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Lam LCW, Chan WC, Kwok TCY, Lee JSW, Yu BML, Lee S, Lee ATC, Ma SL, Cheng ST. Combined physical exercise-working memory training on slowing down cognitive decline in elders with mild clinical Alzheimer disease: a randomised controlled study (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 3:28-30. [PMID: 35701227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - T C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - J S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - B M L Yu
- Social Welfare Department, Hong Kong SAR Government
| | - S Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - A T C Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S T Cheng
- Department of Health and Physical Education, The Education University of Hong Kong
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Wong MMC, Pang PF, Chan CF, Lau MS, Tse WY, Lam LCW, Lee SKL, Tsoh J, Yan CTY. Wilson Sims Fall Risk Assessment Tool Versus Morse Fall Scale in Psychogeriatric Inpatients: a Multicentre Study. East Asian Arch Psychiatry 2021; 31:67-70. [PMID: 34588316 DOI: 10.12809/eaap2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare predictive validity of the Wilson Sims Fall Risk Assessment Tool (WSFRAT) with that of the Morse Fall Scale (MFS) in psychogeriatric inpatients. METHODS Psychogeriatric patients from Shatin Hospital, Tai Po Hospital, Castle Peak Hospital, and United Christian Hospital who had fall incident between April 2019 and April 2020 were identified. Their fall risks were assessed by the WSFRAT and the MFS, and their falls incidents during hospitalisation were recorded. Patients were classified as having high fall risk when their MFS score was ≥45 and when their WSFRAT score was ≥7. Sensitivity, specificity, and positive and negative predictive values of the two scales were calculated. RESULTS We identified 183 (90 male and 93 female) psychogeriatric patients aged ≥65 years who had fall incident and were assessed by both the WSFRAT and the MFS during the study period. Among the 183 patients, four sustained a fall during hospital stay, giving a prevalence of 2.19%. All four patients were classified as having high risk of fall by WSFRAT, but only two of them were classified so by MFS. The sensitivity of WSFRAT was 100%, which was higher than the 50% by MFS, but specificity of MFS was higher than that of WSFRAT (45.81% vs 54.75%). CONCLUSION WSFRAT is a better fall risk assessment scale for psychiatric inpatients than MFS, because of higher sensitivity (100% vs 50%). It has items specific to psychiatric patients and should replace MFS in psychiatric settings.
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Affiliation(s)
- M M C Wong
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - P F Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | | | - M S Lau
- Castle Peak Hospital, Hong Kong
| | - W Y Tse
- Castle Peak Hospital, Hong Kong
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | | | - J Tsoh
- Department of Psychiatry, Prince of Wales Hospital and Shatin Hospital, Hong Kong
| | - C T Y Yan
- Department of Psychiatry, Shatin Hospital, Hong Kong
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Chan WC, Lam LCW, Lautenschlager N, Dow B, Ma SL. Home-based exercise intervention for caregivers of persons with dementia: a randomised controlled trial: abridged secondary publication. Hong Kong Med J 2020; 26 Suppl 7:13-16. [PMID: 33229611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - N Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- NorthWestern Aged Mental Health, Royal Park Campus, Parkville, Australia
- School of Clinical Neurosciences and the Western Australia Centre and Health and Ageing, University of Western Australia, Perth, Australia
| | - B Dow
- National Ageing Research Institute, The University of Melbourne, Melbourne, Australia
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong
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Wong A, Mak MKY, Lam LCW, Mok VCT. Aerobic dance for cognitive and physical functions and mood in older adults with cerebral small vessel disease: abridged secondary publication. Hong Kong Med J 2020; 26 Suppl 6:38-41. [PMID: 33229603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- A Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - M K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - V C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
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Wong PCM, Ou J, Pang CWY, Zhang L, Tse CS, Lam LCW, Antoniou M. Foreign language learning as potential treatment for mild cognitive impairment. Hong Kong Med J 2019; 25 Suppl 7:41-43. [PMID: 31761771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- P C M Wong
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, China
- Brain and Mind Institute, The Chinese University of Hong Kong, China
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, China
| | - J Ou
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, China
- Brain and Mind Institute, The Chinese University of Hong Kong, China
| | - C W Y Pang
- Department of Linguistics and Modern Languages, The Chinese University of Hong Kong, China
- Brain and Mind Institute, The Chinese University of Hong Kong, China
| | - L Zhang
- Department of Chinese Language Studies, The Education University of Hong Kong, China
| | - C S Tse
- Department of Educational Psychology, The Chinese University of Hong Kong, China
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, China
| | - M Antoniou
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Australia
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Cheng CPW, Cheng ST, Tam CWC, Chan WC, Chu WCW, Lam LCW. Relationship between Cortical Thickness and Neuropsychological Performance in Normal Older Adults and Those with Mild Cognitive Impairment. Aging Dis 2018; 9:1020-1030. [PMID: 30574415 PMCID: PMC6284757 DOI: 10.14336/ad.2018.0125] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/25/2018] [Indexed: 01/24/2023] Open
Abstract
Mild cognitive impairment (MCI) has been extensively investigated in recent decades to identify groups with a high risk of dementia and to establish effective prevention methods during this period. Neuropsychological performance and cortical thickness are two important biomarkers used to predict progression from MCI to dementia. This study compares the cortical thickness and neuropsychological performance in people with MCI and cognitively healthy older adults. We further focus on the relationship between cortical thickness and neuropsychological performance in these two groups. Forty-nine participants with MCI and 40 cognitively healthy older adults were recruited. Cortical thickness was analysed with semiautomatic software, Freesurfer. The analysis reveals that the cortical thickness in the left caudal anterior cingulate (p=0.041), lateral occipital (p=0.009) and right superior temporal (p=0.047) areas were significantly thinner in the MCI group after adjustment for age and education. Almost all neuropsychological test results (with the exception of forward digit span) were significantly correlated to cortical thickness in the MCI group after adjustment for age, gender and education. In contrast, only the score on the Category Verbal Fluency Test and the forward digit span were found to have significant inverse correlations to cortical thickness in the control group of cognitively healthy older adults. The study results suggest that cortical thinning in the temporal region reflects the global change in cognition in subjects with MCI and may be useful to predict progression of MCI to Alzheimer’s disease. The different pattern in the correlation of cortical thickness to the neuropsychological performance of patients with MCI from the healthy control subjects may be explained by the hypothesis of MCI as a disconnection syndrome.
