Cindy W C Tam

The Chinese University of Hong Kong, Hong Kong, Hong Kong

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Publications (31)85.42 Total impact

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    ABSTRACT: To compare the effectiveness of Chinese-style mind-body exercise (24 forms simplified Tai Chi) versus stretching and toning exercise in the maintenance of cognitive abilities in Chinese elders at risk of cognitive decline. A 1-year single-blind cluster randomized controlled trial. Community centers and residential homes for elders in Hong Kong. A total of 389 subjects at risk of cognitive decline (Clinical Dementia Rating, CDR 0.5 or amnestic-MCI) participated in an exercise intervention program. A total of 171 subjects were trained with Tai Chi (Intervention [I]) and 218 were trained with stretching and toning exercise (Control [C]). Cognitive and functional performance were assessed at the baseline, and at 5, 9, and 12 months. Data were analyzed using multilevel mixed models. Primary outcomes included progression to clinical dementia as diagnosed by DSM-IV criteria, and change of cognitive and functional scores. Secondary outcomes included postural balance measured by the Berg Balance Scale neuropsychiatric and mood symptoms measured by the Neuropsychiatric Inventory, and Cornell Scale for Depression in Dementia. At 1 year, 92 (54%) and 169 (78%) participants of the I and C groups completed the intervention. Multilevel logistic regression with completers-only analyses controlled for baseline differences in education revealed that the I group had a trend for lower risk of developing dementia at 1 year (odds ratio 0.21, 95% CI 0.05-0.92, P = .04). The I group had better preservation of CDR sum of boxes scores than the C group in both intention-to-treat (P = .04) and completers-only analyses (P = .004). In completers-only analyses, the I group had greater improvement in delay recall (P = .05) and Cornell Scale for Depression in Dementia scores (P = .02). Regular exercise, especially mind-body exercise with integrated cognitive and motor coordination, may help with preservation of global ability in elders at risk of cognitive decline; however, logistics to promote long-term practice and optimize adherence needs to be revisited.
    Journal of the American Medical Directors Association 05/2012; 13(6):568.e15-20. · 5.30 Impact Factor
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    ABSTRACT: Alzheimer's disease (AD), the most common form of dementia, is characterized by the presence of neurofibrillary tangles composed of tau and senile plaques of amyloid-beta peptides (Aβ) derived from amyloid precursor protein (APP). Pin1 is a unique prolyl isomerase that has been shown to protect against age-dependent neurodegeneration by acting on phosphorylated tau and APP to suppress tangle formation and amyloidogenic APP processing. Here we report a functional polymorphism, rs2287839, in the Pin1 promoter that is significantly associated with a 3-year delay in the average age at onset (AAO) of late-onset AD in a Chinese population. More significantly, the Pin1 polymorphism rs2287839 is located within the consensus binding motif for the brain-selective transcription factor, AP4 (CAGCTG) and almost completely abolishes the ability of AP4 to bind and suppress the Pin1 promoter, as shown by chromatin immunoprecipitation, electrophoretic mobility shift assay, and promoter luciferase assay. Moreover, overexpression or knockdown of AP4 resulted in an 80% reduction or 2-fold increase in endogenous Pin1 levels, respectively. Thus, AP4 is a novel transcriptional repressor of Pin1 expression and the Pin1 promoter single nucleotide polymorphism (SNP) identified in this study that prevents such suppression is associated with delayed onset of AD. These results indicate that regulation of Pin1 by AP4 plays a critical role in determining age at onset of AD and might be a novel therapeutic target to delay the onset of AD.
    Neurobiology of aging 04/2012; 33(4):804-13. · 5.94 Impact Factor
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    ABSTRACT: Background: This study investigated whether brief exposure to information has any effect on stigmatizing attitudes towards older people with dementia, and how people responded to this medical diagnosis.Methods: 494 adults were randomly assigned to three groups differentiated by experimental conditions. Group A (control) responded to questions on stigma directly. Group B (symptom) read two vignettes that described the symptoms of two fictitious individuals with dementia, before answering questions on stigma. Group C (label) read the same vignettes which ended with a statement that the person was recently diagnosed with dementia by a physician. Data were analyzed with ANOVA, together with other pre-existing between-subjects factors.Results: Brief exposure to information about dementia led to a statistically significant reduction in stigma (Groups B, C < A), regardless of whether the diagnostic label of “dementia” was included or not. Moreover, lower stigma was reported by persons who knew a relative or friend with dementia, who were younger and more educated, and who thought dementia was treatable.Conclusions: As stigmatizing attitudes toward dementia are still a hindrance to early help-seeking in Asian communities, the findings suggest that community education may play a useful role in alleviating this barrier to early detection and intervention.
