Showing papers by "Shuu Jiun Wang published in 2000"

Effects of estrogen on cognition, mood, and cerebral blood flow in AD: A controlled study

Abstract: Objective: To examine the effects of estrogen therapy on cognition, mood, and cerebral blood flow in patients with AD. Background: Some studies have suggested estrogen may be effective in the treatment of AD. However, most of these studies were not controlled adequately. Methods: Fifty female AD patients were recruited in a randomized, double-blind, placebo-controlled 12-week trial. Each member of the estrogen-treated group received conjugated estrogen (Premarin) 1.25 mg/day. The primary outcome measures were the Cognitive Ability Screening Instrument (CASI), Clinical Dementia Rating (CDR), and Clinician Interview-Based Impression of Change (CIBIC-plus). The secondary outcome measures were Behavioral Pathology in Alzheimer’s Disease (BEHAVE-AD), Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS), and 99m Tc hexamethylpropylene amine oxime SPECT of the brain. Results: No meaningful differences were found between the outcome measures (CASI, CDR, CIBIC-plus, BEHAVE-AD, HARS, HDRS, and cerebral blood flow) taken from the estrogen-treated group and those from the control group. Conclusion: A 1.25-mg/day dose of Premarin administered for 12 consecutive weeks does not produce a meaningful effect on cognitive performance, dementia severity, behavior, mood, and cerebral perfusion in female AD patients. Because estrogen therapy has been suspected of yielding adverse effects, and its therapeutic effectiveness is in doubt, additional evaluation of its role in AD treatment ought to be conducted.

Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes.

Abstract: Objective.—To investigate the frequency of depressive and anxiety disorders in patients with chronic daily headache. Background.—There is a lack of data in the literature on the extent of psychiatric comorbidity in patients with different subtypes of chronic daily headache. Methods.—We recruited consecutive patients with chronic daily headache seen in a headache clinic from November 1998 to December 1999. The subtypes of chronic daily headache were classified according to the criteria proposed by Silberstein et al. A psychiatrist evaluated the patients according to the structured Mini-International Neuropsychiatric Interview to assess the comorbidity of depressive and anxiety disorders. Results.—Two hundred sixty-one patients with chronic daily headache were recruited. The mean age was 46 years, and 80% were women. Transformed migraine was diagnosed in 152 patients (58%) and chronic tension-type headache in 92 patients (35%). Seventy-eight percent of patients with transformed migraine had psychiatric comorbidity, including major depression (57%), dysthymia (11%), panic disorder (30%), and generalized anxiety disorder (8%). Sixty-four percent of patients with chronic tension-type headache had psychiatric diagnoses, including major depression (51%), dysthymia (8%), panic disorder (22%), and generalized anxiety disorder (1%). The frequency of anxiety disorders was significantly higher in patients with transformed migraine after controlling for age and sex (P = .02). Both depressive and anxiety disorders were significantly more frequent in women. Conclusion.—Psychiatric comorbidity, especially major depression and panic disorders, was highly prevalent in patients with chronic daily headache seen in a headache clinic. These results demonstrate that women and patients with transformed migraine are at higher risk of psychiatric comorbidity.

Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural community.

Abstract: To test the psychometric properties of the Chinese (Taiwanese) version of the short form 36 health survey (SF-36), 1439 women, aged 40–54 years and living in Kinmen (a Taiwanese island reflecting a predominantly rural community) were recruited to participate in this survey. The rate of unavailable data points for the 36 tested items remained consistently low, and item-discriminate validity was high (95%) for all subscales. Cronbach's α coefficient remained above the 0.70 threshold criterion for all scales except for social functioning and bodily pain. Principal components analysis supported the two major dimensions of health, physical and mental, in the internal structure of the SF-36 scales, although the dimensions did not match the hypothesized association very well. Poorer health profiles were associated with physical and mental conditions. The mental health subscores in the SF-36 test correlated highly with the associated hospital anxiety and depression score (Spearman rank correlation coefficient = −0.62). In conclusion, the reliability and validity tests performed on the data collected support the cross-cultural application of the Chinese (Taiwanese) version of the SF-36 test.