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Affiliation(s)
- Calvin Pak-Wing Cheng
- 1Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Sheung-Tak Cheng
- 2Department of Health and Physical Education, The Education University of Hong Kong and Norwich Medical School, University of East Anglia, UK
| | | | - Wai-Chi Chan
- 4Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Winnie Chiu-Wing Chu
- 5Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - Linda Chiu-Wa Lam
- 6Department of Psychiatry, Tai Po Hospital, The Chinese University of Hong Kong, Hong Kong
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Cheng CPW, Chiu-Wa Lam L, Cheng ST. The Effects of Integrated Attention Training for Older Chinese Adults With Subjective Cognitive Complaints: A Randomized Controlled Study. J Appl Gerontol 2016; 37:1195-1214. [PMID: 28380705 DOI: 10.1177/0733464816684622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Early intervention to reduce cognitive decline and preserve functioning is a compelling public health issue. Because impaired attention occurs early in the process of cognitive impairment, focusing training strategies upon attention may be a potential intervention to prevent further cognitive decline. We sought to test the effects on cognitive performance and daily functioning of a new cognitive training program that focuses on attention. METHOD This single-blind randomized controlled trial lasted 6 months and included two phases. Assessments were conducted at baseline, at 3 months, and at 6 months. The study was performed in four community older adult centers. Ninety-three participants with subjective cognitive impairment without dementia were included. Forty-seven participants were randomized to the Integrated Attention Training Program (IATP), and 46 were randomized to the control group. The two arms of the study included the IATP (intervention group) and a health-related education program (active control group). RESULTS No significant interactions were identified between group and time for the Clinical Dementia Rating-Sum of Boxes and other secondary outcomes, except for the Digit Forward Score ( p < .05; effect size, 0.057). When the preintervention and postintervention results were compared, the IATP group showed significant improvement in grand mean effect ( p < .05) and accuracy ( p < .05) in the Attention Network Test, Digit Backward Score ( p < .05), Category Verbal Fluency Test ( p < .05), and Trail Making Test A ( p < .01) immediately after the intervention. These improvements were sustained 3 months after the intervention. CONCLUSION The IATP showed domain-specific effects but had no effects on global cognition or functioning. It could not show a superior benefit in cognition and functioning when compared with non-specific mental stimulation in a group format. Further studies are needed to determine the role of attention in cognitive training.
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Affiliation(s)
| | | | - Sheung-Tak Cheng
- 3 The Education University of Hong Kong, China.,4 University of East Anglia, Norwich, UK
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Zhou L, Ma SL, Yeung PKK, Wong YH, Tsim KWK, So KF, Lam LCW, Chung SK. Anxiety and depression with neurogenesis defects in exchange protein directly activated by cAMP 2-deficient mice are ameliorated by a selective serotonin reuptake inhibitor, Prozac. Transl Psychiatry 2016; 6:e881. [PMID: 27598965 PMCID: PMC5048194 DOI: 10.1038/tp.2016.129] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 01/29/2023] Open
Abstract
Intracellular cAMP and serotonin are important modulators of anxiety and depression. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI) also known as Prozac, is widely used against depression, potentially by activating cAMP response element-binding protein (CREB) and increasing brain-derived neurotrophic factor (BDNF) through protein kinase A (PKA). However, the role of Epac1 and Epac2 (Rap guanine nucleotide exchange factors, RAPGEF3 and RAPGEF4, respectively) as potential downstream targets of SSRI/cAMP in mood regulations is not yet clear. Here, we investigated the phenotypes of Epac1 (Epac1(-/-)) or Epac2 (Epac2(-/-)) knockout mice by comparing them with their wild-type counterparts. Surprisingly, Epac2(-/-) mice exhibited a wide range of mood disorders, including anxiety and depression with learning and memory deficits in contextual and cued fear-conditioning tests without affecting Epac1 expression or PKA activity. Interestingly, rs17746510, one of the three single-nucleotide polymorphisms (SNPs) in RAPGEF4 associated with cognitive decline in Chinese Alzheimer's disease (AD) patients, was significantly correlated with apathy and mood disturbance, whereas no significant association was observed between RAPGEF3 SNPs and the risk of AD or neuropsychiatric inventory scores. To further determine the detailed role of Epac2 in SSRI/serotonin/cAMP-involved mood disorders, we treated Epac2(-/-) mice with a SSRI, Prozac. The alteration in open field behavior and impaired hippocampal cell proliferation in Epac2(-/-) mice were alleviated by Prozac. Taken together, Epac2 gene polymorphism is a putative risk factor for mood disorders in AD patients in part by affecting the hippocampal neurogenesis.
