1.Clinical diagnosis rather than aquaporin-4 immunoglobulin status predicts the cognitive performance in central demyelinating disease
Min-Chien Tu ; Wen-Neng Chang ; Chun-Chung Lui ; Nai-Ching Chen ; Chi-Wei Huang ; Chen-Chang Lee ; Ching Chen ; Chiung-Chih Chang
Neurology Asia 2012;17(4):331-340
Background:Reports on the aquaporin-4 immunoglobulin G (AQP4-IgG) status for cognitive performance
and neuroimaging correlations are limited in neuromyelitis optica (NMO) and multiple sclerosis (MS)
literature. Methods: Cognitive results of 19 MS and 15 NMO patients were compared with 47 agematched
controls. Apparent diffusion coeffi cient (ADC) values were used to delineate gray matter
and white matter damages and correlate with neuropsychological results. Results: Verbal memory test
showed signifi cant differences between MS and NMO in the late registration, early and delay recall
(p<0.05), while their retention rates were even. In MS, ADC values were signifi cantly elevated in the
dorsolateral prefrontal and occipital gray matter which was in contrast with NMO group that showed
elevation in the dorsolateral prefrontal gray matter and parieto-occcipital white matter. AQP4-IgG
status exerted a limited effect on ADC values and neuropsychological results.
Conclusions: Verbal memory test might be helpful in differentiating NMO and MS. ADC values
can be used as a surrogate marker for tissue injury in NMO and MS since they were in line with the
cognition scores. Anatomical regions with elevated ADC values were different in NMO and MS.
2.Prognostic value of auto-antibodies to extractable nuclear antigens in neuromyelitis optica
Min-Chien Tu ; Nai-Ching Chen ; Chun-Chung Lui ; Wen-Neng Chang ; Chi-Wei Huang ; Sz-Fan Chen ; Chiung-Chih Chang
Neurology Asia 2014;19(3):287-293
Background: Compared with the Western population, central demyelinating disorders are relatively
rare while the data on the prognostic value of autoantibodies together with clinical characteristics and
cognitive dysfunction has rarely been explored in neuromyelitis optica (NMO) and multiple sclerosis
(MS). Methods: Nineteen patients with MS and 14 with NMO underwent clinical profiling and cognitive
assessment. According to serology tests, they are divided into four subgroups for further analysis.
Results: There was higher frequency of aquaporin-4 immunoglobulin G. sero-positivity (64.3% vs.
10.5%; p=0.003) and antinuclear antibodies (ANA) and/or antibodies to extractable nuclear antigens
(anti-ENA) in NMO compared to MS (42.9% vs. 5.2%; p=0.026). The presence of anti-ENA represented
a unique clinical phenotype, with longer segment of myelitis (p=0.049), female preponderance, and an
inverse correlation between age-of-onset and annual relapse rate (ρ= -0.88, p=0.021). Among patients
with anti-ENA positivity, comprehensive serology panels revealed Sjögren’s syndrome A antibodies
as the most common (83%), in contrast to limited clinical documentation of Sjögren’s syndrome
(16%). There was no significant difference in cognitive assessment by anti-ENA status. MS and NMO
represent two different serologic entities.
Conclusions: Anti-ENA may have prognostic value for its linkage to a unique clinical phenotype,
which has longer initial segment of myelitis, female preponderance, and higher annual relapse rate
on earlier age-of-onset, but has limited clinical impact on cognition. Further studies are warranted
to investigate whether anti-ENA represents an epiphenomenon of myelitis or simply a systemic
inflammatory state.
3.Real-world Evaluation of Tolerability, Safety and Efficacy of Rivastigmine Oral Solution in Patients with Mild to Moderate Alzheimer’s Disease Dementia
Sun-Wung HSIEH ; Jui-Cheng CHEN ; Nai-Ching CHEN ; Kai-Ming JHANG ; Wenfu WANG ; Yuan-Han YANG
Clinical Psychopharmacology and Neuroscience 2021;19(3):459-469
Objective:
The purpose of this study is to investigate the safety, tolerability and efficacy of titrating dose of rivastigmine oral solution in patients with mild to moderate Alzheimer’s disease (AD) in Taiwan.
Methods:
We recruited 108 mild to moderate AD patients with RivastⓇ (rivastigmine oral solution 2 mg/ml) treatment for 52 weeks. We recorded the demographic characteristics, initial cognition by mini-mental state examination (MMSE), initial global status by clinical dementia rating (CDR) with CDR-Sum of Boxes (CDR-SB), initial dose, and titrating dose at each visit. We investigated the adherence, proportion of possible side effects, optimal dose, and time to optimal dose. We demonstrated the proportion of cognitive decline and its possible risk factors.
Results:
During the course, 9 patients discontinued the rivastigmine oral solution due to poor compliance or preference. Twelve out of 99 patients (12.1%) reported possible side effects. Among 87 patients, the mean age was 77.2 ± 9.0 years ago with female predominant (65.2%). The optimal dose was 3.6 ± 1.4 ml in average and 4 ml (n = 31, 35.6%) in mode. The duration to optimal dose was 12.5 ± 10.2 weeks and 24 weeks (n = 35, 40.2%) in mode. It presented 25% with cognitive decline in MMSE, 27% with global function decline in CDR and 63% with global function decline in CDR-SB.
Conclusion
We demonstrated the clinical experience of rivastigmine oral solution in mild to moderate AD patients. It suggested rivastigmine oral solution 4ml is the optimal dose with 24 weeks to the optimal dose for at least one third of patients.
4.Real-world Evaluation of Tolerability, Safety and Efficacy of Rivastigmine Oral Solution in Patients with Mild to Moderate Alzheimer’s Disease Dementia
Sun-Wung HSIEH ; Jui-Cheng CHEN ; Nai-Ching CHEN ; Kai-Ming JHANG ; Wenfu WANG ; Yuan-Han YANG
Clinical Psychopharmacology and Neuroscience 2021;19(3):459-469
Objective:
The purpose of this study is to investigate the safety, tolerability and efficacy of titrating dose of rivastigmine oral solution in patients with mild to moderate Alzheimer’s disease (AD) in Taiwan.
Methods:
We recruited 108 mild to moderate AD patients with RivastⓇ (rivastigmine oral solution 2 mg/ml) treatment for 52 weeks. We recorded the demographic characteristics, initial cognition by mini-mental state examination (MMSE), initial global status by clinical dementia rating (CDR) with CDR-Sum of Boxes (CDR-SB), initial dose, and titrating dose at each visit. We investigated the adherence, proportion of possible side effects, optimal dose, and time to optimal dose. We demonstrated the proportion of cognitive decline and its possible risk factors.
Results:
During the course, 9 patients discontinued the rivastigmine oral solution due to poor compliance or preference. Twelve out of 99 patients (12.1%) reported possible side effects. Among 87 patients, the mean age was 77.2 ± 9.0 years ago with female predominant (65.2%). The optimal dose was 3.6 ± 1.4 ml in average and 4 ml (n = 31, 35.6%) in mode. The duration to optimal dose was 12.5 ± 10.2 weeks and 24 weeks (n = 35, 40.2%) in mode. It presented 25% with cognitive decline in MMSE, 27% with global function decline in CDR and 63% with global function decline in CDR-SB.
Conclusion
We demonstrated the clinical experience of rivastigmine oral solution in mild to moderate AD patients. It suggested rivastigmine oral solution 4ml is the optimal dose with 24 weeks to the optimal dose for at least one third of patients.