Season of Birth in Patients with Schizophrenia in Thailand.

Objective: An excess of schizophrenia births in the winter or spring is a well-known finding in Western studies; however, few studies from equatorial regions have been done. Our purpose is to investigate the seasonality of schizophrenia births in Thailand. Methods: This was a retrospective study in which patients with schizophrenia were identified from computerized records at Thammasat University Hospital. The Edwards test was used to detect any birth seasonality patterns among the patients with schizophrenia. Subsequently, the data were compared against the general population birth month data to examine potential seasonal effects using the Walter-Elwood seasonality test. Results: There are 949 patients with schizophrenia, with a mean age of 39.3 years. The results demonstrate no evidence of distinctive seasonality in birth patterns among patients with schizophrenia (P = .329). The overall monthly distribution of births did not differ between the general population and patients with schizophrenia (P = .365). Conclusion: In Thailand, a tropical country, there does not appear to be an effect of season of birth and the later development of schizophrenia.

Cognitive impairments predict the behavioral and psychological symptoms of dementia.

Introduction: The purpose of this study was to (1) validate the Thai version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) as a screening tool for behavioral and psychological symptoms of dementia (BPSD), and (2) examine the relationship between cognitive performance and BPSD in an elderly population with amnestic mild cognitive impairment (aMCI) and dementia of Alzheimer's type (DAT). Methods: One hundred and twenty participants, comprising 80 aMCI and 40 DAT patients, and their respective caregivers were included in the study. Participants completed the NPI-Q and the Neuropsychiatric Inventory (NPI) within 2 weeks of each other and cognitive performance was primarily assessed using the Montreal Cognitive Assessment (MoCA). Results: The Thai NPI-Q had good validity and reliability. Pure exploratory bifactor analysis revealed that a general factor and a single-group factor (with high loadings on delusions, hallucinations, apathy, and appetite) underpinned the NPI-Q domains. Significant negative correlations between the MoCA total score and the general and single-group NPI-Q scores were found in all subjects (aMCI + DAT combined) and DAT alone, but not in aMCI. Cluster analysis allocated subjects with BPSD (10% of aMCI and 50% of DAT participants) into a distinct "DAT + BPSD" class. Conclusion: The NPI-Q is an appropriate instrument for assessing BPSD and the total score is largely predicted by cognitive deficits. It is plausible that aMCI subjects with severe NPI-Q symptoms (10% of our sample) may have a poorer prognosis and constitute a subgroup of aMCI patients who will likely convert into probable dementia.

Clinical Risk Score for Predicting Vascular Dementia after Ischemic Stroke in Thailand.

Background: Poststroke dementia is an important consequence of stroke and warrants early prevention, detection, and management. The objective of the study was to develop a simple clinical risk score for predicting risk of vascular dementia in patients with ischemic stroke. Methods: The design was a prospective cohort study with 177 ischemic stroke survivors. A standard stroke evaluation was performed at admission, and dementia evaluation was conducted at six months after stroke. The significant predictors were used to develop a risk score using a multivariable logistic regression model. Results: Six months after stroke, 27.1% of the patients were diagnosed with vascular dementia. Five predictors were used in the risk score: age, education, history of stroke, white matter hyperintensities, and stroke subtype. The risk score had an area under receiver operating characteristic curve (AuROC) of 0.76, 72.9% sensitivity, and 79.1% specificity in predicting risk of vascular dementia. The predicted probability of vascular dementia for each risk score point was also reported. Conclusion: The clinical risk score had an acceptable accuracy in predicting vascular dementia in ischemic stroke survivors. It can be used for identifying those who are at a high risk of developing vascular dementia.

Factors Predicting 150 and 200 Microgram Adenosine Requirement during Four Increasing Doses of Intracoronary Adenosine Bolus Fractional Flow Reserve Assessment.

