Displaying publications 1 - 20 of 63 in total

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  1. Abdul Aziz SA, Mcstea M, Ahmad Bashah NS, Chong ML, Ponnampalavanar S, Syed Omar SF, et al.
    AIDS, 2018 05 15;32(8):1025-1034.
    PMID: 29547442 DOI: 10.1097/QAD.0000000000001798
    OBJECTIVES: In a clinic-based, treated HIV-infected cohort, we identified individuals with sarcopenia and compared with age, sex and ethnically matched controls; and investigated associated risk factors and health outcomes.

    DESIGN: Sarcopenia (age-related muscle loss) causes significant morbidity to the elderly, leading to frequent hospitalizations, disability and death. Few have characterized sarcopenia in the HIV-infected who experience accelerated aging.

    METHODS: Sarcopenia was defined as low muscle mass with weak grip strength and/or slow gait speed using lower 20th percentiles of controls. Multivariate logistic and linear regression analyses were used to explore risk factors and health-related outcomes associated with sarcopenia among HIV-infected individuals.

    RESULTS: We recruited 315 HIV-infected individuals aged at least 25 years with at least 1-year history of undetectable viral load on treatment (HIV RNA <50 copies/ml). Percentage of sarcopenia in 315 HIV-infected was 8%. Subsequently, 153 of the 315 were paired with age, sex and ethnically matched HIV-uninfected. The percentage of sarcopenia in the HIV-infected (n = 153) compared with uninfected (n = 153) were 10 vs. 6% (P = 0.193) respectively, whereas of those at least 50 years of age among them were 17% vs. 4% (P = 0.049), respectively. Associated risk factors among the HIV-infected include education level, employment status, BMI, baseline CD4 cell count, duration on NRTIs and GGT levels. Identified negative outcomes include mortality risk scores [5.42; 95% CI 1.46-9.37; P = 0.007) and functional disability (3.95; 95% CI 1.57-9.97; P = 0.004).

    CONCLUSION: Sarcopenia is more prevalent in HIV-infected at least 50 years old compared with matched controls. Our findings highlight associations between sarcopenia with loss of independence and greater healthcare burden among treated HIV-infected individuals necessitating early recognition and intervention.

  2. Ahmad NS, Hairi NN, Said MA, Kamaruzzaman SB, Choo WY, Hairi F, et al.
    PLoS One, 2018;13(11):e0206445.
    PMID: 30395649 DOI: 10.1371/journal.pone.0206445
    OBJECTIVES: This study aims to describe the prevalence and transitions of frailty among rural-community dwelling older adults in Malaysia and to analyse factors associated with different states of frailty transition. Frailty was conceptualized using modified Fried phenotype from the Cardiovascular Health Study.

    DESIGN: This is a prospective longitudinal study with 12-months follow up among older adults in Malaysia.

    SETTING: Kuala Pilah, a district in Negeri Sembilan, which is one of the fourteen states in Malaysia.

    PARTICIPANTS: 2,324 community-dwelling older Malaysians aged 60 years and older.

    RESULTS: The overall prevalence of frailty in this study was 9.4% (95% CI 7.8-11.2). The prevalence increased at least three-fold with every 10 years of age. This increase was seen higher in women compared to men. Being frail was significantly associated with older age, women, and respondents with a higher number of chronic diseases, poor cognitive function and low socioeconomic status (p<0.05). During the 12-months follow-up, our study showed that the transition towards greater frailty states were more likely (22.9%) than transition toward lesser frailty states (19.9%) while majority (57.2%) remained unchanged. Multivariate logistic regression analysis showed that presence of low physical activity increased the likelihood of worsening transition towards greater frailty states by three times (OR 2.9, 95% CI 2.2-3.7) and lowered the likelihood of transition towards lesser frailty states (OR 0.3, 95% CI 0.2-0.4).

