Testamentary capacity is one of the civil competences, it means that a natural person enjoys the capacity or qualification to establish testament and deal with his property. Recently, the cases of testamentary capacity assessment of the mentally disordered are increasing. This article firstly introduces the concepts of the testament as well as the testamentary capacity, and then summarizes the assessment standard of the testamentary capacity, by using the Banks v. Goodfellow case as a basis to make the standard criteria including: the understanding of the nature of a will and codicil, the knowledge of the general extent of one's assets, the knowledge of the natural object of one's bounty, the understanding of the impact of the distribution of the assets of the estate, and the absence of a delusion specifically affecting the distribution of the estate. The impact factors of the testamentary capacity, including dementia, mood disorder, schizophrenia, alcohol, drug, and undue influence, etc., are summarized. Lastly, the related assessment tools such as the Mini-Mental State Examination, the Clock-Drawing Test, and the Testament Definition Scale are introduced briefly.
Alcoholism/psychology* ; Dementia/psychology* ; Expert Testimony/standards* ; Forensic Psychiatry ; Humans ; Mental Competency/standards* ; Mental Disorders/psychology* ; Mental Status Schedule ; Wills/legislation & jurisprudence*

We present a case of delirium tremens lasting for five weeks in an alcohol-dependent individual. The patient required high-dose benzodiazepines, which is atypical and rare. The clinical presentation and management of this patient is discussed.
Adult ; Alcohol Withdrawal Delirium ; diagnosis ; drug therapy ; psychology ; Anti-Anxiety Agents ; therapeutic use ; Diagnosis, Differential ; Diazepam ; therapeutic use ; Humans ; Liver Cirrhosis ; diagnosis ; Male ; Mental Status Schedule

INTRODUCTIONThis study aimed to determine the stratified normative data by age and education for a modified version of the Mini-Mental State Examination (MMSE) test from a large sample of community-dwelling Chinese older adults in Singapore, and to examine the MMSE's value in detecting early cognitive impairment.

METHODSWe studied 1,763 Chinese older adults with normal cognitive function and 121 Chinese older adults with early cognitive impairment (Clinical Dementia Rating global score 0.5). Normative MMSE values were derived for each of the 15 strata classified by age (three groups) and education level (five groups). Receiver operating characteristic curve analysis was conducted for the whole sample and each of the three education subgroups (no education, primary, secondary and above).

RESULTSEducation level and age significantly influenced the normative values of MMSE total scores in Chinese older adults with normal cognitive function. For the purpose of detecting early cognitive impairment, an optimal balance between sensitivity (Se) and specificity (Sp) was obtained at a cutoff score of 25, 27 and 29 for each of the three education groups, respectively. For the whole sample, the optimal cutoff point was 26 (Se 0.61, Sp 0.84, area under curve 0.78).

CONCLUSIONAge and education level must be taken into account in the interpretation of optimal cutoffs for the MMSE. Although widely used, the MMSE has limited value in detecting early cognitive impairment; tests with better performance should be considered in clinical practice.

Age Factors ; Aged ; Area Under Curve ; China ; Cognition Disorders ; diagnosis ; epidemiology ; ethnology ; Dementia ; diagnosis ; epidemiology ; ethnology ; Educational Status ; Female ; Humans ; Male ; Mental Status Schedule ; Middle Aged ; Neuropsychological Tests ; standards ; Psychometrics ; methods ; Reference Values ; Sensitivity and Specificity ; Singapore ; ethnology

INTRODUCTIONThe purpose of the current study is to assess the psychometric properties of Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) on patients with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) in a multicultural Asian context.

MATERIALS AND METHODSSixty-four mild AD patients (mean age ± SD; 72.24 ± 7.88 years), 80 MCI patients (66.44 ± 7.45 years) and 125 healthy controls (HCs) (61.81 ± 6.96 years) participated in the study. Participants underwent a clinical interview and serial neuropsychological testing. ADAS-Cog total and subtest scores were compared across the 3 groups. Receiver operating characteristics (ROC) analysis were performed and sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs) were calculated.

RESULTSPatients with MCI attained significantly worse neuropsychological test scores than healthy controls but significantly better results than patients with mild AD on ADAS-Cog total score, subtest items, and the delayed recall item (P <0.001). The best cutoff score to differentiate between MCI and HC was ≥4 (sensitivity = 0.73, specificity = 0.69, PPV = 0.90, NPV = 0.40), while the best cutoff score to distinguish between MCI and mild AD was ≥12 (sensitivity = 0.86, specificity = 0.89, PPV = 0.99, NPV = 0.32). Evidence of internal consistency of the ADAS-Cog (Cronbach α = 0.85) as well as convergent validity with the Mini-Mental State Examination (MMSE) (ρ = -0.75) and Montreal Cognitive Assessment (MoCA) (ρ = -0.81) (both P <0.001) was also found.

CONCLUSIONThe ADAS-Cog which is widely used in clinical trials is applicable to the Asian cohort. It is useful in the detection of MCI and mild AD as well as in distinguishing these 2 conditions.

Aged ; Aged, 80 and over ; Alzheimer Disease ; diagnosis ; psychology ; Case-Control Studies ; Cognitive Dysfunction ; diagnosis ; Female ; Humans ; Male ; Mental Status Schedule ; Middle Aged ; Neuropsychological Tests ; Predictive Value of Tests ; Psychiatric Status Rating Scales ; Psychometrics ; ROC Curve ; Reproducibility of Results ; Sensitivity and Specificity ; Singapore

OBJECTIVETo evaluate the effectiveness of Chinese medicine granules (Compound Chinese extract from herbs) in the treatment on senile vascular dementia.