    International Psychogeriatrics 10/2011; 23(09):1433 - 1441. · 2.19 Impact Factor
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    ABSTRACT: Neural precursor cell expressed, developmentally down-regulated (NEDD9) gene was a new candidate risk gene for Alzheimer disease (AD). The CC genotype of a single nucleotide polymorphism rs760678 within this gene was associated with increasing risk of AD in a large study with white population. Our study aimed to replicate the initial report in Chinese population and explore its effect on cognitive performance. A total of 262 patients with AD, 293 patients with mild cognitive impairment, and 434 cognitive intact controls were recruited in the study. The result showed that G allele had a greater risk of AD (χ for trend test=5.61, df 1, P=0.018). The effects were mainly observed among Apolipoprotein E (APOE) ε4 noncarriers (χ for trend test=4.30, df 1, P=0.038). After adjustment of sex, age, education year, and APOE ε4 status by logistic regression, significant association between NEDD9 GG genotype and AD remained [OR=2.04, 95% confidence interval (CI)=1.02-4.08, P=0.044]. The scores of Cantonese version of the Mini-mental State Examination and Alzheimer's Disease Assessment Subscale-Cognitive subscale were associated with N polymorphism after adjusting for sex, age, education year, and ApoE ε4 status (Linear regression model, P<0.05). Our study identified rs760678 within NEDD9 gene in association with the risk of AD and cognitive performance in Chinese older persons. The fact that different alleles accounted for the risk in different population might suggest that there were ethnic group specific haplotypes that were primarily responsible for the predisposition.
    Alzheimer disease and associated disorders 03/2011; 26(1):88-90. · 2.88 Impact Factor
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    ABSTRACT: studies have suggested that neuropsychiatric (NP) symptoms influence the development of dementia among older adults. But, the results are inconsistent and there is limited information about NP symptoms in population-based samples. to explore the association between NP symptoms and risk of cognitive decline in Chinese older persons residing in the community. prospective study. community sample. a total of 321 community-dwelling Chinese older persons aged 60 or over with mild cognitive impairment participated in the study. at baseline, each subject was assessed with Clinical Dementia Rating (CDR), Mini-Mental State Examination, list learning and delayed recall, and Category Verbal Fluency Test. Severity of NP symptoms was evaluated with Neuropsychiatric Inventory (NPI). Global cognitive status at the end of 2-year study period was determined by CDR. at baseline, 40.5% of participants exhibited one or more NP symptoms (NPI total score ≥ 1). Night-time behaviours (22.1%), depression (16.8%), apathy (14.0%) and anxiety (12.8%) were the most common NP symptoms. At the end of 2-year follow-up, 27.5% of participants with depression at baseline developed dementia, compared with 14.8% of those without depression (χ² = 4.90, P= 0.03). Aberrant motor behaviour was also significantly associated with deterioration in cognition (χ² = 5.84, P= 0.02), although it was an infrequent occurrence. On logistic regression analysis, only depression at baseline was shown to be a risk factor for progression to dementia (OR= 2.40, 95% CI 1.05-5.46, P= 0.04). depression in non-demented older persons may represent an independent dimension reflecting early neuronal degeneration. Further studies should be conducted to assess whether effective management of NP symptoms exerts beneficial effects on cognitive function.