    CONCLUSION: Frailty is reported among one in every eleven older adults in this study. The prevalence increased across age groups and was higher among women than men. Frailty possesses a dynamic status due to its potential reversibility. This reversibility makes it a cornerstone to delay frailty progression. Our study noted that physical activity conferred the greatest benefit as a modifiable factor in frailty prevention.

  3. Alex D, Khor HM, Chin AV, Hairi NN, Cumming RG, Othman S, et al.
    Front Public Health, 2020;8:506238.
    PMID: 33304870 DOI: 10.3389/fpubh.2020.506238
    Falls are major issues affecting the older population with potentially serious complications, including fractures, head injury, institutionalization, fear of falling and depression. While risk factors for falls have been established across Western Europe and North America, geographical differences in falls risk have not been well researched. We aim to examine the clinical and physical risk factors for falls in a middle-income South East Asian country. Cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study involving 1,362 community dwelling individuals aged 55 years and above was utilized. Information on sociodemographic and medical history was obtained by computer-assisted questionnaires completed during home visits and hospital-based detailed health checks. Univariate and multivariate analyses compared non-fallers and fallers in the previous 12 months. Urinary incontinence, hearing impairment, depression, arthritis and cognitive impairment were risk factors for falls in the past 12 months after adjustment for age in our study population. Awareness about the risk factors in a population helps the design of fall prevention strategies that target specific or multiple risk factors.
  4. Amanat MA, John J, Pin TM, Danaee M, Malhotra V, Abbas SA, et al.
    J Public Health (Oxf), 2020 May 26;42(2):304-311.
    PMID: 30796789 DOI: 10.1093/pubmed/fdz014
    BACKGROUND: Poor oral health affects not only dietary choices but overall well-being. This study explores the influence of lifestyle, socio-demographics and utilization of dental services on the dentition status of an older urban Malaysian population.

    METHODS: A total of 1210 participants 60 years and above, representing the three main ethnic groups were recruited from a larger cohort study. Weighted factors valued for comparison included socio demographics and health status. Knowledge of and attitude and behaviour towards personal oral health were also assessed. Dentition status, adapted from WHO oral health guidelines, was the dependent variable investigated. Data were analysed using descriptive chi square test and multivariate binary logistic regression.

    RESULTS: Overall, 1187 respondents completed the study. The dentition status and oral health related knowledge, attitude and behaviour varied between the three ethnic groups. The Chinese were significantly less likely to have ≥13 missing teeth (OR = 0.698, 95% CI: 0.521-0.937) and ≥1 decayed teeth (0.653; 0.519-0.932) compared to the Malays, while the Indians were significantly less likely than the Malays to have ≥1 decayed teeth (0.695; 0.519-0.932) and ≥2 filled teeth (0.781; 0.540-1.128).

    CONCLUSION: Ethnic differences in dentition outcome are related to oral health utilization highlighting the influence of cultural differences and the need for culturally sensitivity interventions.

  5. Amir NN, Kamaruzzaman SB, Effendi-Tenang I, Jamaluddin M, Tan MP, Ramli N, et al.
    Eur Geriatr Med, 2021 Apr;12(2):313-319.
    PMID: 33486745 DOI: 10.1007/s41999-021-00450-2
    PURPOSE: Using data from the Malaysian Elders Longitudinal Research (MELoR), this study investigated the association between visual function (visual acuity and contrast sensitivity) and frailty in a group of urban-dwelling older adults.

    METHODS: This was a cross-sectional study. 1332 participants aged ≥ 55 years were selected by random sampling from the parliamentary electoral register. Only 1274 participants completed the frailty assessment and 1278 participants completed the contrast sensitivity assessment. Impaired vision was defined as a Snellen visual acuity of worse than 6/12 in the better eye. Poor contrast sensitivity was defined as a score on the Pelli Robson chart of lower than 1.65. Frailty was defined with the Fried's phenotype criteria. Inter-group comparisons were determined with the independent T-test for continuous variables and the Pearson's Chi-squared test for categorical variables. The odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the cross-sectional association between frailty and visual function.

