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Introduction: In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong.Methods: The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1.Results: The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4-9.6) and 8.9% (95%CI: 7.8-10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia.Conclusions: A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity. [ABSTRACT FROM AUTHOR]

It is estimated that 24 million people currently have dementia and that two-thirds of them live in developing countries. However, most of the assessment instruments for dementia have originated in developed countries. This paper explores the relevance of outcome measures in clinical trials of dementia drugs in different cultural groups, particularly in developing countries. The challenges of assessing treatment benefits in dementia in such groups include linguistic and cultural diversity, as well as high illiteracy rates, lack of human resources and the time constraints in assessment of patients. This paper also highlights methodological issues in cross-cultural research of cognitive assessment. Improvement in neuropsychiatric outcomes may be of particular importance to people in non-Western cultures. Functional outcomes and global outcomes are potentially useful outcome measures, but more studies are required in various countries. The use of biological markers such as neuroimaging and cerebrospinal fluid studies may not be practical in developing countries due to their costs and acceptability respectively. More work is also needed in the area of quality of life measures in various countries. [ABSTRACT FROM AUTHOR]

Background/Aims: The apolipoprotein E (ApoE) exon 4 polymorphism has been associated with vascular dementia (VaD) risk. Since not all studies confirm this finding, we explored this association in a case-control study. Methods: We genotyped ApoE in 144 VaD patients and 251 controls. Results: VaD patients were more likely than controls to have ApoE epsilon3/epsilon4 or epsilon4/epsilon4 genotypes: 23.6% versus 15.1%, odds ratio (OR) = 1.7, p = 0.036. This association remained significant after adjustment for age, sex, hypertension and diabetes by multiple logistic regression: OR = 1.9, p = 0.030. The association of epsilon3/epsilon4 or epsilon4/epsilon4 genotypes with VaD was strong among people with hypertension (OR = 2.9, p = 0.007) or diabetes (OR = 6.5, p = 0.011). The association was absent among people without hypertension (OR = 1.1, p = 0.79) or diabetes (OR = 1.3, p = 0.43). Conclusion: This interaction with hypertension and diabetes should be examined in other studies to confirm or refute this observation. Copyright (c) 2006 S. Karger AG, Basel. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between behavioral and psychological symptoms of dementia (BPSD), cognitive function and clinical deterioration over 2 years.Methods: One hundred and four Chinese subjects with late-onset Alzheimer's Disease (AD) who presented to psychogeriatric clinics were followed for an average of 22.5 months. BPSD subgroups were categorized by latent class analysis using the Neuropsychiatric Inventory. Comprehensive cognitive profiles were performed with the Mattis Dementia Scale, the Hong Kong List Learning Test (HKLLT) and the Category Verbal Fluency Test. Interactions between cognitive function and behavioral syndromes were evaluated. Potential predictors for clinical deterioration were computed with logistic regression analysis.Results: Three latent classes of subjects with similar behavioral syndromes were identified: Low BPSD (44%), Affective (32%) and Psychosis (24%) groups. Association between cognitive functions and BPSD was not significant. At follow-up, a higher proportion of subjects in the Affective (70%) and Low BPSD (49%) groups remained stable at the same Clinical Dementia Rating. Baseline scores in the "recognition" test of the HKLLT and age were significant predictors for "deceased" status at 2-year follow-up.Conclusion: The lack of association between behavioral syndromes and cognitive function suggests that these relatively independent dimensions of dementia should be examined individually for different prognostic significance. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the significance of apolipoprotein E4 (Apo E4) in Alzheimer's disease (AD) has been well established in Caucasian populations, its role in determining the rate of cognitive decline in other ethnic groups has yet to be determined. This study examined the two-year progression of cognitive decline and its association with Apo E4 allelic status in a group of Chinese elderly subjects with AD. METHOD: One hundred and four Chinese subjects with mild and moderate AD as assessed by the Clinical Dementia Rating (CDR 1 and 2) were followed up at a mean (SD) duration of 22.53 (5.21) months. The rate of cognitive decline and its association with Apo E4 allelic status was evaluated RESULTS: At follow-up, 74 (73 percent) subjects were reassessed. Forty-nine remained stable at the same CDR and 25 had deteriorated. The mean (SD) deterioration in the Mini-Mental State Examination (MMSE) was 2.52 (4.38) and in the Mattis Dementia Rating Scale (DRS) was 9.03 (14.98) (paired t-test, p < 0. 001). There was no significant difference in the baseline MMSE and DRS scores between the 'stable', 'deteriorated', or 'deceased' groups. Mildly demented subjects with the Apo E4 allele were more likely to have deteriorated to a more severe CDR than subjects without the Apo E4 allele (Pearson chi2 = 5.72, df 1, p = 0.017, Odds ratio = 6.3, CI 1.3 to 30.53). CONCLUSION: The presence of the Apo E4 allele may influence the rate of cognitive deterioration, particularly in subjects with mild AD. [ABSTRACT FROM AUTHOR]

