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Living vegetation volume (LVV) can objectively and accurately reflect the urban greenery quality, and provide a reliable data foundation for the quantitative study aiming to reveal the mechanisms underlying urban greenery ecological functions. According to the characteristics of dispersion and small scale of unit affiliated green space, we proposed a LVV estimation scheme for such urban green space, which included data acquisition, processing, entity segmentation, classification, single tree canopy extraction, and LVV calculation. First, point cloud data was obtained with a backpack LiDAR system, and the ground point clouds were eliminated by a multi-scale algorithm. Second, the Density Based Spatial Clustering of Application with Noise (DBSCAN) algorithm was used to cluster the non-ground point clouds, and density feature-based competitive algorithm was used to re-segmented for the overlapping area to generate independent objects. Third, the PointNet++ network model was used to extracted plant point clouds. Then, the canopy point clouds were extracted using the similarity of principal direction between neighboring points and distribution density of branch and leaf points. Finally, the LVV of individual tree canopy was calculated by the convex hull method, and then the LVV of the accessory greenland was summed up. Taking a science and technology park as an example, its total LVV was 21034.95 m三维绿量能够客观、准确描述城市绿化水平,可为定量研究城市绿地生态功能的机理提供可靠的数据基础。针对单位附属绿地分布分散、规模较小等特点,本研究提出一种面向该类城市绿地的三维绿量估算方案,该方案包括数据获取、处理、实体分割、分类和单木冠层提取以及三维绿量计算的环节。首先,利用背包式激光雷达测量系统获取三维点云数据,利用变尺度地面点滤波算法剔除地面点云;然后,利用基于密度的聚类算法对非地面点云进行聚类,且基于密度特征的竞争算法对重叠区域进行二次分割,形成独立对象;接着,利用PointNet++模型提取植物点云,根据枝叶点云主方向差异性以及轴向分布密度提取冠层点云;最后,使用凸包法计算单木冠层三维绿量,累计每株木的三维绿量得到区域三维绿量。以某科技园区为例,估算其总三维绿量为21034.95 m

Promoting dementia-friendly communities is an important strategy for improving quality of life for people with dementia and dementia-family caregivers. The process of building dementia-friendly communities should include all people living in the community. The objective of this study was to compare perceived dementia friendliness in the community among people with dementia, family caregivers, service providers, and the general public. In Taiwan, we surveyed 60 people with dementia, 140 family caregivers, and 200 members of the general public face to face, with 200 service providers surveyed by mail. Participants completed the Perceived Community Dementia Friendliness measure, consisting of seven subscales: care services, community members, community environment, community interactions, transportation, hospitals, and stores and organisations. This measure has acceptable convergent validity, construct validity, and internal consistency reliability for use in Taiwan. Differences in perceived dementia friendliness were examined by chi-square tests/analysis of variance. Among the seven subscales, hospitals were rated with good dementia friendliness by 70% of people with dementia (n = 42); however, care services were rated poor by 23.3% of people with dementia (n = 14). Hospitals were also rated with good dementia friendliness by 39.2% of family caregivers (n = 54). Care services were rated as having good dementia friendliness by 43.5% of service providers (n = 87) and 47% of the general public (n = 86). Furthermore, community interactions were rated as good by small percentages of family caregivers (11.4%, n = 16), service providers (22.2%, n = 44), and the general public (30.9%, n = 58). Family caregivers, service providers, and the general public rated hospitals with the highest mean dementia-friendliness score and community interactions with the lowest. Perceived community-dementia friendliness among participants with dementia differed from that of participants without. People with dementia prioritised improving care services, while people without dementia rated facilitating community interactions as more vital. These differences provide vital insights into understanding the policies and administration of dementia-friendly communities.

