Linda Lam

Six-month randomized, placebo-controlled, double-blind, pilot clinical trial of curcumin in patients with Alzheimer disease.

To the Editors:Curcumin is a polyphenolic molecule that comprises approximately 5% of turmeric, giving the spice its color but not flavor. It is used in processed foods as a yellow coloring. 1 Because of its anti-inflammatory and antioxidant properties, curcumin has been tested in animal models of A

Prevalence of dementia in Chinese elderly in Hong Kong

This study examines the prevalence of dementia in elderly Chinese aged 70 years and older in Hong Kong using a two-phase design. In phase 1, 1,034 elderly were interviewed with the Cantonese version of the Mini-Mental State Examination. Those who scored below the cutoff points and a subsample of those with scores in the normal range were interviewed in phase 2 to identify those with dementia. The overall weighted prevalence of dementia in our subjects was 6.1 ± 0.7%, which is at the lower end of the range of rates reported in whites. Alzheimers disease (AD) accounted for 64.6% and vascular dementia, 29.3%. Our results, together with previous studies in Chinese populations, suggest that the rates of AD in Chinese are low compared with those in whites. Substantial differences are possible in the epidemiology of dementia across cultures related to interactions of genetic and environmental factors.

Comparison of intensive and low-dose atorvastatin therapy in the reduction of carotid intimal–medial thickness in patients with coronary heart disease

Background: Intensive statin therapy has been shown to improve prognosis in patients with coronary heart disease (CHD). It is unknown whether such benefit is mediated through the reduction of atherosclerotic plaque burden. Aim: To examine the efficacy of high-dose atorvastatin in the reduction of carotid intimal–medial thickness (IMT) and inflammatory markers in patients with CHD. Design: Randomised trial. Setting: Single centre. Patients: 112 patients with angiographic evidence of CHD. Interventions: A high dose (80 mg daily) or low dose (10 mg daily) of atorvastatin was given for 26 weeks. Main outcome measures: Carotid IMT, C-reactive protein (CRP) and proinflammatory cytokine levels were assessed before and after therapy. Results: The carotid IMT was reduced significantly in the high-dose group (left: mean (SD), 1.24 (0.48) vs 1.15 (0.35) mm, p = 0.02; right: 1.12 (0.41) vs 1.01 (0.26) mm, p = 0.01), but was unchanged in the low-dose group (left: 1.25 (0.55) vs 1.20 (0.51) mm, p = NS; right: 1.18 (0.54) vs 1.15 (0.41) mm, p = NS). The CRP levels were reduced only in the high-dose group (from 3.92 (6.59) to 1.35 (1.83) mg/l, p = 0.01), but not in the low-dose group (from 2.25 (1.84) to 3.36 (6.15) mg/l, p = NS). A modest correlation was observed between the changes in carotid IMT and CRP (r = 0.21, p = 0.03). Conclusions: In patients with CHD, intensive atorvastatin therapy results in regression of carotid atherosclerotic disease, which is associated with reduction in CRP levels. On the other hand, a low-dose regimen only prevents progression of the disease.

Memory and organizational strategies in chronic and acute schizophrenic patients

The memory profile of acute and chronic schizophrenic patients was examined according to the information processing model, with which encoding, retention and retrieval processes of these patients were compared. The effects of an external organizational strategy on their verbal learning and memory were also examined. Twenty chronic and 20 acute schizophrenic patients were tested with a list learning task consisting of a random (i.e., words presented randomly) and a blocked (i.e., words presented in clusters) word-list. The schizophrenic patients, as compared with age- and education-matched normal control subjects, demonstrated impaired learning, and the duration of their illness was not a significant factor in the severity of their learning impairment. However, the acute and chronic schizophrenic patients seem able to retain most of the newly acquired materials, regardless of the presentation format, after 30 min. In addition, the learning and subjective organizational strategy of the chronic patients, but not that of the acute patients, improved significantly by the blocked presentation. However, semantic organization could facilitate both the chronic and acute schizophrenic patients to retain more newly learned items.

Clinical validity of the Chinese version of Mattis Dementia Rating Scale in differentiating dementia of Alzheimer's type in Hong Kong

The present study aimed to examine the clinical validity and applicability of the Chinese version of Mattis Dementia Rating Scale (CDRS) for elderly Chinese individuals. The scale was found to have good reliability with internal consistency ranging from 0.7 to 0.9. Its significant correlation with the Chinese version of Mini-Mental State Examination (CMMSE) suggested satisfactory construct validity of the scale. The discriminant validity of the CDRS in differentiating Alzheimers disease (AD) patients and Normal Control (NC) elderly was also supported by the Receiver Operating Characteristics (ROC) analysis. Several cut-off points were presented for different clinical or research applications, and formulas to adjust for the age and educational level of the CDRS total score were provided. The Initiation/Perseveration and Memory subscales were suggested to be an abbreviated version of the CDRS for a quick screening. The present results also showed the association between the impairment of the CDRS performance and the progress of the AD.