    RESULTS: The mean age of participants was 68.8 ± 7.5 years, of which 58.1% (774) were women. Impaired vision and poor contrast sensitivity were present in 187 (14%) and 271 (21.2%) subjects respectively. 73 (5.8%) individuals were classified as frail, 1161 (91.0.%) pre-frail, and 40 (2.8%) non-frail. There was no significant difference in frailty phenotypes between those with good and impaired vision (p = 0.241). Fried's component of handgrip strength, gait speed and exhaustion were significantly better in those with good visual function (p 

  6. Arai H, Maeda K, Wakabayashi H, Naito T, Konishi M, Assantachai P, et al.
    J Cachexia Sarcopenia Muscle, 2023 Oct;14(5):1949-1958.
    PMID: 37667992 DOI: 10.1002/jcsm.13323
    Chronic diseases often lead to metabolic disorders, causing anabolic resistance and increased energy consumption, which result in cachexia. Cachexia, in turn, can lead to major clinical consequences such as impaired quality of life, shortened life expectancy, and increased healthcare expenditure. Existing international diagnostic criteria for cachexia employ thresholds derived from Western populations, which may not apply to Asians due to differing body compositions. To address this issue, the Asian Working Group for Cachexia (AWGC) was initiated. The AWGC comprises experts in cachexia research and clinical practice from various Asian countries and aims to develop a consensus on diagnostic criteria and significant clinical outcomes for cachexia in Asia. The AWGC, composed of experts in cachexia research and clinical practice from several Asian countries, undertook three-round Delphi surveys and five meetings to reach a consensus. Discussions were held on etiological diseases, essential diagnostic items for cachexia, including subjective and objective symptoms and biomarkers, and significant clinical outcomes. The consensus highlighted the importance of multiple diagnostic factors for cachexia, including chronic diseases, either or both weight loss or low body mass index, and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>5 mg/L [0.5 mg/dL]). The AWGC proposed a significant weight change of 2% or more over a 3-6 month period and suggested a tentative cut-off value of 21 kg/m2 for low body mass index in diagnosing cachexia. Critical clinical outcomes were determined to be mortality, quality of life as assessed by tools such as EQ-5D or the Functional Assessment of Anorexia/Cachexia Therapy, and functional status as measured by the Clinical Frailty Scale or Barthel Index, with significant emphasis on patient-reported outcomes. The AWGC consensus offers a comprehensive definition and user-friendly diagnostic criteria for cachexia, tailored specifically for Asian populations. This consensus is set to stimulate future research and enhance the multidisciplinary approach to managing cachexia. With plans to develop further guidelines for the optimal treatment, prevention, and care of cachexia in Asians, the AWGC criteria are expected to drive research across chronic co-morbidities and cancer in Asia, leading to future refinement of diagnostic criteria.
  7. Darawi MN, Ai-Vyrn C, Ramasamy K, Hua PP, Pin TM, Kamaruzzaman SB, et al.
    BMC Med Genet, 2013;14:27.
    PMID: 23419238 DOI: 10.1186/1471-2350-14-27
    The incidence of Alzheimer's disease, particularly in developing countries, is expected to increase exponentially as the population ages. Continuing research in this area is essential in order to better understand this disease and develop strategies for treatment and prevention. Genome-wide association studies have identified several loci as genetic risk factors of AD aside from apolipoprotein E such as bridging integrator (BIN1), clusterin (CLU), ATP-binding cassette sub-family A member 7 (ABCA7), complement receptor 1 (CR1) and phosphatidylinositol binding clathrin assembly protein (PICALM). However genetic research in developing countries is often limited by lack of funding and expertise. This study therefore developed and validated a simple, cost effective polymerase chain reaction based technique to determine these single nucleotide polymorphisms.
  8. Effendi-Tenang I, Tan MP, Khaliddin N, Jamaluddin Ahmad M, Amir NN, Kamaruzzaman SB, et al.
    Arch Gerontol Geriatr, 2020 06 26;90:104165.
    PMID: 32650156 DOI: 10.1016/j.archger.2020.104165
    INTRODUCTION: Published literature on vision impairment and cognitive function amongst older Malaysians remains scarce. This study investigates the association between vision impairment and cognitive function in an older Malaysian population.

