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Biomedical subjects

J L Fuh

Publications and source records attributed to J L Fuh.

66 records · Page 4Linked to original sources
PubMed1993

Creutzfeldt-Jakob disease. Report of a case of the panencephalopathic type and experiences of a teaching hospital in Taiwan.

We report a case of the unusual panencephalopathic type of Creutzfeldt-Jakob disease (CJD) in Taiwan. This 59-year-old woman presented in 1983 with typical clinical manifestations of CJD and died 16 months later. Postmortem examination revealed severe neuronal loss, spongiosis and gliosis extensively in cerebral cortex and striatum as well as in the white matter. We also report 6 other CJD patients seen from 1983 to 1991 at Veterans General Hospital-Taipei.

Aged↗
PubMed1993

Relationship between periventricular lucencies on computed tomographic scans and vascular dementia.

We evaluated 48 consecutive patients with periventricular lucencies (PVL) on CT scan of brain to determine the clinical significance of this finding. Twenty-one (43.7%) patients were demented; 27 (56.3%) patients had no dementia but had various other diseases. PVL were frequently associated with hypertension and previous stroke. We used a PVL scoring system to evaluate the degree of PVL. When the score was greater than 3.5, the sensitivity and specificity in separating vascular dementia from other diseases with PVL were 78% and 67% respectively (Kappa = 0.42). We conclude that although mild PVL may be a frequent but non-specific finding in patients with hypertension or previous stroke, moderate and severe PVL should raise the possibility of vascular dementia.

Age Factors↗
PubMed1992

Single photon emission computed tomography using 99Tcm-HMPAO in Alzheimer's disease.

Brain single photon emission computed tomography (SPET) using 99mTcm-hexamethylpropyleneamine oxime (HMPAO) was performed in 37 patients satisfying the standard clinical criteria of Alzheimer's disease (AD), correlating results with patient's age of onset, duration of illness, severity of dementia, neuropsychological impairment, computed tomography (CT) and EEG findings. All patients had abnormal SPET: 23 were bilaterally symmetric, 10 were bilaterally asymmetric and four showed unilateral low regional cerebral perfusion. Low perfusion in bilateral parietal regions was the most consistent finding and was present alone or with other abnormal regions in 31 patients (84%). The only significant clinical correlation was found between asymmetric SPET changes and onset of disease before the age of 65 years. Fifty per cent of patients with presenile onset, but only 19% with senile onset had asymmetric low regional cerebral perfusion. Fifteen of the 36 patients had normal brain CT scans, and 9 of 31 patients receiving EEG examination had normal results. Although clinical evaluation is the most valuable diagnostic tool, brain SPET is a sensitive test for physiological investigation in AD.

Aged↗
PubMed1992

Cerebral infarction in young men with nephrotic syndrome.

BACKGROUND AND PURPOSE: Thrombosis is one of the main complications of nephrotic syndrome; however, cerebral infarction associated with nephrotic syndrome has been rarely reported. SUMMARY OF REPORT: We describe acute cerebral infarction in two young men with nephrotic syndrome. Both had a hypercoagulable state based on hemostatic studies. By retrospectively reviewing the medical records of the past 10 years at our hospital, we found an additional five cases of cerebral infarction with nephrotic syndrome. Two of the patients were found to have nephrotic syndrome during admission for stroke. CONCLUSIONS: Hypercoagulability may be the major contributing factor of cerebral infarction in patients with nephrotic syndrome.

Acute Disease↗
PubMed1992

Cognition and 99Tcm-HMPAO SPECT in Parkinson's disease.

99Tcm-hexamethylpropyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) of brain was performed in 43 unselected patients with Parkinson's disease to evaluate whether low cerebral perfusion on SPECT correlated with cognitive impairment in the patients. All patients received neurological, Mini-Mental State Examination and a neuropsychological assessment. Eighteen (41.9%) of the 43 patients were demented. Thirty patients (69.8%) had abnormal SPECT: 17 had perfusion defects in cortical regions, eight in basal ganglia and five in both regions. Of the 22 patients with abnormal cortical perfusion, 15 (68.2%) were demented; only three (14.3%) of the 21 patients without cortical defect were demented (P < 0.01). Twelve of the 15 demented patients had low perfusion in the parietal region alone or in parietal and occipital regions. The cortical perfusion defects, present in 22 (51.2%) Parkinson's patients, are highly correlated with cognitive impairment. The pattern of SPECT abnormality in most demented patients with Parkinson's disease is similar to that seen in Alzheimer's disease, suggesting that the underlying pathophysiology for dementia in patients with Parkinson's disease may be similar to that in Alzheimer's disease.

