Thammanard Charernboon

The Thai Version of the Addenbrooke's Cognitive Examination III

The objective of our study was to assess the accuracy of the Thai version of the Addenbrookes Cognitive Examination III (ACE-T). We used the ACE-T to assess 107 participants aged 60 or over, divided into the following groups: early dementia, n=30; mild cognitive impairment (MCI), n=29; and normal controls (NC), n=48. The ACE-T exhibited good internal consistency (0.93) and inter-rater reliability (1.0). The optimal cut-off score for the ACE-T to differentiate MCI from NC was 75/76, giving a sensitivity of 0.9 and specificity of 0.86. At the optimal cut-off of 61/62, the ACE-T had excellent sensitivity (1.0) and specificity (0.97) to distinguish early dementia from non-dementia. The ACE-T had high diagnosis accuracy in the detection of the MCI and early dementia in the Thai population.

Characteristic Profiles of Activities of Daily Living and Relationship with Cognitive Performance in Thai Elderly with Different Stages from Normal Cognitive Function, Mild Cognitive Impairment to Dementia

ABSTRACT Objective: The objectives were twofold—first, to evaluate the functional difference among normal cognitive elderly, mild cognitive impairment (MCI), and people with dementia; and second, to investigate the relationship between cognitive performance and functional abilities. Method: The Disability Assessment for Dementia (DAD) was administered to 90 participants: 20 normal controls (NC), 20 with MCI, 25 with mild dementia, 15 with moderate dementia and 10 with severe dementia patients. Results: The mean (SD) scores on instrumental activities of daily living (IADL) were 94.8 (6.4) for NC, 89.1 (9.9) for MCI, 33.6 (21.7) for mild dementia, 13 (12.2) for moderate dementia and 1.7 (4.2) for severe dementia. MCI participants presented slightly noticeable deficit in one IADL domain: ‘finance and correspondence’, whereas mild dementia presented deficit in all six IADL domains. Scores of basic activities of daily living (BADL) of the NC and MCI groups were equal at a perfect 100. The scores were slightly reduced in mild dementia patients (92.7 [12.3]) and were decreased in moderate (68.6 [26.4]) and severe dementia participants (10 [14.4]). Conclusions: Our studies demonstrated that IADL can be subtly impaired in people with MCI, but markedly impaired in those with mild dementia. BADL begin to decline in moderate dementia and then reach a level of severe impairment in severe dementia.

Comparison of computerized and standard cognitive test in thai memory clinic

Background: Computer-based Thai Cognitive Test or Computer-based Thai Mental State Examination (cTMSE) was developed aiming to help doctors to easily get the accurate results of TMSE in a routine, busy outpatient clinics. The purpose of this study was to compare the evaluation process in terms of feasibility, duration of the test, participants/administrator preference, and the results of cognitive test between cTMSE and the standard Thai Mental State Examination (sTMSE). Methods: Twenty-two elderly participants (>60 years old) who were not demented and 22 patients with mild-to-moderate dementia were included in the study. All participants would be asked to have TMSE by standard method (sTMSE) and computer-based method (cTMSE), at least 2 weeks and up to 2 months apart. Scores and duration of the test were compared using dependent paired t-test. Agreement of the tests between two methods and Kappa statistics were analyzed. Results: Paired t-test showed no significant difference in scores between the two methods (mean sTMSE vs. cTMSE: 22.84 vs. 22.62, 95% confidence interval [CI]: [−0.465] to 0.987, P = 0.524). Percent of agreement between the two methods was 92.5%, with the Kappa of 0.85 (P < 0.001). Duration of the test by sTMSE was slightly shorter than the cTMSE (7.31 min vs. 7.97 min, 95% CI: [−1.159] to [−0.175], P = 0.09). Overall, participants liked being tested by cTMSE more than sTMSE. Conclusion: Computer-based TMSE was feasible to use and accurate for screening in aging adults and for cognitive evaluation in patients with mild-to-moderate dementia.

Social cognition in schizophrenia

Impairments in social cognitions in schizophrenia are increasingly reported in the last decade but only a few studies have come from Asia. The objective of the study was to evaluated emotion perception, theory of mind and social knowledge in people with schizophrenia compared to healthy controls. Participants were 36 clinically stable outpatients with schizophrenia and 36 normal controls with comparable age and level of education. We administered general neurocognition test (the Addenbrooke’s Cognitive Examination), emotion perception (the Faces Test), theory of mind (the Eyes Test) and social knowledge (the Situational Features Recognition Test; SFRT). Schizophrenia patients displayed obvious impairment in all three social cognition domains i.e. the Faces Test [13.7 (2.9) vs 15.7 (1.9), P=0.001], the Eyes Test [18.9 (4.4) vs 23.5 (4.4), P<0.001] and SFRT [0.85 (0.09) vs 0.9 (0.05), P=0.002]. The performances on three social cognition tests did not correlate with positive symptoms. Only the Faces Test seemed to be related to negative symptoms. The results demonstrated that there are deficits of social cognitions in schizophrenia even in a clinically stable population.

Natural course and predictors of severe disability and death in Thai patients with dementia

More than half of patients with dementia lived in countries with low and middle incomes. However, there have been few studies on the natural course of disease in these countries. The purpose of this study was to study the natural course and the predictive factors of advanced stage and death in Thai patients with dementia. Patients with dementia who were treated in neurologic and psychiatric clinic from September 2004 to February 2016, were included. Data about natural course of diseases, behavioral and psychological symptoms in dementia (BPSD) and complications were studied. 207 patients were included. Mean age was 77years old. Mean Thai Mental State Examination (TMSE) was 17.5. Alzheimers disease was the most common cause of dementia (55%). With the mean follow-up of 39months (range from 2 to 126months), 64% of the patients had BPSD. Sixty-two patients (30%) had complications required admission. Seven patients died. Fifty-four patients (29%) ended in the advanced stage of dementia. Mean duration from diagnosis to the advanced stage was 49months. Complications that required admission usually occurred in moderate to severe dementia and were strongly associated with the advanced stage or death (OR 6.1, 95%CI 2.57-14.49, p-value<0.0001). Alzheimers disease was the most common cause of dementia in the study. Most demented patients presented in moderate severity of dementia. Mean duration from diagnosis to the advanced stage of dementia was approximate 4-5years. Complications required admissions related to the progression to advanced stage or death.

The Reading the Mind in the Eyes Test: Validity and Reliability of the Thai Version

Background and Objective: Until now there has not been a validated measure of theory of mind available in the Thai language. Our goal in this study was to assess the validity and reliability of our Thai-language translation of the Reading the Mind in the Eyes Test (the “Eyes Test”). Methods: We gave our Thai version of the Eyes Test to 70 participants: 30 people with schizophrenia and 40 normal controls. We also gave Thai versions of the Faces Test and the Addenbrooke’s Cognitive Examination to assess convergent validity. Results: For known groups validity, the controls scored significantly higher than the participants with schizophrenia on the Eyes Test: 24.6 (standard deviation=3.9) versus 18.2 (standard deviation=4.1), P<0.001. The Eyes Test correlated with the Addenbrooke’s Cognitive Examination (r=0.68, P<0.001) and the Faces Test (r=0.51, P<0.001). Internal consistency by the Cronbach alpha for the Eyes Test was 0.7, and test-retest reliability by intraclass correlation was 0.92 (P<0.001). Conclusions: The Thai version of the Eyes Test is a valid and reliable measurement that can be used in clinical practice and in future investigations of theory of mind in neurologic and psychiatric disorders.