    METHODS: Subjects aged 55 years and above from the Malaysian Elders Longitudinal Research (MELoR) study with available information on vision and Montreal Cognitive Assessment (MoCA) scores were included. Data were obtained through a home-based interview and hospital-based health check by trained researchers. Visual acuity (VA) was assessed with logMAR score with vision impairment defined as VA 6/18 or worse in the better-seeing eye. Cognition was evaluated using the MoCA-Blind scoring procedure. Those with a MoCA-Blind score of <19/22 were considered to have cognitive impairment.

    RESULTS: Data was available for 1144 participants, mean (SD) age = 68.57 (±7.23) years. Vision impairment was present in 143 (12.5 %) and 758 (66.3 %) had MoCA-Blind score of <19. Subjects with vision impairment were less likely to have a MoCA-Blind score of ≥19 (16.8 % vs 36.2 %, p < 0.001). Vision impairment was associated with poorer MoCA-Blind scores after adjustments for age, gender, and ethnicity (β = 2.064; 95 % CI, -1.282 to 3.320; P = 0.003). In those who had > 6 years of education attainment, vision impairment was associated with a significant reduction of cognitive function and remained so after adjustment for age and gender (β = 1.863; 95 % CI, 1.081-3.209; P = 0.025).

    CONCLUSION: Our results suggest that vision impairment correlates with cognitive decline. Therefore, maintaining good vision is an important interventional strategy for preventing cognitive decline in older adults.

  9. Enche Ady CNA, Lim SM, Teh LK, Salleh MZ, Chin AV, Tan MP, et al.
    J Neurosci Res, 2017 Oct;95(10):2005-2024.
    PMID: 28301062 DOI: 10.1002/jnr.24048
    The rapid increase in the older population has made age-related diseases like Alzheimer's disease (AD) a global concern. Given that there is still no cure for this neurodegenerative disease, the drastic growth in the number of susceptible individuals represents a major emerging threat to public health. The poor understanding of the mechanisms underlying AD is deemed the greatest stumbling block against progress in definitive diagnosis and management of this disease. There is a dire need for biomarkers that can facilitate early diagnosis, classification, prognosis, and treatment response. Efforts have been directed toward discovery of reliable and distinctive AD biomarkers but with very little success. With the recent emergence of high-throughput technology that is able to collect and catalogue vast datasets of small metabolites, metabolomics offers hope for a better understanding of AD and subsequent identification of biomarkers. This review article highlights the potential of using multiple metabolomics platforms as useful means in uncovering AD biomarkers from body fluids. © 2017 Wiley Periodicals, Inc.
  10. Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Poi PJ, Chee KH, et al.
    Medicine (Baltimore), 2016 May;95(19):e3614.
    PMID: 27175670 DOI: 10.1097/MD.0000000000003614
    To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators.While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls.A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing.Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%.This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies.
  11. Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Tan MP
    Medicine (Baltimore), 2017 Oct;96(42):e8193.
    PMID: 29049203 DOI: 10.1097/MD.0000000000008193
    The aim of this study was to determine the relationship between falls and beat-to-beat blood pressure (BP) variability.Continuous noninvasive BP measurement is as accurate as invasive techniques. We evaluated beat-to-beat supine and standing BP variability (BPV) using time and frequency domain analysis from noninvasive continuous BP recordings.A total of 1218 older adults were selected. Continuous BP recordings obtained were analyzed to determine standard deviation (SD) and root mean square of real variability (RMSRV) for time domain BPV and fast-Fourier transform low frequency (LF), high frequency (HF), total power spectral density (PSD), and LF:HF ratio for frequency domain BPV.Comparisons were performed between 256 (21%) individuals with at least 1 fall in the past 12 months and nonfallers. Fallers were significantly older (P = .007), more likely to be female (P = .006), and required a longer time to complete the Timed-Up and Go test (TUG) and frailty walk test (P ≤ .001). Standing systolic BPV (SBPV) was significantly lower in fallers compared to nonfallers (SBPV-SD, P = .016; SBPV-RMSRV, P = .033; SBPV-LF, P = .003; SBPV-total PSD, P = .012). Nonfallers had significantly higher supine to standing ratio (SSR) for SBPV-SD, SBPV-RMSRV, and SBPV-total PSD (P = .017, P = .013, and P = .009). In multivariate analyses, standing BPV remained significantly lower in fallers compared to nonfallers after adjustment for age, sex, diabetes, frailty walk, and supine systolic BP. The reduction in frequency-domain SSR among fallers was attenuated by supine systolic BP, TUG, and frailty walk.In conclusion, reduced beat-to-beat BPV while standing is independently associated with increased risk of falls. Changes between supine and standing BPV are confounded by supine BP and walking speed.
  12. Habib MA, Ibrahim F, Mohktar MS, Kamaruzzaman SB, Rahmat K, Lim KS
    World Neurosurg, 2016 Apr;88:576-585.
    PMID: 26548833 DOI: 10.1016/j.wneu.2015.10.096
    BACKGROUND: Electroencephalography source imaging (ESI) is a promising tool for localizing the cortical sources of both ictal and interictal epileptic activities. Many studies have shown the clinical usefulness of interictal ESI, but very few have investigated the utility of ictal ESI. The aim of this article is to examine the clinical usefulness of ictal ESI for epileptic focus localization in patients with refractory focal epilepsy, especially extratemporal lobe epilepsy.

