Cerebellar hemorrhage presenting as orthostatic headache: two case reports.
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Adult↗
Biomedical subjects
J L Fuh
Publications and source records attributed to J L Fuh.
ApoE genotype in relation to AD and cholesterol: a study of 2,326 Chinese adults.
OBJECTIVE: To calculate the frequencies of apolipoprotein E (apoE) alleles in a large Chinese community sample and to compare the serum cholesterol levels of epsilon2, epsilon3, and epsilon4 carriers. BACKGROUND: In comparison with Western populations, a lower frequency of the apoE epsilon4 allele among the Chinese has been proposed as one factor for the lower prevalence of AD found in Chinese populations, but there are insufficient Chinese data on epsilon4 frequency that are based on large community samples. In addition, although Western studies have repeatedly found a lower cholesterol level in epsilon2 carriers and a higher cholesterol level in epsilon4 carriers in comparison with epsilon3 homozygotes, two Chinese studies have yielded inconsistent findings between them. METHODS: During the incidence phase of an epidemiologic survey of several neurologic disorders in a Chinese community, the authors took blood samples from 2,326 participants to determine the apoE genotypes and to measure cholesterol levels. RESULTS: The allelic frequencies of epsilon2, epsilon3, and epsilon4 were 11.8%, 76.4%, and 11.8% among 17 AD patients, and 7.8%, 84.1%, and 8.1% for the entire sample. The mean cholesterol level of the epsilon2 carriers was significantly lower, and that of the epsilon4 carriers significantly higher, than that of the epsilon3 homozygotes. CONCLUSIONS: The obtained epsilon4 rate of 8.1% is lower than most of the Western findings, and this may account in part for the lower prevalence of AD found among the Chinese. The associations between the apoE genotype and serum cholesterol level are similar between Chinese and white populations.
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Colour doppler imaging for diagnosis of intracranial hypotension.
BACKGROUND: Measurement of CSF pressure is the only known way to confirm the diagnosis of intracranial hypotension. We aimed to assess colour doppler flow imaging (CDFI) for measurement of blood flow of the superior ophthalmic vein for the diagnosis of intracranial hypotension. METHODS: We enrolled 25 consecutive patients with orthostatic headache who had clinical features of intracranial hypotension. We defined low-pressure headache as cerebrospinal-fluid pressure below 60 mm H2O. We used CDFI to measure the diameter and maximum flow velocity of the superior ophthalmic vein in all patients. Magnetic resonance imaging of the brain and lumbar puncture with measurement of cerebrospinal-fluid pressure within 24 h were also done after sonographic examination. The control group comprised 13 healthy individuals of a similar age; in addition, those patients who had orthostatic headache without low pressure served as a control group for the patients. FINDINGS: Of the 25 patients recruited for this study, 13 satisfied the criteria for low-pressure headache. The remaining 12 patients with normal cerebrospinal-fluid pressure had transformed migraine (five patients) or chronic tension-type headache (seven patients), and therefore served as the control group for the patients. The mean diameter of the superior ophthalmic vein was substantially larger in the patients with intracranial hypotension (3.9 [SD 0.2] mm) than in the healthy controls (2.6 [0.4] mm) and the controls from the patients' group (2.7 [0.2] mm) (p<0.0001). The mean maximum flow velocity was significantly higher in the intracranial-hypotension group (17.0 [SD 3.4] cm/s) than in the healthy controls (7.9 [1.1] cm/s) and the other patients (7.3 [1.7] cm/s) (p<0.0001). Seven patients with intracranial hypotension were reassessed after treatment with epidural blood patch. After this treatment the clinical symptoms were relieved and there was a striking reversal of the superior ophthalmic vein flow. INTERPRETATION: CDFI to measure blood flow of the superior ophthalmic vein provides a practical, simple, and non-invasive diagnostic method for suspected intracranial hypotension.
Adult↗
Ossification of the posterior longitudinal ligament of the spine. A case-control risk factor study.
