Chin-Liang Chu

Fear of falling (FF): Psychosocial and physical factors among institutionalized older Chinese men in Taiwan

Fear of falling (FF) can have multiple adverse consequences in the elderly. Although there are various fall prevention programs, little is known of FF and its associated characteristics. This study examined FF-associated physical and psychosocial factors in older Chinese men living in a veterans home in southern Taiwan. Subjects with a recent episode of delirium, of bed-ridden or wheelchair-bound status, severe hearing impairment or impaired cognition were excluded. Overall, 371 residents (mean age 82.1 ± 5.11 years, all males) participated. The prevalence of FF was 25.3%. Univariate analysis revealed that subjects in the FF group were older age, having lower education level, poorer sitting and standing balance, poorer activities of daily living (ADL), more depressive symptoms, higher chances of using walking aids, neurologic diseases, and a history of fall within the past 6 months. Logistic regression showed that depressive symptoms (odds ratio = OR = 6.73, 95%CI: 3.03-14.93, p < 0.001), activities of daily living (OR = 2.48, 95%CI: 1.08-5.71, p = 0.033), history of fall in the past 6 months (OR = 2.47, 95%CI: 1.04-5.9, p = 0.041), and neurological diseases (OR = 2.75, 95%CI: 1.15-6.56, p = 0.023) were all independent risk factors for FF.

Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study.

Background The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. Method This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement), surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay), results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL) and 1–12-month postoperative ADL and IADL functional status were collected for analysis. Results Overall, 9.1% of 232 patients (mean age: 74.7±7.8 years) experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08–35.70 and RR: 12.54, 95% CI: 1.88–83.71, respectively). Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65–99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35–46.99 at the 12th month; RR: 13.68, 95% CI: 1.94–96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94–318.54 at the 12th month, respectively). Conclusion Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional status. Early identification of cognitive function and to prevent delirium are needed to improve functional status following orthopaedic surgery.

Short-Form Mini Nutritional Assessment as a useful method of predicting the development of postoperative delirium in elderly patients undergoing orthopedic surgery

OBJECTIVE Postoperative delirium (POD) is a major cause for concern among elderly patients undergoing surgery, often resulting in poor outcome. It is therefore important to predict and prevent POD. The aim of this study was to evaluate the Mini Nutritional Assessment Short-Form (MNA-SF) as a predictor of POD after orthopedic surgery. METHODS Elderly patients undergoing orthopedic surgery between April 2011 and March 2013 were included in the study (n=544; mean age, 74.24 ± 7.92 years). The MNA-SF was used to evaluate preoperative nutritional status. Delirium was assessed daily after surgery using the confusion assessment method. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria were used to confirm delirium diagnosis. Univariate and multivariate logistic regression analyses were performed to identify key factors associated with POD. RESULTS POD occurred in 52 patients (9.6%). According to the MNA-SF, 17.5% of subjects were at risk of undernutrition. Adjusting for all potential factors in the final model, age, male gender and lower Mini-Mental State Examination and higher Charlson Comorbidity Index scores were associated with significantly increased likelihood of POD. Subjects who were identified preoperatively as at risk of undernutrition were 2.85 times more likely to develop POD compared to normally nourished subjects (odds ratio: 2.85, 95% confidence interval: 1.19-6.87). CONCLUSIONS These results suggest that the MNA-SF is a simple and effective tool that can be used to predict incident delirium in elderly patients after orthopedic surgery.

Decreased IL-1ra and NCAM-1/CD56 Serum Levels in Unmedicated Patients with Schizophrenia Before and After Antipsychotic Treatment

Objective Schizophrenia (SZ) has been associated with the inflammatory-related and immunological pathogenesis. This study investigates the aberration of cytokines in patients with SZ. Methods Thirty patients with SZ without antipsychotic treatment for at least two weeks participated. We measured the serum levels of fourteen cytokines at hospital admission and after 8-week antipsychotic treatment. Severity was measured by expanded version of 24-items brief psychiatric rating scale (BPRS-E). Repeated measure analyses of variance were conducted. Results The interleukin-1 receptor antagonist (IL-1ra) was significantly decreased after 8-week antipsychotic treatment than those of before antipsychotic treatment (F=12.15, df=1/30, p=0.002). Neural cell adhesion molecule 1/CD56 (NCAM-1/CD56) was significantly decreased (F=6.61, df=1/30, p=0.016) among those with second-generation antipsychotics but not first-generation antipsychotics treatment. The changes of BPRS-E-manic and BPRS-E-anxiety scores correlated with the baseline IL-1ra (r=-0.393), IL-6 (r=-0.407), and insulin like growth factor binding protein 3 (r=-0.446). Additionally, the changes of BPRS-E and BPRS-E-negative scores correlated with the changes of brain-derived neurotrophic factor (r=0.372) and interferon-gamma (r=0.375). Conclusion Our study supports that IL-1ra and NCAM-1/CD56 may be considered as markers of developing SZ.