BACKGROUND: To our knowledge, there are no previous data on drinking problems in patients with pneumoconiosis. The aim of this study was to examine drinking patterns and the impact of drinking on lung function and health-related quality of life (HRQOL) in Chinese patients with pneumoconiosis. METHODS: Three hundred patients with pneumoconiosis were recruited from a community-based case registry. The HRQOL was measured with the St. George's Respiratory Questionnaire (SGRQ). Pulmonary function, comorbidity, and psychosocial variables were also assessed. The alcohol use of the patients was evaluated with the Alcohol Use Disorders Identification questionnaire. RESULTS: Of the 300 patients, 72.3% (217) reported that they had not consumed any alcohol during the past year, whereas 83 patients (27.7%) did report drinking alcohol. In the drinking group, 88.0% (73) consumed <7 standard drinks per week, and none of them exceeded the safety limit of 21 standard drinks per week. The drinking group (n = 83) was younger, had less concurrent medical diseases, and lower (i.e., better) unadjusted SGRQ symptom, activity, impact, and total scores than the nondrinking group (n = 217). The SGRQ scores, which were adjusted for age, duration of occupation, concurrent medical diseases, smoking status, and forced expiratory volume in 1 sec predicted tests (FEV1%), remained significantly lower for the drinking group. Although the drinking group had a higher unadjusted FEV1% predicted, the difference between the FEV1% of the two groups, after adjustment for covariates, was of borderline significance only. CONCLUSIONS: Most Chinese patients with pneumoconiosis in this study did not consume alcohol, and among those who did, the level of alcohol consumption was low. This low level of alcohol consumption was associated with a better HRQOL and possibly with better lung function. [ABSTRACT FROM AUTHOR]

BACKGROUND: The outbreak of severe acute respiratory syndrome (SARS) posed an unprecedented threat and a great challenge to health professionals in Hong Kong. The study reported here aimed at investigating the origin of stress and psychological morbidity among frontline healthcare workers in response to this catastrophe. METHOD: Self-administered questionnaires were sent to frontline healthcare workers in three hospitals. The General Health Questionnaire was used to identify psychological distress. Socio-demographic and stress variables were entered into a logistic regression analysis to find out the variables associated with psychological morbidity. RESULTS: The response rate was 40%. Sixty-eight per cent of participants reported a high level of stress. About 57% were found to have experienced psychological distress. The healthcare workers' psychological morbidity was best understood by the perceptions of personal vulnerability, stress and support in the workplace. CONCLUSION: These findings shed light on the need for hospital administrators to be aware of the extent and sources of stress and psychological distress among frontline healthcare workers during disease outbreak. [ABSTRACT FROM AUTHOR]

