Exploring the Impacts of Age at Menarche on Cognitive Aging in Late Adulthood: Evidence from a Mendelian Randomization Study on the Taiwanese Population.

INTRODUCTION: The potential influence of age at menarche (AM) on cognitive aging remains inadequate, partly because of the difficulties presented by multiple confounders. To address this issue, Mendelian randomization (MR) analysis was used to explore the causal impacts of AM on cognitive aging. METHODS: Using the publicly accessible Taiwan Biobank, we identified single nucleotide polymorphisms (SNPs) significantly associated with AM as instrumental variables to estimate the effects of instruments on cognitive function assessed with the Mini-Mental State Examination (MMSE). We employed several MR methods, including two-stage least squares, inverse variance weighting (IVW), MR-Egger, weighted median, weighted mode, and constrained maximum likelihood (cML) MR methods, to ensure the stability and reliability of the results. RESULTS: MR analyses indicated no significant causal relationship between genetically determined AMs and total and subdomain MMSE scores, except the G5 subdomain (ßIVW = 0.156, 95% confidence interval [CI]: 0.005, 0.307; ßcML = 0.161, 95% CI: 0.014, 0.309). However, in a leave-one-out sensitivity analysis, we found a significant relationship between AM and cognitive aging after eliminating rs157863 and rs6758290, thus demonstrating the potential pleiotropic effects of these two SNPs. After these two SNPs were eliminated, we found a significant causal relationship between AM and overall MMSE scores (ßIVW = 0.425, 95% CI: 0.011, 0.839), though. CONCLUSION: Evidence from the present MR study did not fully support a causal relationship between AM and cognitive function decline in later life. Potential pleiotropic effects of the genes underlying these two traits are worthy of further investigation.

Comparison of FAST and Stroke-112: A randomized study in Taiwan.

BACKGROUND/PURPOSE: FAST and Stroke-112 are two campaigns to reduce the emergency room arrival time of stroke patients. No study has compared the effectiveness of these campaigns. This study aimed to compare recalling capacity of people in these two campaigns. METHODS: A prospective, open-label randomized study was conducted in 2019. Recall ability for the items of the two campaigns on the 5th and 30th days post-education was compared using non-parametric methods. Subject characteristics including age, education level, presence of stroke in co-residents, and habitual language were evaluated using multiple ordered logistic regression. RESULTS: There were 202 participants in FAST group and 193 participants in Stroke-112 group who completed the study. No differences were observed between the two groups in recall ability, either on day 5 or day 30 after receiving education. For both campaigns, recall ability was better for signs in the face (FAST: 87.1%, Stroke-112: 86.5%) and the arm (FAST: 87.1%, Stroke-112: 88.1%) than for abnormality in speech (FAST: 78.7%, Stroke-112: 76.7%) on day 5. Recall ability on day 30 remained the same only for the arm item (FAST: 86.1%, Stroke-112: 88.6%). The recall ability was correlated to education level equal or more than 7 years in FAST group, and was inversely correlated to age and being a stroke patient in Stroke-112 group. CONCLUSION: We found no difference in recall ability between the 2 campaigns. Education level was associated with recallability of FAST, and age and stroke history were associated with recallability of Stroke-112.

Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan.

BACKGROUND: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan. METHODS: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies. RESULTS: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA2DS2-VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose .78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P = .016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality. CONCLUSION: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.

Role of stimulus types and valence on the affective memory performance of adults with anxiety.

Previous studies have found that the emotion of anxiety in adults is easily influence by negative stimuli However, few studies have explored the effect of stimulus types on working memory performance and cognitive processing of adults with anxiety. This study aimed to explore the effects of anxiety on affective working memory and the role of stimulus types and valences on affective working memory performance. Forty adults were recruited for the experiment and were divided into two groups according to their anxiety levels. The valence and type of stimulus were manipulated in a memory recognition experiment. The results indicated that individuals with anxiety performed poorer when subjected to positive stimuli than for neutral and negative stimuli, whereas healthy adults exhibited the opposite. Furthermore, participants outperformed on affective pictures than affective words, but the effect size of the words was larger than that of the pictures for the difference between the valence and anxiety groups. This study highlights the differences in affective working performance across stimulus types and valences between healthy adults and adults with anxiety. The findings clarified the effect of positive valence and affective words on the affective working memory processing mechanism in adults with anxiety.

Outcome of acute ischemic stroke in very elderly patients: is intravenous thrombolysis beneficial?