    Age and Ageing 01/2011; 40(1):30-5. · 3.82 Impact Factor
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    ABSTRACT: This study examines the association between late-life leisure activity participation and global cognitive decline in community-dwelling elderly Chinese in Hong Kong. Five hundred and five participants, not clinically demented at the baseline, were analysed in the follow-up study of a population-based community survey among Hong Kong Chinese aged 60 and over. Information regarding leisure activity participation, global cognitive function and important sociodemographic variables was collected. Late life leisure activity profiles were classified into intellectual, social, physical and recreational categories, and were measured by total hours per week, total frequency and total number of subtypes. Multivariate logistic regression analyses were used to evaluate the association between leisure activity participation at the baseline and the incidence of global cognitive decline at the 22-month follow-up. The incidence of global cognitive decline was defined as a one-point drop in z-score of the Cantonese version of the mini-mental state examination (CMMSE). At the follow-up, a higher level of participation in intellectual activities was significantly associated with a lower incidence of global cognitive decline as measured by both the total hours per week (multivariate-adjusted OR 0.97 (95% CI 0.94-0.99, p=0.003)), and the total number of subtypes (multivariate-adjusted OR 0.74 (95% CI 0.58-0.95, p=0.018)). A higher level of late-life intellectual activity participation was associated with less global cognitive decline among community-dwelling elderly Chinese in Hong Kong.
    International Journal of Geriatric Psychiatry 01/2011; 26(1):39-47. · 2.98 Impact Factor
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    ABSTRACT: Mild Cognitive Impairment (MCI) is a recognized risk condition for clinical dementia. This paper attempted to explore the applicability of a combined cognitive and clinical approach to identify older Chinese adults at-risk of cognitive decline. Seven hundred forty randomly recruited community dwelling participants (aged 60 or over) were assessed at baseline and 2 years with Clinical Dementia Rating (CDR) and a cognitive battery. Baseline MCI groups were categorized by CDR-MCI, cognitive function (Cog-MCI), and a combined CDR-Cog approach. The cognitive approach adopted the Mayo clinic criteria. For the combined approach, nonamnestic MCI combined CDR 0.5 plus nonmemory cognitive deficits. The overall concordance between CDR and Cognitive test ratings were 65.3% (χ2 =256.4, P<0.001, κ=0.44). With a combined approach, 424(57%) participants were classified as normal. CDR-MCI group had higher cognitive scores compared with MCI groups by other criteria (1 way analysis of variance or ANOVA). At 2 years, the combined CDR-Cog MCI group identified all dementia (N=24) converters although group differences were not significant. Cognitive function and CDR identified participants potentially at-risk for furthermore decline, but exhibited some differences in detection profiles. A combined approach may be more practical in screening for MCI participants with diverse educational and cultural background.
    Alzheimer Disease and Associated Disorders 12/2009; 24(4):343–347. · 2.73 Impact Factor
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    ABSTRACT: Growing evidence suggests that participation in late-life leisure activity may have beneficial effects on cognitive function. The objective of the study was to evaluate the association between leisure activity participation and cognitive function in an elderly population of community-dwelling Hong Kong Chinese. 512 participants were assessed in the follow-up study of a population-based community survey of the prevalence of cognitive impairment among Hong Kong Chinese aged 60 years and over. Leisure activities were classified into four categories (physical, intellectual, social and recreational). Information regarding leisure activity participation, cognitive function and other variables was collected. Multivariate linear regression analyses were performed to examine the association between leisure activity participation and cognitive function. A higher level of late-life leisure activity participation, particularly in intellectual activities, was significantly associated with better cognitive function in the elderly, as reflected by the results of the Cantonese Mini-mental State Examination (p = 0.007, 0.029 and 0.005), the Category Verbal Fluency Test (p = 0.027, 0.003 and 0.005) and digit backward span (p = 0.031, 0.002 and 0.009), as measured by the total frequency, total hours per week and total number of subtypes, respectively; the Chinese Alzheimer's Disease Assessment Scale-Cognitive Subscale (p = 0.045) and word list learning (p = 0.003), as measured by the total number of subtypes; and digit forward span (p = 0.007 and 0.015), as measured by the total hours per week and total number of subtypes, respectively. Late-life intellectual activity participation was associated with better cognitive function among community-dwelling Hong Kong elderly Chinese.