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Affiliation(s)
- L Zhou
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - P K K Yeung
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Y H Wong
- Division of Life Science and the Biotechnology Research Institute, Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong SAR, China,State Key Laboratory of Molecular Neuroscience, Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong SAR, China
| | - K W K Tsim
- State Key Laboratory of Molecular Neuroscience, Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong SAR, China,Division of Life Science and Center for Chinese Medicine, Hong Kong University of Science and Technology, Clear Water Bay, Clear Water Bay, Hong Kong SAR, China
| | - K F So
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,Research Center of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,Department of Ophthalmology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - S K Chung
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,Research Center of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,School of Biomedical Sciences, The University of Hong Kong, 1/F, Laboratory Block, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China. E-mail:
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Tse CS, Lam LCW, Balota DA, Leung GTY, Hau KT, Chang JF. Validation of selective attention and memory measures as early markers for Alzheimer's disease. Hong Kong Med J 2016; 22 Suppl 2:S37-S39. [PMID: 26908342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- C S Tse
- Department of Educational Psychology, The Chinese University of Hong Kong
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - D A Balota
- Department of Psychology and Neurology, Washington University in St. Louis, USA
| | - G T Y Leung
- Department of Psychiatry, The Chinese University of Hong Kong
| | - K T Hau
- Department of Educational Psychology, The Chinese University of Hong Kong
| | - J F Chang
- Department of Educational Psychology, The Chinese University of Hong Kong
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Cheng CPW, Chan SSM, Mak ADP, Chan WC, Cheng ST, Shi L, Wang D, Lam LCW. Would transcranial direct current stimulation (tDCS) enhance the effects of working memory training in older adults with mild neurocognitive disorder due to Alzheimer's disease: study protocol for a randomized controlled trial. Trials 2015; 16:479. [PMID: 26499250 PMCID: PMC4619532 DOI: 10.1186/s13063-015-0999-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/06/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There has been longstanding interesting in cognitive training for older adults with cognitive impairment. In this study, we will investigate the effects of working memory training, and explore augmentation strategies that could possibly consolidate the effects in older adults with mild neurocognitive disorder. Transcranial direct current stimulation (tDCS) has been demonstrated to affect the neuronal excitability and reported to enhance memory performance. As tDCS may also modulate cognitive function through changes in neuroplastic response, it would be adopted as an augmentation strategy for working memory training in the present study. METHODS/DESIGN This is a 4-week intervention double-blind randomized controlled trial (RCT) of tDCS. Chinese older adults (aged 60 to 90 years) with mild neurocognitive disorder due to Alzheimer's disease (DSM-5 criteria) would be randomized into a 4-week intervention of either tDCS-working memory (DCS-WM), tDCS-control cognitive training (DCS-CC), and sham tDCS-working memory (WM-CD) groups. The primary outcome would be working memory test - the n-back task performance and the Chinese version of the Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog). Secondary outcomes would be test performance of specific cognitive domains and mood. Intention-to-treat analysis would be carried out. Changes of efficacy indicators with time and intervention would be tested with mixed effect models. DISCUSSION This study adopts the theory of neuroplasticity to evaluate the potential cognitive benefits of non-invasive electrical brain stimulation, working memory training and dual stimulation in older adults at risk of cognitive decline. It would also examine the tolerability, program adherence and adverse effects of this novel intervention. Information would be helpful for further research of dementia prevention studies. TRIAL REGISTRATION ChiCTR-TRC- 14005036 Date of registration: 31 July 2014.
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Affiliation(s)
- Calvin P W Cheng
- Department of Psychiatry, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong.
| | - Sandra S M Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Rm G25, G/F, Multi-center, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong.
| | - Arthur D P Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Rm G25, G/F, Multi-center, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong.
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, 3/F, HKJC for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong.
| | - Sheung Tak Cheng
- Department of Health and Physical Education, Hong Kong Institute of Education, Rm D4-2/F-03, Block D4, 10 Lo Ping Road, Tai Po, NT, Hong Kong.
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F, Lui Che Woo Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong.
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
| | - Linda Chiu-Wa Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Rm G25, G/F, Multi-center, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong.