BACKGROUND/AIMS: Intravenous tissue plasminogen activator (tPA) treatment is recommended in acute stroke within 3 h of onset; however, the benefit of its use in the elderly remains uncertain. We assessed the safety and efficacy of tPA treatment in elderly patients. METHODS: We recruited 97 elderly Chinese patients aged ≥80 years with cerebral ischemia presenting within 3 h of onset. Favorable outcomes were defined as discharge to home and modified Rankin Scale (mRS) ≤2 at discharge. RESULTS: For moderate to severe patients (NIHSS ≥6), the baseline characteristics between the tPA (n = 30) and non-tPA (n = 41) group were not different. The proportion of patients discharged home was 56.7 and 61%, respectively (p = 0.72). For patients with baseline mRS ≤2, the frequency of discharged mRS ≤2 was not different (27.3% of the tPA group and 26.9% of the non-tPA group; p = 1.00). Symptomatic intracranial hemorrhage was 6.7 and 2.4%, respectively (p = 0.31). For minor stroke patients (NIHSS ≤5), tPA was not considered and the outcome of those discharged home and mRS ≤2 was 73 and 88%, respectively. CONCLUSION: Elderly patients can be treated safely with intravenous tPA, whereas our data did not support routine thrombolysis. Further randomized trials in the elderly are encouraged.

Effects of different takeover request interfaces on takeover behavior and performance during conditionally automated driving.

Automated driving is a developing trend that is coming to the consumer market, and conditionally automated driving (CAD) is anticipated to become the primary automated driving system. For enhancing both the comfort and security of human drivers in self-driving cars, the most significant concern of CAD is ensuring that not only can the driver conduct non-driving related tasks (NDRT) while automated driving is in progress, but also quickly and competently take over when the system reaches a limit and issues a takeover request (TOR). However, the level of distraction by NDRTs may affect the transition from automated driving to the human driver taking over. The focus of the present study was allowing a driver immersed in NDRTs to discover the TOR and take control of the driving quickly. A 3×2×2 factor experimental design was used: vehicle display interface information load (basic vs. prediction vs. advanced prediction interfaces); TOR information load (directional vs. non-directional information notifications); and degree of NDRT immersion (not performing vs. performing an NDRT when TOR prompt was issued). 48 participants were recruited, and different automotive display interfaces were used as TOR prompts with different information loads during driving to analyze the takeover behavior, performance, and subjective perception of the drivers, who were immersed in a smartphone-related task. The takeover process out of NDRT immersion was found to be more efficient with the advanced prediction interface, compared to the other two interfaces. All groups achieved faster takeovers and demonstrated better takeover performance if given directional rather than non-directional information, regardless of interface type or NDRT immersion.

Epidemiology and comorbidities of adult multiple sclerosis and neuromyelitis optica in Taiwan, 2001-2015.

BACKGROUND: The epidemiology of multiple sclerosis (MS) and neuromyelitis optica (NMO) remains to be clarified or updated in many parts of Asia. This study aims to investigate the epidemiology and comorbidities of MS and NMO during 2001-2015 in Taiwan. METHODS: We conducted a retrospective nationwide population-based study using data from Taiwan's National Health Insurance Research Database. Cases of MS and NMO aged 20 years or above during 2001-2015 were enrolled. The incidence, prevalence, demographic features, and comorbidities were investigated. RESULTS: We identified 4627 MS and 861 NMO incident cases aged 20 or above during 2003-2015. The incidence of MS was relatively stationary, while that of NMO apparently rose steeply during the study period. The age-standardized incidence rate of MS and NMO in 2015 were 1.34 and 0.61 per 100,000 person-years, respectively. The age-standardized prevalence rate of MS and NMO in 2015 were 6.69 and 1.47 per 100,000 persons, respectively. The female preponderance was evident for both MS and NMO. Except for diabetes mellitus, the most common autoimmune comorbidities for MS and NMO were Sjogren syndrome and systemic sclerosis, and Sjogren syndrome and systemic lupus erythematosus, respectively. CONCLUSIONS: Taiwan has transitioned from low- to medium-risk zone during 2001-2015 in terms of MS prevalence, although its incidence remained stationary. The apparent upsurge of NMO over the period probably reflects increased awareness of this clinical entity. Comorbid autoimmune disorders were relatively common, and overlapping but differential autoimmune comorbidity profiles were noted for MS and NMO.

Ramsay Hunt syndrome with hemiparesis and hemihypoesthesia: report of 2 cases.

Ramsay Hunt syndrome (RHS) complicated with encephalitis is rare, and the appearance of hemi-motosensory deficit in RHS is even rarer. We reported two such cases. Both patients had a peripheral type facial palsy, facial numbness and zoster in the ipsilateral ear canal. The consciousness was clear and cognitive function was normal. The functional deficits of extremities were ipsilateral to the facial palsy in one case, but contralateral in the other. Magnetic resonance imaging of the brain in both cases showed no abnormality. The manifestations were compared with two more cases from the literature.

