Secretariat, Alumni Association, IDAC
Date Thursday, 26 July 2018, 10:30~
Room Seminar Room,Center for Smart Ageing Research 2F,IDAC
Title 1)Diagnosis and Prognosis of neurodegenerative disease by using diffusion MRI
2)Care Models for Older Persons with Hip Fracture: Randomized Clinical Trials
Speaker 1)Jiun-Jie Wang
2)Yea-Ing Lotus Shyu
Affiliation 1)Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taiwan
2)School of Nursing, Chang Gung University, Taiwan
Organizer Kawashima Ryuta (Department of functional brain imaging)
Contact:Nouchi Rui (Department of functional brain imaging・ext8952)
Abstract 1) The recent development in diffusion Magnetic Resonance Imaging led to new interests on the studies of neurodegenerative diseases. However, limitations do exist which prevent the techniques from further applications. The reported findings are often controversial because of significant variations, either between studies or patient groups. To obtain unbiased results with respect to the current pathophysiological model, systematic investigations of the brain are therefore required. The presentation will discuss the measurement of diffusion by using MRI and examine the changes of the diffusion properties. We will use diffusion MRI to assess the performance on diagnosis, differential diagnosis, correlation to clinical severity and prognosis on two major neurodegenerative diseases, i.e. Alzheimer Diseases and Parkinson Diseases. In the differential diagnosis of Parkinson Disease, the preliminary results from 551 patients showed that mean diffusivity as assessed by diffusion MRI were found to be significantly higher in patients than in controls, and such differences extended beyond the basal ganglia. Image-based classification for idiopathic Parkinson’s disease had 94.1% sensitivity, 96.1% specificity, 94.9% positive predictive value, and 95.5% negative predictive value. Similar performance can be noticed in the differential diagnosis towards patients with Multiple system atrophy, supranuclear palsy and corticobasal syndrome. In the prognosis study, the predicted clinical severity using 82 patients with Parkinson Disease was consistent with the observed values (adjusted R2 = 0.44–0.86). The highest predictive power from diffusion imaging was identified in the total and the motor subscale of Unified Parkinson’s Disease Rating Scale. The improved diagnosis and prediction of the clinical outcome might ultimately increase the confidence of the neurologist during the therapeutic intervention.

2) Hip fractures result in a 13% to 36% mortality within the first year, a 44% to 55.3% mortality within 4 years after the fracture, and excessive morbidity that severely impedes the patients’ health-related quality of life. Consequently, hip fractures have become a major health issue for older persons. This presentation introduces a series of clinical trials of the care models for the older persons with hip fracture that were funded by the National Health Research Institutes. The first clinical trial examined the effects of an interdisciplinary program consisting of geriatric consultation, continuous rehabilitation, and discharge planning. This interdisciplinary intervention improved the clinical outcome, self-care ability, physical health-related outcomes and decreased the depressive symptoms during the first 24 months after hospital discharge. In the second clinical trial, we developed a comprehensive model that includes not only interdisciplinary care, but also the management of any nutritional problems, fall prevention, and the management of depressive symptoms. During the first 2 years following hip fracture, patients in this comprehensive care group had better performance trajectories for activities of daily living (ADLs) and instrumental ADLs (IADLs), as well as fewer emergency room visits than patients in the usual care group and had less risk of depression and malnutrition than the standard interdisciplinary care during the first year following hip fracture. The third clinical trial examined the effects of a diabetes mellitus (DM)-specific care model for older persons with DM who suffered a hip fracture. DM-specific care model, which integrated interdisciplinary care components with interventions to manage DM has been found to enhance range of motion in hip flexion and muscle strength of the quadriceps of the affected limb, and better overall HRV during the 24 months following hospital discharge above and beyond the effects of usual care and interdisciplinary care. The fourth clinical trial examined the effects of a family-centered care model for hip fractured older persons with cognitive impairment. Future clinical trial using a smart-care model to facilitate fall prevention and rehabilitation adherence was proposed.