Epidemiology of Epilepsy in Urban Areas of the People''s Republic of China

To determine the prevalence of major neurologic disorders, a door-to-door survey was conducted in six cities of the People's Republic of China during 1983 in a well-defined population of 63,195. The survey included a complete census and a screening interview together with an examination having high sensitivity for detecting individuals with frequently occurring neurologic disorders, including epilepsy. All individuals with responses or findings suggesting neurologic disease were examined by senior neurologists using standardized diagnostic criteria. There was 100% cooperation among the study subjects. Two hundred eighty-nine individuals alive on prevalence day (January 1, 1983) were identified as having epilepsy, yielding a lifetime age-adjusted (to the 1960 U.S. population) point prevalence ratio of 4.4/1,000. There were 16 people who developed epilepsy in the sample population during 1982, providing an age-adjusted incidence rate of 35/100,000 per year. The most frequent type identified was generalized convulsive seizures. Brain injury, intracranial infection, and cerebrovascular disease, in that order, were the leading putative causes of epilepsy.     

Prevalence of Epilepsy in Kelibia, Tunisia

A door-to-door survey was made in Kelibia, Tunisia to determine the prevalence of major neurologic disorders, including epilepsy. The survey was made according to a World Health Organization (WHO) protocol (1981). All individuals responding positively to the screening tool were examined by a neurologic team using well-defined diagnostic criteria. One hundred forty-one individuals, alive on prevalence day (July 1, 1985), were identified as having active epilepsy, giving a crude prevalence ratio of 4.04 per 1,000 and an age-adjusted (on WHO population) prevalence ratio of 3.64 per 1,000. Prevalence ratios increase with age (in children and young adults with the highest prevalence ratio at ～20 years) and decrease after 40 years. The most frequently identified type was generalized convulsive seizures (93%). The most frequently associated conditions were cerebral palsy and mental retardation.     

Brain injury due to head trauma. Epidemiology in urban areas of the People's Republic of China

A door-to-door survey was carried out in six cities of the People's Republic of China during 1983 in a well-defined population of 63,195 to determine the prevalence of frequently occurring neurologic disorders, including brain injury. In the survey, trained health workers conducted a complete census and administered a questionnaire that had been pretested to assure a high level of sensitivity in identifying individuals suffering from brain injury due to head trauma. All those with responses suggesting brain injury were examined by senior neurosurgeons who used uniform diagnostic criteria and reviewed available medical records to establish a diagnosis. There was 100% cooperation with the screening and diagnostic phases of the survey. Based on this investigation, the age-adjusted (to the 1960 US population) prevalence ratio for brain injury due to head trauma is seven per 1,000, and the incidence rate is 56 per 100,000 per year. The ratios and rates are higher in male than female subjects. The main cause of brain injury due to head trauma in the People's Republic of China is bicycle accidents.     

Epidemiologic survey of migraine in six cities of China

A door-to-door survey was carried out in six cities of China. A total of 63,195 individuals were sampled during 1983 to determine the prevalence of major neurological disorders including migraine. The survey involved a complete census, together with a pretested interview and brief screening examination with a high level of sensitivity for detecting individuals with migraine. All those with responses suggestive of severe headaches were requested to be examined by a senior neurologist using defined clinical criteria to establish the final diagnosis. Based on 396 prevalent cases of migraine, the crude and age-adjusted (to the 1960) total population of the United States point prevalence rate were 6.3 per 1000, and 5.4 per 1000 respectively. The prevalence among the females was nearly 3.5 times the figure for the males. For individuals above the age of 40, the age-specific prevalence rate declined with increasing age. The survey was followed by a case-control pairs matched by age, sex and geographic regions. A family history with "similar headache" seemed to be a significant risk factor while smoking and alcohol consumption appeared to be other relevant factors associated with the occurrence of migraine were also investigated. It seemed to the authors that the most frequently associated factors were psychological and hormonal factors.     