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Chan WC, Chow PPL, Lam LCW, Hung SF, Cheung EFC, Dunn ELW, Ng RMK, Fu JCK. Pathway of psychiatric care in Hong Kong. Hong Kong Med J 2015; 21 Suppl 2:41-44. [PMID: 25852102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - P P L Chow
- Department of Old Age Psychiatry, Castle Peak Hospital
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital
| | - E F C Cheung
- Department of General Adult Psychiatry, Castle Peak Hospital
| | - E L W Dunn
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital
| | - R M K Ng
- Department of Psychiatry, Kowloon Hospital
| | - J C K Fu
- Department of General Adult Psychiatry, Castle Peak Hospital
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Lam LCW, Chan WM, Kwok TCY, Chiu HFK. Effectiveness of Tai Chi in maintenance of cognitive and functional abilities in mild cognitive impairment: a randomised controlled trial. Hong Kong Med J 2014; 20:20-23. [PMID: 25001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - W M Chan
- Elderly Health Services, Department of Health, Hong Kong
| | - T C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong
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13
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Lam LCW, Chan WC, Wong CSM, Chen EYH, Ng RMK, Lee EHM, Chang WC, Hung SF, Cheung EFC, Sham PC, Chiu HFK, Lam M, Chiang TP, van Os J, Lau JTF, Lewis G, Bebbington P. The Hong Kong mental morbidity survey: background and study design. East Asian Arch Psychiatry 2014; 24:30-36. [PMID: 24676485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mental disorders are highly prevalent conditions with immense disease burden. To inform health and social services policy formulation, local psychiatric epidemiological data are required. The Hong Kong Mental Morbidity Survey is a 3-year population-based study in which 5700 community-dwelling Chinese adults aged between 16 and 75 years were interviewed with the aim of evaluating the prevalence, co-morbidity, functional impairment, physical morbidity, and social determinants of significant mental disorders in the population. This paper describes the background and design of the survey, and is the first territory-wide psychiatric epidemiological study in Hong Kong.
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Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C S M Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - R M K Ng
- Kowloon Hospital, Hong Kong SAR, China
| | - E H M Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - S F Hung
- Kwai Chung Hospital, Hong Kong SAR, China
| | | | - P C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Castle Peak Hospital, Hong Kong SAR, China
| | - T P Chiang
- Castle Peak Hospital, Hong Kong SAR, China
| | - J van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J T F Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G Lewis
- Academic Unit of Psychiatry, University of Bristol, Bristol, England
| | - P Bebbington
- Department of Mental Health Sciences, University College London, London, England
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Lam LCW, Lui VWC, Chiu HFK, Leung KF, Appelbaum PS, Karlawish J. Assessing mental capacity for everyday decision-making in the Chinese older population. Hong Kong Med J 2013; 19 Suppl 9:17-20. [PMID: 24473584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
1. The abilities to make everyday decisions may be reliably measured in the local elderly population. 2. The Chinese version of the Assessment of Capacity for Everyday Decision-Making is a reliable tool to assess these abilities. 3. Significant proportion of participants with mild dementia was mentally incapable in making decisions on everyday tasks. Global cognitive functioning appeared to be an important prerequisite for intact mental capacity.
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Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
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Tam CWC, Lam LCW. Association between late-onset depression and incident dementia in Chinese older persons. East Asian Arch Psychiatry 2013; 23:154-159. [PMID: 24374487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE. Previous studies have shown that depression is a precursor / prodrome or susceptible state for the development of dementia. This study aimed to examine the relationship between late-onset depression and subsequent cognitive and functional decline in a cohort of non-demented older Chinese persons at their 2-year follow-up and investigate for possible predictors of cognitive decline. METHODS. A total of 81 depressed subjects and 468 non-depressed community controls were recruited. RESULTS. Subjects with late-onset depression showed significantly more incident Clinical Dementia Rating (CDR) scale decline (odds ratio = 3.87, 95% confidence interval = 2.23-6.70) and dementia (odds ratio = 3.44, 95% confidence interval = 1.75-6.77) than those without depression. A higher proportion of depressed CDR 0 subjects had CDR and functional decline than their non-depressed counterparts. Depressed CDR 0.5 subjects had significantly higher rates of functional decline and lower rates of improvement in CDR than their non-depressed counterparts. CONCLUSION. Diagnosis of depression was a robust predictor of incident very mild dementia (i.e. CDR of 0.5) and depression severity was a predictor of progression to dementia from CDR of 0.5. The association between depression and the risk of CDR decline and dementia was observed in non-demented Chinese subjects. Depression was also associated with persistent mild cognitive deficits in CDR 0.5 subjects.
