Biomedical subjects

Ker-Neng Lin

Publications and source records attributed to Ker-Neng Lin.

12 recordsLinked to original sources

PubMed2005

Family members favor disclosing the diagnosis of Alzheimer's disease.

BACKGROUND: Past negative attitudes towards patients with Alzheimer's disease (AD) have changed in recent years. However, the disclosure of AD diagnosis to patients and family remains an unresolved issue. In this study, we surveyed the family members of neurological patients in Taiwan for the purpose of assessing their attitudes towards the disclosure of AD diagnosis. METHODS: The study sample consisted of family members (150, age range 23-89 years, mean 55.0+/-14.3) who accompanied patients to a neurology outpatient clinic from September 15 to November 24, 2003. The subjects were given an Attitude Questionnaire on AD Disclosure. RESULTS: An overwhelming majority (93%) of subjects favored disclosure of the diagnosis if, hypothetically, they personally were affected by AD. However, a smaller majority of family members (76%) favored disclosure of the diagnosis to current AD patients. Reasons for favoring disclosure included a patient's or family member's right to know, the possibility of assistance in coping with and understanding dementia, and slowing down the progression of the disease by early treatment, as well as the increased probability of accepting treatment and life activity training. Reasons for favoring the withholding of disclosure included the risk of causing the patient emotional disturbance, worsening the disease, the irrelevance of disclosure to drug therapy, and the possibility of causing suicidal ideation. Subjects' attitudes towards disclosure of AD diagnosis were unaffected by their knowledge of dementia, the presence of a family member with AD, their role as the primary caregiver, the length of time that AD symptoms persisted, and the number of hours per day spent in caring for AD patients. CONCLUSIONS: In Taiwan, family members of neurological patients strongly favor being informed and the disclosure of AD diagnosis to the family.

Adult↗

PubMed2005

Cognitive reserve: a SPECT study of 132 Alzheimer's disease patients with an education range of 0-19 years.

This study examines the associations between education, cerebral perfusion, and cognitive test performance among 132 patients with Alzheimer's disease. The participants had had between 0 and 19 years of formal schooling, and had either mild or moderate dementia according to the Clinical Dementia Rating Scale. Cerebral perfusion was evaluated by the (99m)Tc-hexamethylpropylene amine oxime single photon emission computed tomography. The Mini-Mental State Examination and the Cognitive Abilities Screening Instrument were used to assess cognitive performance. For patients at each clinical dementia severity level, statistical parametric mapping was used to examine voxel by voxel the association between education and cerebral perfusion, and Pearson's correlation coefficients were calculated between education and cognitive test scores. Years of formal schooling had negative associations with cerebral perfusion and positive associations with cognitive test scores. The brain regions showing a significant education effect on perfusion involved bilateral posterior association areas in mild dementia, and bilateral parieto-temporo-frontal areas in moderate dementia. The present findings indicate that the cognitive reserve effect starts at the low end of the education range. They also suggest that the main effect of more education is a more facile use of alternative brain circuits instead of locally increased synaptic connections.

Aged↗

PubMed2004

Improving the screening power of the cognitive abilities screening instrument, Chinese version.

The purpose of this study was to find means to increase the power of the Cognitive Abilities Screening Instrument, Chinese version (CASI C-2.0) in the screening of dementia. In assessing the performance of the CASI in dementia screening, it is a common practice to determine a cutoff score for the total CASI score and report the respective sensitivity and specificity. In this paper, we showed that an alternative scoring system, i.e., a weighted sum of the scores from the 9 domains in the CASI C-2.0, may improve its effectiveness in screening. In particular, short-term memory and orientation appeared to be the 2 most relevant domains and their combined score was shown to be more effective than the total score in screening dementia. We also showed that such a scoring system could be kept the same across examinees with different demographic backgrounds. With the weighted scoring system of the 9 domains for patients from the targeted population, we hope to make the CASI a clinically more powerful tool in screening dementia.

Adult↗

PubMed2004

Longitudinal cerebral perfusion decrease in mild alzheimer's disease revealed by SPECT with statistical parametric mapping method.

Fifteen patients with mild Alzheimer's disease received baseline and follow-up technetium-99m hexamethylpropylene amine oxime SPECT examinations paired with neuropsychological assessments, including the Cognitive Ability Screening Instruments (CASI). The differences between baseline and follow-up SPECT images were analyzed by the voxel-based paired t test of the statistical parametric mapping technique. A simple regression analysis was also conducted to analyze the correlation between CASI sub-scores and both sets of SPECT images. In comparison with baseline images, cerebral perfusion at follow-up was significantly reduced in the left superior and middle temporal gyri, right middle and inferior temporal gyri, and right fusiform gyrus. A significant correlation was demonstrated between the list-generating fluency CASI sub-score and perfusion of the left fusiform gyrus. The visual construction sub-score was significantly correlated with perfusion of the right superior and medial frontal gyri.