Direct intracoronary adenosine bolus is an excellent alternative to intravenous adenosine fractional flow reserve (FFR) measurement. This study, during four increasing adenosine boluses (50, 100, 150, and 200 mcg), aimed to explore clinical and angiographic predictors of coronary stenotic lesions for which the significant ischemic FFR (FFR ≤ 0.8) occurred at 150 and 200 mcg adenosine doses. Data from 1055 coronary lesions that underwent FFR measurement at the Central Chest Institute of Thailand from August 2011 to July 2021 were included. Baseline clinical and angiographic characteristics were analyzed. The FFR ≤ 0.8 occurred at adenosine 150 and 200 mcg boluses in 47 coronary lesions, while the FFR ≤ 0.8 occurred at adenosine 50 and 100 mcg boluses in 186 coronary lesions. After univariable and multivariable logistic regression analyses, four characteristics, including male sex, younger age, non-smoking status, and FFR procedure of RCA, were predictors of the occurrence of FFR ≤ 0.8 at adenosine 150 and 200 mcg doses. Combining all four predictors as a predictive model resulted in an AuROC of 0.72 (95% CI: 0.68-0.76), an 86% negative predictive value. Comparing these four predictors, the FFR procedure of RCA gave the most predictive power, with the AuROC of 0.60 (95% CI: 0.56-0.63).

Clinical Prediction Scoring Scheme for 24 h Mortality in Major Traumatic Adult Patients.

A death rate of approximately 32.7 in 100,000 traffic injury victims was reported in Thailand. The prediction of early death would identify and enable prioritization of the most severe patients for resuscitation and consequently reduce the number of deaths. This study aimed to develop a clinical prediction scoring system for 24 h mortality in adult major trauma patients. Retrospective-prognostic clinical prediction was applied in the case of 3173 adult trauma patients who were classified into three groups: death within 8 h, death between 8 and 24 h, and alive at 24 h. The predictors were obtained by univariable and multivariable logistic regression, and the coefficient of parameters was converted to predict early death. The numbers of patients who died within 8 h and between 8 and 24 h were 46 (1.5%) and 123 (3.8%), respectively. The predictors included systolic blood pressure <90 mmHg, heart rate ≥120 bpm, Glasgow coma scale ≤8, traffic injury, and assault injury. The scores of 4 indicated a mortality rate of 12% with a high specificity of 0.89. The suggested TERMINAL-24 scoring system can be used for the prediction of early death in the Emergency Department. However, its discrimination ability and precision should be validated before practical use.

Clinical predictive score for detecting nonalcoholic fatty liver disease with significant fibrosis in patients with metabolic syndrome.

ABSTRACT: Patients with metabolic syndrome are at a higher risk of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis than the general population. Still, accessibility of screening method for NAFLD with significant fibrosis, such as transient elastography (FibroScan) are limited in some settings. This study aimed to develop a simple clinical predictive score for detecting NAFLD with significant fibrosis in patients with metabolic syndrome.A cross-sectional study was designed to obtain the data from medical records of all relevant patients who underwent transient elastography between January 2011 and December 2020 at Siriraj Hospital, Thailand. A liver stiffness cutoff value of 7.0 kilopascal was used to define the presence of significant liver fibrosis. To examine potential predictors, medical history and clinical data commonly assessed in routine practice were selected by following expert opinions and univariable statistical analysis. Backward and forward stepwise logistic regression was performed to acquire a final prediction model. To simplify the model, a weighted score was assigned for each categorized predictor. In addition, eligible cutoff values of the score and their predictive performances were determined.A total of 745 medical records were reviewed. The prevalence of NAFLD with significant fibrosis in patients with metabolic syndrome was 12.6%. Most clinical characteristics of patients with NAFLD with significant fibrosis and those non-NAFLD and NAFLD with no/mild fibrosis were quite disparate. The most practical model comprised globulin, aspartate transaminase, platelet count, and type 2 diabetes. It provided a good predictive performance with an area under the receiver operating characteristic curve of 0.828 (95% confidence interval [CI]: 0.782, 0.874). At the proper cutoff value, sensitivity and specificity were 76.6% (95% CI: 66.7%, 84.7%) and 72.4% (95% CI: 68.7%, 75.8%), respectively. The likelihood ratio of testing positive for NAFLD with significant fibrosis was 2.8 (95% CI: 2.34, 3.27) among patients with scores above the cutoff value.The first score for detecting of NAFLD with significant fibrosis in patients with metabolic syndrome was developed. This practical score, providing a good predictive performance, should be useful to help clinicians prioritize needs for further investigations among high-risk patients, especially in resource-limited settings.

