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Characteristics and diagnostic profile of patients seeking dementia care in a memory clinic in Hong Kong

Published online by Cambridge University Press:  23 December 2008

Bun Sheng ,
Chun Bon Law  and
Kwan Mo Yeung
Bun Sheng*
Affiliation:
Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, People's Republic of China
Chun Bon Law
Affiliation:
Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, People's Republic of China
Kwan Mo Yeung
Affiliation:
Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, People's Republic of China
*
Correspondence should be addressed to: Bun Sheng, Department of Medicine and Geriatrics, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong. Phone: +852 299 01111; Fax: +852 27863629. Email: [email protected].
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Abstract

Background: Seeking medical advice for dementia involves an understanding of norms, values and attitudes towards care-giving and inter-dependency, which are culturally bounded. We hypothesize that local culture and socioeconomic structure affect our Chinese patients who present with forgetfulness to our memory clinic.

Methods: A retrospective case notes review was undertaken on 454 consecutive patients referred to the memory clinic at Princess Margaret Hospital, Hong Kong.

Results: 385 patients were diagnosed with dementia and 27 had mild cognitive impairment. Reversible dementia was identified in 24 patients and normal cognition in 18. In patients with dementia, 55.8% had Alzheimer's disease, 26.2% had vascular dementia, 6.0% had other irreversible dementia, 5.2% had dementia with Lewy bodies, 4.9% had undetermined dementia and 1.8% had frontotemporal dementia. The median duration from symptom onset to medical consultation was two years; 66.5% had advanced disease with initial Mini-mental State Examination scores ≤ 17. On their first visit, 85% of patients were living in the community; after two years this proportion had fallen to 63%.

Conclusions: Dementia patients in Hong Kong apparently enjoy a long subclinical period and only seek medical attention at late stages. Local Chinese culture and socioeconomic backgrounds could be the main reasons that underlie these observations.

Keywords

dementiaChineseculture
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 2 , April 2009 , pp. 392 - 400
Copyright
Copyright © International Psychogeriatric Association 2008

