OBJECTIVE: To study the effectiveness of cognitive enhancers for patients with mild to moderate A... more OBJECTIVE: To study the effectiveness of cognitive enhancers for patients with mild to moderate AD+svCVD in a clinic cohort. BACKGROUND: The prevalence of Alzheimer’s disease (AD) is increasing worldwide. Among Asians, high prevalence of small vessel cerebrovascular disease (svCVD) has resulted in AD+svCVD to be a major cause of dementia. There is limited data on the effectiveness of cognitive enhancers in these patients. DESIGN/METHODS: Retrospective analysis of a prospective clinical database. Demographics, cerebrovascular risk factors, medications and cognitive scores were studied. Patients with mild to moderate AD were included. AD was diagnosed using NINCDS-ADRDA criteria. White Matter Hyperintensities scored using the modified Fazekas scale, was used to diagnose svCVD. AD patients with a modified Fazekas score of 蠅6 were classified as AD+svCVD. Effectiveness of cognitive enhancers was compared between AD and AD+svCVD group using regression analyses. RESULTS: 192 patients were identified, 31 patients with AD and 161 patients with AD+svCVD. Mean age was 71.8 (SD 8.66) years. 84.9% of the patients were Chinese. 60.4% of the cohort had a diagnosis of hypertension. Baseline MMSE for AD+svCVD and pure AD were 20.0 (SD 5.38) and 22.9 (SD 4.68) respectively. Despite patients with AD+svCVD having significantly lower baseline MMSE scores, the rate of decline in MMSE in this group was lower compared to patients with pure AD and by month 24, the difference in MMSE between patients with AD+svCVD and pure AD were no longer significantly different. Based on 48 month data, with cognitive enhancer treatment, the annual change in MMSE among pure AD patients was -0.2 points/year while the change in MMSE score among AD+svCVD patients was +0.15 points/year. CONCLUSIONS: Our findings demonstrated a trend towards greater benefit with cognitive enhancers among patients with AD+svCVD compared to pure AD. These findings would need to be confirmed in randomized clinical trials. Disclosure: Dr. Ng has nothing to disclose. Dr. Ng has nothing to disclose. Dr. Heng has nothing to disclose. Dr. Huang has nothing to disclose. Dr. Assam has nothing to disclose. Dr. Kandiah has received personal compensation for activities with Lundbeck Research USA Inc., Novartis and Eisai Inc.
Background: To develop a model for collaborative care for persons with dementia and their family ... more Background: To develop a model for collaborative care for persons with dementia and their family caregivers in the San Francisco Bay Area. Methods:By delivering consistent compassionate care, strong relationships can be built between providers and the patients/families they work with. Listening carefully to desires and needs, including a desire to help others, practitioners can then work with their philanthropic organization to develop a business plan that can be supported with donations. The goal of the partnership is to provide newly diagnosed patients and their families a range of dementia related services, support and education as the disease progresses. Results: With extensive research and development effort, we were able to secure a $20 million (US$) endowment gift to create a Brain Health Center (BHC) at California Pacific Medical Center in San Francisco. This center will offer a multidisciplinary care team to diagnose, assess, treat, counsel and support families throughout the course of Alzheimer’s and related disorders. The team consists of medical providers in neurology, psychiatry, pharmacy and geriatric medicine, neuropsychologists and therapists, neuro-imaging, social work, physical and occupational therapy, nutrition and nursing. The team also includes staff employed by the Alzheimer’s Association but housed within the BHC to work as a member of the “Care Navigation Team”. Education programs including “Savvy Caregiver” classes, “Living with Alzheimer’s Disease,” "Know the Ten Signs of Alzheimer’s", “Maximizing Your Memory” and various caregiver training programs are offered through the BHC by the onsite Alzheimer’s Family Care Specialist. This clinician and other team members offer structured and unstructured groups, provide referrals to off-site support services/groups, answer questions about the disease process and smoothly lead patients/families through the healthcare maze. Conclusions: This poster presents a conceptual framework for creating partnerships that utilize the strengths of each institution to positively impact quality of dementia care, and allow easier access to resources to facilitate earlier diagnosis. Given the increasing need for patient and family services that is becoming difficult to finance, this manner of program building will fill a gap going forward. This project can serve as a model for replication at other centers.
