Thesis (M. Soc. Sc.)--University of Hong Kong, 2003.

Occupation provides valuable information on premorbid ability in dementia. Not only is occupation related to cognitive and brain reserve, but premorbid sub-symptomatic impairment may influence prospective career choice. Frontotemporal lobar degeneration (FTLD) patients with professions dependent upon one hemisphere have demonstrated contralateral degeneration. The present work was the first group study to examine the relationship between atrophy in FTLD and occupation. Chapter one reviews methods for quantifying occupations and introduces the Occupational Information Network database. This database provided quantified occupation attribute data and enabled subsequent multivariate analyses. A principal component analysis yielded five factors that parsimoniously summarized verbal, physical, mechanical, mathematical and visuospatial occupational demands, some with hypothesized neuroanatomical substrates. Chapters two and three tested the hypothesis that occupation characteristics systematically relate to origin of atrophy in FTLD. In a multi-centre chart review of 588 patients, occupation information was related to location of atrophy. Patients with unilateral right atrophy had higher verbal scores than patients with unilateral left or bilateral atrophy. Thus, occupation selection occurring in early adulthood is related to lateralized brain damage in patients who develop FTLD decades later. The finding suggests that verbal occupations may have been pursued due to incipient right-hemisphere functional impairment. Alternatively, long-term engagement of verbal processes contributed to left-hemisphere reserve, right-hemisphere dysfunction, or both. In a subgroup of well-characterized patients with quantified brain imaging data, chapter three replicated and extended these findings. The lateralization effect was limited to the temporal lobes and included both verbal and mathematical ability. This pattern may reflect shared attributes between mathematics and language processing, which are mediated by left-temporal lobe structures. Patients whose professions placed high demands on language had relatively preserved left temporal lobes and atrophy originating in the right temporal lobes at disease onset whereas patients with less challenging linguistic occupations were more susceptible to the onset of atrophy in the left-temporal lobe. In chapter four, the hypothesized relationship between occupational attainment and global degeneration was supported. Patients with highly skilled occupations had less atrophy than patients with lower-skilled occupations. Notably, specific occupational attributes were predictive of brain volume after controlling for demography and disease progression. Overall, a relationship between occupation and FTLD is supported.

Occupation provides valuable information on premorbid ability in dementia. Not only is occupation related to cognitive and brain reserve, but premorbid sub-symptomatic impairment may influence prospective career choice. Frontotemporal lobar degeneration (FTLD) patients with professions dependent upon one hemisphere have demonstrated contralateral degeneration. The present work was the first group study to examine the relationship between atrophy in FTLD and occupation. Chapter one reviews methods for quantifying occupations and introduces the Occupational Information Network database. This database provided quantified occupation attribute data and enabled subsequent multivariate analyses. A principal component analysis yielded five factors that parsimoniously summarized verbal, physical, mechanical, mathematical and visuospatial occupational demands, some with hypothesized neuroanatomical substrates. Chapters two and three tested the hypothesis that occupation characteristics systematically relate to origin of atrophy in FTLD. In a multi-centre chart review of 588 patients, occupation information was related to location of atrophy. Patients with unilateral right atrophy had higher verbal scores than patients with unilateral left or bilateral atrophy. Thus, occupation selection occurring in early adulthood is related to lateralized brain damage in patients who develop FTLD decades later. The finding suggests that verbal occupations may have been pursued due to incipient right-hemisphere functional impairment. Alternatively, long-term engagement of verbal processes contributed to left-hemisphere reserve, right-hemisphere dysfunction, or both. In a subgroup of well-characterized patients with quantified brain imaging data, chapter three replicated and extended these findings. The lateralization effect was limited to the temporal lobes and included both verbal and mathematical ability. This pattern may reflect shared attributes between mathematics and language processing, which are mediated by left-temporal lobe structures. Patients whose professions placed high demands on language had relatively preserved left temporal lobes and atrophy originating in the right temporal lobes at disease onset whereas patients with less challenging linguistic occupations were more susceptible to the onset of atrophy in the left-temporal lobe. In chapter four, the hypothesized relationship between occupational attainment and global degeneration was supported. Patients with highly skilled occupations had less atrophy than patients with lower-skilled occupations. Notably, specific occupational attributes were predictive of brain volume after controlling for demography and disease progression. Overall, a relationship between occupation and FTLD is supported.