Prevalence of Migraine in Taipei, Taiwan: A Population-Based Survey

Abstract: We conducted the first population-based migraine survey in Taipei, Taiwan, using a validated questionnaire administered by interviewers during the period from August 1997 to June 1998. Our target population comprised all individuals (age > or = 15 years) in 1400 randomly selected households. Migraine diagnoses were made according to the classification criteria of migraine without aura proposed by the International Headache Society, 1988, except that attacks with a duration of between 2 h and 4 h were also included. Of the 4434 eligible subjects in the 1211 respondent households, 3377 (76%) completed the questionnaire. After adjustment for age and sex distribution according to the population structure, the prevalence of migraine was 9.1% (F/M 14.4%/4.5%). Fifty-four percent of the subjects with migraine had consulted a physician about their headaches in the past year. However, only 18% of them reported that their migraine had been diagnosed by physicians. This study found that Taipei residents have the highest migraine prevalence of all Chinese populations studied, although it is still in the low range of prevalence compared with the results from Western countries.

Subjective memory complaint in relation to cognitive performance and depression: a longitudinal study of a rural Chinese population.

Abstract: OBJECTIVES: To examine the associations of subjective memory complaint (SMC) in old age with (a) objective test performance, (b) past and subsequent cognitive decline, and (c) depression. DESIGN: A group of community residents were examined twice during a 3-year period. SETTING: Two townships on a rural Chinese islet. PARTICIPANTS: A total of 543 men and women aged 65 years and older. MEASUREMENTS: During each examination, neurologists interviewed and examined all participants for dementia and asked the question, “Do you have trouble with your memory?” In addition, research assistants administered (a) the Cognitive Abilities Screening Instrument (CASI) to assess cognitive abilities, including long-term memory (LTM) and short-term memory (STM), and (b) the Geriatric Depression Scale-Short Version (GDS-S) to assess symptoms of depression. RESULTS: At each examination, almost half of the subjects acknowledged having trouble with their memory (the SMC+ group). At both examinations, the SMC+ group scored significantly lower on the CASI and significantly higher on the GDS-S than the SMC− group. However, the presence of SMC was not associated with faster cognitive decline over the past or subsequent 3 years. There were no consistent associations between SMC and the demographic variables of age, gender, and education at the two examinations. Logistic regression analysis showed that SMC was associated with poorer memory test scores after controlling for gender, age, education, and depression. CONCLUSIONS: SMC was associated with poorer objective memory performance even after controlling the effect of depression and demographic data, but SMC did not predict faster cognitive decline or dementia over 3 years. J Am Geriatr Soc 48: 295–299, 2000.

Migraine prevalence in adolescents aged 13–15: a student population‐based study in Taiwan

Abstract: To estimate the lifetime migraine prevalence in school adolescents aged 13-15 in Taiwan, we conducted a self-administered questionnaire survey in four sampled public junior high schools. Migraine was diagnosed according to the diagnostic criteria of the International Headache Society. A total of 4064 students (1983 boys, 2081 girls) completed the questionnaire (response rate 91.6%). The lifetime prevalence of migraine was 6.8%. It was significantly higher in girls than boys (7.8% vs. 5.7%) and increased with age in both sexes. Students with migraine were more likely to be absent from school because of their headaches than those with non-migraine headaches (30% vs. 14%, odds ratio (OR) 2.7). They were also more likely to use painkillers for their headaches than their non-migraine headache peers (72% vs. 40%, OR 4.0). These results suggest that migraine is a common disorder of adolescents in Taiwan and its impact on the quality of life can not be ignored.

Benign cough headache is responsive to acetazolamide.

Abstract: Benign cough headache (BCH) is a rare headache syndrome.1,2 It is defined by the International Headache Society (IHS) as a headache precipitated by coughing in the absence of any intracranial disorder. The headache is usually bilateral and of sudden onset, lasting less than 1 minute, and may be prevented by the avoidance of coughing.3 Most patients are responsive to indomethacin, although lumbar puncture has been advocated by Raskin.4 He suggested that both indomethacin and lumbar puncture were effective after a sudden decrease in intracranial pressure (ICP), and proposed that determination of the nature of the receptors that were sensitive to ICP alterations was probably the key to understanding this disorder.4 We conducted an open-label trial using acetazolamide in the treatment of BCH. The objectives were to provide an alternative treatment and to test the hypothesis that the efficacy of indomethacin and lumbar puncture results from the reduction of CSF volume. Five outpatients (four men, …

Repetitive intravenous prochlorperazine treatment of patients with refractory chronic daily headache.