Post-stroke cognitive impairment (PSCI) warrants early detection and management. We sought to dev... more Post-stroke cognitive impairment (PSCI) warrants early detection and management. We sought to develop a risk score for screening patients at bedside for risk of delayed PSCI. Ischemic stroke survivors with PSCI and no cognitive impairments (NCI) 3–6 months post-stroke were studied to identify candidate variables predictive of PSCI. These variables were used to develop a risk score using regression models. The score, and the best identified clinical cutoff point, underwent development, stability testing, and internal and external validation in three independent cohorts from Singapore and Hong Kong. Across 1,088 subjects, the risk score, dubbed CHANGE, had areas under the receiver operating characteristics curve (AUROC) from 0.74 to 0.82 in detecting significant risk for PSCI, and had predicted values following actual prevalence. In validation data 3–6 and 12–18 months post-stroke, subjects with low, medium, and high scores had PSCI prevalence of 7–23%, 25–58%, and 67–82%. CHANGE was ...
Background/Aims: Cognitive screening programmes may improve awareness and help at-risk subjects r... more Background/Aims: Cognitive screening programmes may improve awareness and help at-risk subjects receive earlier medical attention. Cognitive profiles of subjects who attend cognitive screening by personal choice (self-referred) compared to those where the referral was initiated by family members (family-referred) were compared. Methods: A cross-sectional survey of community subjects attending a cognitive screening initiative. Performance on the MMSE, Frontal Assessment Battery (FAB), Elderly Cognitive Assessment Questionnaire (ECAQ) and Even Briefer Assessment Scale for Depression was evaluated. Results: A total of 342 subjects with a mean age of 59.2 ± 9.0 years were screened. Overrepresentation of Chinese and Indian subjects and underrepresentation of Malay subjects was noted. The prevalence of cognitive impairment ranged from 7.0 to 9.6% depending on the screening instrument used. Of the 342 subjects, 267 were self-referred, while 75 subjects were family-referred. Family-referred...
ABSTRACTBackgroundThe pericapsular nerve group (PENG) block was first described for the treatment... more ABSTRACTBackgroundThe pericapsular nerve group (PENG) block was first described for the treatment of hip fracture, including neck of femur, in 2018. We hypothesise that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the emergency department (ED), for which it may be superior to fascia iliaca compartment block (FICB) and femoral nerve block (FNB).MethodsFrom October 2019 to July 2020, consecutive patients receiving regional anaesthesia for hip fracture in the ED of a single large regional hospital were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 minutes after regional anaesthesia. Maximal reduction in pain scores within 60 minutes were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 hours after regional anaesthesia and adverse even...
Objectives Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decli... more Objectives Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decline and death. Multidisciplinary MND clinics provide an integrated approach to management and facilitate discussion on advanced care directives (ACDs). The study objectives are to analyse (1) the prevalence of ACD in our MND clinic, (2) the relationship between ACD and patient demographics and (3) the relationship between ACD decision-making and variables such as NIV, PEG, hospital admissions and location of death. Methods Using clinic records, all patients who attended the MND clinic in Liverpool Hospital between November 2014 and November 2019 were analysed. Data include MND subtypes, symptom onset to time of diagnosis, time of diagnosis to death, location and reason of death. ACD prevalence, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) requirements were analysed. Results There were 78 patients; M:F=1:1. 44 (56%) patients were limb onset, 28 (36%) bulbar ...
Journal of Neurology, Neurosurgery & Psychiatry, 2019
IntroductionThe incidence of epilepsy is higher in patients with underlying dementia.1 The goal o... more IntroductionThe incidence of epilepsy is higher in patients with underlying dementia.1 The goal of the present study is to look at the incidence of dementia in patients presented to our epilepsy clinic and analyse electroencephalogram (EEG), imaging findings and response to antiepileptic drug (AED) in these individuals.MethodsA retrospective study was performed on patients presented to Nepean Hospital epilepsy clinic from 2015 to 2017. Multiple clinical parameters were obtained from electronic medical records.ResultsA total of 258 patients presented to the clinic, of which 38 patients were above the age of 65 years. 11 patients were excluded due to insufficient information or patients without any history of seizures. Out of the remaining 27 patients studied, nine patients (33%) had dementia including five patients (19%) with Alzheimer’s dementia. Sixteen patients (59%) experienced complex partial seizures. Brain MRI was performed in twenty one patients (78%). Sixteen patients (59%) ...