Aged↗

PubMed2004

Getting lost: directed attention and executive functions in early Alzheimer's disease patients.

This study explores the link between directed attention (DA) and getting lost behavior (GLB) in early Alzheimer's disease (AD) using a cross-sectional design with 3 groups. Based on their dementia levels, 116 community-dwelling participants were recruited from a teaching hospital in Taiwan and classified as the non-demented control, questionably demented, and mild AD groups. Statistical analyses include Pearson correlations, one-way ANOVA, and multiple regressions. Attentional impairments, consisting of distractibility, impulsivity, and executive function problems, significantly predict GLB in familiar and unfamiliar environments. Irritability and executive function problems are associated with mental difficulties in choosing a turn, whereas the use of way-finding strategies reduces GLB. Future interventions may include: (a) mental hygiene of aging; (b) programs targeted at improving attentional function and effective way-finding, and (c) inclusion of DA tests in a routine clinical neuropsychological examination for early detection and accurate diagnosis of dementia.

Aged↗

PubMed2004

Weight loss, nutritional status and physical activity in patients with Alzheimer's disease. A controlled study.

The etiology of weight loss in Alzheimer's disease (AD) patients is still uncertain. This study was designed to investigate the possible factors that might contribute to weight change of AD patients. From July 1999 to June 2001, we recruited 51 AD patients and 27 non-demented controls. Demographic data, neuropsychological tests, Geriatric Depression Scale-Short Form, eating behavior questionnaire, dietary and physical activity diaries, anthropometric and laboratory measures of nutritional status were assessed. More than half of our AD patients developed body weight loss, and overall, the AD patients were significantly thinner than the non-demented subjects. Anthropometric and laboratory measures suggested a poorer nutritional status in the AD patients. The AD patients had fewer daily physical activities. More AD patients had the problem of poor appetite. However, daily calorie intake was not significantly different between the two groups. The AD patients, especially those who presented with body weight loss, even consumed more calories per body weight kilogram (kg) per day. In the food composition analysis, AD patients took more carbohydrate than controls. Multivariate regression analysis showed the existence of AD and poor appetite were the main risk factors of weight loss. We suggest that the pathophysiological process in AD gives rise to the changes of appetite and metabolic state in AD patients, and that these changes contribute to the weight loss.

Aged↗

PubMed2003

The three-item clock-drawing test: a simplified screening test for Alzheimer's disease.

The Clock-Drawing Test (CDT) has been used to screen for Alzheimer's disease (AD) as a supplement to cognitive tests that focus on memory impairment. We examined a comprehensive scoring system of the CDT in screening of AD in a Chinese population and derived a simplified scoring system. All 403 (144 AD and 259 nondemented) subjects were administered the CDT, including both the drawing part (CDT-D) and the copying part (CDT-C). The Cognitive Abilities Screening Instrument and the Clinical Dementia Rating were also administered. Stepwise discriminant analysis was used to develop a simplified CDT scoring system. The optimal CDT cutoff scores (CDT-D: 10/11; CDT-C: 12/13) show intermediate sensitivity (CDT-D: 66.7%; CDT-C: 51.4%) and specificity (CDT-D: 74.5%; CDT-C: 74.1%). The simplified 3-item CDT scoring system, with a cutoff score of 2/3, has a sensitivity of 72.9% and a specificity of 65.6%; it can be used as a quick test for AD screening.

Adult↗

PubMed2003

Smoking and cognitive performance in the community elderly: a longitudinal study.

This prospective study investigated the association between smoking and cognitive performance in a community of nondemented elderly subjects aged 65 or older. All subjects were categorized as current smokers, former smokers, or never smokers. The lifetime cigarette exposure was computed. At baseline, we found the abstainers from smoking had better cognitive performances; however, the differences were not significant after adjusting for age, education, hypertension, diabetes, and vascular events. The lifetime cigarette exposure was not predictive of the cognitive status. At a 3-year follow-up, neither the smoking status nor the lifetime cigarette exposure predicted the declination of cognition.

Aged↗

PubMed2002

The Alzheimer's Disease Assessment Scale: findings from a low-education population.