Objectives:To investigate potential risk factors for mild behavioral impairment (MBI) among non-demented geriatrics.Design:Population-based, cross-sectional survey.Setting:Taiwan Alzheimer Disease Association (TADA) Database.Participants:Participants were selected by multistage random sampling of all Taiwan counties. They received in-person interviews between December 2011 and March 2013.Measurements:Demographic data, lifestyle and habits, medical comorbidities, cognitive status measured by the Taiwanese Mini-Mental Status Examination (TMSE) and presence of MCI of the participants were collected. Subjects were distributed to the MBI and non-MBI groups. These factors had been evaluated for their effects on MBI in the univariate and multivariable logistic regression models.Results:In total, 6,196 non-demented participants aged 65 years or older, including 409 MBI and 5,787 non-MBI participants, were recruited. After adjustment for age, sex, education, body mass index, lifestyle and habits, medical comorbidities, and MCI, good sleep was associated with lower risk of MBI (OR 0.09, 95% CI 0.07 – 0.12). Low body weight (OR 2.01, 95% CI 1.21–3.33), low-to-medium education (OR 1.40, 95%CI 1.06–1.85; OR 2.32, 95% CI 1.67–3.21), medical comorbidities of hypertension (OR 1.56, 95% CI 1.25–1.95), hyperlipidemia (OR 1.29, 95% CI 1.00–1.67), cancer (OR 2.05, 95% CI 1.37–3.06) were significantly associated with increased MBI risk. MCI neither increased nor decreased risk of MBI (OR 1.00, 95% CI 0.76–1.32).Conclusions:Good sleep was associated with lower MBI risk. Underweight, lower education, medical comorbidities of cancer, hypertension, hyperlipidemia were predictive of MBI.

This study aimed to develop a conceptual framework of the experience of persons living with the early stages of dementia. A grounded theory approach examined the experience from the perspective of the patient. Data were collected from dyads of persons with mild dementia and their family caregivers (N = 17) using face-to-face interviews at three timepoints over a one-year period. Transcribed interviews were analyzed with constant comparative analysis. The core category was “Fluctuating interpretations: striving to maintain one's sense of self.” Interpretations were comprised of three subcategories: being a stranger to oneself, sense-making, and strategies for coexistence. Different situations influenced the process and affected individuals’ attitudes and behaviors. Interpretations were a protective vehicle and stabilizing force that enabled persons with dementia to coexist with disease changes. Perspectives of persons with dementia during the early stages should be considered when designing intervention strategies for patient-centered care.

The driving safety of persons with dementia (PwD) is an important public-health issue worldwide. Driving is closely related to personal autonomy, self-esteem, and independence. When PwD lose their driving privileges, this may lead to negative effects on mental health.The purpose of this study was to evaluate the relationship between driving cessation and mental health in PwD.A cross-sectional design with convenient sampling was used, Data were collected using structured questionnaires. Participants were all PwDs who were recruited from a medical center in northern Taiwan.A total of 78 PwD were recruited. Two-fifths (41%) of the participants were still driving, with motorcycle the most common vehicle used. The participants who had retired from driving were older, and most did not have a spouse, were less socially active, had a lower mean level of functional ability, and perceived a lower association between driving and quality of life. Driving cessation was found to be positively correlated with age and the instrumental activities of daily living. Depression and anxiety levels in former drivers were higher than in current drivers, although the differences were not significant.Among PwD, depression and anxiety is higher in former drivers. It is suggested that a prospective study should be conducted, that driving safety issues for PwD should be addressed in public health education, and that standards of driving safety for PwD should be developed and enacted.失智症病人停止駕駛與其心理健康初探.失智症安全駕駛是全球公共衛生關心的主要議題，駕駛與個人自主性、自尊及獨立性有密切相關，一旦失去駕駛權利，則可能產生心理健康的負面效應。.本研究目的旨在探討停止駕駛與失智症病人心理健康之關係。.研究為橫斷式描述性研究，採方便取樣，使用問卷調查法，研究對象為北部某準醫學中心之失智症個案。.本研究共收案78位失智症病人，研究結果發現有41%之失智症病人仍在駕駛，最常使用交通工具為機車，停止駕駛者通常年齡較大、無配偶者較多、沒參與社交活動居多、日常生活功能較差，以及自覺駕駛對生活品質的重要程度較低。失智症病人停止駕駛之相關因子為年齡及工具性日常生活功能；停止駕駛者之憂鬱及焦慮程度較高，但未達統計差異。.由本研究結果可知停止駕駛之失智症病人的憂鬱與焦慮程度較高，建議未來研究可以進行長期追踪研究，以了解停止駕駛之失智病人的心理健康變化及預測因子；安全駕駛議題應納入公共衛生教育，並制定失智症之安全駕駛規範。.