Adjusting the Thai version of the Addenbrooke's Cognitive Examination III for education to screen for dementia.

Aim: To examine whether education adjusted cut-off points of the Thai version of the ACE-III improve diagnostic accuracy in the detection of mild cognitive impairment (MCI) and dementia. Materials & methods: There were 172 participants consisting of 70 normal controls, 49 people with MCI and 53 patients with dementia. Results: To screen for MCI, the adjusted for education method yielded greater accuracy for the area under the receiver operating characteristic curve (AuROC) than the unadjusted method (0.9-0.92 vs 0.86). For the detection of dementia, when applying the education correction, AuROC increased from 0.87 (unadjusted) to 0.91 for the education >6 group, but there was no improvement for education ≤6 group (AuROC 0.86). Conclusion: The use of adjusted cut-off score for education level could increase the diagnostic accuracy of the test.

Lay abstract This study aimed to evaluate the ability of the Thai version of the Addenbrooke's Cognitive Examination-III to detect mild cognitive impairment and dementia. Since educational level often affects cognitive test performance, in this study we adjusted the cut-off score according to the educational level to improve the test utility. Our results show that the Thai version of the Addenbrooke's Cognitive Examination-III is a valid cognitive instrument for detecting mild cognitive impairment and dementia. In addition, adjusting the cut-off scores for education level is found to enhance the accuracy of the test.

Interplay among positive and negative symptoms, neurocognition, social cognition, and functioning in clinically stable patients with schizophrenia: a network analysis.

Background: Schizophrenia has a broad range of interrelated symptoms and impairment in functioning. The objective of the study was to explore the interplay between positive symptoms, negative symptoms, neurocognition, social cognition and functional outcome in patients with schizophrenia using network analysis. Methods: Participants were 64 clinically stable patients with schizophrenia. Psychopathologic, neurocognition, social cognition, and functional outcome were measured using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Addenbrooke's Cognitive Examination III, Faces test, Reading the Mind in the Eyes test, and Personal Social Performance scale. Results: The network analysis suggested that functional outcome was the most central in the network followed by avolition and asociality. Functioning was directly connected to avolition, asociality, blunted affect, neurocognition and emotion recognition. The positive symptoms were the most remote and therefore the least important node. Conclusion: The high centrality of functioning suggests the need for improving of everyday life skills for patients with schizophrenia. Moreover, treatment of specific negative symptoms, neurocognition and emotion recognition could also enhance functional outcome.

Effectiveness of Cannabinoids for Treatment of Dementia: A Systematic Review of Randomized Controlled Trials.