Adult↗
PubMedDate not supplied

Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes.

OBJECTIVE: To investigate the frequency of depressive and anxiety disorders in patients with chronic daily headache. BACKGROUND: There is a lack of data in the literature on the extent of psychiatric comorbidity in patients with different subtypes of chronic daily headache. METHODS: We recruited consecutive patients with chronic daily headache seen in a headache clinic from November 1998 to December 1999. The subtypes of chronic daily headache were classified according to the criteria proposed by Silberstein et al. A psychiatrist evaluated the patients according to the structured Mini-International Neuropsychiatric Interview to assess the comorbidity of depressive and anxiety disorders. RESULTS: Two hundred sixty-one patients with chronic daily headache were recruited. The mean age was 46 years, and 80% were women. Transformed migraine was diagnosed in 152 patients (58%) and chronic tension-type headache in 92 patients (35%). Seventy-eight percent of patients with transformed migraine had psychiatric comorbidity, including major depression (57%), dysthymia (11%), panic disorder (30%), and generalized anxiety disorder (8%). Sixty-four percent of patients with chronic tension-type headache had psychiatric diagnoses, including major depression (51%), dysthymia (8%), panic disorder (22%), and generalized anxiety disorder (1%). The frequency of anxiety disorders was significantly higher in patients with transformed migraine after controlling for age and sex (P =.02). Both depressive and anxiety disorders were significantly more frequent in women. CONCLUSION: Psychiatric comorbidity, especially major depression and panic disorders, was highly prevalent in patients with chronic daily headache seen in a headache clinic. These results demonstrate that women and patients with transformed migraine are at higher risk of psychiatric comorbidity.

Adolescent↗
PubMedDate not supplied

Predictors of depression among Chinese family caregivers of Alzheimer patients.

From April 1996 to January 1997, 74 Alzheimer disease (AD) patients and their caregivers were recruited for participation in a comprehensive assessment at the Veterans General Hospital-Taipei, a 2,198-bed tertiary care teaching hospital in Taipei, Taiwan. Diagnosis of AD was made according to criteria of the Diagnostic and Statistical Manual of Mental Disorders-III-R (DSM-III-R). All AD patients were tested with the Chinese version of Cognitive Abilities Screening Instrument (CASI). Their primary caregivers rated the patients using the Revised Memory and Behavior Problems Checklist (RMBPC), the short version of Geriatric Depression Scale (GDS-S), and obtained information about coping strategies using the Carer's Stress scale. The three subscale scores for memory-related problems, depression, and disruptive behavior were obtained from the RMBPC. Scores for three subscales for management of situations, meaning, and distress were obtained from the coping strategies' assessment. Depression was defined as a GDS-S score > or = 5. Among the 74 AD patients, 38 were men and 36 women. Their ages ranged from 47 to 90 years, with a mean age of 72.2 years (SD, 9.0). The CASI scores ranged from 1 to 88 (mean, 45.2; SD, 22.9). Thirty-three caregivers were men and 41 were women. Their age ranged from 20 to 85 years, with a mean age of 53.5 years (SD, 16.9). Twenty-six of the 74 caregivers (35.1%) were classified as depressed. The GDS-S scores of caregivers were correlated positively with the frequency of the use of a management of distress coping strategy and the frequency of the patients' disruptive behavior and were correlated negatively with the educational years of the caregivers.

Adaptation, Psychological↗
PubMedDate not supplied

The caregiving burden scale among Chinese caregivers of Alzheimer patients.

