INTRODUCTION

Dementia has been a public health concern for several years. As the population continuously ages, the prevalence of dementia is projected to significantly rise, thus governments will face an increasing demand for support services. Unfortunately, dementia is not recognized as a major public health concern in the Philippines. As the extent of the dementia epidemic needs to be further delineated in the Philippines, and research on dementia is still limited, a larger study is needed to provide more information about the disease burden. This will raise awareness and inform policy makers about the necessity of social and health care reform in dementia care.

We aimed to collect uniform data from patients with cognitive impairment and determine the frequency of dementia and mild cognitive impairment in the study population. These data are crucial for providing information to policy makers in the country.

This is a multi-center, prospective, observational, non-interventional study and standing database of patients clinically diagnosed with Mild Cognitive Impairment (MCI) or dementia seen at the participating training institutions. Corresponding anonymized data on demographics, medical history, risk factors, level of functional impairment, diagnosis, baseline cognitive scores and management will be collected from each patient and entered into the database using a secure online data collection tool. Collective data will be extracted, summarized and analyzed every year with oversight provided by the Philippine Neurological Association (PNA).

Approval from the ethics committees or institutional review boards (EC/IRB) was obtained from the Single Joint Research Ethics Board and all participating institutions.

The PNA1DB-Dementia initiative will be crucial in providing information to policy makers, to further enhance the implementation of the Mental Health Act. The dissemination of results will be conducted through scientific or public conferences and scientific journal publication.

NCT05484960; ClinicalTrials.gov.

Background: and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. Methods: This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). Results: Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. Conclusions In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Background: and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. Methods: This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). Results: Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. Conclusions In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Posterior Cortical Atrophy is a group of neurodegenerative disorders characterized by early, prominent and progressive impairment of visuospatial and visuoperceptual functions in the context of relatively preserved memory and insight in the early phases. Initial visual symptoms are vague, compelling patients to seek ophthalmologic consult. They present with simultagnosia and spatial disorientation, which are often missed by routine ophthalmologic and neurologic exams, causing delay in diagnosis. As the disease progresses, Posterior Cortical Atrophy ultimately leads to a more diffuse pattern of cognitive dysfunction. The underlying pathology is believed to be Alzheimer’s Disease and a greater level of amyloid plaques is correlated with earlier clinical symptoms of Posterior Cortical Atrophy. The clinical features of reported cases are heterogenous, leading to a classification of different variants and underlying pathologies. We report the serial clinical, cognitive and imaging data of a variant of Posterior Cortical Atrophy primarily affecting the dorsal stream.
Neuropsychological Tests

BACKGROUND: Cognitive screening is currently recommended as part of the routine evaluation in the primary care setting of older patients because of the high prevalence and social costs of dementia. However, previous studies have shown frequent lack of recognition of the dementia syndrome and high rates of missed dementia diagnosis both in the local as well as developed countries especially in primary care visits. Hence, it is recognized that there is a need for a simple screening instrument that can empower primary care practitioners and internists in general to initiate screening and diagnose dementia in their offices since they are the ones who sees the bulk of older patients. The Time and Change Test (TCT), developed by Froehlich, et al, is a simple, rapid performance-based test which assesses the patient's ability to tell time and make change. It has been previously validated for the detection of dementia both in the inpatient and outpatient population. Previous studies also reported it to be accurate, reliable and acceptable by elderly persons. However, the usefulness and applicability of TCT in our locality is yet to be tested.

OBJECTIVE: To determine the reliability and validity of 'Time and Change Test as a screening tool for dementia In patients 60 years old and above seen at the Memory Center of St. Luke's Medical Center.

METHODOLOGY: Consecutive patients referred to the i Memory Center for cognitive evaluation from March 2003 to September 2004 were included in the study. Patients underwent a battery of psychological tests administered by a trained psychologist who were blinded to the diagnosis of the neurologist using the DSM-IV criteria and the stage of dementia using the Clinical Dementia Rating Scale (CDR-4). The neurologist interviewed the patient, the relatives or caregivers separately for collateral information to establish the patient's level of functioning and rate of cognitive decline and the presence of behavioral symptoms. The Time and Change Test was added to the psychological tests administered by the psychologist. The patient was asked to tell the time of a clock face set at 11:10. Two tries are allowed for a correct response within a 60-second period of time. Next, patient was asked to make a change. A set of three Php 20 bills, seven Php 10 bills and seven Php 5 bills were placed before the patient. The patient was then asked to give back a total of Php 100 change and was allowed two tries for a correct change within a two minute period. Incorrect responses in either or both tasks are scored as positive, indicating the need for further evaluation for the presence of dementia. Reliability of TCT was tested in both demented and normal patients. The clinical diagnosis by the neurologist based on the DSM-IV criteria was used as the gold standard.

RESULTS: The reliability of TCT was tested in 31 patients (n=31), with inter-observer agreement of 100%. The test-retest also showed high reliability. The validity of TCT was tested on total of 84 patients. The sensitivity was at 65.45 percent and specificity of 97 percent. Positive predictive value was 97.30 percent.

CONCLUSION: Time and Change Test is a reliable assessment tool with high positive predictive value for the presence of dementia. Because of its being simple and easy to administer, it can help primary care physicians screen for cognitive decline in older Filipinos.