Objective: In the last decade, research has focused on developing novel medications for the treatment of dementia. Cannabinoids are one of the potential agents under investigation. The present study aimed to examine the evidence concerning the effectiveness of cannabinoids for the treatment of dementia. Methods: We undertook a systematic review complying to PRISMA guidelines. Four databases were searched including Medline, Embase, Cochrane Library, and PsychINFO. Results: Five studies evaluated the use of cannabinoids for anorexia and agitation in dementia. One study used dronabinol 5 mg/day to target anorexic symptoms of dementia which positively impacted on weight. Results of two trials investigating the effectiveness of tetrahydrocannabinol (THC) 1.5-4.5 mg/day for the treatment of agitation indicated no significant differences between THC and placebo. The most recent trial reported significant improvement in agitation using nabilone at 1-2 mg/day. However, levels of evidence of these agents were rated as low and very low because of low sample size and methodology issues. No studies were available that investigated the use of cannabinoids to moderate cognitive symptoms in dementia. Conclusions: Findings from a few robust randomized controlled trials suggest that nabilone might be useful for the treatment of agitation in patients with dementia, but there is no convincing evidence for THC. Additional studies are needed to further clarify and assess the benefits of these treatments. Clinical Implications: There were no randomized controlled trials investigating the use of cannabinoids for the treatment of cognitive decline in dementia. Studies on THC reported no significant improvement in agitation. It may be too early to postulate that cannabinoids have any effect on dementia symptoms or their progression.

Psychological impacts on patients with COVID-19 in a Thai field hospital

ABSTRACT Objective: This study investigates the psychological impacts and their associated factors on patients with COVID-19 at a Thai field hospital. Methods: All eligible patients confirmed to have COVID-19 at Thammasat University field hospital completed an online self-reported mental health screening questionnaire which collected sociodemographic data, their clinical characteristics, and used the depression, anxiety, and stress scale (DASS-21). Results: A total of 40 patients participated in the study. The depression rate was found to be 22.5%, while the anxiety rate was 30%, and the stress rate was 20%. Having a history of psychiatric disorder alone was significantly associated with a higher DASS-21 score (p = 0.001). Meanwhile, gender, age, level of education, occupation, living status, severity of COVID-19, and the number of days admitted to hospital prior to the field hospital were not found to be associated with the DASS-21 scores (P > 0.05). Conclusion: The depression, anxiety, and stress symptoms in patients with COVID-19 at the field hospital were common. Patients with a history of psychiatric disorder should undergo specific evaluation during the isolation phase.

Screening Test on Metabolic Syndrome Using Electro Interstitial Scan Instrument.

BACKGROUND: Metabolic syndrome is diagnosed using clinical and laboratory data. Electro interstitial scan (EIS) is a rapid and noninvasive screening. It measures and calculates the parameters to reflect hypertension, sympathetic activity, stiffness of the arteries, body fat composition, leptin and insulin resistance. Metabolic syndrome will be diagnosed if calculated score ≥10 CU. PURPOSE: To evaluate the accuracy, validity and appropriate cut-off score to diagnose metabolic syndrome. MATERIALS AND METHODS: A cross-sectional study was conducted using the population-based approach. Metabolic syndrome was diagnosed according to the modified National Cholesterol Education Program (NCEP ATP III) and International Diabetes Federation (IDF) criteria. The appropriate cut-off score to diagnose metabolic syndrome by instrument was determined. RESULTS: A total of 253 participants were enrolled with mean age of 40.06±6.33 years, and 64.43% (163/253) were female. Metabolic syndrome was diagnosed among 123 (48.62%) and 104 (41.11%) patients according to the NCEP ATP III and IDF criteria, respectively. The diagnostic indices of metabolic syndrome score ≥10 CU had a sensitivity of 23.6% and 27.9%, a specificity of 100% and area under ROC of 0.62 and 0.64, according to the NCEP ATP III and IDF criteria, respectively. The best cut-off level of metabolic syndrome score was ≥9 CU with a sensitivity of 79.67% (95% CI, 71.5-86.4%) and 88.46% (95% CI, 80.7-93.9%), a specificity of 96.92% (95% CI, 92.3-99.2%) and 93.29% (95% CI, 88.0-96.7%) and area under ROC 0.89 (95% CI, 0.85-0.93) and 0.92 (95% CI, 0.88-0.95), respectively, according to the NCEP ATP III and IDF criteria. CONCLUSION: Screening of metabolic syndrome using ES TECK in a Thai population demonstrated inadequate accuracy when using metabolic syndrome score ≥10 CU. We recommend using a metabolic syndrome score ≥9 CU to provide the best accuracy. This instrument is safe, fast and easy to use for metabolic syndrome screening.

