PubMed Health⌕ Search

Biomedical subjects

J L Fuh

Publications and source records attributed to J L Fuh.

At least 19 recordsLinked to original sources
PubMed1997

The Kinmen Neurological Disorders Survey (KINDS): a study of a Chinese population.

We conducted an epidemiological study of several neurological disorders among the Chinese aged 50 years or older on the islet of Kinmen. All participants were interviewed and examined by neurologists. From the targeted population of 5,061 individuals, 3,915 (77.4%) of them completed the evaluations. Among the 4,087 individuals with whom face-to-face contact was made, the refusal rate was 4.2%. The disorders of interest were dementia, Parkinson's disease, essential tremor, stroke, transient ischemic attacks, and migraine. Among the 3,915 participants, 366 cases were found with 1 or more of the surveyed neurological disorders on the prevalence day, August 1, 1993, yielding a prevalence of 93.5/1,000. The purpose of this study, the general methodology, and some overall findings are presented in this communication in order to provide a common background for detailed findings on each disorder to be reported separately.

Age Factors↗
PubMed1996

A door-to-door survey of Parkinson's disease in a Chinese population in Kinmen.

BACKGROUND: Most published studies have shown lower prevalence rates of Parkinson's disease (PD) in Asian and black African than in Western countries, leading to the hypothesis that Asians and blacks might be protected from PD. OBJECTIVE: To investigate the prevalence of PD in a Chinese population. DESIGN: Community-based survey. SETTING: Registered residents 50 years of age or older (N = 5061) on the islet of Kinmen located off the southeastern coast of China [corrected]. METHOD: Single-phase door-to-door survey by neurologists. All participants were administered a questionnaire and received motor examinations of the Unified Parkinson's Disease Rating Scale. RESULTS: The participation rate was 96% (N = 3915) among 4158 contacted individuals. Twenty-three cases of PD were identified, including three cases with dementia. The crude prevalence rate of PD was 587 (95% confidence interval (CI), 373 to 884) per 100,000 persons 50 years of age or older. Assuming no case of PD among individuals under 50 years of age, the prevalence rate was 119 (95% CI, 80 to 169) per 100,000 for the total population. CONCLUSIONS: The prevalence rates of PD in Kinmen were much higher than those reported from mainland China, but slightly lower than those reported from more developed countries. The present findings suggest that, instead of genetic factors, differences in case-ascertainment, life expectancy, and the length of survival with PD may be more important contributors to the variations in observed PD prevalence rates.

Aged↗
PubMed1996

Acute disseminated encephalomyelitis in middle-aged or elderly patients.

Acute disseminated encephalomyelitis (ADEM) in middle-aged or elderly adults is rarely reported. We present here three ADEM patients of these age groups, who manifested behavioral changes, mutism or psychosis. Single clinical episodes, widespread encephalopathic disturbances and magnetic resonance imaging (MRI) findings favored the diagnosis of ADEM. However, no obvious preceding infections could be discovered. Two of them had traveled to mainland China prior to admission to psychiatric wards. All three patients had fair-to-good recovery after steroid treatment. A review of the literature showed that clinical and neuroimage findings of ADEM in the elderly group did not differ from those in the younger group. However, ADEM has rarely been reported in older age groups, probably due to: (1) differences between the elderly and young people in susceptibility or immune response to infectious agents, and (2) lack of a sensitive tool to examine patients prior to the wide-spread use of MRI. We suggest ADEM as one of the possible etiologies of acute or subacute onset of psychosis in adult patients, especially in those with a history of traveling.

Acute Disease↗
PubMed1996

Prevalence of stroke in Kinmen.

BACKGROUND AND PURPOSE: Stroke is the second most common cause of death in Taiwan. We studied its prevalence, risk factors, and mortality in a rural Chinese population. METHODS: A door-to-door survey of stroke was conducted in two Kinmen Island townships with a total population of 26105 people. Our target population (n = 5061) consisted of all the registered residents in these townships who were aged > or = 50 years on August 1, 1993. All participants were given a standardized neurological examination and a questionnaire. RESULTS: The participation rate was 77.4% (n = 3915). Ninety-six cases of completed stroke were identified. Eighty-nine patients had one, 6 patients had two, and 1 patient had three episodes of stroke. The prevalence of stroke in persons aged > or = 50 years was 24.5 per 1000 (95% confidence interval, 19.7 to 29.3 per 1000). Prevalence increased with age. Statistically significant risk factors associated with stroke included hypertension, diabetes mellitus, and irregular heartbeats. Of the stroke survivors, 59% were independent in activities of daily living and 71% could walk independently. CONCLUSIONS: Compared with other countries, Taiwan has a moderately high prevalence of stroke. The risk factors for stroke in this rural region of a developing country are similar to those in developed countries. Most stroke survivors here perform their daily activities independently without outside assistance.

