Huntington''s disease in Chinese: a hypothesis of its origin.

The period prevalence (1984-91) of Huntington's disease (HD) in Hong Kong Chinese was 3.7 per million population. HD patients in Mainland China and Hong Kong showed similar hereditary pattern, clinical and pathological features as in the West. Chinese HD patients were male predominant with a younger age of onset and death. Their ancestral origin could be traced mostly to the coastal provinces of China. It is proposed that Chinese HD patients may have a European origin and share the same gene pool as their white counterparts.     

The Alzheimer's Disease Assessment Scale: findings from a low-education population.

We constructed a Chinese version of the cognitive component of the Alzheimer's Disease Assessment Scale (ADAS-Cog). In order to accommodate illiteracy, the Chinese version used pictures instead of words for assessing recall and recognition. The Chinese ADAS-Cog was administered to 125 individuals with no dementia, 127 with questionable dementia, and 77 with Alzheimer's disease (AD). Their age range was 51-92 years and their education range was 0-20 years. The Chinese ADAS-Cog had high internal consistency (Cronbach's alpha = 0.87) and very high interrater reliability (intraclass correlation coefficient, or ICC, = 0.99) and test-retest reliability (ICC = 0.96). It had high correlations with scores on the Clinical Dementia Rating Scale (Pearson's r = 0.85), the Cognitive Abilities Screening Instrument (CASI, Pearson's r = -0.88), and CASI-estimated scores on the Mini-Mental State Examination (Pearson's r = -0.85). Performance on the Chinese ADAS-Cog was uninfluenced by age or gender, nor by education level except within the low education range of 0-6 years. Its memory items were best for early detection of dementia; its language items were best for monitoring the progression of dementia. This study found that the Chinese ADAS-Cog is a good instrument for use with Chinese AD patients.     

Measuring depression in Canada's elderly Chinese population: use of a community screening instrument.

OBJECTIVE: To assess the reliability and validity of a 15-item Chinese Geriatric Depression Scale (GDS) to measure depression in Canada's elderly Chinese population. METHOD: A random sample of 96 elderly Chinese in a Canadian city was surveyed by telephone. The measure of depression used was the 15-item Chinese version of the GDS. In addition, the physical and mental health of the respondents was assessed by a Chinese version of the SF-12, questions on self-perceived general health, and questions on self-reported illnesses and health concerns. RESULTS: The prevalence rate of depression in the elderly Chinese who participated in this study is approximately 20%, which is much lower than that of elderly Chinese in the United States (US). Cronbach's alpha and split-half reliability coefficients were 0.88 and 0.89 respectively. GDS scores are significantly correlated with the mental health component (r = -0.74) of the SF-12, indicating a strong convergent validity. GDS scores are also correlated with the physical health component of the SF-12 (r = -0.41), self-perceived general health (r = -0.26), and illnesses (r = 0.52), demonstrating concurrent validity. CONCLUSIONS: The 15-item Chinese GDS has good internal consistency and both convergent and concurrent validity. It can help to identify depression among the elderly Chinese, allowing early identification and prevention of this problem. Further research is required to support its use in clinical settings.     

A left-lateralized network for reading Chinese words: a 3 T fMRI study.

fMRI was used to investigate brain organization for reading in Chinese. Subjects were shown two-character Chinese words. A control task was used to eliminate the non-linguistic visual and motor confounds. Results show that naming of Chinese logographs is characterized by left-lateralized neuronal networks for the processing of orthographic, phonological, and semantic attributes. The orchestration of the middle frontal cortex, superior temporal cortex, superior parietal cortex, basal temporal area and extrastriate cortices of the left hemisphere may manifest the particularity of the central representation of simple word naming in Chinese.     

Qigong-induced mental disorders: a review.