OBJECTIVE: To study the effectiveness of cognitive enhancers for patients with mild to moderate A... more OBJECTIVE: To study the effectiveness of cognitive enhancers for patients with mild to moderate AD+svCVD in a clinic cohort. BACKGROUND: The prevalence of Alzheimer’s disease (AD) is increasing worldwide. Among Asians, high prevalence of small vessel cerebrovascular disease (svCVD) has resulted in AD+svCVD to be a major cause of dementia. There is limited data on the effectiveness of cognitive enhancers in these patients. DESIGN/METHODS: Retrospective analysis of a prospective clinical database. Demographics, cerebrovascular risk factors, medications and cognitive scores were studied. Patients with mild to moderate AD were included. AD was diagnosed using NINCDS-ADRDA criteria. White Matter Hyperintensities scored using the modified Fazekas scale, was used to diagnose svCVD. AD patients with a modified Fazekas score of 蠅6 were classified as AD+svCVD. Effectiveness of cognitive enhancers was compared between AD and AD+svCVD group using regression analyses. RESULTS: 192 patients were identified, 31 patients with AD and 161 patients with AD+svCVD. Mean age was 71.8 (SD 8.66) years. 84.9% of the patients were Chinese. 60.4% of the cohort had a diagnosis of hypertension. Baseline MMSE for AD+svCVD and pure AD were 20.0 (SD 5.38) and 22.9 (SD 4.68) respectively. Despite patients with AD+svCVD having significantly lower baseline MMSE scores, the rate of decline in MMSE in this group was lower compared to patients with pure AD and by month 24, the difference in MMSE between patients with AD+svCVD and pure AD were no longer significantly different. Based on 48 month data, with cognitive enhancer treatment, the annual change in MMSE among pure AD patients was -0.2 points/year while the change in MMSE score among AD+svCVD patients was +0.15 points/year. CONCLUSIONS: Our findings demonstrated a trend towards greater benefit with cognitive enhancers among patients with AD+svCVD compared to pure AD. These findings would need to be confirmed in randomized clinical trials. Disclosure: Dr. Ng has nothing to disclose. Dr. Ng has nothing to disclose. Dr. Heng has nothing to disclose. Dr. Huang has nothing to disclose. Dr. Assam has nothing to disclose. Dr. Kandiah has received personal compensation for activities with Lundbeck Research USA Inc., Novartis and Eisai Inc.
Background: To develop a model for collaborative care for persons with dementia and their family ... more Background: To develop a model for collaborative care for persons with dementia and their family caregivers in the San Francisco Bay Area. Methods:By delivering consistent compassionate care, strong relationships can be built between providers and the patients/families they work with. Listening carefully to desires and needs, including a desire to help others, practitioners can then work with their philanthropic organization to develop a business plan that can be supported with donations. The goal of the partnership is to provide newly diagnosed patients and their families a range of dementia related services, support and education as the disease progresses. Results: With extensive research and development effort, we were able to secure a $20 million (US$) endowment gift to create a Brain Health Center (BHC) at California Pacific Medical Center in San Francisco. This center will offer a multidisciplinary care team to diagnose, assess, treat, counsel and support families throughout the course of Alzheimer’s and related disorders. The team consists of medical providers in neurology, psychiatry, pharmacy and geriatric medicine, neuropsychologists and therapists, neuro-imaging, social work, physical and occupational therapy, nutrition and nursing. The team also includes staff employed by the Alzheimer’s Association but housed within the BHC to work as a member of the “Care Navigation Team”. Education programs including “Savvy Caregiver” classes, “Living with Alzheimer’s Disease,” "Know the Ten Signs of Alzheimer’s", “Maximizing Your Memory” and various caregiver training programs are offered through the BHC by the onsite Alzheimer’s Family Care Specialist. This clinician and other team members offer structured and unstructured groups, provide referrals to off-site support services/groups, answer questions about the disease process and smoothly lead patients/families through the healthcare maze. Conclusions: This poster presents a conceptual framework for creating partnerships that utilize the strengths of each institution to positively impact quality of dementia care, and allow easier access to resources to facilitate earlier diagnosis. Given the increasing need for patient and family services that is becoming difficult to finance, this manner of program building will fill a gap going forward. This project can serve as a model for replication at other centers.