STUDY DESIGN: A case-control study. OBJECTIVES: To determine the risk factors for ossification of the posterior longitudinal ligament (OPLL) of the spine. SUMMARY OF BACKGROUND DATA: Previous epidemiologic studies conducted in Japan showed consuming vegetable protein and salt was a risk factor for OPLL. Dietary habits of the Taiwanese and Japanese people are similar. Whether the similar dietary habits play an important role in the high prevalence of OPLL in Taiwan was of interest. METHODS: A case-control study was conducted in a tertiary teaching hospital. The study included 98 consecutive cervical spine patients with OPLL, with 98 age-matched patients with cervical spondylosis serving as control subjects. Radiologic examinations, clinical interviews, physical examinations, and risk factor questionnaires were administered to all the participants. RESULTS: Compared with incidence in the control patients, the frequency of the ossification of the anterior longitudinal ligaments was significantly higher in OPLL patients with OPLL (31% vs. 19%; P = 0.049), but there was no difference in incidence of ossification of the ligamentum flavum (13.3% vs. 16.3%; P = 0.546). More OPLL patients preferred a high-salt diet (OPLL/CS, no:somewhat:yes = 23/38:18/25:57/35;, X2 for trend = 6.3; P = 0.001) and pickled foods (OPLL/CS, no:somewhat:yes = 39/56:11/11:48/31; X2 for trend = 6.7; P = 0.0099). Fewer patients with OPLL consumed meat daily (63% vs. 79%; P = 0.018). High-salt diet (odds ratio = 2.62) and daily meat intake (odds ratio = 0.39) showed persistent association with OPLL in a multivariate logistic regression. CONCLUSIONS: The similar dietary habits, particularly a high-salt and low meat intakes, may partially explain the high prevalence of OPLL in Taiwan and Japan. Modifying dietary habits may help prevent this disease, especially in those high-risk populations.
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Revised memory and behavior problems checklist in Taiwanese patients with Alzheimer's disease.
The Revised Memory and Behavior Problems Checklist (RMBPC) is a 24-item caregiver report that measures observable behavioral and memory problems in dementia patients and their caregivers' reaction to these problems. The purpose of the present study was to evaluate the applicability of the RMBPC for use in Taiwanese patients with Alzheimer's disease (AD). The subjects included 76 AD patients (39 men and 37 women, mean age 72.3) and their caregivers (34 men and 42 women, mean age 53.5) who participated in a comprehensive assessment at the Veterans General Hospital-Taipei. The Chinese version of the Cognitive Abilities Screening Instrument was administered to the patients. Their caregivers rated the RMBPC and the short version of the Geriatric Depression Score (GDS). To assess the test-retest reliability, 30 caregivers rated a second RMBPC 3 days after the first evaluation. The mean score for the frequency rating on the RMBPC was 32.63 (SD = 12.44, range = 5-61) and the mean reaction score was 10.96 (SD = 11.53). The reaction score was significantly correlated with the GDS score (r = .363, p = .001). The Cronbach's alpha coefficients for frequency and reaction scores were .816 and .895 respectively. The test-retest reliabilities of total frequency and reaction scores were significantly correlated; overall correlations were .89 for frequency (p < .001) and .74 for reaction (p < .001). These findings suggest that the RMBPC be recommended as a reliable tool to assess behavioral and memory disturbance in Taiwanese AD patients.
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Depressive disorders in Chinese patients with Alzheimer's disease.
OBJECTIVE: The present study was to investigate the prevalence and potential risk factors of depressive disorders in Chinese patients with Alzheimer's disease (AD). METHOD: A series of consecutive AD patients from the Memory Disorders Clinic of the Veterans General Hospital, Taipei were studied. Psychiatric diagnosis was made according to DSM-III-R criteria with the use of the Structured Clinical Interview for DSM-III-R (SCID). The Chinese version of the Cognitive Abilities Screening Instrument (CASI) and the Hamilton Depression Rating Scale (HDRS) were also applied. Primary caregivers were interviewed for the Clinical Dementia Rating (CDR) scale, the Barthel Index and the Alzheimer's Deficit Scale (ADS). RESULTS: Among 141 AD patients, seven (5.0%) were diagnosed with major depression, 11 (7.8%) with dysthymia and five (3.5%) with depressive disorder not otherwise specified. Women were at elevated risk for depressive disorders and had more severe symptoms of depression. CONCLUSIONS: The prevalence of depressive disorders among Chinese AD patients is in the middle of the range of western findings. The risk factor for depression is female gender.
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Use of the hospital anxiety and depression scale as a screening tool for patients with headache.