OBJECTIVE: This review article aims to explore current opinions on Qigong-induced mental disorders, an entity which is unfamiliar to Western psychiatrists. METHOD: Relevant literature published in Chinese and English is reviewed. RESULTS: The review is divided into three sections: first, there is brief consideration of the historical development of Qigong in traditional Chinese medicine and its role in psychiatry; second, there is a review of the literature published on Qigong deviations and Qigong-induced mental disorders; and third, there is a discussion on the aetiological role of Qigong in these conditions. CONCLUSIONS: Qigong remained veiled in secrecy and available only to the elite until the early 1980s. Despite the widespread use of Qigong, there is a conspicuous lack of controlled data regarding its effects on mental health. Qigong, when practised inappropriately, may induce abnormal psychosomatic responses and even mental disorders. However, the ties between Qigong and mental disorders are manifold, and a causal relationship is difficult to establish. Many so-called 'Qigong-induced psychoses' may be more appropriately labelled 'Qigong-precipitated psychoses', where the practice of Qigong acts as a stressor in vulnerable individuals.     

Mollaret's meningitis revisited. Report of a case with a review of the literature

Recurrent aseptic meningitis of Mollaret is a rare condition. We report a Chinese patient with Mollaret's meningitis and describe the characteristic cytological changes in the cerebrospinal fluid. The diagnosis and treatment of this condition is discussed with a review of the English literature.     

ApoE genotype in relation to AD and cholesterol: a study of 2,326 Chinese adults.

OBJECTIVE: To calculate the frequencies of apolipoprotein E (apoE) alleles in a large Chinese community sample and to compare the serum cholesterol levels of epsilon2, epsilon3, and epsilon4 carriers. BACKGROUND: In comparison with Western populations, a lower frequency of the apoE epsilon4 allele among the Chinese has been proposed as one factor for the lower prevalence of AD found in Chinese populations, but there are insufficient Chinese data on epsilon4 frequency that are based on large community samples. In addition, although Western studies have repeatedly found a lower cholesterol level in epsilon2 carriers and a higher cholesterol level in epsilon4 carriers in comparison with epsilon3 homozygotes, two Chinese studies have yielded inconsistent findings between them. METHODS: During the incidence phase of an epidemiologic survey of several neurologic disorders in a Chinese community, the authors took blood samples from 2,326 participants to determine the apoE genotypes and to measure cholesterol levels. RESULTS: The allelic frequencies of epsilon2, epsilon3, and epsilon4 were 11.8%, 76.4%, and 11.8% among 17 AD patients, and 7.8%, 84.1%, and 8.1% for the entire sample. The mean cholesterol level of the epsilon2 carriers was significantly lower, and that of the epsilon4 carriers significantly higher, than that of the epsilon3 homozygotes. CONCLUSIONS: The obtained epsilon4 rate of 8.1% is lower than most of the Western findings, and this may account in part for the lower prevalence of AD found among the Chinese. The associations between the apoE genotype and serum cholesterol level are similar between Chinese and white populations.     

Degree of suicide intent and the lethality of means employed: a study of Chinese attempters.

This study was designed to determine if there is a relationship between the degree of suicide intent and the lethality of means employed by those who try to kill themselves. The study sample consists of 74 suicide attempters admitted to emergency rooms in a northeastern area of China. Structured interviews were performed with the patients and their companions to the hospital if necessary. It was found that the reason for the suicide attempt claimed by the highest percentage of attempters (35 of 74) was love/marriage issues, and there were significant gender differences in suicide reasons. It also was found that the choice of suicide means is generally independent of gender, and the lethality of means is positively correlated with the degree of suicide intent. One of the implications of the findings is a better understanding of the higher suicide rates for Chinese women than Chinese men. A hypothesis for future study on Chinese suicide may be that the high fatality rate of Chinese women who have swallowed poisonous pesticide is a function of the strong intent of death of the victim coupled with the well-known lethality of the pesticides.     

Dentatorubropallidoluysian atrophy in Chinese.