Abstract: Objectives.—To investigate the efficacy and long-term outcome of intravenous prochlorperazine for the treatment of refractory chronic daily headache. Background.—Unlike dihydroergotamine, the treatment results of intravenous neuroleptics as first-line agents for refractory chronic daily headache have rarely been reported. Methods.—We retrospectively analyzed the data of inpatients with refractory chronic daily headache who received intravenous repetitive prochlorperazine treatment from November 1996 to March 1999. A semistructured telephone follow-up interview was done in September 1999. Results.—A total of 135 patients (44 men, 91 women) were recruited, including 95 (70%) with analgesic overuse. After intravenous prochlorperazine treatment, 121 (90%) achieved a 50% or greater reduction of headache intensity, including 85 (63%) who became headache-free. The mean hospital stay was 6.2 ± 2.7 days, and mean total prochlorperazine used was 98 ± 48 mg. Acute extrapyramidal symptoms occurred in 21 patients (16%). One hundred twenty-four patients (92%) were successfully followed up, with a mean duration of 14.3 ± 7.5 months. Compared with pretreatment status, 93 patients (75%) considered their headache intensity decreased, and 86 patients (69%) considered their headache frequency decreased, although 40 (32%) still had a daily headache. Of the 87 patients with analgesic overuse who could be followed, 61 (70%) no longer overused analgesics. Poor response to prochlorperazine treatment (relative risk, 1.8) and presence of major depression (relative risk, 1.8) were predictors of persistent chronic daily headache at follow-up. Conclusions.—Prochlorperazine was effective and safe in the treatment of patients with refractory chronic daily headache with or without analgesic overuse. Compared with dihydroergotamine, prochlorperazine seemed less effective at achieving “freedom from headache” during hospitalization, but had a similar outcome at follow-up.

Incidence of stroke on Kinmen, Taiwan.

Abstract: This study aims to assess the incidence, case-fatality rate and risk factors of stroke on Kinmen Island, Taiwan, from 1993 to 1996. A population-based stroke survey was carried out in 1993 and 1996 to

Histopathologic analysis of sentinel lymph nodes in breast carcinoma.

Abstract: BACKGROUND Intraoperative lymphatic mapping and identification of the first draining lymph node (the sentinel lymph node) may allow some patients with breast cancer to avoid the morbidity of formal axillary clearance. The aim of this study was to determine the accuracy of sentinel lymph node (SLN) biopsy in predicting axillary nodal involvement. METHODS From August, 1998 until July, 1999, 41 patients with clinically node-negative breast cancer underwent SLN biopsy that was immediately followed by axillary lymph node dissection. If the SLN section was found free of metastasis by routine hematoxylin and eosin staining (H&E), then an additional four sections of the SLN were cut and examined for the presence of tumor cells by H&E staining (three sections) and by cytokeratin immunohistochemical staining (IHC) (one section). If the SLN had metastatic cells and the other remaining nonsentinel axillary lymph nodes were free of metastases by routine H&E staining, then an additional three sections of the nonsentinel axillary lymph nodes were cut and examined for the presence of tumor cells by H&E staining. RESULTS The 41 patients had a mean of 2.2 sentinel (range, 1-7) and 14.6 nonsentinel (range, 5-32) lymph nodes excised per patient. Routine H&E staining identified 13 patients (31.7%) with SLN metastases and 28 patients (68.3%) with tumor-free SLNs. Applying IHC and the additional three sections stained with H&E to these tumor-free SLNs showed one additional patient with sentinel node metastasis. The conversion rate from being a sentinel node-negative patient to a sentinel node-positive patient was 3.6% (1/28). Overall, SLN metastases were detected in 14 (34.1%) of the 41 patients. The SLNs were negative in 27 patients (65.9%), two of whom had at least one positive nonsentinel lymph node each (7.4% "skip" metastasis). Biopsy of SLNs was 92.6% accurate in predicting the absence of nonsentinel nodal metastasis (p=0.001). CONCLUSIONS Our results suggest that formal axillary lymph node dissection may need only be performed in SLN-positive patients. Nonetheless, further experience and refinement are needed to perfect this technique.