Background Screening or diagnosis for the elderly with dementia in rural regions might be delayed and underestimated due to limited utilization of healthcare resources. This study aimed to evaluate the disparities of prevalence and risk factors of mild cognitive impairment (MCI) and dementia between urban and rural residence. Methods In this nationwide door-to-door survey, 10,432 participants aged 65 years and more were selected by computerized random sampling from all administrative districts in Taiwan and were assessed by an in-person interview. We calculated the prevalence of MCI and dementia with their risk factors examined by multivariable logistic regression. Results The prevalence of dementia in rural, suburban, and urban areas among the elderly was 8.69% (95% CI, 8.68-8.69), 6.63% (95% CI, 6.62-6.63), and 4.46% (95% CI, 4.46-4.47), respectively. A similar rural-suburban-urban gradient relationship on the dementia prevalence was observed in any age and sex group. The rural/urban ratio was higher in women than in men for both MCI and dementia. Urbanization remained to be an independent factor for both MCI and dementia after adjustment for age, gender, education, lifestyle, and health status. The beneficial effects of exercise on dementia were more evident in rural areas than in urban ones. Conclusions Significantly higher prevalence of MCI and dementia were found in rural areas than in urban ones, especially for women. The odds of risk factors for MCI and dementia varied between urbanization statuses. Focus on the rural-urban inequality and the modification of associated factors specifically for different urbanization levels are needed.

To fill the gap in knowledge about associations of health-related quality of life (HRQoL) with comorbid diabetes mellitus (DM), hypertension (HTN), and/or mild cognitive impairment (MCI) in the elderly, we explored associations of comorbid DM, HTN, and/or MCI with HRQoL. Data for this study were from a population-based cross-sectional survey of elderly Taiwanese (≥ 65 years old). Participants (N = 4,634; 47.9% male) were categorized into eight chronic-illness groups: DM only (n = 224); HTN only (n = 1226); DM and HTN (n = 365); MCI only (n = 497); DM and MCI (n = 58); HTN and MCI (n = 303); DM, HTN, and MCI (n = 101); and none (healthy; n = 1860). Associations were examined between the eight chronic-illness groups and HRQoL (measured by EQ-5D scores) using binary logistic regression analyses and generalized linear models adjusted for covariates. Index scores were calculated from EQ-5D scores using Taiwan’s general population-preference weights. Compared to the healthy group, after adjusting covariates, MCI alone or with other comorbidities was significantly, negatively associated with HRQoL. Among all chronic-illness groups, comorbid DM, HTN, and MCI exhibited the lowest HRQoL. After adjusting covariates, between-group odds ratios for index scores were significant when comparing comorbid DM and MCI to DM only, comparing comorbid HTN and MCI to HTN only and comorbid DM, comparing HTN and MCI to comorbid DM and HTN, suggesting that MCI additively affects HRQoL. HRQoL of older Taiwanese adults was negatively associated with having MCI. Thus, clinicians managing older persons with chronic illnesses should assess their cognitive function to identify high-risk groups needing HRQoL assistance.

BACKGROUND Dementia causes cognitive and memory difficulties which can reduce the driving safety of the individuals. The decision-making process for driving retirement is challenging, and yet limited guidance is available. OBJECTIVES This article reports the development of the Taiwanese version of dementia and driving decision aid (DDDA) and the evaluation from stakeholders through a dementia and driving education programme. METHODS A multi-method approach was adopted using a pre-test, post-test survey and focus group interviews. A total of 154 healthcare professionals, family caregivers and people with dementia participated education programme, and 12 experts attended the focus group discussion. The survey included demographics, knowledge, confidence, competence and awareness of using DDDA. Participants completed a survey prior and immediately after the education programme. We translated a 32-page interactive DDDA booklet from the original English version to Mandarin. The education programme consisted of three-hour dementia and driving education module delivered both face-to-face and online. RESULTS The majority of participants described the booklet as balanced (91.7%) with the information presented in a 'good' or 'excellent' manner (93.4%). Most participants (85.3%) felt that DDDA helps them in making decisions about driving. Five themes were extracted from the focus group interview: (1) approach targeted to people with dementia, (2) specific content and additional information, (3) culturally appropriate modification, (4) having the right to drive and (5) booklet dissemination. The knowledge, confidence, competence and awareness of using the DDDA increased significantly (p

Objectives This review summarized the applicability of various decision-making tools for helping people with dementia or mild cognitive impairment (MCI) and their families make decisions. Design This study was a narrative literature review. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42020182259). Setting and Participants People with dementia or MCI and their families were included in this study. Methods This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Chinese Electronic Periodical Services databases from inception to May 2021. The Joanna Briggs Institute Critical Appraisal Checklists for a variety of study designs were used. Results Topics related to decision-making were categorized as everyday activity decisions or medical treatment decisions. Various types of decision-making tools were identified, and we observed that decision aids can be modified and used for both everyday activity decisions and medical treatment decisions. In addition to highlighting decision aids for specific decisional issues and topics, we also elucidated other validated tools that can be used to facilitate the decision-making process. Conclusions and Implications This study highlighted the topics involved in decision-making and using decision-making tools. The current review provides information that can help individuals and health care professionals choose optimal decision-making tools. On the basis of our findings, future studies can determine the most appropriate tools for intervention or outcome measures.

