to elicit caregivers' maximum WTP. The correlations between the WTP and characteristics of caregiver and patient were analyzed, including sex, educational level, severity of dementia, neuropsychiatric symptoms assessed by Neuropsychiatric Inventory, time needed to support patients assessed by Caregiver Activity Survey, and caregivers' monthly income. Results: A total of 1134 informal caregivers of patients with AD or MCI were included. Caregivers of patients with AD were willing to pay for a curative AD medication, and their maximum WTP value was higher than informants of MCI patients. Among patients with AD and patients with MCI, caregivers' monthly income was positively correlated with WTP. Apathy subsyndrome was the only factor correlated with percentage of WTP in caregiver's income in the MCI group. Conclusion: Support for out-of-pocket WTP for a hypothetical curative AD medication was significantly related to caregiver's income. [ABSTRACT FROM AUTHOR]

Tardive syndrome (TS) is a group of movement disorders caused by the long-term use of dopamine receptor blocking agents. The phenotypic presentation of TS is diverse, ranging from the most well-characterized symptom of tardive dyskinesia to other symptoms, including dystonia, akathisia, myoclonus, parkinsonism, tremor, and tics. These tardive symptoms are distinct not only in their phenomenology but also in their clinical outcomes. However, our knowledge of the pathophysiology and management of TS is almost exclusively based on tardive dyskinesia. First-generation antipsychotics have a higher risk of inducing TS and have largely been replaced by second-generation antipsychotics with a lower risk of TS. However, patients with off-label use of second-generation antipsychotics are still at risk of developing TS. Thus, the management of TS remains a challenging and important issue for physicians. In this review, we update the information on the epidemiology, phenomenology, and treatment of TS from the perspective of the specific form of TS. [ABSTRACT FROM AUTHOR]

Background: The severe impairment battery (SIB) was developed to evaluate cognitive functions in moderate to severe dementia patients. We aimed to examine the reliability and validity of the Taiwanese version of the SIB (T-SIB) in patients with moderate to severe Alzheimer's disease (AD). Methods: AD patients with clinical dementia rating (CDR) stage 2 (n = 79) or 3 (n = 21) and scores <15 on the Taiwanese version of mini mental state examination (T-MMSE) were recruited from six hospitals in Taiwan. Cronbach's alpha was used to evaluate the internal consistency of the T-SIB. The CDR and functional assessment staging (FAST) scores were used to assess dementia severity. Results: We recruited 100 AD patients (73 women and 27 men; mean T-SIB score, 56.4 ± 24.8). The mean T-SIB total score for patients with CDR 2 and 3 were 60.3 ± 23.3 and 41.2 ± 24.9, respectively. The internal consistency of the T-SIB was 0.96. The T-SIB was moderately correlated with the T-MMSE (Pearson's correlation coefficient = 0.76). The areas under the curve for discriminating between CDR 2 and CDR 3 were 0.81 (95% CI = 0.91-0.71) and 0.72 (95% CI = 0.84 -0.61), respectively. Using a cut-off score of 59, the T-SIB had a sensitivity of 80% and specificity of 61% for discriminating between CDR 2 and CDR 3. Using a cut-off score of 45, the T-SIB had a sensitivity of 83.3% and specificity of 73.1% for discriminating between the FAST stage 7c. Conclusion: T-SIB is a reliable and valid instrument for measuring cognition of severely demented Taiwanese AD patients. [ABSTRACT FROM AUTHOR]