Prevalence of Parkinson's disease in the biracial population of Copiah County, Mississippi

A door-to-door survey of major neurologic disorders was conducted in the essentially biracial population of Copiah County, MS, using a pretested screening questionnaire. All those suspected of having Parkinson's disease were requested to have a neurologic examination by board-certified neurologists. The study also included those living in institutions. The prevalence of Parkinson's disease (age 40+) was 347 per 100,000 inhabitants. No substantial differences in the age-adjusted prevalence ratios by race or by sex were found in the population studied. Age-specific prevalence ratios for Parkinson's disease increase with advancing age. Over 40% of identified cases were newly diagnosed during the study.     

Prevalence of Parkinson's disease in the Parsi community of Bombay, India

A door-to-door survey was carried out to screen a community of 14010 people (Parsis living in colonies in Bombay, India) for possible neurologic diseases. High school graduates, social workers, and medical students administered a screening questionnaire that had been shown in a pilot survey to have a sensitivity of 100% for identifying those with Parkinson's disease. Neurologists used defined diagnostic criteria to evaluate individuals positive on the screening survey. There were 46 people (25 men, 21 women) who suffered from Parkinson's disease (328.3 cases per 1000 population). The age-specific prevalence ratios increased consistently with age. Age-adjusted prevalence ratios were slightly higher for men.     

Prevalence of lumbosacral radiculopathy in two Sicilian municipalities

Objectives – As part of a door-to-door survey of neurologic diseases, we investigated the prevalence of lumbosacral radiculopathy (LR) in two Sicilian municipalities (N= 14,540, as of November 1, 1987). Material & methods – During phase 1, we administered a brief screening instrument to subjects in the study population. In phase 2, study neurologists using specified diagnostic criteria investigated those subjects who screened positive. Our case finding was restricted to subjects who manifested symptoms of LR in the six months preceding the prevalence day. Results – We found 143 subjects affected by LR (112 definite, 31 possible) yielding a crude prevalence of 9.8 cases per 1,000 population. Age-specific prevalence was generally higher in men; it increased to a peak at age 50–59 years and decreased steadily thereafter. At the peak, prevalence was higher in factory workers, housewives, and clerks compared to workers in other occupations. Conclusions – LR is a common neurologic disease in the general population.     

Prevalence of neurological disorders in Bangalore, India: a community-based study with a comparison between urban and rural areas

A population-based neuroepidemiological survey of 102,557 individuals in urban and rural Bangalore in Southern India was conducted to determine the prevalence and pattern of neurological disorders. The study population included subjects from urban (51,502) and rural (51,055) areas, identified through a two-stage stratified random sampling method. Trained social workers administered the screening questionnaire, which had been tested and validated in an earlier pilot study and a neurologist examined the individuals who screened positive. Adults, children (<15 years) and elderly adults (>60 years) constituted 61, 34 and 5% of the study group, respectively. There was a distinct difference in education, occupation and income levels between urban and rural areas with all these parameters being lower in the rural population. In the surveyed population, 3,206 individuals with neurological disorders were detected resulting in crude and age-adjusted prevalence rates of 3,126 and 3,355 per 100,000 population, respectively. The prevalence rate among children, middle-aged (31-40 years) and elderly adults was 2,653, 3,932 and 5,012 per 100,000 population, respectively. The prevalence of neurological disorders among women (3,617) was higher compared with men (2,657). The prevalence rate in urban and rural populations was 2,190 and 4,070/1,00,000, respectively, implying that neurological disorders were twice as frequent in rural areas as in urban areas. The prevalence rates per 100,000 population of the most frequent disorders in the descending order of frequency were: headache (1,119), epilepsy (883), febrile convulsions (330), cerebrovascular disorder (150), and mental retardation (142). This large-scale population-based survey provides data that will be crucial for developing hospital and community-based neurological services in India and other developing countries.     

Exogenous corticosteroids and major depression in the general population

Objective: An existing literature suggests that corticosteroid exposures are associated with an elevated level of depressive symptoms in various clinical populations. The objective of this study was to evaluate this association in a general population sample. Methods: Data from a large-scale Canadian health survey were used in this analysis. The survey sample included 73,402 subjects over the age of 12 from the general Canadian population. The survey interview included a short-form version of the Composite International Diagnostic Interview (CIDI) section evaluating major depressive episodes. All estimates were weighted to account for unequal selection probabilities, and variance estimates were calculated using methods accounting for the survey design. Results: A statistically significant elevation in major depression prevalence was observed in corticosteroid-treated subjects. The estimated 12-month period prevalence of major depression was approximately three times as high in corticosteroid treated vs. non-treated subjects irrespective of age, gender and perceived health. Conclusions: In the general population, persons taking corticosteroids have a higher frequency of major depression than non-exposed subjects. Because this was an analysis of cross-sectional survey data, causal inference is not possible. However, the existence of an epidemiological association, in conjunction with information from the broader literature, suggests that corticosteroid exposure may be a determinant of depressive disorders in the general population.     