Aim Abnormally activated vascular smooth muscle cells are key factors in pulmonary artery remodelling (PAR) and pulmonary artery hypertension (PAH). Keratin 1 is involved in inflammatory diseases; however, its role in PAH is unknown. We speculated that keratin 1 could regulate PASMCs and prevent PAH. Methods Rats were exposed to hypoxia (10% O2 ) or MCT (50 mg/kg, intraperitoneal injection) or treated with AAV6 virus. PAR was measured through HE and Masson staining. PASMC activities were measured using MTS assay, EdU and Western blot analyses after cell knockdown with siRNAs or overexpression with Krt1 vectors. Results 1. Hypoxic PAR was associated with a decrease in keratin 1, especially in PASMCs. 2. Keratin 1 knockdown led to cell proliferation, migration and contraction to synthetic transformation, while keratin 1 overexpression attenuated hypoxia-induced changes in PASMCs. 3. Decreased keratin 1 induced TLR7 upregulation and mediated increases in the inflammatory factors S100a8 and S100a9. 4. Keratin 1 overexpression reduced the inflammatory factor expression induced by TLR7 activation. 5. Further studies demonstrated that keratin 1 expression was negatively correlated with pulmonary vascular pressure following prolonged hypoxia. 6. Pre-treatment with keratin 1 decreased pulmonary artery pressure and the right heart hypertrophy index and alleviated PAR in two model rats. 7. Keratin 1 exhibited a hypermethylation status in hypoxic pulmonary arteries in the sequencing. Hypoxia-induced decrease in keratin 1 expression was associated with Dnmt1 upregulation induced by YY1 downregulation in PASMCs. Conclusion This study suggests that keratin 1 regulates PASMC expansion and has a preventive effect on PAH.

Background many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection. Objective to examine whether the Lawton's Instrumental Activities of Daily Living (IADL) scale, compared with other cognitive screening tools-the Mini-Mental State Examination (MMSE), and the Ascertain Dementia 8-item Informant Questionnaire (AD8)-can identify older (≥ 65 years) adults with dementia. Design population-based cross-sectional observational study. Setting all 19 counties in Taiwan. Participants community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03). Methods all participants underwent a structured in-person interview. Dementia was identified using National Institute on Aging-Alzheimer's Association core clinical criteria for all-cause dementia. Receiver operator characteristic curves were used to determine the discriminant abilities of the IADL scale, MMSE and AD8 to differentiate participants with and without dementia. Results we identified 917 (8.9%) participants with dementia, and 9,423 (91.1%) participants without. The discriminant abilities of the MMSE, AD8 and IADL scale (cutoff score: 6/7; area under curve = 0.925; sensitivity = 89%; specificity = 81%; positive likelihood ratio = 4.75; accuracy = 0.82) were comparable. Combining IADL with AD8 scores significantly improved overall accuracy: specificity = 93%; positive likelihood ratio = 11.74; accuracy = 0.92. Conclusions our findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity.

This study investigated the associations of cognitive status with specific/overall health-related quality of life (HRQoL) in older stroke survivors in Taiwan.A subsample of 592 older stroke survivors in a nationwide population-based survey of cognitive-dysfunction prevalencewas analyzed. HRQoL was assessed using the EuroQol five-dimension questionnaire (EQ-5D).Stroke survivors with dementia were 5.60 times more likely to have mobility problems, 12.20 times to have self-care problems, 16.61 times to have problems in usual activities, 4.31 times to have pain/discomfort, and 3.28 times to have anxiety/depression than stroke survivors with normal cognitive function. Stroke survivors with mild cognitive dysfunction (MCD) were 2.57 times more likely to have mobility problems, 3.17 times to have self-care problems, 3.31 times to have problems in usual activities, 2.11 times to have pain/discomfort, and 2.35 times to have anxiety/depression than those with normal cognitive function. Both dementia (b = -15.13, p.001) and MCD (b = -6.24, p.001) significantly contributed to lower EQ-5D VAS; both dementia (b = -.15, p.001) and MCD (b = -.10, p.001) significantly contributed to lower EQ-5D index.Dementia and MCD strongly predicted worse overall and specific HRQoL dimensions, especially self-care and usual activities for older stroke survivors.