Association between Polymorphisms in Dopamine-Related Genes and Orthopedic Pain Expression in Chinese Elderly Population

The dopaminergic pathway plays a vital role in pain expression. Here, our aim was to investigate the effects of polymorphisms in genes encoding the dopamine active transporter (SLC6A3) and dopamine receptor D2 (DRD2) on preoperative pain expression among patients preparing for orthopedic surgery.

Serum nerve growth factor beta, brain- and glial-derived neurotrophic factor levels and psychopathology in unmedicated patients with schizophrenia

Background: There is accumulating evidence that neurotrophic factors may be involved in the pathophysiology of patients with schizophrenia. This study aimed to explore the relationship between serum nerve growth factor beta (NGF‐beta), brain‐derived neurotrophic factor (BDNF), and glial‐derived neurotrophic factor (GDNF) levels and psychopathology in unmedicated patients with schizophrenia. Methods: Serum NGF‐beta, BDNF, and GDNF levels were determined using enzyme‐linked‐immunosorbent assay (ELISA) in the serum of 30 unmedicated patients with schizophrenia. Symptomatology was assessed with the expanded version of the 24‐items brief psychiatric rating scale (BPRS‐E), which was divided into four conceptual domains: manic excitement/disorganization, depression/anxiety, negative symptoms, and positive symptoms. Kolmogorov–Smirnov one sample test was performed to test non‐parametric variables. Spearmans correlation was performed to examine the correlations between the cytokines of interest and psychopathology. Benjamini‐Hochberg procedure was applied for multiple corrections. Results: Serum GDNF levels correlated negatively with the BPRS‐total (r = −0.533, corrected p = 0.002) and BPRS‐manic (r = −0.456, corrected p = 0.011) subtests. BDNF levels showed a positive correlation with BPRS‐total (r = 0.480, corrected p = 0.007). In addition, NGF‐beta did not associate with psychopathology measured by BPRS scores. Conclusion: Neurotrophic factors play a vital role in the regulation of neuroplasticity and neurogenesis in humans. This study suggests that BDNF and GDNF may be contributing to the pathological mechanisms involved in unmedicated patients with schizophrenia.

Mini-Nutritional Assessment Short-Form as a useful method of predicting poor 1-year outcome in elderly patients undergoing orthopedic surgery

The present study aimed to determine whether the Mini‐Nutritional Assessment Short‐Form (MNA‐SF) can predict the 1‐year outcome of orthopedic fracture surgery in elderly patients.

Regain of visuospatial capacity after coenzyme Q10 in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes: a case report.

Objective: MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) is a neurodegenerative disorder caused by mitochondrial dysfunction. Multiple systems of the body, including cognitive function and heart conduction, can be affected by this disorder. We report a case with global cognitive impairment. Method: A single-case report. Results: The patient got improved cognitive function, especially visuospatial function, under coenzyme Q10 treatment. Conclusion: First, coenzyme Q10 may give some benefit to control MELAS. Second, cognitive functions and intellectual abilities decline with disease progression. Routine neuropsychological tests should be performed.

Allergic Skin Reactions to Multiple Antiepileptic Drugs

Objective: We report a case of bipolar disorder patient who was allergic to multiple newer anti-epileptic drugs (AEDs). Case report: This 67-year-old woman patient was diagnosed as bipolar disorder for more than 20 years. At first she received valproic acid (VPA) and lamotrigine (LTG) for her mixed episode of bipolar disorder. After a three-week-combined treatment, she was diagnosed as Stevens-Johnson syndrome (SJS). We stopped all psychiatric medications and prescribed steroid. Few days later, her dermatologic symptoms were improved. When we tried to reload VPA, her dermatologic lesion was exacerbated. Therefore, we stopped VPA for one month and her dermatologic symptoms got remitted. Because of her hypomania, we prescribed topiramate (TPM) and gradually titrated to 200 mg/d. After few days, she developed intolerant general pruritus, therefore, olanzapine was given to substitute for TPM. Then, her allergic symptoms were relieved and her mental status had become stable. Conclusion: LTG has been most associated with rash of the nine newer AEDs introduced in the past decade. When prescribed with VPA, lamotrigins initial dose and the subsequent rate of dose escalation must be lower and slower than usual, respectively. In addition, if patients have a history of allergic reaction to multiple AEDs, secondary generation antipsychotic medication may be an alternative choice.