    International Psychogeriatrics 09/2009; 22(1):2-13. · 2.19 Impact Factor
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    ABSTRACT: Alzheimer's disease (AD) is a neurodegenerative disease with a higher prevalence in women. Expression of estrogen receptor 1 (ESR1) gene has been identified throughout the brain. Owing to the putative neuroprotective effects of estrogen, estrogen receptor gene is a potential candidate modulating the development of AD. Preliminary associations between two polymorphisms of ESR1 (PvuII and XbaI) gene and AD have been reported. In this study, 16 single nucleotide polymorphisms (SNPs) of the ESR1 gene (including four commonly studied ESR1 SNPs and 12 other tagging SNPs selected from the HapMap database) were investigated to further evaluate the association between ESR1 polymorphisms and the risk of AD in the Chinese population. A total of 233 Chinese AD patients and 245 age-matched elderly control subjects were recruited. Genetic associations were analyzed by chi-square test and interaction effect was analysed by logistic regression analysis. Five SNPs (clustered between intron 3 and intron 7) were associated with the risk of AD (p-value ranges from 0.001 to 0.035); another two SNPs (located on exon 2 and intron 2) were shown to modulate the age-at-onset (AAO) in AD (p-value = 0.036 and 0.011). ESR1 gene polymorphisms may be associated with the AAO in AD. The present results provided information for possible associations between certain polymorphisms of ESR1 gene and the risk of AD.
    International Psychogeriatrics 08/2009; 21(5):977-86. · 2.19 Impact Factor
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    ABSTRACT: This study aims at assessing mental competence in Chinese patients with mild and very mild dementia with a semistructured assessment method and the impact of repeated presentations of information on patients' mental competence. Subjects with mild and very mild dementia were compared with cognitively intact subjects. Chinese subjects were recruited from local social centers and residential hostels for the elderly in Hong Kong. Sixty-six Chinese community-dwelling older adults (aged from 65 to 87 years) were recruited. Clinical diagnosis was made by experienced geriatric psychiatrists. Subjects were assessed with the Mini-Mental State Examination and the Clinical Dementia Rating (CDR). Mental capacity to consent to treatment was assessed by using the Chinese version of the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and independent clinician ratings based on the definition in the Mental Capacity Act 2005 of the United Kingdom. Thirty-three (50%) participants were diagnosed with very mild or mild dementia (CDR = 0.5 or 1). In this group, 15 (45.5%) subjects were rated as mentally incompetent in clinician ratings. In the assessment of interrater reliability, the intraclass correlation coefficient of MacCAT-T summary scores among three raters ranged from 0.64 to 0.83. The MacCAT-T summary scores correlated significantly with clinician ratings, years of education, Mini-Mental State Examination score, and CDR. In contrast to the nonimpaired group, repeated presentation of information did not significantly improve capacity in the demented group. Results from this study suggest that even patients with very mild dementia in this population can show substantial deficits in decision-making capacity, and that improved capacity is not likely to result from repeated disclosure of information.
    The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 06/2009; 17(5):428-36. · 3.35 Impact Factor
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    ABSTRACT: We previously found that the polymorphisms of cholesterol 24-hydroxylase (CYP46A1) gene were associated with the risk of Alzheimer's disease (AD) in Chinese. However, its effect in predicting progression of cognitive decline remains unknown. Two hundred and eighty-one Chinese subjects (121 cognitively intact, 101 with mild cognitive impairment and 59 with mildly dementia) were followed-up with a mean (SD) duration of 25.22(5.74) months. Association between the CYP46A1 gene polymorphisms and 2-year cognitive deterioration were evaluated. At follow-up, 225(80.0%) subjects were reassessed. Sixty-three subjects were diagnosed as AD, 68 were MCI and 94 were cognitively intact. Among them, 158 had improved or remained stable while 67 deteriorated. The 'deteriorated' group was older than 'improved or stable' group (t-test, t = -2.87, p < 0.001). IVS2-150 polymorphism was associated with a higher risk of cognitive deterioration. Subjects with T allele were more likely to deteriorate compared with those without T allele (Pearson chi(2) = 8.98, df 2, p = 0.011). IVS3-128 CC genotype was higher in 'improved or stable' group (Likelihood Ratio = 6.55, df 2, p = 0.038), suggesting a protective role for this allele. The two other polymorphisms, IVS1-192 and IVS4-122, did not show any significant association with cognitive function. CYP46A1 gene may act to modulate the course of cognitive deterioration in late life.
    International Journal of Geriatric Psychiatry 02/2009; 24(9):921-6. · 2.98 Impact Factor
  • Alzheimers & Dementia - ALZHEIMERS DEMENT. 01/2009; 5(4).