Objective: To determine which screening instrument is most suitable for detecting depression in Chinese stroke patients. Method: A random sample of 60 Chinese subjects recruited from consecutively admitted patients with first-ever stroke to a rehabilitation facility were assessed using the Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the Geriatric Depression Scale (GDS). Psychiatric diagnoses, which served as a benchmark for the comparison of screening instruments, were made using the SCID-DSM-III-R. Rating instruments were compared with respect to response rate, sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves. Results: The VAMS was not useful in screening for depression in Chinese stroke patients while both the HADS and the GDS demonstrated satisfactory accuracy in detecting depression in Chinese stroke patients. Conclusions: Screening instruments for poststroke depression are culture-specific and even scales well established in other cultures should be tested before being used in clinical practice and research. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare two short measures, viz., the 15-item version of Geriatric Depression Scale (GDS-15) and the 12-item General Health Questionnaire (GHQ-12) in the assessment of the psychological well-being of the old-old in Hong Kong. The sample (N= 1,034) consisted of 504 mates and 530 females aged 70 or above. Results of the study indicated that both measures were of satisfactory reliability (Cronbach alpha = .82 and .75 respectively). Significant and meaningful relationships of GDS-15 and GHQ-12 with social support, physical health, and financial status were established, which provided evidence for the construct validity of the two measures. The findings suggested further that GDS-15 was a more sensitive outcome measure than GHQ-12. [ABSTRACT FROM AUTHOR]

Comprehensive neuropsychological batteries focus on the subtle cognitive deficits in dementia, but a brief screening instrument is also of immense practical value. As the clock-drawing test encompasses a number of cognitive domains frequently disturbed by the dementing process, it is considered to be a suitable screening instrument for the disorder. We documented the usefulness of a new scoring method of the clock-drawing test for screening of dementia in the elderly Chinese in Hong Kong. Fifty-three demented individuals and 53 healthy elderly controls were assessed. At a cutoff score of 3/4, the sensitivity and specificity of the clock-drawing test in screening of dementia was 83% and 79%. With a composite test of clock reading and clock setting, the positive predictive value of the clock face test was 98%. This new scoring method of clock-drawing proved to be a valid measure for screening of dementia. It is applicable in non-English speaking populations and should be a useful adjunct for quick screening assessment of dementia. [ABSTRACT FROM AUTHOR]

Objectives: To examine the validity of the best-estimate method for making psychiatric diagnoses and determine potential psychosocial risk factors in a cohort of Hong Kong Chinese who attempted suicide. Participants and Methods: Seventy-one persons attempting suicide and their proxy-informants were interviewed separately to ascertain each patient's diagnosis (according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I diagnosis), psychosocial profile, and life circumstances surrounding the index suicide attempt.Results: There were substantial levels of agreement, high sensitivity and specificity on Axis I psychiatric diagnoses in subject-proxy pairs. Levels of subject-proxy agreement were substantial for other risk factor domains such as physical diagnoses, suicidal behaviour profile, social networking, and most life-event items. Fair-to-modest levels of agreement were observed in perceived well-being in general health, health service utilisation and life-events involving interpersonal conflicts within family and peer groups.Conclusions: Results support the validity of the best-estimate methodology for assessing psychosocial risk factors and making psychiatric diagnosis among Hong Kong Chinese who attempt suicide. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship of the 4 decision-making abilities (Understanding, Appreciation, Reasoning, and Expressing a Choice) and neuropsychological performance in patients with very mild and mild dementia. Methods: Chinese subjects were recruited from local social centres and residential hostels for elderly people in Hong Kong. Clinical diagnosis was made by experienced geriatric psychiatrists. A battery of neuropsychological tests that assesses general cognitive abilities, verbal memory, executive function, concept formation, and auditory and visual attention, was administered. Mental capacity to consent to treatment was assessed using the Chinese version of the MacArthur Competence Assessment Tool DS Treatment. Results: Fifty participants with very mild or mild dementia were compared with 42 cognitively intact subjects. After controlling for the effects of age and education, stepwise linear regression analysis demonstrated that the 4 decision-making abilities correlated with different neuropsychological test performances, which predicted 45% of the common variance for Understanding, 39% for Appreciation, 20% for Reasoning, and 30% for Expressing a Choice. The Reasoning score was only predicted by the Category Verbal Fluency Test (beta = 0.4, p = 0.01). Conclusion: Neuropsychological test performance differentially predicted different decision-making abilities in older patients with mild or very mild dementia. [ABSTRACT FROM AUTHOR]