Activities of Daily Living↗
PubMed1996

Epsilon 4 allele of apolipoprotein E increases risk of Alzheimer's disease in a Chinese population.

We examined the apolipoprotein E genotype in 56 Chinese patients with late-onset sporadic Alzheimer's disease (AD) and 57 Chinese control subjects of similar age. The frequency of epsilon 4 in the AD group was significantly higher than that in the control group (23.2% versus 7.9%, p = 0.003). The odds ratio for AD in individuals with either one or two epsilon 4 was 2.96 (95% CI 1.11 to 8.03). The linear trend for AD in proportion to alleles of epsilon 4 was also significant (chi 2 = 8.2, p = 0.004). Our results support the association between epsilon 4 and AD in the Chinese.

Age of Onset↗
PubMed1996

Bipolar disorder following a stroke involving the left hemisphere.

OBJECTIVE: Post-stroke mania has rarely been noted and researched, and reported cases have mostly involved the non-dominant hemisphere. In this paper, we report a case of bipolar disorder secondary to a stroke over the dominant hemisphere. CLINICAL PICTURE: A 48-year-old, right-handed man had a cerebral infarct over the left temporal region. He became depressed after the stroke, and 4 months later developed a manic episode. TREATMENT: The patient was treated with haloperidol and lorazepam. OUTCOME: The symptoms subsided within 2 months after treatment. CONCLUSIONS: It is premature to consider mania to be a syndrome of the right, or non-dominant, hemisphere. We suggest that further study focusing on specific anatomical regions, rather than laterality, will help to elucidate the interrelationship between mood and brain function.

Bipolar Disorder↗
PubMed1995

Performance on a smell screening test (the MODSIT): a study of 510 predominantly illiterate Chinese subjects.

The 12-item Modular Smell Identification Test (MODSIT) was administered to 239 male and 271 female Chinese subjects whose age ranged from 50 to 92 years (68.3 +/- 10.9) and whose education ranged from 0 to 20 years (2.5 +/- 4.3). Every participant was examined by a physician and was found to be free of dementia, stroke, and Parkinson's disease. Different from the standard procedures, only one-third of each odor pad was used for each subject, the four odor choices were presented orally for the majority of subjects, and they were not forced to make a selection when they could not detect or identify the odor. The average level of performance was 46% correct. The score was negatively associated with age, positively associated with education and with performance on a dementia screening test, and corroborated with subjects' report of smell deterioration in recent years. Nonsmokers and women performed better than smokers and men. The 12-item MODSIT had an internal consistency reliability of 0.73 and a 7-month retest stability of 0.57 with different examiners. The MODSIT is satisfactory for group studies, even when administered with suboptimal procedures such as those used in the present study.

Age Distribution↗
PubMed1995

Caudate hemorrhage: clinical features, neuropsychological assessments and radiological findings.

The nucleus caudatus is not a common location of spontaneous intracerebral hemorrhage. Twelve patients (8 men and 4 women) aged 38-76 years who had caudate hemorrhage between November 1, 1992 and March 31, 1994 were evaluated. These cases represented 2.1% of intracerebral hemorrhage cases at Neurological Institute, Veterans General Hospital-Taipei, Taiwan. Cerebral angiography was performed on eight patients. Six patients were evaluated by an extensive neuropsychological battery. The most frequent symptoms of caudate hemorrhage were headache and/or vomiting, and decreased consciousness. Clinical features were similar to those of subarachnoid hemorrhage. Angiography showed characteristic moyamoya disease in one patient but did not show an aneurysm or arteriovenous malformation in any patient. The etiology in most patients was hypertension. Neuropsychological assessments showed significant impairment in tasks of short-term and long-term memory and in verbal fluency as well as trends of impairment of orientation rather than of controls. Neurobehavioral symptoms probably resulted from interruption of the cortical-subcortical loops between the caudate nucleus and prefrontal cortex.

Adult↗
PubMed1995

Prevalence and subtypes of dementia in Taiwan: a community survey of 5297 individuals.

OBJECTIVE: To study the prevalence rate of dementia in Taiwan, the relative frequencies of its subtypes, and its associations with age, education, gender, and residence location. PARTICIPANTS: A total of 2753 men and 2544 women from four urban and four rural communities participated. Their age ranged from 41 to 88 years; 28% of them were at least 65 years old. Their education ranged from 0 to 20 years; 27% of them had less than 1 year of formal schooling. DESIGN: Phase I was a screening survey by trained nurses who administered a Chinese version of the Mini-Mental State Examination, the MMSE-T1, to all participants. Phase II involved the assessment for dementia by neurologists on the 1521 individuals who had scored less than 24 on the 30-point MMSE-T1. MAIN RESULTS: Thirty-one cases of dementia were identified by the DSM-III-R criteria, including 18 cases of Alzheimer's disease, 10 cases of vascular dementia, and three cases of other dementias. The prevalence rate in individuals aged 65 and over was 2.0%. Aging and illiteracy were associated with higher rates of dementia; gender and residence location made no difference. CONCLUSIONS: The prevalence rate of dementia was low in this Chinese population. Consistent with common findings from other parts of the world, a high rate of dementia was associated with older age and illiteracy, and Alzheimer's disease was the most frequent cause.