Prevalence and Pattern of Epilepsy (Lath/Mirgi/Laran) in Rural Kashmir, India

The rural population of 63,645 living in the mountainous Kuthar Valley of South Kashmir, Northwest India was surveyed to determine the prevalence of major neurologic disorders, including epilepsy (called Lath/Mirgi/Laran in the local language). The survey was done according to a World Health Organization protocol (1981). House-to-house screening was done by Anganwadi workers to identify people with possible epilepsy. The screening questionnaire was translated into local vernacular. Persons who had some indication of a history of seizures or other neurologic disease were subsequently examined by a neurologic team. The diagnostic criteria of Hauser and Kurland (1975) were used to define cases of active epilepsy and seizure classification (ILAE, 1981) was done only with clinical data. One hundred fifty-seven cases of active epilepsy were detected, giving a crude prevalence rate of 2.47/1,000 general population. In those aged less than 14 years, prevalence was 3.18/1,000. Ninety-five (60.5%) of all cases were male; 91% of active epilepsy cases had onset of seizures before age 30 years. Mean age of onset in males was 5.3 years, and in females it was 7.1 years. Mean duration of seizures was 6 years; 78.9% cases had generalized seizures, 74.5% cases were receiving no specific treatment, 99.4% cases were born of home delivery, and 8.9% cases had a positive family history of seizures. Mental retardation was the most common associated abnormality in 22.9% of cases.     

Prevalence of essential tremor in the Parsi community of Bombay, India

A door-to-door survey for neurologic diseases was conducted in a community of 14,010 people (Parsis living in colonies in Bombay, India). Neurologists used defined diagnostic criteria to evaluate persons with positive results on the screening survey. Two hundred thirty-three people (104 men; 129 women) were identified as having essential tremor. The overall prevalence ratio was 1663.1 [corrected] per 100,000 population. Age-specific prevalence ratios increased with age. Age-adjusted prevalence ratios were similar for men and women. To the best of our knowledge, this is the first community-based survey for essential tremor in Asia.     

Incidence and lifetime prevalence of Bell's palsy in two Sicilian municipalities

Introduction – In a door-to-door two-phase survey of common neurologic diseases conducted in two Sicilian municipalities, we investigated the incidence and the lifetime prevalence of Bell's palsy (BP). Material & methods – During phase 1, we administered a screening instrument for facial palsy to 11,901 adult persons. During phase 2, study neurologists using specified diagnostic criteria evaluated those subjects who screened positive. Results – We found 73 subjects who had experienced BP during their life. The lifetime prevalence as of November 1, 1987, was 642.8 cases per 100,000 population age 15 years and above. The prevalence increased with age and was similar in men and women. Eighteen episodes of BP occurred in the three years preceding the prevalence day. The average annual incidence rate was 52.8 new episodes per 100,000 population age 15 years and above. Incidence increased with age. Conclusion – Comparison with other incidence studies suggests some geographic variability.     

Prevalence of Parkinson’s disease in Korea

The prevalence of neurodegenerative disorders is not well documented in Korea. We assessed the prevalence of Parkinson's disease in an elderly population in a newly industrialized city in a rural region. Subjects for this study were randomly selected from a community-based cohort study. The sample in the cohort represented approximately 1.3% (4700) of 362 625 adults (age>18 years) listed in the city register in 1998. Among this group, 4218 subjects (1086 subjects aged>60 years) agreed to be interviewed and underwent a physical examination and neuropsychological tests administered by a neurologist and neuropsychologist. All participants were examined. Participants who had bradykinesia and at least one other possible cardinal sign of parkinsonism at the neurologic screening, and those who reported that they had Parkinson's disease, or were taking antiparkinsonian drugs were identified. In our study, 16 subjects showed evidence of Parkinson's disease. The prevalence in this population was 0.37%. Prevalence increased with age, and prevalence was 1.47% for those aged older than 60 years. Postural instability and gait disturbance were more common in the older age group. The results of neuropsychological tests were as follows: (1) only two subjects had low scores (<20) in the Korea-version mini-mental status examination; (2) seven subjects scored 0.5, one subject scored 2 and the other eight subjects scored 0 in the clinical dementia rating. The results of our prevalence study are similar to those of studies carried out in Western countries. Age is a risk factor for Parkinson's disease in Korea.     