Background: To examine the relationships between cognitive dysfunction status and quality of life. Methods: Secondary analysis of a nationwide population-based survey (≥65 years) in Taiwan. The 5-dimension EuroQoL questionnaire (EQ-5D) was completed by 10 013 participants. Results: Participants with mild cognitive impairment (MCI; odds ratio = 4.88), very mild dementia (VMD; 7.96), or dementia (32.85) were more likely than those with normal cognition to report self-care problems. Participants with MCI (3.86), VMD (9.26), or dementia (31.61) were more likely to have usual-activity problems, and those with MCI (3.04), VMD (3.82), or dementia (9.23) were more likely to have mobility problems. Participants with MCI (2.10 and 2.14), VMD (2.77 and 2.18), or dementia (3.04 and 3.02) were more likely to report pain/discomfort and anxiety/depression. Conclusion: Dementia was negatively associated with EQ-5D, especially self-care, usual activities, and mobility. Mild cognitive impairment or VMD was also negatively associated, with VMD more negatively associated. Developing interventions for patients with specific cognitive dysfunctions is critical.

To identify dementia-friendly communities' indicators and their current conditions in Taiwan from the perspectives of people with dementia and dementia-family caregivers.This qualitative study explored the opinions and experiences of people with dementia and dementia-family caregivers regarding dementia-friendly communities.Participants (16 people with dementia and 20 family caregivers) were recruited from neurological clinics, day care centres for people with dementia and support groups for family caregivers in the Taipei community from July - October, 2016. Data were collected in face-to-face interviews, which were tape recorded and transcribed verbatim. Transcripts were analysed by Miles and Huberman's (1994) guidelines.Similar indicators for dementia-friendly communities were identified in Taiwan as in other countries, including dementia-friendly care services, dementia-friendly hospitals, dementia-friendly community environment, dementia-friendly transportation, dementia-friendly stores and shops, dementia friendly people, integrated dementia-related information and community contribution- and -involvement opportunities for people with dementia. However, Taiwanese people with dementia and family caregivers described no emphasis on the potential of people with dementia to contribute to developing dementia-friendly communities and more top-down expectations for the government's role.These indicators can be a guide for developing and evaluating dementia-friendly communities in Taiwan. Differences between Taiwan and Western developed countries in indicators for dementia-friendly communities can be further explored. Community nursing assessment, interventions, and evaluation based on these dementia-friendly communities indicators can be further developed.This study developed indicators for dementia-friendly communities in an Asian country. These indicators can be used as a guide for developing and evaluating dementia-friendly communities.目的: 根据痴呆患者和痴呆家庭照顾者的意见,制定痴呆友好社区指标以及台湾目前的痴呆友好社区指标。 设计: 此定性研究主要内容是探讨痴呆患者和痴呆家庭照顾者关于痴呆友好社区指标的观点。 方法: 从2016年7月到10月,研究参与者(16位痴呆患者和20 位痴呆家庭照顾者)都是来自台北社区的神经学诊所、痴呆患者日托中心、家庭照顾者的相关专业人士。 结果: 得出的台湾痴呆友好社区指标与其他国家类似,指标包括痴呆友好护理服务、痴呆友好医院、痴呆友好社区环境、痴呆友好交通、痴呆友好商店、痴呆友好人员、完善痴呆信息、社区贡献与痴呆患者参与机会。但是,台湾的痴呆患者和痴呆家庭照顾者表示并不期待痴呆患者和政府会为建设痴呆友好社区做出贡献。 结论: 台湾痴呆友好社区指标与西方发达国家痴呆友好社区指标的不同值得我们进一步研究。根据痴呆友好社区指标发展社区护理评估、干预措施和评估等。 影响: 此研究发现了亚洲国家痴呆友好社区指标。研究得出的指标可用作指南,引导发展和评估痴呆友好社区。.