From April 1996 to January 1997, a total of 76 Alzheimer's disease (AD) patients and their caregivers were recruited for participation in a comprehensive assessment at the Veterans General Hospital-Taipei, a 2,198-bed tertiary-care teaching hospital in Taipei, Taiwan. The AD patients responded to the Chinese version of the Cognitive Abilities Screening Instrument. Primary caregivers rated the patients using the Symptom Check List-90 (SLC-90) and the Revised Memory and Behavior Problems Checklist and then rated themselves with the caregiving burden scale (CBS), coping strategies scale and the short version of the Geriatric Depression Score (GDS-S). The internal consistency of the CBS, as assessed by Cronbach's alpha, was 0.849. The correlations between the CBS, SCL-90 and GDS-S ranged from 0.435 to 0.698. The CBS scores increased with disease progression and were higher among spouse caregivers than adult children caregivers. Multiple-regression analysis revealed that caregivers with higher CBS scores were more likely to have lower education levels and to use the meaning subscales of coping strategies, and that these caregivers' patients had greater disruptive behavior and were older (R2 = 0.727, p = 0. 001). The current study establishes the reliability and validity of the Chinese version of the CBS for assessment of Chinese caregivers of AD patients.

Aged↗
PubMedDate not supplied

A double-blind, placebo-controlled study of tacrine in Chinese patients with Alzheimer's disease.

The purpose of the study was to evaluate the efficacy and safety of tacrine over 30 weeks in Chinese patients with probable Alzheimer's disease (AD). A total of 100 patients with mild to moderate AD were recruited and randomly assigned to active or placebo treatment. The active group received 30 mg/day of tacrine for the first 6 weeks, 60 mg/day for the next 6 weeks, 90 mg/day for 6 more weeks and then 120 mg/day for the remaining 12 weeks. Safety evaluations included biweekly determinations of alanine aminotransferase (ALT). The primary outcome measures were Cognitive Abilities Screening Instrument (CASI), Clinical Global Impression of Change (CGIC) by investigator and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Secondary outcome measures were Mini-mental State Examination (MMSE), Alzheimer's Deficit Scale (ADS) and CGIC by caregivers. Sixty-eight patients were included in an intent-to-treat analysis (48 active and 20 placebo); 56 patients had evaluable data at week 30 (36 active and 20 placebo). The results of the complete case analysis revealed a significant improvement in the CASI and MMSE scores of the active group in the 18th week (90 mg/day) and the 30th week (120 mg/day) (p < 0.01). In the intent-to-treat analysis, significant improvement of the active group was noted on CASI at week 30 (p = 0.05), but there was no significant difference in the measures of IQCODE, CGIC and ADS. The primary reasons for withdrawal of tacrine-treated patients (39 patients, 52%) were asymptomatic ALT elevation, anorexia and nausea/vomiting. These patients all recovered from the adverse events on discontinuation of treatment. Tacrine produced a statistically significant improvement in the CASI and MMSE in Chinese patients with mild to moderate AD using a lower dose than in western people.

Aged↗
PubMedDate not supplied

Incidence of stroke on Kinmen, Taiwan.

This study aims to assess the incidence, case-fatality rate and risk factors of stroke on Kinmen Island, Taiwan, from 1993 to 1996. A population-based stroke survey was carried out in 1993 and 1996 to collect data on all subjects in the population aged 50 years and older residing on Kinmen. There were 63 stroke events (53 first ever and 10 recurrent) identified in this period. The average annual incidence rate of first-ever stroke for people aged 50 years or older was 527 per 100,000 population (95% confidence interval, CI, 297-757). The 28-day case-fatality rate was 24.5% (95% CI 12.9-36. 1%) for first-ever stroke and 60% (95% CI 29.6-90.4%) for recurrent stroke. Multivariate analyses performed with the Cox proportional hazard model revealed the following risk factors to be independent predictors of stroke: hypertension, diabetes and alcohol use. The incidence and case- fatality rate of stroke on Kinmen is similar to that of several other countries. Hypertension is the most common risk factor in this population. Due to a relatively small number of outcome events, these findings require confirmation.

Age Factors↗
PubMedDate not supplied

Neurologic diseases presenting with gait impairment in the elderly.

We conducted a prospective study to evaluate the underlying diseases and their frequencies in 50 consecutive patients older than 50 years of age admitted to our neurologic service because of walking difficulty. The diseases identified in our study were as follows: multiple cerebral infarcts, 24%; myelopathy, 22%; parkinsonism, 12%; cerebellar degeneration, 8%; other diseases, 24%; and unknown etiology, 10%. Potentially treatable causes of gait impairment were found in nearly one third of patients.

Aged↗