BACKGROUND: Dentatorubropallidoluysian atrophy (DRPLA) is a rare, autosomal dominant neurodegenerative disease characterized by a range of clinical manifestations, including cerebellar ataxia, epilepsy, myoclonus, choreoathetosis, and dementia. Outside the Japanese population, the prevalence is extremely low worldwide. The reason for different ethnic prevalences of DRPLA is unclear. A previous assumption was that large normal alleles contribute to generation of expanded alleles and the relative frequencies of DRPLA. OBJECTIVES: To describe the clinical, radiological, and genetic features of the first reported Chinese family with DRPLA, to our knowledge, and to compare the size distribution of normal alleles at the DRPLA locus in healthy Chinese individuals with that of other ethnic groups. PATIENTS AND METHODS: Of 80 Chinese kindreds with autosomally dominant spinocerebellar ataxias, 1 pedigree with 2 affected patients was found by polymerase chain reaction to carry the characteristic DRPLA mutation. The allele frequencies of different CAG repeat lengths at the DRPLA locus in 225 healthy Chinese individuals were also analyzed and compared with Japanese, white, and African American distributions. RESULTS: The clinical presentations of the 2 Chinese patients affected with DRPLA are similar to those described in Japanese patients, except that the affected father exhibited myoclonus but not chorea. Although the normal DRPLA allele size is distributed similarly in Chinese and Japanese populations, DRPLA in Chinese individuals is rare. Thus far, to our knowledge, only 1 intermediate-sized allele containing more than 30 CAG repeats has been reported among healthy Chinese individuals, in contrast to 3 among Japanese populations. CONCLUSION: The ethnic prevalence of DRPLA seems to be correlated with the prevalence of intermediate-sized alleles in individual populations.     

The executive clock drawing task (CLOX) is a poor screening test for executive dysfunction in Chinese elderly patients with subcortical ischemic vascular disease.

Executive dysfunction (ED) is a prominent feature of subcortical ischemic vascular disease. A screening test for ED is lacking among Chinese. The objective of the study is to investigate the validity and reliability of a Chinese version of the Executive clock drawing task (CLOX) in screening ED among Chinese elderly patients with small subcortical infarct (SSI). The Chinese version of CLOX correlated with MMSE, CDRS I/P, and WCST perseverative errors. However, multivariate regression analysis showed that only education (R(2) change=0.22, p < 0.001 ) and MMSE (R(2) change=0.35, p < 0.001), but none of the standard executive function tests, significantly accounted for the variance in the CLOX. Test-retest (r=0.84) and inter-rater reliability (r=0.84) were high for the CLOX. Conclusions. Although the CLOX is reliable, it is not valid in detecting ED in Chinese elderly patients with SSI.     

Identification of a high frequency of mutation at exon 8 of the ATP7B gene in a Chinese population with Wilson disease by fluorescent PCR.

BACKGROUND: Wilson disease (WD) is an autosomal recessive disorder of copper transport. Mutation analysis has led to the discovery of more than 100 mutations at ATP7B, and most of them are population specific. OBJECTIVES: To verify the high frequency of mutation at exon 8 of ATP7B in Chinese patients with WD and to establish a DNA diagnostic method for WD. SETTING: University medical centers. PATIENTS AND METHODS: Screening for mutations at exon 8 of ATP7B by fluorescent polymerase chain reaction analysis and restriction analysis was conducted in 106 unrelated Chinese patients with WD and in 55 individuals from 10 Chinese families with WD. RESULTS: Five homozygotes and 32 heterozygotes were identified. Sequence analysis showed a missense mutation (2273G-->T) and a nonsense mutation (2250C-->G) together at exon 8. The rate of gene mutation in 106 patients was 35% (5% homozygous and 30% heterozygous). Samples of DNA from 55 individuals from 10 Chinese families with WD were examined by fluorescent polymerase chain reaction. We found that 13 siblings were carriers (24%). CONCLUSIONS: A high frequency of mutation at exon 8 of the ATP7B gene exists in the Chinese population, and fluorescent polymerase chain reaction analysis may be an effective and accurate assay in detection of the WD gene.     

Adrenoleukodystrophy in a Chinese boy.