Objectives: To determine the optimal cut-off score on the Chinese version of the Executive Interview to discriminate all-cause dementia patients from non-dementia subjects. Participants and Methods: A total of 141 community-dwelling elders were assessed with the Chinese version of the Executive Interview, the Cantonese version of the Mini-Mental State Examination, and Nelson's Modified Card Sorting Test. Severity of dementia was determined using the Clinical Dementia Rating Scale. Results: Higher total scores on the Chinese version of Executive Interview (greater impairment) yielded a statistically significant negative correlation with Nelson's Modified Card Sorting Test's 'Number of categories', but positive correlations with the test's 'Errors', 'Perseverative errors', 'Non-perseverative errors', and 'Percentage of perseverative errors'. The sensitivity and specificity at different cut-off values on the Chinese version of the Executive Interview used to plot the receiver operating characteristic curve gave an area under the curve of 0.97 (95% confidence interval, 0.94-0.99; p <= 0.01). The cut-off value of 15 best distinguished Clinical Dementia Rating 0 and 0.5 from Clinical Dementia Rating 1 and 2 (sensitivity = 90.7%; specificity = 87.2%). Conclusions: The results of the current study and the previous pilot study support that the Chinese version of the Executive Interview as a potentially useful bedside tool for executive functional assessment in Chinese elders, by virtue of good internal consistency, inter-rater reliability, concurrent validity and discriminatory power. [ABSTRACT FROM AUTHOR]

Objectives: This was a pilot study exploring the psychometric performance of the Chinese version of the Assessment of Capacity for Everyday Decision-Making questionnaire in financial management among Chinese psychogeriatric patients. Participants and Methods: The English version of the Assessment of Capacity for Everyday Decision-Making questionnaire was translated into Chinese. Its potential applicability was assessed by 2 focus groups. Eighteen Chinese psychogeriatric patients were recruited. Subjects were administered the Chinese instrument and assessed by independent clinician ratings based on the definition in the United Kingdom Mental Capacity Act 2005. Results: In the assessment of inter-rater reliability, the intraclass correlation coefficient showed satisfactory reliability for the ability scores of understanding (0.99), appreciation (0.97), reasoning (0.99) and expressing a choice (0.85). The internal consistency, as measured by Cronbach's alpha, was 0.83 for understanding and 0.86 for reasoning. The ability scores of understanding and reasoning correlated with the clinician ratings. Conclusion: For this pilot study, the reliability of the Assessment of Capacity for Everyday Decision-Making Ability questionnaire for Chinese older patients was satisfactory. This instrument warrants further evaluation for its validity and applicability in other Chinese populations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of polymorphisms in the tumour necrosis factor receptor 2 (TNFR2) and tumour necrosis factor superfamily, member 6 (TNFRSF6, FAS) genes and the risk of Alzheimer's disease (AD) in a Chinese population.Patients and Methods: One hundred and fifty Chinese AD patients and 155 cognitively intact control subjects were recruited for the study. Genotypes of TNFR2+196, FAS-670, and FAS-1377 were investigated in this study by polymerase chain reaction-restriction fragment length polymorphisms. Results: The TNFR2+196 TT genotype was more prevalent in the AD group than in the controls. However, no significant difference in genotypic and allelic frequencies between AD and control groups (p = 0.68) was observed.Conclusion: We suggested that TNFR2+196, FAS-670, and FAS-1377 genotypes were not associated with the risk of AD in our Chinese population. However, evidence suggests involvement of tumour necrosis factor-alpha pathway in the pathogenesis of AD and a more comprehensive study may be required to identify the underlying associations. [ABSTRACT FROM AUTHOR]