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Affiliation(s)
- C W C Tam
- Department of Psychiatry, North District Hospital, Hong Kong SAR, China
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Fung AWT, Lam LCW. Spiritual activity is associated with better cognitive function in old age. East Asian Arch Psychiatry 2013; 23:102-107. [PMID: 24088403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This cross-sectional study aimed to explore the association between late-life spiritual activity participation and cognitive function in older Chinese adults in Hong Kong. METHODS Participants aged 60 years or older without clinical dementia or major psychiatric disorders were recruited. Dementia severity and global cognitive function were assessed using the Clinical Dementia Rating and Cantonese version of the Mini-Mental State Examination, respectively. Cognitive performance was measured using 10-minute delayed recall, the Category Verbal Fluency Test, Visual Aural Digit Span Test, and Modified Card Sorting Test. Psychological status was assessed using the Chinese version of the Purpose in Life scale. Activities participated in were categorised into 6 domains of physical, cognitive, social, prosocial, spiritual, and recreational activities. RESULTS A total of 380 participants were enrolled. Bivariate correlation showed that the composite score of cognitive function was positively correlated with aerobic exercise (r = 0.14; p = 0.01), cognitive activity (r = 0.30; p < 0.001), and spiritual activity (r = 0.16; p = 0.002). Multiple linear regression suggested that frequent participation in cognitive activity (B = 0.87, beta = 0.22; 95% confidence interval [CI] = 0.52-1.25 and p < 0.001) and spiritual activity (B = 0.45, beta = 0.11; 95% CI = 0.13-0.76 and p = 0.01) were associated with better cognitive function after controlling for age and years of education. CONCLUSION Engagement in spiritual activity may benefit cognitive function in old age. Longitudinal studies are recommended to further examine the causal relationship of spiritual activity and cognitive function.
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Affiliation(s)
- A W T Fung
- Department of Psychiatry, Tai Po Hospital, Hong Kong SAR, China
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Tam CWC, Lam LCW. Clinical remission of late-onset depression in elderly Chinese: a short-term outcome study. East Asian Arch Psychiatry 2013; 23:126-132. [PMID: 24088406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Better understanding of the relationship between executive and memory functions and treatment response in late-onset depression may improve our ability to identify those individuals who are less likely to benefit from traditional pharmacological interventions. This study aimed to investigate the remission rate in elderly Chinese people with late-onset depression, and to examine the predictors of outcomes. METHODS Patients aged 60 years or older with late-onset depression without dementia were recruited into the study. Mood symptoms were assessed by the 24-item Hamilton Rating Scale for Depression and Neuropsychiatric Inventory at 12 and 24 weeks. Cognitive domains assessed included global cognitive function, episodic memory, executive functions, and processing speed. The clinical characteristics and cognitive scores were compared among the early remitters, late remitters, and non-remitters. RESULTS Of the 105 subjects, 42 (40%) had remission at 12 weeks and were categorised as early remitters, 41 (39%) who did not remit at 12 weeks achieved remission at 24 weeks (late remitters), and 22 (21%) had not achieved remission at 24 weeks (non-remitters). Executive function, processing speed, episodic memory, apathy and depression severity were related to remission outcomes. Regression analyses found that severity of baseline apathy and depression were predictors of remission at 12 and 24 weeks, respectively. CONCLUSIONS This study identified 2 subgroups of patients according to outcomes. One group with clinical characteristics similar to vascular depression achieved a late response to treatment. The other group were non-remitters who had features of depression-executive dysfunction syndrome, which might have underlying degenerative process and presented with the co-occurrence of depression and mild cognitive impairment.
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Affiliation(s)
- C W C Tam
- Department of Psychiatry, North District Hospital, Hong Kong SAR, China
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Tam CWC, Lam LCW. Cognitive function, functional performance and severity of depression in Chinese older persons with late-onset depression. East Asian Arch Psychiatry 2012; 22:12-17. [PMID: 22447800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES. The relationship between cognitive status and depressive symptoms and their liability to cause functional decline are of clinical and public health importance as it appears to be common, frequently coexists, and may be treatable. This study examined the relationship of depression severity and cognitive performance and the impact of such an interaction on functional ability in Chinese elderly subjects with late-onset depression. METHODS. A total of 105 non-demented elderly patients with late-onset depression were recruited. Impairment in instrumental activities of daily living and severity of depression were respectively assessed with the Disability Assessment for Dementia scale and the 24-item Hamilton Depression Rating Scale. Various cognitive domains were assessed including global cognitive function, delayed episodic memory, and executive functions. The relationship between specific cognitive impairment and mood symptom severity was assessed. The clinical correlates of functional performance were also examined. RESULTS. Increasingly severe depression was associated with lower scores in the Mini-Mental State Examination, delayed recall, and poorer performance in the Trail Making Test-Part A (after adjusting for the effect of age and education). The severity of apathy correlated negatively with the Mini-Mental State Examination scores only. Among the depressed subjects, greater levels of depression and apathy, poorer performance in Trail Making Test-Part B, and mild parkinsonian signs were associated with lower functional scores. CONCLUSIONS. Lack of interest and motivation, depressive mood, compounded by behavioural abnormalities resulting from executive dysfunction, accounted for functional disability in elderly subjects with late-onset depression. These relationships may provide the background for developing interventions targeting functional deficits associated with specific cognitive dysfunctions and depression.
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Affiliation(s)
- C W C Tam
- Department of Psychiatry, North District Hospital, Hong Kong SAR, China.