BACKGROUND Polypharmacy, defined as the concomitant use of 5 or more medications, has a documented negative association with cognitive impairment such as delirium and is associated, potentially, with a higher risk of dementia. However, whether polypharmacy contributes to increased risk of mild cognitive impairment (MCI) or decreased cognitive capacity requires further investigation. This nationwide population survey investigated the association among polypharmacy, MCI, and dementia. METHODS Through random sampling based on the proportion of all Taiwan counties, subjects were recruited and received in-person interviews between December 2011 and March 2013. Demographic data and clinical information included medical histories, medication use, and mental status measured by the Taiwanese Mini-Mental State Examination (TMSE) and Clinical Dementia Rating (CDR). Data on lifestyle and habits were collected, and subjects were distributed to cognitively normal, MCI, or all-cause dementia groups based on criteria by the National Institute on Aging and the Alzheimer's Association. RESULTS A total of 7,422 people aged 65 years or older were recruited. After adjustment for age, sex, body mass index, education, medical comorbidities, and lifestyle and habits, polypharmacy was associated with a 1.75-fold increased odds of MCI and 2.33-fold increased odds of dementia. Polypharmacy was associated with a 0.51-point decrease in TMSE scores (P = .001) and a 0.10-point increase in CDR score (P < .001). Additionally, for those without specific vascular comorbidities, polypharmacy had a greatly more negative impact on cognitive capacity. CONCLUSIONS Polypharmacy is common in the elderly and is associated with significantly lower cognitive capacity and higher risks of MCI and dementia, especially for persons without diabetes, hypertension, hyperlipidemia, or cerebrovascular diseases.

Background Comorbid medical diseases are highly prevalent in the geriatric population, imposing hardship on healthcare services for demented individuals. Dementia also complicates clinical care for other co-existing medical conditions. This study investigated the comorbidities associated with dementia in the elderly population aged 65 years and over in Taiwan. Methods We conducted a nationwide, population-based, cross-sectional survey; participants were selected by computerized random sampling from all 19 Taiwan counties between December 2011 and March 2013. After exclusion of incomplete or erroneous data, 8,456 subjects were enrolled. Of them, 6,183 were cognitively normal (control group), 1,576 had mild cognitive impairment (MCI), and 697 had dementia. We collected information about types of comorbidities (i.e., vascular risk factors, lung diseases, liver diseases, gastrointestinal diseases, and cancers), Charlson comorbidity index score, and demographic variables to compare subjects with normal cognition, MCI, and dementia. Results Regardless of the cognitive condition, over 60% of the individuals in each group had at least one comorbid disease. The proportion of subjects possessing at least three comorbidities was higher in those with cognitive impairment (MCI 20.9%, dementia 27.3%) than in control group (15%). Hypertension and diabetes mellitus were the most common comorbidities. The mean number of comorbidities and Charlson comorbidity index score were greater in MCI and dementia groups than in control group. Logistic regression demonstrated that the comorbidities significantly associated with MCI and dementia were cerebrovascular disease (OR 3.35, CI 2.62–4.28), cirrhosis (OR 3.29, CI 1.29–8.41), asthma (OR 1.56, CI 1.07–2.27), and diabetes mellitus (OR 1.24, CI 1.07–1.44). Conclusion Multiple medical comorbid diseases are common in older adults, especially in those with cognitive impairment. Cerebrovascular disease, cirrhosis, asthma, and diabetes mellitus are important contributors to cognitive deterioration in the elderly. Efforts to lower cumulative medical burden in the geriatric population may benefit cognitive function.

Background/Purpose Behavioral and psychologic symptoms of dementia (BPSD) are major sources of a caregiver's burden and also the most important factor when considering the need for institutionalization of dementia patients. BPSD occur in about 90% of patients with dementia. Studies comparing the BPSD in the major types of dementia using unitary behavioral rating scales are limited. We studied BPSD in patients with four major types of dementias from a memory clinic. Methods We recruited patients with dementia from our memory clinic from January 2003 to February 2004. The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) was used to measure BPSD severity. Clinical Dementia Rating and Mini Mental State Examination were used to determine dementia severity. Results A total of 137 patients with four major types of dementia were recruited from 155 patients with dementia who attended the clinic during the study period. The main dementia types identified were Alzheimer's dementia (AD) in 54.8%, vascular dementia (VaD) in 20.6%, frontotemporal dementia (FTD) in 8.4%, dementia with Lewy bodies (DLB) in 4.5%, and other dementias in 11.6%. BPSD were found in 92.0% of the patients but only 43.1% received psychotropic treatment. The relative risk of receiving psychotropic treatment for BPSD subscales paralleled the extent of caregivers' burden as assessed by the BEHAVE-AD global rating. Type-specific BPSD, e.g. hallucination was identified for DLB, activity disturbances for FTD, anxiety and phobias for AD and affective disturbance for VaD. Conclusion A strategy of targeting type-specific BPSD may be beneficial, such as environmental stimulus control for DLB patients who are prone to have hallucinations, design of a pacing path for patients with FTD who need support for symptoms of wandering and emotional support for patients with VaD who are susceptible to depression.