BACKGROUND: The Hospital Anxiety and Depression Scale (HADS) is becoming widely used in medical settings to screen for anxiety or depressive disorders. It has been shown to be a good screening instrument in different ethnic and disease populations. The objective of this study was to evaluate the validity and reliability of HADS in patients with headache at a headache clinic. METHODS: Consecutive new patients to a headache clinic at the Taipei Veterans General Hospital from September to December, 1998, were recruited in the study. The participants completed the HADS questionnaire and underwent a psychiatric semistructured interview according to the Diagnostic and Statistical Manual (4th revision). The reliability and validity of the HADS were evaluated with respect to headache. RESULTS: A total of 62 patients (21 men, 41 women) completed the study. The HADS had a good internal consistency when applied to patients suffering from headache, with a Cronbach's alpha coefficient of 0.84 and a split-half reliability of 0.84. Factor analysis in this sample revealed four factors: anxiety, depression, panic and somatic factors. A total of 48 patients (77%) had a psychiatric diagnosis. The frequency of depressive disorders was 57% and anxiety disorders 31%. A total HADS score of 10 or more was the optimal cut-off point for depressive disorders. The sensitivity was 85.7%, and the specificity 33.3%. A total score of at least 13 was the optimal cut-off point for anxiety disorder. The sensitivity was 84.2%, while the specificity was 41.9%. CONCLUSIONS: Depression and anxiety were quite common among patients with headache in a headache clinic. The HADS can be used as a screening instrument for depressive and anxiety disorders. Because of the low specificity, the HADS should not be used solely as an indicator of psychiatric comorbidity among patients with headache in a headache clinic. This is the first study that verifies the use of the HADS as a psychiatric screening tool in patients with headache by comparing the scores of the HADS with psychiatric diagnoses.
Adolescent↗
Proton magnetic resonance spectroscopy in deep cerebral venous thrombosis.
A 63-year-old man developed a severe left frontal headache followed by an acute change of mentality 6 days later. Magnetic resonance imaging revealed bilateral thalamic ischemia. Angiography confirmed the occlusion of deep cerebral veins. Proton magnetic resonance spectroscopy (1H-MRS) of the thalami showed normal N-acetylaspartate (NAA) peak and the presence of lactate peak, indicating a relatively preserved neuronal viability. The patient improved during the follow-up period, and returned to work 45 days after the onset of the disease. With 1H-MRS, prognosis following venous infarctions may be feasible.
Humans↗
Prevalence and subtypes of dementia in a rural Chinese population.
We conducted a single-stage community-based study of dementia on all registered residents > or =65 years in age in a rural Chinese community. Neurologists conducted semistructured interviews and examined all participants; they also interviewed family members in cases where dementia was suspected. The diagnosis was made by consensus according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised (DSM-III-R). Among the 2,055 contacted individuals, 1,736 (84.5%) participated in the study and 44 ( 13 men and 31 women) were diagnosed as having dementia, including 35 (80%) with probable Alzheimer disease (AD) and 3 (7%) with vascular dementia (VsD). The rates of dementia were 0.5% for ages 65-74 years, 2.9% for ages 75-84 years, and 12.0% for ages 85-101 years. The overall rate was 2.5% for age > or =65 years. After controlling for age, neither a lack of formal education nor being a woman was a risk factor for dementia. At 2-year follow-up, 30 of the 44 demented participants had died, yielding a 2-year survival rate of 32%. The present results corroborated our previous findings of lower prevalence rates of dementia among the Chinese than among Western populations, and both genetic and sociocultural factors may have contributed to the low rates. The lack of neuroradiological imaging studies in the present study may have contributed to the finding of an unusually low rate of VsD.
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A SPECT study of patients with gait apraxia without evidence of frontal lobe dysfunction.
BACKGROUND: The pathogenesis of gait apraxia (GA) is unknown. Even though imaging studies provide excellent assessment of brain morphology, there is still a lack of congruous results. Single photon emission computed tomography (SPECT) using Tc-99m hexamethylpropyleneamine oxime (HMPAO) may show alterations in regional cerebral blood flow (rCBF) and provide indirect information about brain metabolism. METHODS: We conducted a SPECT study of GA patients and evaluated the related cortical function. rCBF was assessed in 16 GA patients (15 male, one female; age range 65-79 years, mean 70.5 years) by SPECT using HMPAO. Mean HMPAO cortical or basal ganglia/cerebellum activity ratios were calculated. The regions of interest included the frontal lobe, parietal lobe and basal ganglia. A battery of GA tests and magnetic resonance imaging (MRI) of the brain were also performed in these 16 patients. RESULTS: Nine of the patients had equilibrium disorder, and all 16 patients had locomotion disorder. The MRI findings were lacunar infarct (16/16 in basal ganglia, or 6/16 in thalamus), leukoaraiosis (4/16), enlarged ventricle (3/16), frontal lesion (3/16) and parietal lesion (1/16). Lower rCBF was noted in the frontal lobe (3/16), occipital lobe (1/16, thalamus (7/16) and basal ganglia (9/16). Though SPECT showed decreased rCBF in nine patients (9/16), mean cortical and basal ganglia regional uptake ratios in the patient group were not significantly different from values in the control group (cortical p = 0.0613; basal ganglia p = 0.0576, by Student's t-test). CONCLUSIONS: Though only a small number of patients were studied, it was clear that brain SPECT and MRI did not show any significant abnormalities in the frontal or parietal lobes of patients with GA. Thus, the pathogenesis of GA and its related anatomic lesion should be further investigated.