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Tam CWC, Lam LCW. Cognitive and functional impairment in Chinese elderly with late-onset depression. East Asian Arch Psychiatry 2012; 22:25-30. [PMID: 22447802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES. To investigate cognitive and functional impairment in Chinese elderly subjects with late-onset depression. METHODS. Subjects with late-onset depression and who were clinically non-demented were recruited. Their cognitive and functional scores were compared with those of cognitively normal elderly controls and elderly persons with mild cognitive impairment. Functional ability was assessed by the Disability Assessment for Dementia score. Various cognitive domains were assessed including global cognitive function, delayed episodic memory, working memory, and categorical verbal fluency test. RESULTS. A total of 105 depressed subjects and 324 non-depressed controls (149 normal elderly controls and 175 with mild cognitive impairment) were recruited. The depression group had significantly poorer performance in all cognitive assessments compared to the normal elderly control group. The depression group had a similar cognitive profile to those with mild cognitive impairment, except that its subjects had slightly better performance in the Categorical Verbal Fluency Test, delayed recall testing, and the Chinese version of the Alzheimer's Disease Assessment Scale-Cognitive subscale test. Depressed subjects had significantly lower functional scores in instrumental activities of daily living than the non-depressed, normal elderly controls, and those with mild cognitive impairment. CONCLUSIONS. Our results demonstrate that Chinese elderly with late-onset depression had cognitive impairments in multiple domains similar to those encountered in the age- and sex-matched non-depressed controls with mild cognitive impairment. However, their functional performance was significantly poorer than that in these controls. This study provided extensive characterisation of the range and depth of cognitive and functional impairments in elderly patients with late-onset depression.
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Affiliation(s)
- C W C Tam
- Department of Psychiatry, North District Hospital, Hong Kong SAR, China.
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Siu BWM, Chow KKW, Lam LCW, Chan WC, Tang VWK, Chui WWH. A questionnaire survey on attitudes and understanding towards mental disorders. East Asian Arch Psychiatry 2012; 22:18-24. [PMID: 22447801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES. To obtain information about basic knowledge towards mental disorders and to evaluate public attitudes towards mental disorders in the Hong Kong Chinese population. METHODS. Questionnaires which collected basic demographic information, opinions about potential stigmas and myths, and knowledge on case vignettes depicting fictional characters with symptoms of mental illness were delivered to subjects in a secondary school, 2 homes for the elderly, a private housing estate, and a public housing estate in Hong Kong. RESULTS. Completed questionnaires were collected from 1035 subjects. In general, the participants' acceptance of mental illness was good. Regular contacts with such patients were associated with better knowledge (t = -2.71, p < 0.01) and better acceptance (t = 2.77, p < 0.01) of mental illness. Younger participants aged 15 to 19 years had a lower level of knowledge about mental health problems compared with other age-groups (p < 0.001). CONCLUSIONS. Personal contact with people with mental illness may help to improve knowledge and acceptance. Younger people in secondary school should be the target and prioritised group for mental health education. Apart from the delivery of mental health knowledge, strategies to increase social contact of the public with people having mental illness could be considered in the design and implementation of anti-stigma programmes.
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Affiliation(s)
- B W M Siu
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.
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Fung AWT, Leung GTY, Lam LCW. Modulating factors that preserve cognitive function in healthy ageing. East Asian Arch Psychiatry 2011; 21:152-156. [PMID: 22215789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Most studies examining factors contributing to cognitive impairments and dementia in late life focused on risks. In this study, we aimed to evaluate factors that might help preserve cognition in healthy Hong Kong elders. METHODS This was a 2-year prospective study of 476 cognitively healthy community dwellers (aged 60-92 years) recruited in Hong Kong. Participants were assessed with a battery of cognitive tests and questionnaires on their sense of loneliness and leisure activities. RESULTS A high level of cognitive activity participation (r = 0.13, p = 0.03) and a low level of loneliness (r = -0.15, p = 0.01) were associated with better cognitive test performance. Participants with more years of education (odds ratio = 1.27, P < 0.001) and a higher frequency of drinking (odds ratio = 1.17, p = 0.05) were associated with high cognitive function, while those with a high level of loneliness (odds ratio = 0.79, p = 0.01) were associated with low cognitive function. The correlation with cognitive activity participation remained significant in participants with very good cognitive function (r = 0.20, p = 0.04). CONCLUSIONS These results suggested that social engagement and moderate drinking may be modulating factors for cognition. Further studies should explore the interactions between lifestyle factors and cognition in older adults with no significant cognitive impairment.
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Affiliation(s)
- A W T Fung
- Department of Psychiatry, Tai Po Hospital, Hong Kong SAR, China.