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References

Alladi, S., Arnold, R., Mitchell, J., Nestor, P. J. and Hodges, J. R. (2006). Mild cognitive impairment: applicability of research criteria in a memory clinic and characterization of cognitive profile. Psychological Medicine, 36, 507–515.CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn, international version). Washington, DC: American Psychiatric Association.Google Scholar
Biessels, G. J., Koffeman, A. and Scheltens, P. (2006). Diabetes and cognitive impairment: clinical diagnosis and brain imaging in patients attending a memory clinic. Journal of Neurology, 253, 477–482.CrossRefGoogle ScholarPubMed
Cattel, C., Gambassi, G., Sgadari, A., Zuccala, G., Carbonin, P. and Bernabei, R. (2000). Correlates of delayed referral for the diagnosis of dementia in an outpatient population. Journal of Gerontology, 55A, M98–M102.Google Scholar
Chiu, H. F. K. et al. (1998). Prevalence of dementia in Chinese elderly in Hong Kong. Neurology, 50, 1002–1009.CrossRefGoogle ScholarPubMed
Dilworth-Anderson, P. and Gibson, B. E. (2002). The cultural influence of values, norms, meanings and perceptions in understanding dementia in ethnic minorities. Alzheimer Disease and Associated Disorders, 16 (Suppl. 2), S56–S63.CrossRefGoogle ScholarPubMed
Elberling, T. V., Stokholm, J., Høgh, P., and Waldemar, G. (2002). Diagnostic profile of young and middle-aged memory clinic patients. Neurology, 59, 1259–1262.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D. et al. (2003). Tailoring psychological interventions for ethnically diverse dementia caregivers. Clinical Psychology: Science and Practice, 10, 423–438.Google Scholar
Hejl, A., Hogh, P. and Waldemar, G. (2002). Potentially reversible conditions in 1000 consecutive memory clinic patients. Journal of Neurology, Neurosurgery and Psychiatry, 73, 390–394.CrossRefGoogle ScholarPubMed
Heyman, A. et al. (1998). Cerebral infarcts in patients with autopsy-proven Alzheimer's disease: CERAD, part XVIII. Neurology, 51, 159–162.CrossRefGoogle ScholarPubMed
Knopman, D. S. et al. (2001). Practice parameter: diagnosis of dementia (an evidence-based review). Neurology, 56, 1143–1153.CrossRefGoogle ScholarPubMed
Kua, E. H., Tan, S. L., Lee, K. S., Ko, S. M. and Tan, C. H. (1997). The NUH Memory Clinic. Singapore Medical Journal, 38, 112–115.Google ScholarPubMed
Lim, W. S., Chin, J. J., Lam, C. K., Lim, P. P. J. and Sahadevan, S. (2005). Clinical dementia rating: experience of a multi-racial Asian population. Alzheimer Disease and Associated Disorders, 19, 135–142.CrossRefGoogle ScholarPubMed
Livingston, G. (1994). The scale of the problem. In Burns, A. and Levy, R. (eds.), Dementia (pp. 21–34). London: Chapman & Hall.CrossRefGoogle Scholar
Luce, A., McKeith, I., Swann, A., Daniel, S. and O'Brien, J. (2001). How do memory clinics compare with traditional old age psychiatry services? International Journal of Geriatric Psychiatry, 16, 837–845.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993) The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.CrossRefGoogle ScholarPubMed
Richards, S. S. and Hendric, H. C. (1999). Diagnosis, management and treatment of Alzheimer's disease: a guide for the internist. Archives of Internal Medicine, 159, 789–798.CrossRefGoogle ScholarPubMed
Román, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250–260.CrossRefGoogle ScholarPubMed
Rosen, W. G., Mohs, R. C. and Davis, K. L. (1984). A new rating scale for Alzheimer's disease. American Journal of Psychiatry, 141, 1356–1364.Google ScholarPubMed
Royall, D. R., Cordes, J. A. and Polk, M. (1998). CLOX: an executive clock drawing task. Journal of Neurology, Neurosurgery and Psychiatry, 64, 588–594.CrossRefGoogle ScholarPubMed
Schramm, U., Berger, G., Műller, R., Kratzsch, T., Peters, J. and Frölich, L. (2002). Psychometric properties of clock drawing test and MMSE or short performance test (SPT) in dementia screening in a memory clinic population. International Journal of Geriatric Psychiatry, 17, 254–260.CrossRefGoogle ScholarPubMed
Selwyn, J., Findlay, D. J. and McMurdo, M. E. T. (2006). Diagnoses and vascular risk factors in a cohort of 150 attendees at a memory clinic. International Journal of Geriatric Psychiatry, 21, 1101–1102.CrossRefGoogle Scholar
Seshadri, S. et al. (2002). Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. New England Journal of Medicine, 346, 476–483.CrossRefGoogle ScholarPubMed
Shinagawa, S. et al. (2007). Frequency and clinical characteristics of early-onset dementia in consecutive patients in a memory clinic. Dementia and Geriatric Cognitive Disorders, 24, 42–47.CrossRefGoogle ScholarPubMed
Snowdon, D. A., Greiner, L. H., Mortimer, J. A., Riley, K. P., Greiner, P. A. and Markesbery, W. R. (1997). Brain infarction and the clinical expression of Alzheimer's disease: the Nun Study. JAMA, 277, 813–817.CrossRefGoogle ScholarPubMed
Stratford, J. A., Logiudice, D., Flicker, L., Cook, R., Waltrowicz, W. and Ames, D. (2003). A memory clinic at a geriatric hospital: a report on 577 patients assessed with the CAMDEX over 9 years. Australian and New Zealand Journal of Psychiatry, 37, 319–326.CrossRefGoogle Scholar
van der Flier, W. M., Pijnenburg, Y. A. L., Schoonenboom, S. N. M., Dik, M. G., Blankenstein, M. A. and Scheltens, P. (2008). Distribution of APOE genotypes in a memory clinic cohort. Dementia and Geriatric Cognitive Disorders, 25, 433–438.CrossRefGoogle Scholar
van Hout, H et al. (2001). CAMDEX, can it be more efficient? Observational study on the contribution of four screening measures to the diagnosis of dementia by a memory clinic team. International Journal of Geriatric Psychiatry, 16, 64–69.3.0.CO;2-4>CrossRefGoogle Scholar