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Clinical manifestations of tardive truncal dystonia--abdominal movements: report of two cases.
A variety of involuntary abdominal movements may result from peripheral insults or have a central origin. However, the spectrum of differential diagnoses can be broadened by this report of two patients whose involuntary abdominal movements were related to chronic use of haloperidol or sulpiride. Electromyographic studies revealed two patterns of muscle activity in these two patients. The first patient showed long-duration bursts of the thoracic and lumbar paraspinal muscles, causing repetitive backward tilting of the pelvis and downward shifting of the umbilicus. The second patient showed persistent contraction of the rectus and the external oblique abdominal muscles, causing sustained retraction of the abdominal wall and episodic jerking. Both patients improved dramatically after treatment with reserpine. We conclude that electromyographic study is useful in identifying truncal dystonia and abdominal dystonia, two variants of tardive syndrome.
Abdominal Muscles↗
The correlation of depression with functional activity in Parkinson's disease.
We evaluated 109 Chinese patients with Parkinson's disease (PD) in three ways: using a standardized psychiatric interview for depression and anxiety, using standardized neurological evaluation for motor disability, and using cognitive assessment for cognitive impairment. Six of the 109 patients who had dementia and another two afflicted with organic delusional disorder were excluded from further analysis. The remaining 101 PD patients were divided into the following three groups according to the DSM-III-R criteria: major depressive disorder (n = 18), other depressive disorders (n = 25) including dysthymic disorder and depressive disorder not otherwise specified, and no depression (n = 58). The frequency of major depressive disorder of the 109 PD patients was 16.5%, and the frequency of major and other depressive disorders, taken together, was 42.2%. Using the percentage points measured on the Schwab & England Activities of Daily Living Scale as the dependent variable to fit a multivariate regression model, we found the lower score significantly correlated with the diagnosis of depressive disorder and higher score of the Hamilton Depression Rating Scale, in addition to motor disability and disease severity of PD. Given the high frequency of depression and the significant correlation between depression and performance in daily functional activites, we believe that an evaluation of PD patients for coexisting depression is necessary for a better therapeutic outcome.
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Swallowing difficulty in Parkinson's disease.
Dysphagia is a frequent and potentially serious complication of Parkinson's disease (PD). We examined the oropharyngeal swallowing ability in 19 PD patients (15 men and 4 women, mean age 68.42 years, mean Hoehn and Yahr stage 1.8) using modified barium swallow before and after administering oral levodopa (in combination with benserazide). Twelve (63.2%) patients demonstrated objective evidence of swallowing abnormalities; although only six patients (31.6%) had subjective complaints. Vallecula sinus and pyriform sinus residues were the most frequent abnormalities (47.4% and 42.1%); followed by delayed swallowing reflex (26.3%). Three patients demonstrated silent aspiration. In the 12 patients with abnormal swallowing, six (50%) showed objective improvement after levodopa treatment, while the remaining six showed no change. Of the former group of six, one patient showed improvement in the oral phase, but deterioration in the pharyngeal phase. We concluded that PD patients had a high percentage of objective swallowing abnormalities which could be reduced in half of the patients through the administration of levodopa treatment.
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Depressive disorders among older residents in a Chinese rural community.
BACKGROUND: Two recent surveys of depression among Chinese elderly people sampled different populations, used different case ascertainment methods and resulted in a seven-fold difference in prevalence rates. The present study was conducted to compare prevalence rates obtained with two commonly used methods in the same population, and to examine the risk factors for depression. METHODS: The target population included all residents aged 65 years and over in a rural Chinese community. Participants were interviewed for demographic and medical information, examined by a neurologist and administered Chinese versions of the Geriatric Depression Scale-Short Form (GDS-S), the Cognitive Abilities Screening Instrument (CASI) and an Activities of Daily Living (ADL) form. Individuals who screened positive on the GDS-S were also interviewed by a psychiatrist for diagnosis according to the DSM-III-R criteria. RESULTS: Among the 1313 participants, 26% screened positive on the GDS-S and 13% were diagnosed as having a depressive disorder, including 6.1% with major depression. Individuals with depressive disorders were more likely to have poor ADL scores, lower CASI scores, and chronic physical illnesses. They were also more likely to be female, older, illiterate and without a spouse, but adding these variables did not increase the overall association with the GDS-S score. CONCLUSIONS: Depression was quite common in this Chinese rural geriatric population. The prevalence rate was twice as high when judged by depression symptomatology rather than clinical diagnosis. The critical risk factors were functional impairments, poor cognitive abilities and the presence of chronic physical illnesses.