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    ABSTRACT: HLA-A is a locus of the major histocompatibility complex situated on chromosome 6p21.3. Several genome-wide linkage analyses suggested that a putative locus predisposition for Alzheimer's disease (AD) is found on chromosome 6p21. In this study, we investigated the association between HLA-A alleles and AD in a Chinese community. Fine genotyping of 160 Chinese AD and 167 age-matched nondemented subjects was performed for the first time by sequence-based typing of the HLA-A locus. We found that HLA-A2 carriers (including prevalent alleles, 0201, 0203 and 0207) were more prevalent in the AD group; the frequency of HLA-A2 was increased in AD patients versus controls, but the difference was not significant after Bonferroni correction for the number of alleles tested (p = 0.075). A gene-gene interaction was observed between ApoE and HLA-A, the presence of HLA-A24 (particularly the prevalent allele 2402) might act as another independent risk factor of developing AD for subjects not carrying the ApoE epsilon4 allele (relative risk = 2.98, 95% CI = 1.14-8.24). Carriers of HLA-A2 had an earlier onset of AD by 2.4 years (p = 0.030) and HLA-A2 interacted with ApoE epsilon4 in modulating the age at onset in AD. This study suggested that HLA-A may be involved in the pathogenesis of AD.
    Dementia and Geriatric Cognitive Disorders 11/2008; 26(5):391-7. · 2.79 Impact Factor
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    ABSTRACT: This study examined the clinical correlates of parkinsonian signs including neuropsychiatric symptoms, cognitive impairment and medical illness burden in the community-dwelling non-demented Chinese elderly. A random sample of 765 Chinese elderly subjects from a thematic household survey was recruited. There were 389 normal elderly controls (Clinical Dementia Rating [CDR] 0) (NC) and 376 subjects with questionable dementia (CDR 0.5). The subjects with questionable dementia (CDR 0.5) were categorized into two groups: a MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Parkinsonian signs were measured by Unified Parkinson Disease Rating Scale- motor scale (UPDRS). The clinical correlates were investigated in each group. UPDRS motor score was associated with age, cumulative medical illness burden and cerebrovascular accidents in the normal control and MCI groups. It correlated negatively with MMSE scores in the NC group. It was associated with presence of soft signs in the NC and MCI groups; and apathy in the VMD group. Neuropsychiatric symptoms, cognitive impairment and vascular risk factors had different patterns of associations with parkinsonian signs in the older persons with different degree of cognitive impairment.
    International Journal of Geriatric Psychiatry 08/2008; 23(7):719-25. · 2.98 Impact Factor
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    ABSTRACT: Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis. A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-2006. In the first phase, 6,100 randomly selected community dwelling elders were assessed with Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC). Two thousand and seventy-three subjects were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject. 1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms (>or= 8 on CSDD). Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms. In our sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.
    International Journal of Geriatric Psychiatry 07/2008; 23(6):611-7. · 2.98 Impact Factor
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    ABSTRACT: Cyclooxygenase-2 (COX-2, encoded by the gene prostaglandin-endoperoxide synthase 2, PTGS2) is a key enzyme in the conversion of arachidonic acid to prostaglandins. The prostaglandins produced by COX-2 are involved in inflammation and pain response in different tissues in the body. Enhanced COX-2 expression had been found in regions of brains from patients with Alzheimer's disease (AD). Here, we proceeded to test the hypothesis that polymorphisms of the PTGS2 gene predispose to AD. IVS5-275 T>G and Ex10+837 T>C in addition to three tagging SNPs from HapMap database, which provided a comprehensive coverage of genetic variations in the PTGS2 gene in Chinese were genotyped among 257 AD patients and 244 age-matched healthy Chinese subjects. Genetic associations were analyzed by chi(2)-test and haplotypes analysis. Although the previously reported protective polymorphism (rs20417, -765 G/C) for AD in PTGS2 gene was not polymorphic in the Chinese population, SNPs in both the promoter (-2319 G>T) and 3' region (Ex10+837 T>C) of PTGS2 were associated with the risk of AD (p=0.01 and 0.03, respectively). Carriers of Ex10+837 T allele had a 1.5-fold increase in the risk of AD. This study suggested that PTGS2 gene was a predisposition gene and arachidonic acid metabolism might be involved in the pathogenesis of AD. It provided further evidence to support a role of inflammation in the development and progression of AD.