We report the first Chinese boy with adrenoleukodystrophy (ALD) who presented with hyperpigmentation, behavioral change and demyelination shown in magnetic resonance imaging of the brain. ALD was confirmed by the elevation of very long chain fatty acid in the serum and biochemical evidence of adrenal insufficiency. A trial of special diet with restriction of very long chain fatty acid and addition of glyceryl trierucate/glycerol trioleate oil (GTEO or Lorenzo's oil) failed to prevent clinical deterioration. The child had progressive visual loss and spastic tetraparesis despite dietary manipulation, adrenal steroid replacement and intravenous gammaglobulin treatment.     

Depressive disorders in elderly Chinese patients in Macau: a comparison of general practitioners' consultations with a depression screening scale.

OBJECTIVE: The objectives of this study were to identify the prevalence of depressive symptomatology in an elderly population using a screening scale; to assess general practitioner (GP) recognition of depression; to determine patient reasons for consultation; and to relate depression to social and demographic factors. METHOD: An analytical cross-sectional study was carried out on a systematic sample of elderly Chinese patients currently resident in Macau, who presented to general practices in December 1997. Data collected included patient demographics, economic and social supports, patient depressive status assessed using the Hospital Anxiety and Depression scale (HAD), reason for attendance, and the reason for the consultation. Clinical records were analysed in order to collect GP-registered morbidity and recent relevant management. RESULTS: Data were collected from 386 elderly Chinese patients of 31 GPs (97% patient response rate). Patients presented with somatic symptoms rather than psychological issues. Using HAD cut-off score of >8, 47% of the population studied were depressed; with a HAD subscale score >11, 26.2% were depressed. Depression was detected more often in women (59%) and being female was associated with depressive status (p = 0.010). Age (greater than 75 years) was also associated with being depressed, as was not having someone to talk to (p = 0.037), and being from low social class (p = 0.050). Not having someone willing to listen to their problems, difficulties and worries, was significantly related to depression (p = 0.041). There were no referrals or antidepressive medications detected in the clinical charts. CONCLUSION: Participants' characteristics such as being over 75 years of age, being female and socially isolated were related to depression. General practitioners can play an important role in the early detection and management of psychological disorders. Although studies on a sample of Chinese patients in Macau cannot be generalized to Chinese populations elsewhere, awareness of somatic presentation of psychological illness is crucial in detecting depression in this and possibly other Chinese populations.     

Crossed aphasia in a Chinese bilingual dextral

A persistent nonfluent aphasia following a right cerebral infarction developed in a 54-year-old right-handed Chinese man. Computerized axial tomography localized the lesion in the distribution of the right middle cerebral artery. The speech and language dysfunction was greater for performances in Chinese than in English, despite the fact that the patient was born in China, was schooled in Chinese until age 7, and spoke Chinese at home and in his business. It is suggested that early learning of Chinese, an ideographic language based on visual spatial percepts, might have been critical for the establishment and maintenance of language dominance in the right hemisphere.     

Computerized psychiatric diagnoses based on euclidean distances: a Chinese example.

Current diagnostic methods in psychiatry use sequential logical decision rules that generate a single diagnosis. Insufficient attention has been paid to parallel methods that can simultaneously determine the relative probability of many diagnoses. This study installed 45 items from various symptom scales on a portable computer and applied a euclidean distance formula to generate immediate diagnoses based on responses to the items. The reliability and validity of the method were assessed using Chinese psychiatric inpatients. Interrater reliability was excellent (kappa = 0.91) and 3-week test-retest reliability was fair (k = 0.50). The concordance of this method with clinicians' diagnoses and with diagnoses based on standardized Chinese diagnostic criteria was excellent (k = 0.73 and 0.76). Concordance with DSM-III-R diagnoses and ICD-10 diagnoses was fair (kappa = 0.55 and 0.65). The clinical utility of such parallel methods of psychiatric diagnosis deserves further evaluation.     