Thesis (Ph.D.)--University of Texas at Dallas, 2008. / Includes vita. Includes bibliographical references (leaves 187-189)

Thesis (M.A.)--Central Connecticut State University, 2001. / Thesis advisor: C. Charles Mate-Kole. " ... in partial fulfillment of the requirements for the degree of Master of Arts in Psychology." Includes bibliographical references (leaves 36-44). Also available via the World Wide Web.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references (leaves 159-173). Available also in a digital version from Dissertation Abstracts.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Background: With the aging of the global population, the prevalence and incidence of Alzheimer’s disease or related dementia are increasing. Most mild or moderate dementia clients are taken care of at home by informal caregivers, which leave a heavy burden to the caregivers. Researchers have found out that with good intervention services and programmes for the caregivers, their burden, emotional distress and even the care recipients’ symptoms and institutionalization rates would be improved. Objectives: This project is to review these researches to evaluate whether the interventions are effective and/ or cost-effective and how the decision-makers could use the results for evidence-based policy. Methods: A literature search was performed on randomized controlled trials in education, information/ support intervention programmes published from October 2005 to July 2012. Electronic databases (EBSCO, PubMed and CNKI) were searched until July 2012. The Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting randomized controlled trials was used as the guideline to evaluate the quality of identified papers. Results: 16 papers (15 studies) were included in this review and classified into three groups, as home-based, individual-based and group-based interventions. This review found that the intervention programmes had various outcomes and showed some evidence of effectiveness. Most of the papers had good quality. The home-based programmes showed cost-effectiveness in the identified studies. Conclusion: There was some evidence that the home- and group-based interventions were effective and the home-based interventions could be cost-effective. Further studies are recommended and a meta-analysis on the studies and more researches on economic analysis are needed. A community-based long-term dementia management should be built up for better outcomes. / published_or_final_version / Public Health / Master / Master of Public Health