Activities of Daily Living↗
The Kinmen Neurological Disorders Survey (KINDS): a study of a Chinese population.
We conducted an epidemiological study of several neurological disorders among the Chinese aged 50 years or older on the islet of Kinmen. All participants were interviewed and examined by neurologists. From the targeted population of 5,061 individuals, 3,915 (77.4%) of them completed the evaluations. Among the 4,087 individuals with whom face-to-face contact was made, the refusal rate was 4.2%. The disorders of interest were dementia, Parkinson's disease, essential tremor, stroke, transient ischemic attacks, and migraine. Among the 3,915 participants, 366 cases were found with 1 or more of the surveyed neurological disorders on the prevalence day, August 1, 1993, yielding a prevalence of 93.5/1,000. The purpose of this study, the general methodology, and some overall findings are presented in this communication in order to provide a common background for detailed findings on each disorder to be reported separately.
Age Factors↗
Risk factors for Alzheimer's disease: a case-control study.
The extent of current knowledge of risk factors for Alzheimer's disease (AD) is still limited. We conducted a case-control study of 98 AD patients and 98 age- and sex-matched controls. Light smoking had a decreased risk for AD (AD: 2.0%, controls: 21.4%, odds ratio = 0.10, p = 0.003), whereas daily smoking showed a trend to increase the risk for AD (AD: 45.9%, controls: 26.5%, odds ratio = 1.73, p = 0.08). After multivariable analyses factors associated with AD included the presence of apolipoprotein epsilon4 allele, and the duration of well water consumption.
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Poststroke depression among the Chinese elderly in a rural community.
BACKGROUND AND PURPOSE: A door-to-door survey was conducted in two townships in the Kinmen islets to investigate the prevalence and other characteristics related to depressive disorders of stroke survivors in an elderly Chinese population. METHODS: Our target population comprised the registered residents > or = 65 years old (n = 2056) of a total population of 26 105 on August 1, 1993. All participants answered a questionnaire, filled in a Geriatric Depression Scale-short form (GDS-S), and received a neurological examination. Depression was defined as a GDS-S score > or = 5. RESULTS: Twenty-eight of 45 stroke survivors (62.2%) and 491 of 1471 nonstroke subjects (33.4%) were classified as depressed. The frequency of stroke survivors' depressive disorders was significantly higher that of nonstroke subjects (P < .001). Multiple regression analysis indicated that GDS-S scores were most related with the activities of daily living (R2 = .19, P = .004) in the stroke survivors. CONCLUSIONS: Depressed mood was common after stroke, and activities of daily living were an important factor for depression in stroke survivors in the community.
Activities of Daily Living↗
Prevalence of headaches in a Chinese elderly population in Kinmen: age and gender effect and cross-cultural comparisons.
OBJECTIVE: To investigate the prevalence of headaches in a Chinese elderly population. BACKGROUND: There are few headache surveys in the elderly. Previous studies have shown a low headache prevalence in Chinese. METHODS TARGET POPULATION: eligible registered residents > or = 65 years old (N = 2,003) in two townships of Kinmen Island on August 1, 1993. All participants completed a headache questionnaire and underwent clinical evaluation and examination by a neurologist. Headache diagnoses were made according to the International Headache Society, 1988. RESULTS: 1,533 persons (77%) participated in the study, of whom 584 (38%) had at least one episode of headache in the previous year. One-year prevalence of migraine was 3.0%, and tension-type headache, 35%. The prevalence of migraine, but not tension-type headaches, continued to decline with age in the elderly. Life-time prevalence of "incapacitating headache" was 10%, and that of migraine, 5.2%. Forty-two percent of migraineurs stopped having migraine before this survey. In comparison with "10 years ago" 8% participants felt their current headaches were worse, 25% better, and 67%, no change, with a net improvement of 17%. CONCLUSIONS: We have reported the highest headache prevalence among different Chinese elderly populations, but these were still lower than those reported from Western series. More than half of the elderly life-time migraineurs still had attacks of migraine. Severe headaches, including migraine but not tension-type headaches, declined with age.
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