Economic burden of Parkinson's disease in a developing country: a retrospective cost analysis in Shanghai, China.

We investigated economic costs from patients with Parkinson's disease (PD) in Shanghai, China, which could be used as a baseline for future evaluations. Data were collected from 190 patients by interview during 1-year period. Direct medical care costs averaged approximately Chinese yuan, renminbi (RMB) 4,305 (USD 519, or EUR 410) per year per patient, of which drugs (RMB 2,677) accounted for the major costly component. Nonmedical direct costs were much less than direct health care costs, averaging approximately RMB 3,301 (USD 398, or EUR 314). Costs due to loss of productivity averaged approximately RMB 73 (USD 8.8, or EUR 7.0) per patient per year. Taken together, the overall mean annual cost for PD in our series was approximately RMB 7,679 (USD 925, or EUR 731), and these costs accounted for around half of the mean annual income. Total cost was significantly associated with the disease severity and the frequency of outpatient visits. In addition, levodopa equivalent dose (LED) and the number of drugs being taken were also closely related with the drug cost. The results indicate that the economic burden of Chinese PD patients is heavy.     

Leber氏遗传性视神经萎缩病——一种因线粒体DNA突变引起的疾病

本文研究了8个独立来源的中国汉族人Leber氏病家系的患者,其中在4个家系的患者中找到了这种突变。这种转换突变使NADH脱氢酶第4个亚单位(ND_4)的第340位编码子的精氨酸转变为组氨酸,并使SfaNI酶的切割位点消失,因此可提供一种简单的诊断方法。     

The Chinese student--acculturation and mental illness.

This paper reviews the history of the Chinese student in America and examines the conflicts which the special role of the Chinese on campus created. Specifically the nature of the problems manifested by Chinese students who sought help through the student health program at a large West Coast university are examined as a reflection of the stresses caused by currently changing attitudes toward assimilation in the Chinese-American population. Interestingly, except for a brief overview by Fong, this is a group that, despite its size and significance, has been ignored in the literature.     

Cerebral amyloid angiopathy in Chinese: incidence and significance.

Histological sections of 210 randomly selected autopsy brains and 49 consecutive autopsy cases of spontaneous intracerebral haemorrhage in the Chinese population aged over 40 years were examined by H&E and congo red stain with and without polarized light. In the randomly selected group, 10% of cases are positive for cerebral amyloid angiopathy (CAA) while 8.2% of cases are positive in the group with haemorrhage. The incidence is strongly age-related. Compared with Western figures. Chinese are less frequently and less severely affected by CAA. Although CAA does account for some cases of spontaneous intracerebral haemorrhage, it cannot account for the high incidence of cerebral haemorrhage among Chinese. Its significance in Chinese is much lower than in Caucasians.     

褪黑素合成酶ASMT基因启动子和第一外显区单核苷酸多态性与儿童孤独症的关联研究

目的探讨参与褪黑素合成的乙酰血清素甲基转移酶(acetylserotonin methyltransferase,ASMT)基因启动子和第1外显子区遗传多态性位点与儿童孤独症是否关联。方法对390例儿童孤独症患者和420例正常对照者的ASMT基因启动子和第1外显子区域进行测序。比较该区域5个单核苷酸多态性(single nucl-eotide polymorphisms,SNPs)位点的等位基因频率、基因型频率和单体型频率在患者组与对照组之间的差异。结果患者组和对照组之间,5个SNPs(rs4446909、rs5989681、rs56690322、rs6644635、rs17149149)等位基因和基因型频率的差异均无统计学意义(P>0.05)。3个SNPs位点rs4446909、rs5989681和rs6644635之间存在连锁不平衡(linkage disequilibrium,LD)(D’值为0.85-0.98)。但此3个SNPs构成的单体型频率在两组间的差异无统计学意义(P>0.05)。结论本研究未发现ASMT基因启动子和第1外显子区域的遗传多态性位点与儿童孤独症关联,提示这些位点可能未参与中国汉族人群孤独症的致病。