A randomized placebo controlled trial of homocysteine lowering to reduce cognitive decline in older demented people

INTRODUCTION Whether homocysteine lowering by B vitamins can reduce cognitive decline in Alzheimer disease and vascular dementia patients is unclear. METHODS AND MATERIALS 140 subjects with mild to moderate Alzheimer disease or vascular dementia were randomly assigned to take 1 mg of methylcobalamin and 5 mg of folic acid, or placebo once daily for 24 months. The primary outcome was Mattis dementia rating scale (MDRS). Secondary outcomes were MDRS domain scores, neuropsychiatric inventory and Cornell scale for depression in dementia. Measurements were performed at baseline and every six months during the study. Fasting plasma tHCY concentrations were measured at baseline and month 18. RESULTS Trial groups were well matched in baseline characteristics. The average plasma tHCY concentration of subjects was 14.1 ± 3.8 μmol/L. 80% of subjects completed the trial. The supplement group had average plasma tHCY reduced to 9.3 ± 2.7 μmol/L. There was no significant group difference in changes in any of the neuropsychological scores, but among those with elevated plasma tHCY (>13 μmol/L), the decline in MDRS (construction domain) was significantly smaller in the supplement group (median 0 versus 2 points in placebo group, P = 0.003). CONCLUSION Homocysteine lowering in dementia patients did not significantly reduce global cognitive decline.

A breakdown of event schemas in patients with schizophrenia: an examination of their script for dining at restaurants

Event schemas, the conceptualization of past experience, in schizophrenic patients were examined based upon script theory. Forty schizophrenic patients and 40 age- and education-matched normal control subjects participated in this study. This experiment consisted of three tasks. In the recall task, subjects recalled a typical scenario of going to a formal restaurant. In the frequency judgment task, subjects determined whether the given events happen frequently, occasionally or rarely in a restaurant. In the sequencing task, the subjects put the randomly presented events in the correct order. The responses of the schizophrenic patients in the recall task, when compared with those of the normal control subjects, had significantly fewer concepts and a greater proportion of highest-frequency concepts. In addition, the sequence of their responses was less accurate than that of normal individuals. This abnormality is unlikely due primarily to a retrieval deficit (i.e. generating fewer concepts in the recall task) given that their performances on the frequency judgment and sequencing tasks, tasks that require less retrieval effort, were consistent with those of the recall task. These results suggest that event schemas in schizophrenic patients contain little detailed information and are incoherent in organization.

Subjective health-related quality of life of Chinese older persons with depression in Shanghai and Hong Kong: relationship to clinical factors, level of functioning and social support

This study aimed to measure and compare the perceptions of HRQoL amongst Chinese older people with depression between Hong Kong and Shanghai and to explore the association of HRQoL with clinical factors, level of functioning and social support in the two sites.

A randomized controlled trial of dietetic interventions to prevent cognitive decline in old age hostel residents

Background/objectives:To examine whether dietary interventions promote intakes of fruit, vegetable, fish and lower salt intake were effective in preventing cognitive decline in older people. Dietary factors have been associated with cognitive function in older people.Subjects/methods:A total of 429 non-demented subjects in 14 old age hostels, with an average age of 83 years, were randomly assigned by hostel to have either regular group dietary counselling and menu changes or advice on hostel menu only. Food and salt intakes were estimated at regular intervals by 24-h recall or food record and fasting urinary sodium, respectively. The primary outcome was cognitive decline as defined by an increase in clinical dementia rating scale score. Secondary clinical outcomes were mini mental state examination, category fluency test, body weight, blood pressures and health-related quality of life.Results:At baseline, the intervention group had more men and lower fish intake. When compared with control group, the intervention group had significantly less decline in intakes of fruit and fish. At month 33%, 22.2% and 27.2% of intervention and control group subjects had cognitive decline, respectively (Unadjusted P=0.285, χ2 test). There were no significant group changes in secondary clinical outcomes. On subgroup analysis, fewer cognitively normal subjects in intervention group had cognitive decline at month 24 (adjusted P=0.065).Conclusions:Dietary interventions in older people were effective in maintaining fruit and fish intake, but this did not lead to a significant reduction in cognitive decline.

Utility of olfactory identification test for diagnosing Chinese patients with Alzheimer's disease.

The present study examined the utility of two tests, the olfactory identification test and the olfactory threshold test, in detecting dementia of the Alzheimers type in Chinese patients in Hong Kong. The olfactory identification test developed by Murphy, Anderson, and Markinson (1994) was utilized with some modifications of odor stimuli suitable for the Chinese culture. Results showed that patients with Alzheimers disease (AD) identified significantly fewer odors and had significantly higher olfactory threshold than their age- and education-matched normal control subjects. With the cut-off point of 5 identified odors (out of 6), the olfactory identification test yielded a sensitivity of 83% in discriminating AD patients from normal controls which was consistent with that reported by Morgan, Nordin, and Murphy (1995). Thus, the present results suggested that the olfactory identification test could be applied cross-culturally for identifying patients with dementia of the Alzheimers type.