Objective: To develop an instrument that measures observable problematic behaviors in patients with dementia.Methodology: We used focus group interviews to identify the problematic behaviors of patients with dementia. Eighty-two behaviors grouped into 12 domains were generated from the data collected from five different focus groups. After conducting a content validation process, a 72-item Dementia Behavior Disturbance Inventory (DBDI) rated by a frequency and a disturbance scale was formed. The DBDI was administered to 200 institutionalized elderly patients with dementia by formal caregivers for psychometric evaluation.Results: Inter-item correlation of items in each domain was performed for item reduction. Forty-eight items remained after this procedure. Exploratory factor analysis obtained nine factors that explained 59.2% and 59.6% of the total variance in the frequency and disturbance scales, respectively. Cronbach's α of the entire 48-item frequency and disturbance scales was 0.88 and 0.91, respectively. Most of the factors had acceptable internal consistency reliability. Test–re-test reliability coefficients of the frequency and disturbance scales were 0.78 and 0.64, respectively. The DBDI was weakly but positively related to functions of daily activities and ambulation.Conclusion: The DBDI demonstrates promising psychometrical properties as an instrument to assess problematic behaviors in elderly people with dementia.

In Taiwan, to measure the quality of life (QOL) of elderly Chinese, one must rely on instruments developed in other Chinese or Western populations and not specifically for the elderly. The purpose of this study is to understand the components of QOL for elderly Chinese from Taiwan living in residential homes or in their communities. Forty-four elderly men and women divided into six focus groups were interviewed on video tape and the resultant recording was analyzed qualitatively by six independent researchers. The study yielded 15 QOL domains grouped into six dimensions: physical health (physical well-being, impact of illness, medical care), psychological health (mood states, life attitude and retrospection, philosophy of living, self-efficacy), social function (connectedness, exercise and leisure activities, social activities and services), living environment (living environment and arrangements, institutional factors), economic status, and religion and death (religion, death). For elderly Chinese in Taiwan, positive and negative life domains are equally important in the perception of life quality; person-environment interaction is a major consideration in the evaluation of QOL; family ties are an important component of QOL; traditional Chinese beliefs exert a positive influence on perceived QOL; and social functioning and vitality have a different meaning in Chinese compared to Western cultures.

An increasing population of dementia patients produces substantial societal impacts. We assessed the prevalence of mild cognitive impairment (MCI) and all-cause dementia, including very mild dementia (VMD), in Taiwan. In a nationwide population-based cross-sectional survey, participants were selected by computerized random sampling from all 19 Taiwan counties and were enrolled between December 2011 and March 2013. Cases were identified through in-person interviews based on the National Institute on Aging-Alzheimer's Association clinical criteria. Demographic data and histories involving mental status and function in daily living were collected. The principal objective assessments were the Taiwanese Mental Status Examination and Clinical Dementia Rating. In all, 10,432 people aged 65 years or older (mean age 76.2 ± 6.7, 52.3% women) were interviewed. The age-adjusted prevalence of all-cause dementia was 8.04% (95% CI 7.47-8.61), including a 3.25% (95% CI 2.89-3.61) prevalence of VMD; that of MCI was 18.76% (95% CI 17.91-19.61). Women had a higher prevalence than men of both all-cause dementia (9.71% vs. 6.36%) and MCI (21.63% vs. 15.57%). MCI affects a considerable portion of the population aged 65 and above in Taiwan. The inclusion of VMD yields dementia prevalence rates higher than those previously reported from Taiwan. Old age, female gender, and a low educational level are significant associated factors.