    Neurobiology of aging 07/2008; 29(6):856-60. · 5.94 Impact Factor
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    ABSTRACT: We reported the association between modality of Physical Exercise and cognitive function in 782 older Chinese adults assessed in the second phase of a population survey for dementia in Hong Kong. Profiles of physical exercise was measured by a questionnaire (no exercise, stretching, aerobic and mind-body exercise). Cognitive Assessments included the CMMSE, ADAS-Cog, and Category Verbal Fluency Test (CVFT). The aerobic and mind body exercise groups with longer exercise habits (>5 years) had higher scores in most cognitive tests (Kruskal Wallis tests, p < 0.01). Beneficial effects were more significant in the young old group from 65- 75 years. Possible age related specific effects of aerobic and mind body exercise on cognitive reserve are worthy of further exploration.
    International Journal of Geriatric Psychiatry 07/2008; 24(1):48-53. · 2.98 Impact Factor
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    ABSTRACT: Increasing evidence suggests that functional impairment can be detected in older persons with mild cognitive impairment (MCI). This study explores the functional profiles and the clinical correlates of a population-based sample of Chinese older persons with MCI in Hong Kong. A random sample of 765 Chinese elderly subjects without dementia was recruited, of which 389 were elderly normal controls (Clinical Dementia Rating = 0), and 376 had questionable dementia (CDR = 0.5). The latter were categorized into an MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Their functional performances were measured and compared with the normal controls (NC). Multiple regression analyses investigated the associations between functional scores (Disability Assessment in Dementia) and clinical correlates (cognitive test scores, neuropsychiatric symptoms and motor signs) in the NC subjects and cognitively impaired subjects. Subjects with MCI had intermediate functional performance between the NC and those with VMD. Regression analyses revealed that lower scores of cognitive tests (delayed recall and categorical verbal fluency tests), apathy, aberrant motor symptoms and parkinsonism features were associated with lower functional scores in clinically non-demented subjects. Functional scores had no correlation with age, education and medical illness burden. Neuropsychiatric symptoms and parkinsonism features were associated with functional impairment in the clinically non-demented elderly in the community. Assessment of these should be incorporated in the evaluation of older persons for early cognitive impairment.
    International Psychogeriatrics 06/2008; 20(5):1059-70. · 2.19 Impact Factor
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    ABSTRACT: In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong. The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1. The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4-9.6) and 8.9% (95%CI: 7.8-10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia. A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity.
    International Psychogeriatrics 03/2008; 20(1):135-48. · 2.19 Impact Factor
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    ABSTRACT: To develop a short cognitive test for screening mild cognitive impairment (MCI) in Hong Kong Chinese older adults. The Chinese Abbreviated MCI (CAMCI) test was developed with a multistage process. In phase 1, a short version of the cognitive test comprising a 1-min animal fluency test and a 10-min delayed word list recall was developed and tested in 578 volunteers (community-dwelling active elderly persons). In phase 2, the CAMCI test was validated in an independent and randomly recruited sample of 459 participants in a community survey. Additionally, the predictive significance of the CAMCI test was evaluated in a group of 196 subjects assessed in phase 1 for conversion to clinical dementia at 20 months' follow-up. The discriminating power of the CAMCI test in differentiating MCI from normal control (NC) and mildly demented subjects was compared with Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscales. The CAMCI test was found to have high discriminating power in differentiating NC from MCI and mildly demented subjects in the phase 1 volunteer sample. The receiver operating characteristics (ROC) revealed an area under the curve (AUC) of 0.91. The ROC were further validated in the phase 2 sample. The AUC of the CAMCI test was compared with MMSE and ADAS-Cog subscales. The short MCI test was comparable to the ADAS-Cog subscale in discriminating NC from MCI and demented subjects (chi(2) test, p = n.s.). Logistic regression analysis was carried out to determine significant baseline predictors for conversion to dementia at phase 3 follow-up. Both ADAS-Cog total [Exp(B) = 1.115, p = 0.028] and CAMCI [Exp(B) = 0.88, p = 0.045] scores were significant predictors for dementia status at follow-up. The CAMCI test is able to discriminate NC from MCI and mild dementia in Hong Kong Chinese older adults. Its potential for large-scale community screening for early detection of cognitive impairment in late life should be emphasized and explored.
    Neuroepidemiology 02/2008; 30(1):6-12. · 2.37 Impact Factor