Adult↗
PubMed1995

The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening tool for dementia for a predominantly illiterate Chinese population.

The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) provides ratings of an individual's changes in everyday cognitive functions during the previous 10 years. Original studies conducted in Australia showed that its score was not influenced by the subjects' educational backgrounds and that it performed at least as well as the Mini-Mental State Examination (MMSE) as a screening instrument for dementia. The subjects of the present study were Chinese and included 399 community residents and 61 dementia patients. Their ages ranged from 50 to 92 years; their education levels ranged from 0 to 19 years, and 63% of them had never attended school. We administered the IQCODE to informants and the Cognitive Abilities Screening Instrument (CASI), from which a CASI-estimated score of the MMSE (MMSE-CE) can be obtained, to the subjects. The diagnosis of dementia was made independently by physicians according to the DSM-III-R criteria based on semistructured interview and testing, neurologic examination, and standardized assessments of cerebral vascular disease, Parkinson's disease, and depression. The Chinese IQCODE showed no association with the subjects' education level or gender, low association with their age, and moderately high association with their MMSE-CE score. The area under the receiver operating characteristic curve of the IQCODE was significantly larger than that of the MMSE-CE for the whole group and for the subgroup with 1 to 19 years of education but not for the subgroup with 0 years of education. Nine of the 26 items of the IQCODE could be deleted without appreciable reduction in sensitivity and specificity. The IQCODE (1) can be shortened to 17 items, (2) had good cross-cultural applicability, and (3) was better than the MMSE-CE as a screening tool for dementia in a population with large variation in educational backgrounds.

Age Factors↗
PubMed1994

Transient unilateral hypoglossal nerve palsy: a case report.

Transient unilateral hypoglossal nerve palsy is very rare. We report an 81-year-old woman with right hypoglossal nerve palsy who recovered in 4 weeks without specific treatment. Extensive investigations did not disclose a cause for her hypoglossal nerve palsy. We believe that hypoglossal nerve palsy may sometimes be self-limited, just as Bell's palsy is.

Aged↗
PubMed1994

Swallowing difficulty in primary progressive aphasia: a case report.

A 71-year-old right handed man showed insidious and progressive decline of language skills, in contrast with relatively preserved performance on tests and ability to be independent in daily living. Three years later, he developed swallowing difficulties. MRI scans showed widening of the left sylvian fissure. A SPECT scan demonstrated focal hypometabolism restricted to the left temporal lobe. Videofluoroesophagography revealed marked hesitation of oral preparation and oral phases, while the reflex phases were unimpaired. The patient failed to perform oral tasks on command and imitation without motor and sensory deficit. We believe that his swallowing difficulty was due to oral apraxia. This case adds to the heterogeneity of patients with primary progressive aphasia.

Aged↗
PubMed1994

Assessing cognitive abilities and dementia in a predominantly illiterate population of older individuals in Kinmen.

A community survey of dementia was conducted on a Chinese islet. A total of 221 men and 234 women in the age range of 50-92 were assessed. The Cognitive Abilities Screening Instrument (CASI), a 100-point cognitive test designed for cross-cultural studies and adapted in Chinese for individuals with little or no formal education, was administered twice by trained field workers with a retest interval of 3 to 4 weeks. In addition, all participants were assessed by physicians who did not know the CASI scores. The physicians' assessment included a complete neurological examination, plus semi-structured tests and interviews covering cognitive abilities, daily activities, depression, cerebrovascular disease, and Parkinson's disease. Dementia was diagnosed by consensus among the physicians according to the DSM-III-R criteria. Among the 455 participants, 16 cases of dementia were identified, including 13 with probable Alzheimer's disease and 1 each with vascular dementia, Parkinson's disease, and alcoholism. The rates of dementia were 0, 3.9 and 11.5% for the age groups of 50-69, 70-79 and 80-92; and 4.4, 2.0 and 0% for the education groups of 0-1, 2-6 and 7-15 years of schooling. No sex difference was found after controlling for education. The Chinese version of the CASI had an intraclass retest reliability of 0.90. Using a cut-off score of < or = 50 for dementia, the sensitivity was 0.88 and the specificity was 0.94. The preliminary study suggests that the CASI can be used in Chinese populations with generally low education levels and that Alzheimer's disease was the most common type of dementia in this population.