Stability of prevalences of mental disorders in a normal population cohort followed for 16 years

Summary Results from the Finnish UKKI study on longitudinal changes in prevalences of different mental disorder categories in a population cohort (n=723) are presented. The subjects were investigated three times: in the original survey during 1969–71, and in two follow-ups (5 and 16 years after the original survey). The prevalence of all mental disorders was about 30% in all phases of the study, although the prevalence of psychoses increased from 1.1% to 3.5%. A special focus of interest was the changes in different 10-year birth cohorts during the 16 years. The results indicated that the youngest birth cohort (born in 1945–54) did not reach the same prevalence level of all mental disorders combined as the birth cohort 10 years older upon reaching the same age.     

Profile of mental disorders among the elderly United Arab Emirates population: sociodemographic correlates

OBJECTIVES: To investigate the prevalence, nature and sociodemographic correlates of mental disorders among the elderly United Arab Emirates (UAE) population. STUDY SUBJECTS AND SAMPLE: UAE nationals aged 60 years or more, were recruited from within a random sample of households representing the UAE national population, irrespective of the age of individuals in each household. RESEARCH INSTRUMENTS: (i) Geriatric Mental State Interview (GMS-A3): an Arabic version, using the AGECAT for analysis; (ii) A short questionnaire for relevant sociodemographic data. PROCEDURE: Purposely trained, Arabic speaking interviewers visited the targeted sample households to interview study subjects at their homes. RESULTS: The total number of screened subjects was 610: 166 (27.2%) in Al-Ain; 286 (46.9%) in Dubai and 158 (25.9%) in Ras Al-Khaimah. There were 347 (56.9%) male subjects and 263 (43.1%) female subjects. The mean age of the interviewed subjects was 68.6 (SD 8.3). The commonest diagnostic entities at the AGECAT syndrome case level were depression (20.2%), anxiety (5.6%), hypochondriasis (4.4%) and organic, mostly cognitive impairment with or without dementia (3.6%). Organic syndrome caseness, as an independent entity, showed significant correlation only to older age, while the rest of the mental disorders showed significant correlation with female gender, insufficient income and being single, separated, divorced or widowed. CONCLUSION: The GMS-AGECAT package proved to be a useful tool for psychiatric assessment among the elderly in this Arabian culture. The prevalence rates of mental disorders among the elderly UAE population were, more or less, within the same range reported by other comparable worldwide studies.     

Prevalence of Dementia Among the Elderly in a Japanese Community Population—Comparative Study on the 1983 and 1996 Survey: The Aichi Study

Background: An epidemiological survey of dementia among community residents over 65 years of age in Aichi Prefecture (Japan) was conducted in 1983 and 1996. We compared the prevalence rates of dementia in 1996, with the previously published rates of 1983.
Methods: The study employed a two-stage design. First stage: A test based on the DSM-III-R criteria for dementia was administered to all participating residents, who were randomly drawn from the resident register (856,879) of Aichi Prefecture in 1995 (495,923 in 1983). Second stage: A detailed clinical and cognitive evaluation (including MMSE and neurological examination) of the subjects identified in the first stage was carried out by trained psychiatrists.
Results: The prevalence rate for dementia in 1996 was 4.8% (moderate and severe 2.1%) compared with 5.8% (2.2%) in 1983; for senile dementia of Alzheimer type (SDAT) it was 2.8% in 1996 and 2.4% in 1983; for cerebrovascular dementia (CVD), 1.8% in 1996 and 2.8% in 1983.
Conclusion: Up to this time, the cases of CVD have been more frequent than those of SDAT in Japan, especially in the urban areas. However, the relationship between CVD and SDAT has now reversed. These data suggest that SDAT is a common condition and that its public health impact will continue to increase with the increasing longevity of the population in Japan.     