Post-stroke cognitive impairment (PSCI) warrants early detection and management. We sought to dev... more Post-stroke cognitive impairment (PSCI) warrants early detection and management. We sought to develop a risk score for screening patients at bedside for risk of delayed PSCI. Ischemic stroke survivors with PSCI and no cognitive impairments (NCI) 3–6 months post-stroke were studied to identify candidate variables predictive of PSCI. These variables were used to develop a risk score using regression models. The score, and the best identified clinical cutoff point, underwent development, stability testing, and internal and external validation in three independent cohorts from Singapore and Hong Kong. Across 1,088 subjects, the risk score, dubbed CHANGE, had areas under the receiver operating characteristics curve (AUROC) from 0.74 to 0.82 in detecting significant risk for PSCI, and had predicted values following actual prevalence. In validation data 3–6 and 12–18 months post-stroke, subjects with low, medium, and high scores had PSCI prevalence of 7–23%, 25–58%, and 67–82%. CHANGE was ...
Background/Aims: Cognitive screening programmes may improve awareness and help at-risk subjects r... more Background/Aims: Cognitive screening programmes may improve awareness and help at-risk subjects receive earlier medical attention. Cognitive profiles of subjects who attend cognitive screening by personal choice (self-referred) compared to those where the referral was initiated by family members (family-referred) were compared. Methods: A cross-sectional survey of community subjects attending a cognitive screening initiative. Performance on the MMSE, Frontal Assessment Battery (FAB), Elderly Cognitive Assessment Questionnaire (ECAQ) and Even Briefer Assessment Scale for Depression was evaluated. Results: A total of 342 subjects with a mean age of 59.2 ± 9.0 years were screened. Overrepresentation of Chinese and Indian subjects and underrepresentation of Malay subjects was noted. The prevalence of cognitive impairment ranged from 7.0 to 9.6% depending on the screening instrument used. Of the 342 subjects, 267 were self-referred, while 75 subjects were family-referred. Family-referred...
ABSTRACTBackgroundThe pericapsular nerve group (PENG) block was first described for the treatment... more ABSTRACTBackgroundThe pericapsular nerve group (PENG) block was first described for the treatment of hip fracture, including neck of femur, in 2018. We hypothesise that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the emergency department (ED), for which it may be superior to fascia iliaca compartment block (FICB) and femoral nerve block (FNB).MethodsFrom October 2019 to July 2020, consecutive patients receiving regional anaesthesia for hip fracture in the ED of a single large regional hospital were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 minutes after regional anaesthesia. Maximal reduction in pain scores within 60 minutes were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 hours after regional anaesthesia and adverse even...
Objectives Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decli... more Objectives Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decline and death. Multidisciplinary MND clinics provide an integrated approach to management and facilitate discussion on advanced care directives (ACDs). The study objectives are to analyse (1) the prevalence of ACD in our MND clinic, (2) the relationship between ACD and patient demographics and (3) the relationship between ACD decision-making and variables such as NIV, PEG, hospital admissions and location of death. Methods Using clinic records, all patients who attended the MND clinic in Liverpool Hospital between November 2014 and November 2019 were analysed. Data include MND subtypes, symptom onset to time of diagnosis, time of diagnosis to death, location and reason of death. ACD prevalence, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) requirements were analysed. Results There were 78 patients; M:F=1:1. 44 (56%) patients were limb onset, 28 (36%) bulbar ...
Journal of Neurology, Neurosurgery & Psychiatry, 2019
IntroductionThe incidence of epilepsy is higher in patients with underlying dementia.1 The goal o... more IntroductionThe incidence of epilepsy is higher in patients with underlying dementia.1 The goal of the present study is to look at the incidence of dementia in patients presented to our epilepsy clinic and analyse electroencephalogram (EEG), imaging findings and response to antiepileptic drug (AED) in these individuals.MethodsA retrospective study was performed on patients presented to Nepean Hospital epilepsy clinic from 2015 to 2017. Multiple clinical parameters were obtained from electronic medical records.ResultsA total of 258 patients presented to the clinic, of which 38 patients were above the age of 65 years. 11 patients were excluded due to insufficient information or patients without any history of seizures. Out of the remaining 27 patients studied, nine patients (33%) had dementia including five patients (19%) with Alzheimer’s dementia. Sixteen patients (59%) experienced complex partial seizures. Brain MRI was performed in twenty one patients (78%). Sixteen patients (59%) ...
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Papers by Aloysius Ng