Aged↗
PubMed1994

Cardiovascular autonomic functions in Alzheimer's disease.

We investigated cardiovascular autonomic functions in 23 patients with Alzheimer's disease (AD) and 23 age-matched control subjects. The vagal parasympathetic function was assessed with R-R interval variation (RRIV), and sympathetic function with sympathetic skin response (SSR) and orthostatic cardiovascular reflexes. Compared with controls, the AD patients had significantly depressed RRIV during rest (6.4 +/- 1.3% vs. 7.5 +/- 1.6%, p < 0.02) and deep breathing (12.6 +/- 4.6% vs. 17.0 +/- 5.1%, p < 0.006), but all AD patients had normal SSR. After standing for 3 minutes from supine, the changes of blood pressure and heart rate from baseline in AD patients did not differ from those in controls. The AD patients had a lower systolic blood pressure than controls in both supine (130.7 +/- 17.4 vs. 145.4 +/- 20.7 mmHg, p < 0.02) and standing (129.2 +/- 20.1 vs. 146.6 +/- 21.1 mmHg, p < 0.008) positions, especially in those patients with more severe dementia. We conclude that AD patients have mildly impaired autonomic functions, mainly in vagal parasympathetic functions. The pathogenesis and clinical significance of low blood pressure in AD needs further study.

Aged↗
PubMed1994

Parkinson's disease in Kin-Hu, Kinmen: a community survey by neurologists.

A door-to-door survey by neurologists in Kin-Hu township, Republic of China, of a sample of the Chinese population of 683 persons aged 50 years and over was performed in August, 1992. A total of 482 subjects (70.6%) completed the study. Kin-Hu, a township of Kinmen, is predominantly rural with agriculture as the main occupation. Six subjects (5 men, 1 woman) were diagnosed with Parkinson's disease (PD). Of these six, five were newly diagnosed; one of the five also had dementia. The crude prevalence rate per 1,000 persons over 50 years of age of PD in Kin-Hu was 6.2. The age-specific prevalence rates per 1,000 persons (95% confidence intervals) were 0 for age 50-59, 7.8 (0-22.9) for age 60-69, 17.5 (5.2-29.8) for age 70-79, and 25.4 (10.9-39.9) for age > or = 80. These rates are considerably higher than those reported in the People's Republic of China, and similar to rates found in Western countries. The higher prevalence of PD found in this pilot study suggests that environmental factors may be more important than racial factors in the pathogenesis of PD. If confirmed, the results suggest that epidemiologic studies looking for environmental risk factors might be of value.

Aged↗
PubMed1994

Stroke associated with methamphetamine inhalation.

Seven patients (all men, mean age 32 years, range 17-47) with stroke following methamphetamine inhalation were collected during the last 2 years. Like oral or intravenous abusers, our patients had more hemorrhagic (n = 5) than ischemic strokes (n = 2). Cases of intracerebral hemorrhage (ICH) were lobar (n = 3), caudate (n = 1) or putaminal (n = 1), whereas the infarctions were both in the middle cerebral artery region. Each stroke event occurred within 3 days after drug use. Three patients had hypertension on admission. Though young in age, most patients had multiple stroke risk factors. In 3 patients with ICH, we also found small, low attenuated lesions on the brain computed tomography, however, without clinical correlations. Except for arteriovenous malformation in 1 patient, all angiograms failed to show vasculopathy or vasospasm. Contrary to what one might surmise from previously published reports, methamphetamine inhalation is at least as likely to produce ICH as it is to produce brain infarction.

Administration, Inhalation↗
PubMed1993

Sympathetic skin response and R-R interval variation in Parkinson's disease.

We investigated autonomic function in patients with idiopathic Parkinson's disease (PD) by measuring sympathetic skin response (SSR) and R-R interval variation (RRIV). Sixty-two PD patients and 62 age-matched normal subjects were recruited. Abnormal SSR was noted in nine (14.5%) PD patients, including three in Stage II, three in Stage III, and three in Stage IV, but not in Stage I patients or normal subjects. Four of these nine patients had postural hypotension. Abnormal SSR was correlated with duration of illness and impotence. In PD patients, abnormal SSR may be due to intermediolateral column dysfunction. After logarithmic transformation and age adjustment, 19 (31.6%) of 60 PD patients had abnormal RRIV during rest and deep breathing. Abnormal RRIV was not related to staging or duration of illness. Patients with constipation had significantly lower RRIV, indicating parasympathetic dysfunction. RRIV was not affected by acute or chronic L-dopa treatment. The agreement between RRIV and SSR in PD patients was poor (kappa = -0.07). It appears that abnormal SSR, but not RRIV, may be associated with more autonomic disturbances in PD patients.

Aged↗