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Lui VWC, Lam LCW, Luk DNY, Chiu HFK, Appelbaum PS. Neuropsychological performance predicts decision-making abilities in Chinese older persons with mild or very mild dementia. East Asian Arch Psychiatry 2010; 20:116-122. [PMID: 22348865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the relationship of the 4 decision-making abilities (Understanding, Appreciation, Reasoning, and Expressing a Choice) and neuropsychological performance in patients with very mild and mild dementia. METHODS Chinese subjects were recruited from local social centres and residential hostels for elderly people in Hong Kong. Clinical diagnosis was made by experienced geriatric psychiatrists. A battery of neuropsychological tests that assesses general cognitive abilities, verbal memory, executive function, concept formation, and auditory and visual attention, was administered. Mental capacity to consent to treatment was assessed using the Chinese version of the MacArthur Competence Assessment Tool - Treatment. RESULTS Fifty participants with very mild or mild dementia were compared with 42 cognitively intact subjects. After controlling for the effects of age and education, stepwise linear regression analysis demonstrated that the 4 decision-making abilities correlated with different neuropsychological test performances, which predicted 45% of the common variance for Understanding, 39% for Appreciation, 20% for Reasoning, and 30% for Expressing a Choice. The Reasoning score was only predicted by the Category Verbal Fluency Test (β = 0.4, p = 0.01). CONCLUSION Neuropsychological test performance differentially predicted different decision-making abilities in older patients with mild or very mild dementia.
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Affiliation(s)
- V W C Lui
- Department of Psychiatry, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong SAR, China.
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Fu Y, Hu SH, Lam LCW. A selected review of recent biological psychiatric research in China (translated version). East Asian Arch Psychiatry 2010; 20:44-50. [PMID: 22351809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This review highlights significant biological psychiatric research published by Chinese researchers in recent years. Chinese periodicals with full-text database (Chinese National Knowledge Infrastructure) and English periodicals with PubMed, published from 2003 to 2009 on schizophrenia, depression, bipolar affective disorder, obsessive-compulsive disorder, anxiety disorder and Alzheimer's disease, were reviewed. Articles studying the above-mentioned psychiatric disorders focusing in the area of molecular genetics, neuroendocrine immunology, electrophysiology and psychopharmacology applied to animal models or clinical populations were included. The findings suggest that biological psychiatric research is being developed at a rapid pace and covers a wide perspective from disease mechanisms to clinical interventions.
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Affiliation(s)
- Y Fu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
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Fu JCK, Chow PPL, Lam LCW. The experience of admission to psychiatric hospital among Chinese adult patients in Hong Kong. BMC Psychiatry 2008; 8:86. [PMID: 18928557 PMCID: PMC2596108 DOI: 10.1186/1471-244x-8-86] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 10/17/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The paper reports on a study to evaluate the psychometric properties and cultural appropriateness of the Chinese translation of the Admission Experience Survey (AES). METHODS The AES was translated into Chinese and back-translated. Content validity was established by focus groups and expert panel review. The Chinese version of the Admission Experience Survey (C-AES) was administered to 135 consecutively recruited adult psychiatric patients in the Castle Peak Hospital (Hong Kong SAR, China) within 48 hours of admission. Construct validity was assessed by comparing the scores from patients admitted voluntarily versus patients committed involuntarily, and those received physical or chemical restraint versus those who did not. The relationship between admission experience and psychopathology was examined by correlating C-AES scores with the Brief Psychiatric Rating Scale (BPRS) scores. RESULTS Spearman's item-to-total correlations of the C-AES ranged from 0.50 to 0.74. Three factors from the C-AES were extracted using factor analysis. Item 12 was omitted because of poor internal consistency and factor loading. The factor structure of the Process Exclusion Scale (C-PES) corresponded to the English version, while some discrepancies were noted in the Perceived Coercion Scale (C-PCS) and the Negative Pressure Scale (C-NPS). All subscales had good internal consistencies. Scores were significantly higher for patients either committed involuntarily or subjected to chemical or physical restrain, independent on severity of psychotic symptoms. CONCLUSION The Chinese AES is a psychometrically sound instrument assessing the three different aspects of the experience of admission, namely "negative pressure, "process exclusion" and "perceived coercion". The potential of C-AES in exploring subjective experience of psychiatric admission and effects on treatment adherence should be further explored.
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Affiliation(s)
- Jackie Chi-Kin Fu
- Department of Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong, PR China.
| | - Paulina Po-Ling Chow
- Psychogeriatric Team, Department of Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong, PR China
| | - Linda Chiu-Wa Lam
- Department of Psychiatry, the Chinese University of Hong Kong, Tai Po Hospital, Tai Po, Hong Kong, PR China
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Tang VWK, Leung SK, Lam LCW. Clinical correlates of the caregiving experience for Chinese caregivers of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2008; 43:720-6. [PMID: 18438734 DOI: 10.1007/s00127-008-0357-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 04/02/2008] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the correlation between clinical characteristics and the caregiving experience of caregivers of patients with schizophrenia. PATIENTS AND METHODS Two hundred and one patients with schizophrenia and their caregivers were recruited from a psychiatric clinic. The involvement evaluation questionnaire (IEQ) and the general health questionnaire (GHQ) were administered to the caregivers. The patients were assessed by the Structured Clinical Interview, the positive and negative syndrome scale (PANSS) and the global assessment of functioning scale (GAF). Correlation analysis and regression analysis was performed to identify the best predictors of caregiver stress. RESULTS The most important clinical predictor of caregiver stress as assessed using IEQ was the GAF, followed by PANSS-Pos and Neg scores and admission. Positive symptoms contributed more to overall caregiver stress than negative symptoms. DISCUSSION Both symptom severity and patient function were important factors in the caregiver experience. Treatment should aim not only to reduce symptoms but also maximize function. Service planning should include psychosocial intervention involving caregivers.