We constructed a Chinese version of the cognitive component of the Alzheimer's Disease Assessment Scale (ADAS-Cog). In order to accommodate illiteracy, the Chinese version used pictures instead of words for assessing recall and recognition. The Chinese ADAS-Cog was administered to 125 individuals with no dementia, 127 with questionable dementia, and 77 with Alzheimer's disease (AD). Their age range was 51-92 years and their education range was 0-20 years. The Chinese ADAS-Cog had high internal consistency (Cronbach's alpha = 0.87) and very high interrater reliability (intraclass correlation coefficient, or ICC, = 0.99) and test-retest reliability (ICC = 0.96). It had high correlations with scores on the Clinical Dementia Rating Scale (Pearson's r = 0.85), the Cognitive Abilities Screening Instrument (CASI, Pearson's r = -0.88), and CASI-estimated scores on the Mini-Mental State Examination (Pearson's r = -0.85). Performance on the Chinese ADAS-Cog was uninfluenced by age or gender, nor by education level except within the low education range of 0-6 years. Its memory items were best for early detection of dementia; its language items were best for monitoring the progression of dementia. This study found that the Chinese ADAS-Cog is a good instrument for use with Chinese AD patients.

Aged↗

PubMed2002

Performance on the cognitive abilities screening instrument at different stages of Alzheimer's disease.

The Cognitive Abilities Screening Instrument (CASI) contains nine cognitive domains. Its total score has been used to screen for dementia in epidemiological studies conducted in the US, Japan and Taiwan, but its usefulness in distinguishing different levels of dementia has not been examined. This study was conducted to compare CASI scores of patients with Alzheimer's disease (AD) with different levels of severity of dementia. The CASI was administered to 475 AD patients with mild, moderate or severe dementia according to the Clinical Dementia Rating Scale. The patients' scores were compared to the scores of 475 age-, education- and gender-matched control subjects. More specifically, each patient's score, X, was transformed to a z score with reference to the mean and SD of the scores of the control group, where z = (X - mean)/SD. Then, the mean of the z scores and the percentage of patients with z scores of <-2.0 were compared among the three patient groups. For the CASI total score and all of its nine domain scores, the mean z score decreased (except that for short-term memory) and a higher percentage of patients scored below the normal range with increasing severity of dementia. This study validates the usefulness of the CASI for assessing the severity of dementia. The domain scores differed in their relative usefulness for detecting dementia and for distinguishing in different levels of dementia.

Alzheimer Disease↗

PubMed2002

Cutoff scores of the cognitive abilities screening instrument, Chinese version in screening of dementia.

The purpose of this study of dementia screening was to obtain different cutoff scores of the Cognitive Abilities Screening Instrument, Chinese versions (CASI C-2.0) for subjects with different educational backgrounds. The diagnosis of dementia was based on the Diagnostic and Statistical Manual of Mental Disorders, ed 3 revised or ed 4 criteria. To diagnose Alzheimer's disease, the guidelines of the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association was followed. The severity of dementia was determined on the Clinical Dementia Rating scale. Altogether 2,096 subjects, aged 65 years and more, were included. Of them, 1,178 were normal and 918 were demented. Their performance on CASI C-2.0 was influenced by their education and age. Gender difference on CASI C-2.0 scores was only significant in the illiterate, but not in the literate group. We recommend that the population be divided into three levels, namely those who (1) had no formal education (Edu = 0); (2) received 1-5 years of schooling (Edu = 1-5), and (3) received 6 or more years of education (Edu >/=6). The cutoff scores of CASI C-2.0 in the diagnosis of dementia in these three educational groups were as follows: Edu = 0: 49/50 (sensitivity = 0.83; specificity = 0.85); Edu = 1-5: 67/68 (sensitivity = 0.83; specificity = 0.91), and Edu >/=6: 79/80 (sensitivity = 0.89; specificity = 0.90).

Aged↗

PubMed2002

Lack of association between the apolipoprotein E genotype and depression in Alzheimer's disease.

The epsilon4 allele of apolipoprotein (apo E) is one of the risk factors for late-onset Alzheimer's disease (AD). We evaluated the association between apo E genotypes and depression in patients with AD. A psychiatrist interviewed all patients and their caregivers for depression using a Chinese version of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and for the severity of depression using the Hamilton Depression Rating Scale (HDRS). Twenty-five of the 149 patients with AD were diagnosed with depressive disorders. The numbers of patients in each apo E genotype were 10 in epsilon2/3, 2 in epsilon2/4, 74 in epsilon3/3, 46 in epsilon3/4, and 17 in epsilon4/4. We did not find an association between depression and the presence or absence of the epsilon4 or epsilon2 allele. The HDRS scores were not different in patients with AD with the epsilon4 or epsilon2 allele or in those patients without them. Our study did not find an association between depression and the apo E epsilon4 or epsilon2 allele in AD.

Age of Onset↗