METHODOne hundred and twenty patients meeting criteria for vascular dementia were selected from patients in Dongzhimen Hospital and were randomly assigned into a treatment group (n = 70 cases), given 1 package of Chinese medicine granules with 1 placebo tablets, and a positive control group (n = 50 cases), given 1 tablets of Duxil with 1 package of placebo. All subjects took this medication 3 times a day for 2 months. Double-blind and double-moulding control were used in this study. At a baseline and end (two months later), all subjects were assessed using a battery consisting of MMSE and Blessed behavior measuring scale.

RESULTBoth Chinese medicine granules and Duxil could remarkably increase the score of cognition and activity (P < 0.01). They had Similarly effectiveness and there was no statistical difference between the two groups in effectiveness of increasing memory scores. Chinese medicine granules was better than Duxil in increasing the scores of behavior (P < 0.05).

CONCLUSIONChinese medicine granules has certain effects on vascular dementia. And it has remarkable effectiveness in ameliorating the status of total body. And it can relieve the symptoms in vascular dementia.

Activities of Daily Living ; Aged ; Cognition ; drug effects ; Dementia, Vascular ; drug therapy ; physiopathology ; Double-Blind Method ; Drug Combinations ; Drugs, Chinese Herbal ; isolation & purification ; therapeutic use ; Female ; Humans ; Male ; Mental Status Schedule ; Middle Aged ; Phytotherapy ; Plants, Medicinal ; chemistry

OBJECTIVETo observe the therapeutic effect of Shenyin Oral Liquid (SOL) in relieving mild cognitive impairment (MCI) and decreasing the Alzheimer's disease (AD) transformation rate.

METHODSOne hundred and seventeen MCI patients were randomly assigned to the Chinese medicine group (42 cases), the vitamin E group (38 cases) and the placebo group (37 cases). The treatment course was 12 months and a 6-month follow-up was conducted after ending the treatment course.

RESULTSAfter treatment, the scores of clock drawing test (CDT), nonsensical figure recognition and mini-mental state examination (MMSE) raised significantly in the Chinese medicine group (P < 0.05 or P < 0.01), the activity of acetylcholine esterase in erythrocytic membrane was lower in the Chinese medicine group than that in the placebo group and the Vitamin E group (P < 0.05 or P < 0.01). Six months after the treatment, there were 2 and 5 cases in the placebo group and the vitamin E group which were diagnosed as AD, respectively, and none in the Chinese medicine group.

CONCLUSIONSOL has an effect similar to cholinesterase inhibitor, it could improve cognitive function in MCI patients and reduce the AD transformation rate in them.

Aged ; Alzheimer Disease ; prevention & control ; Cognition Disorders ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Memory ; drug effects ; Mental Status Schedule ; Middle Aged ; Nootropic Agents ; therapeutic use ; Phytotherapy ; Treatment Outcome

Adult ; Antipsychotic Agents ; therapeutic use ; Diagnosis, Differential ; Humans ; Insulin-Like Growth Factor I ; biosynthesis ; Magnetic Resonance Imaging ; methods ; Male ; Mental Status Schedule ; Pituitary Neoplasms ; complications ; diagnosis ; Prolactinoma ; complications ; diagnosis ; Psychotic Disorders ; complications ; diagnosis

INTRODUCTIONIn tandem with our ageing population, it is observed there is a growing trend of elderly patients presenting for the first time with psychotic symptoms. Clinical experience suggests differences in the phenomenology of late-onset psychosis in our Asian context compared to studies done in the West. This study aimed to analyse the characteristics and psychopathology of first presentation psychosis in our local elderly and to determine the treatment outcome over a 12-month period.

METHODSA total of 64 subjects with first presentation psychosis were consecutively recruited. Those with a non-affective, non-organic psychotic disorder were evaluated using the Positive and Negative Symptoms Scale, the Clinical Global Impression Scale, Mini-Mental State Examination and the Beck's Depression Inventory.

RESULTSOf the 64 subjects recruited, 55 were enrolled in the study. 59.3% (n = 32) of the subjects were diagnosed to be suffering from very-late-onset schizophrenia-like psychosis, followed by delusional disorder in 31.5% (n = 17). The remaining 11.1% (n = 6) were diagnosed to have late-onset schizophrenia. The sample showed a high preponderance of women, with 88.9% reporting persecutory-type delusions. The majority of them were married and 80% of the subjects were living with relatives. Treatment was effective in ameliorating symptoms, but there was a high loss to follow-up of male subjects (81.8%).

CONCLUSIONThis descriptive study found sociodemographic and phenomenological similarities to other studies of late-onset psychosis in the West, except that social isolation and partition delusions were not prominent.

Age of Onset ; Aged ; Aging ; Female ; Geriatrics ; methods ; Humans ; Male ; Mental Status Schedule ; Psychometrics ; methods ; Psychotic Disorders ; diagnosis ; epidemiology ; Schizophrenia, Paranoid ; diagnosis ; epidemiology ; Schizophrenic Psychology ; Sex Factors ; Singapore ; Social Class ; Time Factors ; Treatment Outcome

Adult ; Age Factors ; Burnout, Professional ; epidemiology ; Female ; Health Status ; Humans ; Male ; Marital Status ; Mental Health ; Occupational Health ; Orthopedic Surgeons ; statistics & numerical data ; Pain ; epidemiology ; Personnel Staffing and Scheduling ; Sex Factors ; Singapore ; epidemiology ; Social Behavior ; Stress, Psychological ; epidemiology ; Surveys and Questionnaires ; Work Schedule Tolerance