    METHODS: Both ictal and interictal ESI were performed by the use of patient-specific realistic forward models and 3 different linear distributed inverse models. Lateralization as well as concordance between ESI-estimated focuses and single-photon emission computed tomography (SPECT) focuses were assessed.

    RESULTS: All the ESI focuses (both ictal and interictal) were found lateralized to the same hemisphere as ictal SPECT focuses. Lateralization results also were in agreement with the lesion sides as visualized on magnetic resonance imaging. Ictal ESI results, obtained from the best-performing inverse model, were fully concordant with the same cortical lobe as SPECT focuses, whereas the corresponding concordance rate is 87.50% in case of interictal ESI.

    CONCLUSIONS: Our findings show that ictal ESI gives fully lateralized and highly concordant results with ictal SPECT and may provide a cost-effective substitute for ictal SPECT.

  13. Habib MA, Ibrahim F, Mohktar MS, Kamaruzzaman SB, Lim KS
    Clin Neurophysiol, 2020 03;131(3):642-654.
    PMID: 31978849 DOI: 10.1016/j.clinph.2019.11.058
    OBJECTIVE: This study aimed to present a new ictal component selection technique, named as recursive ICA-decomposition for ictal component selection (RIDICS), for potential application in epileptogenic zone localization.

    METHODS: The proposed technique decomposes ictal EEG recursively, eliminates a few unwanted components in every recursive cycle, and finally selects the most significant ictal component. Back-projected EEG, regenerated from that component, was used for source estimation. Fifty sets of simulated EEGs and 24 seizures in 8 patients were analyzed. Dipole sources of simulated-EEGs were compared with a known dipole location whereas epileptogenic zones of the seizures were compared with their corresponding sites of successful surgery. The RIDICS technique was compared with a conventional technique.

    RESULTS: The RIDICS technique estimated the dipole sources at an average distance of 12.86 mm from the original dipole location, shorter than the distances obtained using the conventional technique. Epileptogenic zones of the patients, determined by the RIDICS technique, were highly concordant with the sites of surgery with a concordance rate of 83.33%.

    CONCLUSIONS: Results show that the RIDICS technique can be a promising quantitative technique for ictal component selection.