Differences in road-crossing decisions between healthy older adults and patients with Alzheimer's disease.

INTRODUCTION: This study investigated the differences in road-crossing behavior among healthy older adults and patients with Alzheimer's disease (AD). METHOD: Twelve pedestrians with mild AD and 24 age-, gender-, and education-matched controls were examined with a battery of cognitive, visual, and motor tests. Using a simulated two-lane, one-way road-crossing situation, we determined the remaining time and safety margin for each participant in traffic situations involving different vehicle speeds (40 km/h vs. 60 km/h vs. 80 km/h), time gaps (5 s vs. 7 s vs. 9 s), and time of day (dusk vs. midday). RESULTS: We found that patients with AD were more vulnerable to traffic crash while crossing the road than healthy older adults (Odds Ratio = 2.50, P < 0.05). Compared with healthy older adults, patients with AD were more severely affected by daylight conditions, faster vehicle speed, and shorter time gap. Participants in both groups had a significantly higher risk of unsafe crossing behavior if they had lower scores on the Mini-Mental State Examination (MMSE), Complex Figure Test - recall (CFT-Recall), Trail Making Test (TMT) B-A, Useful Field of View (UFOV) - total, and Visual Form Discrimination (VFD). We also found that when given a long enough time gap (9 s), patients with AD and healthy older adults used similar safe road-crossing behaviors, independent of other factors. PRACTICAL APPLICATIONS: These results provide important suggestions for road design for patients with AD and healthy older adults during road-crossing.

Primary granulomatous angiitis of the central nervous system with amyloid angiopathy: a case report and literature review.

Primary angiitis of the central nervous system is a rare idiopathic inflammation of vessels. We report on a 75-year-old male with primary angiitis of the central nervous system and cerebral amyloid angiopathy. He presented with subacute onset of progressive decline in cognitive functions, followed by confusion and coma. Initial brain magnetic resonance imaging favored meningoencephalitis. There was no improvement after treatment with antibiotics. Final diagnosis was proven by brain biopsy. Corticosteroids were given, but without significant improvement. This case is reported because of its rarity and its clinical presentation.

Ambient temperature and spontaneous intracerebral haemorrhage: a cross-sectional analysis in Tainan, Taiwan.

OBJECTIVES: Ambient temperature has been reported to play a role in the occurrence of spontaneous intracerebral haemorrhage (ICH). This study aimed to investigate the relation between ambient temperature of onset time and ICH and the effect of hourly temperature within 72 h before ICH. DESIGN: This is a cross-sectional case-only study and a retrospective analysis of a prospective database. SETTING: Two medical centres in Southern Taiwan participating a prospective stroke registry. PARTICIPANTS: A total of 933 patients with ICH registered from August 2006 to July 2008. PRIMARY AND SECONDARY OUTCOME MEASURES: The hourly temperature was collected, and patients were grouped according to the deciles of hourly temperature at onset. Primary outcome was the association between the number of ICH cases and mean temperature (or temperature variation). Secondary outcome was the difference of onset temperature and hourly temperature before onset in patients with known onset time. RESULTS: Winter (n=282) had significant higher ICH cases than other seasons (n=651; p=0.002). Of those patients with an exact time of onset, the results showed 13% patients occurred at the lowest decile temperature group (<17.4°C) and 8% patients occurred at the highest decile temperature group (>30.8°C). It showed a significant temperature change before onset for these patients (p<0.005). CONCLUSIONS: This study showed that lower ambient temperature and variation of temperatures precipitated ICH in southern Taiwan. Better protecting vulnerable people from cold temperatures may prevent the occurrences of ICH.

Acute aortic dissection mimicking basilar artery occlusion in a patient presenting with sudden coma.

A 77-year-old female suddenly became comatose. Examination at the emergency room revealed stable vital signs and bilateral positive plantar reflexes but absent brainstem reflexes. Basilar artery occlusion was initially diagnosed and recombinant tissue plasminogen activator was administered. However, her blood pressure dropped after thrombolysis. A chest CT scan showed aortic dissection extending to the bilateral common carotid arteries. Her follow-up brain CT scan disclosed infarctions over bilateral carotid territories without brainstem involvement. Aortic dissection should be listed as a possible diagnosis in a patient who presents with a sudden coma mimicking basilar artery occlusion. Detailed clinical examination and discussion might lead to the correct diagnosis and avoid inadvertent thrombolysis in the emergency room.