Negative and Neutral Valences of Affective Theory of Mind are More Impaired than Positive Valence in Clinically Stable Schizophrenia Patients.

OBJECTIVE: People with schizophrenia show impairment in social cognition, such as emotion recognition and theory of mind. The current study aims to compare the ability of clinically stable schizophrenia patients to decode the positive, negative and neutral affective mental state of others with educational match-paired normal control. METHODS: 50 people with schizophrenia and 50 matched controls were compared on the positive, negative and neutral emotional valence of affective theory of mind using the Reading the Mind in the Eyes Tests. RESULTS: The results showed that people with schizophrenia performed worse in negative and neutral emotional valence than normal controls; however, no significant differences in decoding positive valence were found. CONCLUSION: Our data suggest that there is variability in the performance of affective theory of mind according to emotion valence; the impairments seem to be specific to only negative and neutral emotions, but not positive ones.

Incidence and risk factors of vascular dementia in Thai stroke patients.

BACKGROUND: Besides disability in stroke survivors, vascular cognitive impairment (VCI) can prevent these patients from living independently. The purpose of this study is to look for the incidence and risk factors of vascular dementia in Thai patients with stroke. METHODS: Adults patients with ischemic stroke were prospectively included. Cognitive assessment was performed at 3-6 months after stroke onset. Montreal Cognitive Assessment (MOCA)- Thai version was used to evaluate cognitive function, with the cutoff point of 24/25 of MOCA to define cognitive impairment/normal cognition. Vascular mild cognitive impairment (VMCI) and vascular dementia (VAD) were diagnosed in those with cognitive impairment. Epidemiologic data, Apolipoprotein E (ApoE) status, and stroke characteristics were compared between patients with and without VAD. RESULTS: There were 180 patients with the mean age of 65 years. Median time after stroke onset to have cognitive assessment was 6 months. Ninety patients (50%) had VMCI. VAD was diagnosed in 49 patients (27%). Mean Thai version of mental state examination (TMSE) and MOCA scores in patients with VAD were 20 and 12, respectively. Multivariate analysis showed that older age (OR 4.994, 95%CI 1.602-15.565, p-value = 0.006), lower education (OR 10.306, 95%CI 3.162-33.586, p-value < 0.001), history of stroke (OR 4.959, 95%CI 1.036-23.741, p-value = 0.045) and moderate to severe cerebral white matter lesions (OR 5.555, 95%CI 1.710-18.041, p-value = 0.004) were associated with VAD. ApoE 4 allele was found in 25% of the patients, but the presence did not show any association with the increased risk of VAD. CONCLUSIONS: VAD occurred in 27% of the stroke patients. Older age, low education level, history of stroke, and the presence of moderate to severe white matter lesions were associated with the increased risk of VAD.

Preliminary study of the Thai-version of the Scale for the Assessment of Positive Symptoms (SAPS-Thai): content validity, known-group validity, and internal consistency reliability

Abstract Objective To assess the psychometric properties of the Thai version of the Scale for the Assessment of Positive Symptoms (SAPS-Thai). Methods Content validity was evaluated by four psychiatrists who rated the SAPS-Thai, and the content validity indexes (CVI) were also analyzed. Known-group validity was assessed by comparing the SAPS-Thai score among thirty outpatients and ten inpatients with schizophrenia. Internal consistency was calculated using the Cronbach's coefficient alpha. Results SAPS-Thai has excellent content validity, with an average-CVI of 0.92. The inpatient group had a significant higher score for both the global SAPS-Thai scores [7.4 (1.95) vs. 1.93 (1.59), p < 0.001] and total SAPS-Thai scores [21.2 (11.8) vs. 3.67 (2.87), p < 0.001] indicating good known-group validity. SAPS-Thai had a good internal consistency with a Cronbach's alpha of 0.87. Discussion SAPS-Thai provides a comprehensive measurement of positive symptoms and indicated content and known-group validity and a satisfactory level of internal consistency reliability.