    SIGNIFICANCE: Properly selected ictal component gives good approximation of epileptogenic zone, which eventually leads to successful epilepsy surgery.

  14. Habib MA, Mohktar MS, Kamaruzzaman SB, Lim KS, Pin TM, Ibrahim F
    Sensors (Basel), 2014 Apr 22;14(4):7181-208.
    PMID: 24759116 DOI: 10.3390/s140407181
    This paper presents a state-of-the-art survey of smartphone (SP)-based solutions for fall detection and prevention. Falls are considered as major health hazards for both the elderly and people with neurodegenerative diseases. To mitigate the adverse consequences of falling, a great deal of research has been conducted, mainly focused on two different approaches, namely, fall detection and fall prevention. Required hardware for both fall detection and prevention are also available in SPs. Consequently, researchers' interest in finding SP-based solutions has increased dramatically over recent years. To the best of our knowledge, there has been no published review on SP-based fall detection and prevention. Thus in this paper, we present the taxonomy for SP-based fall detection and prevention solutions and systematic comparisons of existing studies. We have also identified three challenges and three open issues for future research, after reviewing the existing articles. Our time series analysis demonstrates a trend towards the integration of external sensing units with SPs for improvement in usability of the systems.
  15. Hashim NNA, Mat S, Myint PK, Kioh SH, Delibegovic M, Chin AV, et al.
    Eur J Clin Invest, 2023 Feb;53(2):e13874.
    PMID: 36120810 DOI: 10.1111/eci.13874
  16. Jaafar MH, Mahadeva S, Tan KM, Chin AV, Kamaruzzaman SB, Khor HM, et al.
    Nutr Clin Pract, 2019 Apr;34(2):280-289.
    PMID: 30251336 DOI: 10.1002/ncp.10195
    BACKGROUND: A barrier to gastrostomy feeding exists among Asian clinicians and caregivers due to negative perceptions regarding complications. We compared clinical and nutrition outcomes in older dysphagic Asian patients with nasogastric (NG) or gastrostomy tube feeding using a pragmatic study design.

    METHODS: The choice of enteral tube access was determined by managing clinicians and patients/caregivers. Comparisons of tube feeding methods were made during a 4-month period, adjusting statistically for inherent confounders.

    RESULTS: A total of 102 participants (NG: n = 52, gastrostomy: n = 50) were recruited over 2 years from 2013 to 2015. Subjects on long-term NG tube feeding were older (82.67 ± 7.15 years vs 76.88 ± 7.37 years; P < .001) but both groups had similar clinical indications (stroke: 63.5% NG vs 54% gastrostomy; P = .33). After adjustment for confounders, gastrostomy feeding was associated with fewer tube-related complications (adjusted odds ratio [aOR] = 0.19; 95% confidence interval [CI] = 0.06-0.60) and better complication-free survival rate (aOR = 0.32; 95% CI = 0.12-0.89) at 4-month follow-up. Anthropometric and biochemical nutrition parameters improved significantly in both groups at 4 months, but no significant differences were observed at the end of the study.

    CONCLUSION: Gastrostomy feeding is associated with a greater 4-month complication-free survival and lower tube-related complications compared with long-term NG feeding in older Asians with dysphagia. However, no differences in nutrition outcomes were observed between NG and gastrostomy feeding at 4 months.