We had previously identified visual impairment increasing risk of incident dementia. While a bi-directional vision-cognition association has subsequently been proposed, no study has specifically examined the longitudinal association between dementia and incidence of clinically defined visual impairment. In this territory-wide community cohort study of 10,806 visually unimpaired older adults, we examined their visual acuity annually for 6 years and tested if dementia at baseline was independently associated with higher risk of incident visual impairment (LogMAR ≥ 0.50 in the better eye despite best correction, which is equivalent to moderate visual impairment according to the World Health Organization definition). By the end of Year 6, a total of 3151 (29.2%) participants developed visual impairment. However, we did not find baseline dementia associating with higher risk of incident visual impairment, after controlling for baseline visual acuity, cataract, glaucoma, diabetes, hypertension, hypercholesterolemia, heart diseases, stroke, Parkinson's disease, depression, hearing and physical impairments, physical, intellectual and social activities, diet, smoking, age, sex, educational level, and socioeconomic status. Among different covariables, baseline visual acuity appears to be more important than dementia in contributing to the development of visual impairment. Our present findings highlight the need for re-evaluating whether dementia is indeed a risk factor for visual impairment., (© 2022. The Author(s).)

Aims: Schizophrenia is a major mental disorder with a wide range of psychiatric symptoms. This study explored the structure of psychiatric symptoms of schizophrenia using network analysis in a large representative Asian sample based on a survey of clinical features and treatment used in schizophrenia patients across 15 countries/territories in Asia., Methods: Data on the demographic characteristics and psychiatric symptoms in schizophrenia patients were extracted from the dataset of the fourth Research on Asia Psychotropic Prescription for Antipsychotics (REAP-AP) project. The presence of the following psychiatric symptoms including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, social/occupational dysfunction, verbal aggression, physical aggression, and affective symptoms were analyzed., Results: A total of 3681 patients were included. The network analysis revealed that verbal aggression, hallucinations, and social/occupational dysfunction were the most central symptoms, while the connections between social/occupational dysfunction and verbal aggression, and between hallucinations and disorganized speech were the two strongest edges. There were significant gender differences in the network structure based on the network structure invariance test (M=0.74, P = 0.03) and invariant edge strength test. The positive correlation between verbal aggression and hallucinations was significantly stronger in the female network than that in the male network (P = 0.03), while a negative correlation between affective symptoms and negative symptoms was found in the female, but not the male network (P < 0.01)., Conclusion: Central symptoms including verbal aggression, hallucinations, and socio-occupational dysfunction should be addressed in developing targeted treatment strategy for schizophrenia patients., (Copyright © 2022 Elsevier B.V. All rights reserved.)

While hypertension is widely recognized as a risk factor for dementia, few observational studies and clinical trials fully accounted for the effect of age on blood pressure (BP) changes prior to dementia onset. In this territory-wide population-based longitudinal study of 16,591 community-living dementia-free older adults, we followed their BP and cognitive status and tested if loss of longitudinal increase in BP in late life was associated with higher dementia risk in 6 years, with consideration of the confounding effects of hypertension, hypotension, BP variability, and other health problems and behaviours and, in the data analysis, exclusion of individuals who developed dementia within 3 years after baseline to minimize risk of reverse causality. Over 72,997 person-years of follow-up, 1429 participants developed dementia. We found that loss of longitudinal increase in systolic BP (defined as SBP increased by either < 10 mmHg or 10%) from baseline to Year 3 was independently associated with higher risk of incident dementia at Years 4 to 6 (adjusted OR 1.22, 95% CI 1.02-1.45, p = 0.03; adjusted OR 1.24, 95% CI 1.03-1.50, p = 0.02; respectively). Our findings suggest that late-life SBP trajectory changes might independently predict dementia onset and highlight the importance of including longitudinal BP monitoring in dementia risk assessment., (© 2022. The Author(s).)

Background: The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms., Method: This is a population-based two-phase household survey of Chinese population in Hong Kong aged 16-75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up., Results: The 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up., Conclusions: Results highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.