OBJECTIVE: To describe the rate of suicide and explore its possible related factors among patients with X-linked Dystonia Parkinsonism. Specifically, this paper aimed to describe the rate of suicide among patients with XDP based on the Philippine XDP registry and to describe these patients in terms of severity of XDP and psychosocial factors.
BACKGROUND: Chronic progressive neurologic conditions have been associated with serious psychosocial stresses. Suicide among patients with X-linked Dystonia Parkinsonism has been previously reported to be high.
METHODS: A retrospective chart review was done on XDP patients with deaths attributable to suicide. XDP related variables and available psychosocial factors were noted.
RESULTS: The prevalence of suicide among all XDP patients registered is 4.16%. There are 194 deaths in the Philippine XDP registry, 21 of which were attributable to suicide, a proportion of 10.8%. Their mean age at suicide was 44, around 7.76 mean years from the onset of illness. All of the patients were either in generalized dystonia or parkinsonian stage when they had suicide. Psychosocial variables noted were marital and family conflict, and loss of employment. None of the patients had a prior documented psychiatric illness but several of them showed symptoms of depression prior to suicide.
CONCLUSIONS: There is a high rate of suicide among patients with XDP which is comparable to other disabling neurodegenerative diseases. It occurs relatively late in the course where the patient is already in the stage of generalized dystonia or parkinsonism. Possible psychosocial risks include poor family support, marital conflict, loss of employment and symptoms suggestive of depression. The present understanding is that depression and suicide in XDP is more likely reactive to the disease rather than part of its clinical feature. This study supports this view.

Human ; Male ; Female ; Depression ; Dystonia ; Dystonic Disorders ; Family Conflict ; Genetic Diseases, X-linked ; Neurodegenerative Diseases ; Parkinsonian Disorders ; Suicide ;

Objective: To assess the effectiveness and tolerability of the 23 mg tablet donepezil in patients with Alzheimer’s disease (AD) using meta-analysis of randomized controlled trials. Methods: Major healthcare databases were searched from May to September 2016. Evaluation of relevant trials, assessment of risk of bias, collection and analyses of data were performed. Results: A total of 1,774 adult participants with AD were pooled from the two trials included. Pooled data showed that after 24 weeks of treatment, no significant difference was noted between Donepezil 23 mg/day and Donepezil 10 mg/day in terms of cognitive function (1.06 SIB points [-0.13, 2.26]; 1704 participants) and in terms of global clinical assessment (-0.02 CIBIC+ points [-0.13, 0.09]; 1705 participants). The participants who took the higher dose were at higher risk to experience “any adverse event” than those who received the lower dose (1.17 RR [1.09, 1.26]; 1785 participants). Conclusion Current evidences do not support the routine use of Donepezil 23 mg tablet for the improvement of cognitive function and global clinical status of patients with AD. The higher dose is also marked with an increased incidence of adverse events compared to the lower dose.
Meta-analysis

Objective: This study aims to identify factors associated with mild cognitive impairment (MCI) among elderly Filipinos with Type 2 diabetes mellitus. Methodology: This is an analytic cross-sectional study involving 133 elderly (≥60 years old) with Type 2 diabetes mellitus consecutively sampled from the General Medicine and Diabetes Clinics of the Philippine General Hospital. Eligible subjects were interviewed to gather demographic and clinical data. Body mass index, waist-hip ratio and mean blood pressure were computed. HBA1c, lipid profile, creatinine and urine proteinuria were tested or recorded if done recently. Dilated fundus examination via indirect ophthalmoscopy and 10-gram monofilament test were performed to detect retinopathy and neuropathy. The Montreal Cognitive Assessment-Philippines tool was administered to detect patients with probable MCI using a cutoff score of ≤21. Multivariate logistic regression analysis was performed to determine the associated factors. Results: Using MoCA-P tool, MCI has a rate of 45% among elderly Filipino diabetics. Having more than 12 years of education is significantly associated with lower odds of MCI. (OR 0.38 CI 0.18, 0.80, p value 0.010). Conclusion The rate of MCI among Filipino elderly diabetics is high. Higher education is associated with lower odds of having MCI. Case-control or prospective cohort studies involving larger sample and non-diabetic population are recommended.
Cognitive Dysfunction ; Diabetes Mellitus, Type 2