Rungnirand Praditsuwan

Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Objective: To study the effectiveness of simply-performed balancing exercises in fall prevention. Design: Pre- and post-trial. Setting: University hospital from January 2009 to May 2010. Participants: Elderly with falls in the previous year. Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet. Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods. Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P < 0.001) except for functional reach in the frequent fall group. Most subjects (72%–79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling ≥3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98). Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.

Efficacy study of galantamine in possible Alzheimer's disease with or without cerebrovascular disease and vascular dementia in Thai patients: a slow-titration regimen.

The objective is to evaluate the efficacy of galantamine when a slow titration regimen is employed in Thai Alzheimers disease (AD) patients with or without cerebrovascular disease and vascular dementia (VaD).

Galantamine for the treatment of BPSD in Thai patients with possible Alzheimer's disease with or without cerebrovascular disease.

Objectives. This study was to investigate an efficacy of galantamine in treatment of behavioral and psychological symptoms of dementia in Thai elderly who suffered from possible Alzheimers disease (AD) with or without cerebrovascular disease and vascular dementia. Methods. A 6-month, multicenter, open-label, uncontrolled trial was undertaken in 75 patients. Eligible patients received an initial galantamine dose of 8 mg/dayand escalated over 5 to 8 weeks to maintenance doses of 16 or 24 mg/day. The behavioral response was assessed as an intention-to-treat analysis using the Behavioral Pathology in Alzheimers Disease Rating Scale (BEHAVE-AD). Results. Galantamine improved behavioral and psychological symptoms of dementia (P < .05 vs baseline) over the 24 weeks of treatment. BEHAVE-AD score was significantly improved from baseline in paranoid and delusion ideation, diurnal rhythm disturbances, anxieties, and phobias. Conclusions. Galantamine may be a well-tolerated and effective treatment option for improving psychotic, behavioral, and psychological symptoms in Thai elderly with possible AD with or without cerebrovascular disease and vascular dementia.

The platelet amyloid precursor protein ratio as a diagnostic marker for Alzheimer’s disease in Thai patients

The platelet amyloid precursor protein (APP) ratio has recently been shown to be a promising diagnostic marker for Alzheimers disease (AD). To evaluate its usefulness in Thai patients, platelet APP was analyzed by immunoblotting. The APP ratio was calculated as the ratio of the combined band density of the 120-kD and 130-kD isoforms compared to that of the 110-kD isoform. The mean ages (and ranges) of 27 normal and 13 AD-affected subjects were 68.3 (60-84) and 79.3 (70-97) years, respectively. The Thai Mental State Examination (TMSE) scores demonstrated that the AD patients had significantly poorer cognitive functions than the normal subjects, with mean TMSE scores of 20.3 and 27.6 (maximum score of 30 points), respectively (p<0.05). The platelet APP ratios of the AD patients were significantly lower than those of normal subjects: values (mean ± standard deviation) were 7.32 ± 1.29 and 9.13 ± 3.00, respectively (p<0.05) for AD patients and normal subjects. However, the ranges of the APP ratios from both groups markedly overlapped, which precluded the establishment of a cutoff level to differentiate between the AD and normal subjects. In addition, no significant correlations were observed between the platelet APP ratio and the TMSE score or between the APP ratio and the serum cholesterol in this study, in contrast to previous reports.

Kinetics of the Antibody Response to Seasonal Influenza Vaccination Among the Elderly

Influenza vaccination, which has been targeted to the elderly and those at serious risk of complications, is recommended. The purpose of this study was to determine antibody responses after influenza vaccination among Thai elderly persons living in the community. A total of 591 subjects consisting of 308 vaccinees and 283 non-vaccinees were enrolled in the study. Antibodies to H1N1, H3N2, and B viruses were detected by hemagglutination inhibition (HI) testing. The numbers of subjects who had protective antibody titers ≥40 and geometric mean titers (GMTs) of antibodies against A(H1N1), A(H3N2), and B viruses prior to vaccination were similar for the vaccine and placebo groups. The seroprotection rates and GMTs for influenza virus A(H1N1), A(H3N2), and B strains after influenza vaccination at 1, 5, and 12 mo in the vaccine group were significantly higher than those in the placebo group. The seroprotection rates for the A(H1N1) and A(H3N2) strains, but not the B strain, met Committee for Proprietary Medicinal Products (CPMP) criteria (>60%). GMTs and seroprotection rates against influenza B strain in the vaccinees at all time points were <40% and <60%, respectively, and significant differences between the vaccinees and the placebo controls were observed. The GMTs and seroprotection rates for influenza strains in those with pre-existing antibody titers ≥40 were significantly higher than those in the group with pre-existing antibody titers <40. These findings demonstrated that the elderly living in the community developed adequate antibody responses with sustainable titers throughout the 12-month study period after influenza vaccine immunization. Moreover, the presence of pre-existing antibody at a titer ≥40 prior to vaccination strongly affected the antibody response to influenza vaccination.

Short‐term clinical outcomes in delirious older patients: A study at general medical wards in a university hospital in Thailand

Delirium, a common disorder in hospitalized older patients, frequently results in unfavorable consequences. Previous studies in different settings have provided conflicting results regarding clinical outcomes and mortality. We aimed to study three clinical outcomes – length of stay (LOS), in‐hospital mortality and 3‐month mortality – among delirious Thai older patients.

Impact of an early clinical exposure project conducted by senior clinical students compared between participating and nonparticipating students

An early clinical exposure project conducted by clinical students aimed to promote direct clinical experience to preclinical students. The aim of this study was to determine the effects of the project on academic achievement and study attitudes and habits between participating and nonparticipating students before ( test 1) and after the project ( test 2) in the second preclinical year and at the end of the first semester of the first clinical year ( test 3), with a subgroup analysis of the first (lowest) to third (highest) tertile of the score. Questionnaires were sent to the first clinical year students at test 3 and asked the information retrospectively at test 1 and test 2 in second year preclinical and currently at test 3, with 83.86% (265/316) being returned. Mean percentile of scores was higher at test 2 compared with test 1 in the first tertile group of participating students. Motivation to study medicine (motivation), realization of application of preclinical knowledge to clinical study (application), understanding of clinical environment (environment), and lesson review after class (review) were higher for participating than nonparticipating students at test 2 and/or test 3. Searching additional study information was higher at test 2 compared with test 1 only for participating students. This project could effectively promote application, motivation, environment, and review for participating vs. nonparticipating students at test 2 and/or test 3. Effortless, intimate, and effective communication between clinical and preclinical students and a direct experience in early clinical exposure might be key success factors.