Introduction: Dementia refers to impairments of memory and other cognitive functions with consequent decline in activities of daily living. Besides cognitive symptoms, demented patients can also exhibit behavioral and psychological symptoms of dementia (BPSD), which are stressors leading to family caregivers’ burden. Physical activity may give rise to benefits in cognitive function, and may reduce behavioral symptoms and caregivers’ burden. However, most previous studies were reported from Caucasian populations. There was no previous report on the relationship of physical activity in dementia patients on family caregiver’s burden in Hong Kong Chinese older adults. Objectives: The objective of this study was to investigate the associations of physical activity level with cognitive function, behavioral and psychological symptoms and caregivers’ burden in dementia patients in Hong Kong Chinese population. Method: This was a cross-sectional study. 201 dementia patients who were screened by the inclusion and exclusion criteria were recruited from the Geriatric Clinic in Queen Mary Hospital, Hong Kong, from May 2013 to August 2013. Social demographic information and comorbid diseases information were collected from all subjects. Subjects were then assessed with the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL), Physical Activity Scale for the Elderly (PASE), as well as Neuropsychiatric Inventory (NPI). Subjects’ family caregivers were assessed with Zarit Burden Interview (ZBI). Main outcome measures: The outcome measures for the cognitive function were the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The outcome measures for BPSD and caregiver’s burden were the Neuropsychiatric Inventory (NPI) and Zarit Burden Interview (ZBI), respectively. Results: We screened a total of 239 subjects in the Geriatric Clinic of Queen Mary Hospital. 201 subjects (70 males and 131 females) were recruited. 38 participants were excluded according to the exclusion criteria. The score means (SD) of the recruited were: PASE =27.5 (23.9); ADCS-ADL=45.3 (14.5); MMSE=17.3 (5.4); MoCA=9.9 (5.3); NPI=9.5 (9.7); ZBI=33.3 (14.8). In bivariate analysis, the PASE score was significantly associated with the MMSE score (rho=0.259, p<0.001), the MoCA score (rho=0.311, p<0.001), the NPI score (rho=-0.225, p=0.001), and the ZBI score (rho=-0.253, p<0.001). In multivariate analyses, using general linear models, the PASE score was independently associated with the MMSE (F=5.57, p=0.001) and MoCA (F=7.10, p<0.001) scores, after adjusting for significant confounders in bivariate analyses (i.e. age, education and gender). The PASE was also independently associated with the NPI score (F=2.89, p=0.037). The PASE score was not an independent predictor of the ZBI score. However, the subjects’ ADCS-ADL score (F=15.65, p<0.001), and the NPI score (F=8.55, p=0.004) were independent predictors of the caregiver’s ZBI score. / published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Background: Dementia is a global chronicle disease which will impact on millions of elders in the following decades. The increased number of patients would be a huge burden for healthcare professionals. It is important to equip nursing students with proper knowledge and attitude to care for patients with dementia in the clinical practicing; however, little is known about the current dementia literacy level among Chinese nursing students. Objective: The aim of the current study are (1) to test the psychometric properties of the Modified Dementia Attitude Scale-Chinese Version (MDAS-C), (2) to investigate the current dementia literacy level among Chinese nursing students in three cities in China, and (3) to identify factors that were associated with nursing students’ dementia literacy. Method: The study consisted of two phases. Phase I was a validation study with cross-sectional design, surveying Year III nursing students in one university in Mainland China. Content validity, internal consistency, convergent validity, the exploratory factor analysis, and the test-retest reliability testing were employed to test the psychometric properties of the MDAS-C. Phase II employed cross-sectional design, surveying all year nursing students in three universities in China. Demographic information, dementia knowledge, attitude toward patients with dementia, and perceptions about healthcare professionals and services related to dementia were measured. Factors that associated with dementia literacy were evaluated. Results: In phase I, a total of 223 students participated. The MDAS-C contained 12 items, and the Cronbach’s alpha of the scale was 0.685. Three factors (‘Interaction with Patient with Dementia’, ‘Responses to Patient with Dementia’ and ‘Feelings of Patient with Dementia’) were identified, explaining 48.50% of variance. The MDAS-C was positively correlated with Kogan Attitude toward Older People Scale- Chinese Version (KAOP-C) (r=0.458, p<0.001) and its positive subscale (r=0.421, p<0.001). The Pearson-correlation for the 2-week interval test-retest reliability for the scale was 0.703 (p<0.001), which was adequate. In Phase II, 563 subjects participated. The mean score of Alzheimer’s Disease Knowledge Scale (ADKS) was 18.92 (SD = 2.90), which was equivalent to 63.1% of the correct answer. Three factors, namely location, year of study, and whether they knew a person with dementia, were associated with their knowledge. The mean score of MDAS-C was 53.71 (SD= 8.59), which was equivalent to 63.9% of the total score. This result reflected that the participants held positive attitudes toward patients with dementia. Two factors, namely location and whether they knew a person with dementia, were associated with their attitudes toward patients with dementia. Majority of the subjects (93.8%) were not aware of community services provided for patients with dementia. Most subjects (92.2%) ranked skill-training services for both patients and caregivers as the most helpful one. Among healthcare professionals, the majority (91.8%) of the participants considered nurses as the most helpful personnel to patients with dementia. Discussion and Conclusion: The current study showed that the MDAS-C had good psychometric properties. This instrument can be used for research and clinical practices. The study also contributed to the understanding of dementia literacy among Chinese nursing students and factors associated with dementia literacy. / published_or_final_version / Nursing Studies / Master / Master of Philosophy