  17. Jamaluddin Ahmad M, Maw Pin T, Khaliddin N, Effendi-Tenang I, Amir NN, Kamaruzzaman SB, et al.
    Asia Pac J Public Health, 2020 12 29;33(2-3):280-286.
    PMID: 33375833 DOI: 10.1177/1010539520983667
    Low vision and blindness are major health issues affecting ageing population. This cross-sectional study aims to determine the prevalence of visual impairment (VI) in Petaling Jaya North, Petaling Jaya South, and Lembah Pantai using data from the Malaysian Elders Longitudinal Research. There were 1322 participants aged ≥55 years selected by random sampling from parliamentary electoral rolls. Visual acuity was assessed using the logarithm of the minimum angle of resolution chart at 4 m distance. The overall population-adjusted prevalence of VI was 9.0%. The estimated prevalence of VI was highest in Malays followed by Indians and Chinese. Following adjustments for ethnic discrepancies in age, marital status, education level, gender and medical illness, the Malay ethnicity remained an independent association for VI. Education level was associated with Indian ethnicity. In conclusion, the Malay ethnicity and lower education level among Indian ethnicity were found to be associated with VI among the older population in Malaysia. The Malay ethnicity showed the highest prevalence of VI followed by Indians and Chinese.
  18. Kan KC, Subramaniam P, Shahrizaila N, Kamaruzzaman SB, Razali R, Ghazali SE
    Dement Geriatr Cogn Dis Extra, 2019 02 08;9(1):66-76.
    PMID: 31043965 DOI: 10.1159/000495107
    Background/Aims: This study aimed to investigate the validity and reliability of the Malay version of Addenbrooke's Cognitive Examination III (ACE-III) for detecting mild cognitive impairment (MCI) and dementia.

    Methods: A total of 152 participants (dementia = 53, MCI = 38, controls = 61) were recruited from two teaching hospitals. The Malay version of ACE-III was translated following the standard guidelines for cross-cultural adaptation of measure. All the participants were assessed with the Malay version of ACE-III and Mini-Mental State Examination (MMSE).

    Results: The reliability of the Malay version of ACE-III was good with Cronbach's α coefficient of 0.829 and intraclass correlation coefficient of 0.959. There was a strong positive correlation between the Malay version of ACE-III and MMSE (r = 0.806). Age (r = -0.335) and years of education (r = 0.536) exerted a significant correlation with total score performance. The cutoff score to discriminate dementia from healthy controls was 74/75 (sensitivity = 90.6%, specificity = 82.0%) whereas to discriminate MCI, the cutoff score was 77/78 (sensitivity = 63.2%, specificity = 63.9%). The diagnostic accuracy of ACE-III was higher than that of MMSE in the detection of dementia (area under the curve: ACE-III = 0.929 vs. MMSE = 0.915).

    Conclusions: The Malay version of ACE-III demonstrated to be a reliable and valid screening tool for dementia.

  19. Khor HM, Tan J, Saedon NI, Kamaruzzaman SB, Chin AV, Poi PJ, et al.
    Arch Gerontol Geriatr, 2014 Nov-Dec;59(3):536-41.
    PMID: 25091603 DOI: 10.1016/j.archger.2014.07.011
    The presence of pressure ulcers imposes a huge burden on the older person's quality of life and significantly increases their risk of dying. The objective of this study was to determine patient characteristics associated with the presence of pressure ulcers and to evaluate the risk factors associated with mortality among older patients with pressure ulcers. A prospective observational study was performed between Oct 2012 and May 2013. Patients with preexisting pressure ulcers on admission and those with hospital acquired pressure ulcers were recruited into the study. Information on patient demographics, functional status, nutritional level, stages of pressure ulcer and their complications were obtained. Cox proportional hazard analysis was used to assess the risk of death in all patients. 76/684 (11.1%) patients had pre-existing pressure ulcers on admission and 30/684 (4.4%) developed pressure ulcers in hospital. There were 68 (66%) deaths by the end of the median follow-up period of 12 (IQR 2.5-14) weeks. Our Cox regression model revealed that nursing home residence (Hazard Ratio, HR=2.33, 95% confidence interval, CI=1.30, 4.17; p=0.005), infected deep pressure ulcers (HR=2.21, 95% CI=1.26, 3.87; p=0.006) and neutrophilia (HR=1.76; 95% CI 1.05, 2.94; p=0.031) were independent predictors of mortality in our elderly patients with pressure ulcers. The prevalence of pressure ulcers in our setting is comparable to previously reported figures in Europe and North America. Mortality in patients with pressure ulcer was high, and was predicted by institutionalization, concurrent infection and high neutrophil counts.
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