Diagnostic accuracy of the Thai version of the Mini-Addenbrooke's Cognitive Examination as a mild cognitive impairment and dementia screening test.

AIM: To examine the diagnostic accuracy of the Thai version of the Mini-Addenbrooke's Cognitive Examination (MACE-T) for detecting mild cognitive impairment and dementia. METHODS: Participants consisted of 60 controls, 40 people with mild cognitive impairment (MCI) and 48 people with dementia. All participants completed the Thai version of the Addenbrooke's Cognitive Examination - III (ACE-T) and the MACE-T scores were obtained from items within the ACE-T. RESULTS: A cut-off score of 21/22 detected MCI with a sensitivity of 95% (95% confidence interval (CI): 86.1-100) and specificity of 85% (95% CI: 77.8-93.4). A cut-off score of 16/17 detected dementia with a sensitivity and specificity of 95.8% (95% CI: 88.2-100) and 85% (95% CI: 76.4-89.7), respectively. Using Bayes theorem, the MACE-T demonstrated high negative predictive values (> 94%) for diagnosing MCI and dementia, independent of their prevalence rates. Education was the only significant predictor of performance in the MACE-T. CONCLUSION: The MACE-T is a good short cognitive screening test with high diagnostic accuracy for screening for MCI and dementia.

Detecting cognitive impairment in patients with schizophrenia with the Addenbrooke's Cognitive Examination.

OBJECTIVE: To assess the feasibility of the Addenbrooke's Cognitive Examination III (ACE) in detecting cognitive deficits in people with schizophrenia and to examine the profile of cognitive impairments. METHODS: There were 32 participants with schizophrenia and 32 normal controls were carried out at Thammasat University Hospital, Thailand. They were matched 1:1 using comparable age and educational level. All participants completed the ACE. RESULTS: Schizophrenia patients had lower mean totals in their ACE scores than normal controls [82.9(8.4) vs 89.6(6.1), p < 0.001]. Analysis of the individual cognitive subdomains demonstrated that patients performed significantly worse than normal controls on three subdomains: attention (p 0.007), memory (p 0.003) and verbal fluency (p 0.018). There were no statistically significant differences in the language (p 0.223) and visuospatial ability domains (p 0.055). CONCLUSIONS: The ACE can detect the cognitive deficits in people with schizophrenia. They had a lower cognitive function compared to the normal controls.

Comparison of Computerized and Standard Cognitive Test in Thai Memory Clinic.

BACKGROUND: Computer-based Thai Cognitive Test or Computer-based Thai Mental State Examination (cTMSE) was developed aiming to help doctors to easily get the accurate results of TMSE in a routine, busy outpatient clinics. The purpose of this study was to compare the evaluation process in terms of feasibility, duration of the test, participants/administrator preference, and the results of cognitive test between cTMSE and the standard Thai Mental State Examination (sTMSE). METHODS: Twenty-two elderly participants (>60 years old) who were not demented and 22 patients with mild-to-moderate dementia were included in the study. All participants would be asked to have TMSE by standard method (sTMSE) and computer-based method (cTMSE), at least 2 weeks and up to 2 months apart. Scores and duration of the test were compared using dependent paired t-test. Agreement of the tests between two methods and Kappa statistics were analyzed. RESULTS: Paired t-test showed no significant difference in scores between the two methods (mean sTMSE vs. cTMSE: 22.84 vs. 22.62, 95% confidence interval [CI]: [-0.465] to 0.987, P = 0.524). Percent of agreement between the two methods was 92.5%, with the Kappa of 0.85 (P < 0.001). Duration of the test by sTMSE was slightly shorter than the cTMSE (7.31 min vs. 7.97 min, 95% CI: [-1.159] to [-0.175], P = 0.09). Overall, participants liked being tested by cTMSE more than sTMSE. CONCLUSION: Computer-based TMSE was feasible to use and accurate for screening in aging adults and for cognitive evaluation in patients with mild-to-moderate dementia.