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Chow TW, Liu CK, Fuh JL, Leung VPY, Tai CT, Chen LW, Wang SJ, Chiu HFK, Lam LCW, Chen QL, Cummings JL. Neuropsychiatric symptoms of Alzheimer's disease differ in Chinese and American patients. Int J Geriatr Psychiatry 2002; 17:22-8. [PMID: 11802226 DOI: 10.1002/gps.509] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of Alzheimer's disease is similar across ethnic groups. To our knowledge, no comparison of behavioral symptoms has been addressed. OBJECTIVE This cross-sectional, retrospective, descriptive study compares neuropsychiatric symptoms of Chinese subjects with Alzheimer's disease (AD) at tertiary care centers in Taiwan and Hong Kong against Caucasian subjects in Los Angeles, California. We compared the frequency and severity of symptoms and caregiver responses to neuropsychiatric symptoms of AD using the Neuropsychiatric Inventory (NPI). We hypothesized that Chinese patients do not seek care unless they have high severity of neuropsychiatric symptoms and that Caucasian Americans do not wait for behavioral disturbances to develop before coming to medical attention. RESULTS The Caucasian sample had the highest mean educational level and mildest Clinical Dementia Rating (CDR) scale distributions of all four groups. Older age and lower educational levels contributed to higher CDR scale scores, which in turn correlated with higher total NPI scores. Only one of the Chinese samples had a higher frequency of severe neuropsychiatric symptoms than the Caucasian sample. Chinese caregivers reported anxiety and delusions more frequently (58.1%) than Caucasians (37.3% and 39.6%; chi(2), p < 0.01 and p < 0.05, respectively). Caucasians reported appetite changes (47.3%) and apathy (59.2%) more frequently than the Chinese samples (chi(2), p < 0.05 and p < 0.01, respectively). Caregivers at all four centers were distressed by behaviors qualified as severe. CONCLUSION We found support for our hypothesis, in that Chinese subjects presented during a more severe stage of dementia than American subjects, but the delay in seeking care could not be correlated with significant differences in neuropsychiatric profiles of the demented subjects. Other barriers to dementia care warrant investigation.
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Affiliation(s)
- T W Chow
- Rancho Los Amigos National Rehabilitation Center/University of Southern California Alzheimer's Disease Center, Downey 90242, USA.
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Pang FC, Chow TW, Cummings JL, Leung VPY, Chiu HFK, Lam LCW, Chen QL, Tai CT, Chen LW, Wang SJ, Fuh JL. Effect of neuropsychiatric symptoms of Alzheimer's disease on Chinese and American caregivers. Int J Geriatr Psychiatry 2002; 17:29-34. [PMID: 11802227 DOI: 10.1002/gps.510] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In Chinese culture, extended family support, acceptance of age-related cognitive changes and filial tradition of caring for elders may decrease caregiver burden and distress in the context of dementia. OBJECTIVE To study cross-regional and cross-cultural differences in symptom-related caregiver distress due to the behavioral problems of Chinese and American patients with Alzheimer's disease. METHOD Caregivers of patients with Alzheimer's disease at Taipei Veterans General Hospital, Taiwan (n = 89), Chinese University of Hong Kong (n = 31) and the UCLA Alzheimer's Disease Research Center, Los Angeles, California (n = 169) reported the neuropsychiatric symptoms of patients and their corresponding distress on the Neuropsychiatric Inventory. RESULT Presence or absence of distress due to the neuropsychiatric symptoms of the patients with Alzheimer's disease was assessed. The three centers differed significantly in the proportions of caregivers with distress caused by depression (p < 0.05) and apathy (p < 0.001). UCLA had higher proportions of caregivers with depression-related distress than Taipei. UCLA caregivers were also more stressed by apathy than caregivers in Taipei and Hong Kong. Logistic regression further supported the findings that depression-related and apathy-related caregiver distress differed between Chinese and American caregivers (p < 0.05). CONCLUSIONS The results were surprising, in that American and Chinese (Taipei and Hong Kong) caregivers exhibited similar distress or lack of distress in response to delusions, hallucinations, agitation, anxiety, euphoria, disinhibition, irritability, aberrant motor behavior, sleep and appetite symptoms of Alzheimer's disease patients. Chinese caregivers were less affected by depression and apathy in patients with Alzheimer's disease than Caucasian caregivers.
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Affiliation(s)
- F C Pang
- Department of Geriatrics, Tuen Mun Hospital, Hong Kong.
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Chiu HFK, Wing YK, Lam LCW, Li SW, Lum CM, Leung T, Ho CKW. Sleep-related Injury in the Elderly—An Epidemiological Study in Hong Kong. Sleep 2000. [DOI: 10.1093/sleep/23.4.1e] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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