This study evaluates the construct validity and internal consistency of a Chronic Illness–Related Stress Inventory (CRSI) for primary care Chinese patients and studies the relationship between chronic illness–related stress and sociodemographic characteristics and indices of disease severity. A total of 301 patients were interviewed using a structured questionnaire. The responses to the CRSI were divided into a frequency scale and a severity scale. Six factors including physical integrity and discomfort, psychosocial function and economic burdens, self-fulfillment and daily life, sexual function, self-esteem, and diet limitations were obtained for each CRSI scale. Except for the last factor, all other factors and the scale as a whole for both scales have a Cronbach α of >0.90. The results of the convergent and discriminant validity analysis were promising. In addition, chronic illness–related stress was related to insurance status and the self-perceived severity of disease.

The next-generation smartphones should provide a signification improvement in terms of personalization. A major challenge in smartphone personalization is how to tackle the diversity in smartphone usage. This paper presents iLauncher, an intelligent quick launch that can adapt to individual usage patterns on the fly to change apps dynamically without user intervention. The rationale behind the development process is that we collected traces of real user activity and conducted statistical analysis to derive some observations that provide useful insights into the design of our algorithm. The results of experiments conducted to evaluate the proposed algorithm are encouraging in terms of prediction accuracy. We have implemented iLauncher based on the algorithm and released it in an Android marketplace for free usage.

This study was designed to test the performance and related factors of a self-administered instrument in assessing behavioral and psychological symptoms of dementia (BPSD) by family caregivers. We recruited 173 patients with dementia and major caregivers from two neurological clinics. Information about clinical diagnosis, the Mini Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), the Dementia Behavior Disturbance Inventory (DBDI), and global caregivers’ strain were collected from interview and chart review. We found that DBDI has acceptable construct validity and good internal consistency reliability. BPSD was more frequently found in patients with advanced dementia, poor cognitive function and highly correlated to caregivers’ strain. Multivariate analysis revealed that female patients and caregivers, advanced CDR stages, patient–caregiver relationship, types of dementia and MMSE score were related to the increase of frequency and disturbance index of DBDI. We concluded that BPSD could be evaluated by family caregivers using a self-administered instrument. Further study is indicated to clarify how caregiver characteristics affect the report of behavioral symptoms, and its clinical importance.

Background/Aims: It is estimated that there are 90,000 patients with dementia in the 23 million habitants of Taiwan, with a few institutions specialized in dementia care. To assess the need of institutional care for dementia, we investigated the institution prevalence of dementia. Methods: We performed stratified randomized sampling of elder residents from different types of institutions in different regions of Taiwan. A 2-stage survey with screening and clinical confirmation was carried out in 2004. Results: In total, 1,525 residents aged 65 years and over in 60 institutions participated in the study in which 1,308 elders completed the 2-stage survey. Among these, 631 elders were diagnosed as having dementia. The dementia prevalence was 26.8% in the residential houses, 61.8% in the assisted living facilities and 64.5% in the nursing homes. Vascular dementia was the leading cause of dementia in the institutions. Old age, diabetes mellitus and family history of dementia increased risks for both Alzheimer’s disease and vascular dementia. Conclusion: The investigation showed that the prevalence of dementia in the long-term care units of Taiwan was much higher than those from community studies and the high prevalence in the institutions depended on the type of the long-term care unit.

The relationship between self-rated health (SRH) and subsequent mortality was examined in a cohort of 411 Chinese elderly individuals living in institutions. SRH was assessed by a global health rating, by comparing health with others of the same age, and by perception of recent physical condition. Covariates including age, sex, daily activity function, instrumental daily activity function, cognitive function, self-reported visual acuity, urinary function, number of chronic conditions, number of medications, and history of falls were controlled by the Cox proportional hazard model. Elderly people who rated their global health as “fair or poor” had increased mortality compared to those in the “good” category (RR = 6.00; 95% CI 1.39–25.1) and a borderline significant increase in mortality risk for those who rated themselves in the “average” category (RR = 4.05; 95% CI 0.93–17.70). Elderly people who compared their health with others of the same age as “worse or worst” and “similar” had an RR of 2.75; 95% CI of 0.64–11.83 and RR of 2.40; 95% CI of 0.64–8.96, respectively. Elderly people who rated their physical symptoms as “moderate or severe” and “slight” had an RR of 2.54; 95% CI 0.65–9.80 and RR of 1.05; 95% CI 0.32–3.41, respectively. Age, institutional factors, and history of multiple falls were associated with an increased risk of mortality. We concluded that only the global health rating has direct predictive power for mortality in institutionalized elderly people.