The Reading the Mind in the Eyes Test: Validity and Reliability of the Thai Version.

BACKGROUND AND OBJECTIVE: Until now there has not been a validated measure of theory of mind available in the Thai language. Our goal in this study was to assess the validity and reliability of our Thai-language translation of the Reading the Mind in the Eyes Test (the "Eyes Test"). METHODS: We gave our Thai version of the Eyes Test to 70 participants: 30 people with schizophrenia and 40 normal controls. We also gave Thai versions of the Faces Test and the Addenbrooke's Cognitive Examination to assess convergent validity. RESULTS: For known groups validity, the controls scored significantly higher than the participants with schizophrenia on the Eyes Test: 24.6 (standard deviation=3.9) versus 18.2 (standard deviation=4.1), P<0.001. The Eyes Test correlated with the Addenbrooke's Cognitive Examination (r=0.68, P<0.001) and the Faces Test (r=0.51, P<0.001). Internal consistency by the Cronbach alpha for the Eyes Test was 0.7, and test-retest reliability by intraclass correlation was 0.92 (P<0.001). CONCLUSIONS: The Thai version of the Eyes Test is a valid and reliable measurement that can be used in clinical practice and in future investigations of theory of mind in neurologic and psychiatric disorders.

Natural course and predictors of severe disability and death in Thai patients with dementia.

More than half of patients with dementia lived in countries with low and middle incomes. However, there have been few studies on the natural course of disease in these countries. The purpose of this study was to study the natural course and the predictive factors of advanced stage and death in Thai patients with dementia. Patients with dementia who were treated in neurologic and psychiatric clinic from September 2004 to February 2016, were included. Data about natural course of diseases, behavioral and psychological symptoms in dementia (BPSD) and complications were studied. 207 patients were included. Mean age was 77years old. Mean Thai Mental State Examination (TMSE) was 17.5. Alzheimer's disease was the most common cause of dementia (55%). With the mean follow-up of 39months (range from 2 to 126months), 64% of the patients had BPSD. Sixty-two patients (30%) had complications required admission. Seven patients died. Fifty-four patients (29%) ended in the advanced stage of dementia. Mean duration from diagnosis to the advanced stage was 49months. Complications that required admission usually occurred in moderate to severe dementia and were strongly associated with the advanced stage or death (OR 6.1, 95%CI 2.57-14.49, p-value<0.0001). Alzheimer's disease was the most common cause of dementia in the study. Most demented patients presented in moderate severity of dementia. Mean duration from diagnosis to the advanced stage of dementia was approximate 4-5years. Complications required admissions related to the progression to advanced stage or death.

Social Cognition in Schizophrenia.

Impairments in social cognitions in schizophrenia are increasingly reported in the last decade but only a few studies have come from Asia. The objective of the study was to evaluated emotion perception, theory of mind and social knowledge in people with schizophrenia compared to healthy controls. Participants were 36 clinically stable outpatients with schizophrenia and 36 normal controls with comparable age and level of education. We administered general neurocognition test (the Addenbrooke's Cognitive Examination), emotion perception (the Faces Test), theory of mind (the Eyes Test) and social knowledge (the Situational Features Recognition Test; SFRT). Schizophrenia patients displayed obvious impairment in all three social cognition domains i.e. the Faces Test [13.7 (2.9) vs 15.7 (1.9), P=0.001], the Eyes Test [18.9 (4.4) vs 23.5 (4.4), P<0.001] and SFRT [0.85 (0.09) vs 0.9 (0.05), P=0.002]. The performances on three social cognition tests did not correlate with positive symptoms. Only the Faces Test seemed to be related to negative symptoms. The results demonstrated that there are deficits of social cognitions in schizophrenia even in a clinically stable population.