昆明市焦虑障碍现况调查及相关因素分析

目的 调查昆明市焦虑障碍的患病情况.方法 2005年11月至2006年1月采用分层容量比例概率随机抽样法,应用中文版复合性国际诊断交谈检查2.1版(CIDI-2.1)对昆明市≥15岁的居民5033人进行访谈,调查焦虑障碍的患病率,分析影响焦虑障碍的相关因素、起病年龄及共病情况.结果 (1)焦虑障碍的加权终生患病率为7.05%(324例),其中,男性为5.34%(100例),女性为8.89%(224例);城镇人口为7.81%(189例),农村人口为5.33%(135例);以特殊恐怖障碍患病率最高(5.64%,236例),惊恐障碍患病率最低(0.14%,6例).(2)女性患病风险[相对危险度(OR)=1.00]高于男性(OR=0.61;P<0.01);各类焦虑障碍的起病年龄中位数为16岁;焦虑障碍与美国精神障碍诊断与统计手册第4版诊断的物质使用障碍,情感障碍及疼痛障碍存在共病情况.结论 昆明市焦虑障碍患病率较高,焦虑障碍是一类起病年龄早、呈慢性病程且普遍存在与其他精神障碍共病状况的精神障碍,有必要加强对焦虑障碍的防治.     

Clinical neurogenetics. A survey of the relationship of medical genetics to clinical neurology.

A retrospective survey was made of the prevalence of neurologic disorders with an established or possible genetic component in a university hospital patient population. More than half the patient visits to the Medical Genetics Clinic concerned diseases of the nervous system. More than 20 percent of pediatric neurology inpatients and at least 8.5 percent of adult neurology inpatients had disorders with a genetic factor. This study documents the common ground shared by medical genetics and clinical neurology.     

Prevalence of Epilepsy in the Parsi Community of Bombay

A door-to-door survey was carried out to screen a community of 14,010 people (Parsis living in colonies in Bombay, India) for possible neurologic diseases. High school graduates, social workers, and medical students administered a screening questionnaire that in a pilot survey had a sensitivity of 100% for identifying persons with epilepsy. Neurologists used defined diagnostic criteria to evaluate individuals positive on the screening survey. Sixty-six persons (43 males, 23 females) suffered from epilepsy (4.7 cases/1,000). Of those, 50 (34 males, 16 females) had active epilepsy (3.6 cases/1,000). The age-specific prevalence ratios remained fairly constant for each age group except for a small peak in the group aged 20-39 years for all epilepsy cases combined. Age-adjusted prevalence ratios were higher for males. The most common seizure type was partial (36 cases). The most frequently associated conditions were cerebral palsy and mental retardation. The majority of individuals were receiving medication as of prevalence day (47 cases).     

Type 2 diabetes among persons with schizophrenia and other psychotic disorders in a general population survey

Schizophrenia and other psychotic disorders are associated with increased risk of developing type 2 diabetes. However, previous studies are mainly based on clinical samples where the comorbidity may be stronger. We investigated in a general population survey the prevalence of type 2 diabetes in persons with psychotic disorders and in users of antipsychotic medication. The study was based on a nationally representative two-stage cluster sample of 8,028 persons aged 30 or over from Finland. Diagnostic assessment of psychotic disorders combined SCID-I interview and case note data. Prevalences of type 2 diabetes, adjusting for age and sex, were estimated by calculating predicted marginals. The prevalence estimate of type 2 diabetes was 22.0% among subjects with schizophrenia, 13.4% among subjects with other nonaffective psychosis and 6.1% in subjects without psychotic disorders. Only two subjects (3.4%) with affective psychosis had type 2 diabetes. Users of all types of antipsychotic medication had increased prevalence of type 2 diabetes. Our results suggest that type 2 diabetes is a major health concern among persons with schizophrenia and other nonaffective psychotic disorders and also in users of antipsychotic medication, but persons with affective psychosis in the general population may not have increased prevalence of type 2 diabetes.