Raffles Hospital (abbreviation: RH)(Chinese: 莱佛士医院 : Lái fú shì yīyuàn) is a tertiary care private hospital of the Raffles Medical Group, a private healthcare provider in Singapore.
Hypertension, diabetes, and hyperlipidemia are common in Singapore and linked to cognitive decline. Evidence on cognitive effects of related medications is mixed, with limited multiethnic Singapore data. This study investigated associations between antihypertensive, antidiabetic, and antihyperlipidemic medications and cognitive performance. This cross-sectional (n = 1556) and longitudinal study (n = 565) utilized two datasets from a multiethnic Asian population. Medications were categorized by Anatomical Therapeutic Chemical (ATC) Classification, and analyses compared users and non-users across the full sample and within respective medical conditions. Cognitive function was assessed using a neuropsychological battery evaluating seven domains and global cognition. Linear regression and linear mixed models were used for cross-sectional and longitudinal analyses, respectively. Cross-sectional findings showed no association between antihypertensive or antihyperlipidemic use and cognition. Among diabetic patients, antidiabetic use was linked to poorer global cognition (β = −0.149 (−0.253, −0.045)), executive function (β = −0.287 (−0.468, −0.093)), and visual memory (β = −0.217 (−0.343, −0.092)). Longitudinally, antihypertensive use was associated with better global cognition (β = 0.239 (0.052, 0.426)) and visual memory (β = 0.316 (0.11, 0.522)) among hypertensive participants, while antidiabetic use was associated with poorer visuoconstruction (β = −0.514 (−0.87, −0.158)), and antihyperlipidemic use was not associated with cognition. Baseline antihypertensive use may be associated with better cognitive performance among hypertensive individuals. Poorer cognition among antidiabetic users may reflect underlying disease severity rather than drug toxicity, given the limited longitudinal evidence of consistently poorer cognitive performance. No associations were observed with antihyperlipidemic use. Further large longitudinal studies are needed.
Background: Plasma brain derived-p-Tau217 (BD-p-Tau217) may outperform total-p-Tau217 in detecting brain amyloid burden and warrants evaluation. Objectives: To perform head-to-head comparison of plasma BD- as well as total-p-Tau181, p-Tau217 and p-Tau231 for detecting beta-amyloid positivity (Aβ+), evaluate reference ranges for Aβ+, and assess the prognostic utility of BD-p-Tau217 reference ranges. Design: Observational study. Setting: Participants recruited from memory clinics and the community in Singapore. Participants: 213 participants, including 44 cognitively normal, 107 cognitively impaired no dementia, and 62 dementia (mean [SD] age, 73 [1] years; 121 females). Measurements: Amyloid status (Aβ- [n = 139] vs Aβ+ [n = 74]) was determined by positron emission tomography (PET). Plasma BD-p-Tau and total-p-Tau were measured using the NULISAseq™ CNS Disease Panel 120. The diagnostic performance for detecting Aβ+, reference ranges (three-range: 95% specificity/95% sensitivity); binary: maximizing Youden index), and the prognostic performance of p-Tau biomarkers were evaluated. Results: Plasma BD-p-Tau217 (AUC = 0.965) outperformed other BD- and total-p-Tau species in detecting PET Aβ+ (AUC = 0.823–0.937; all p ≤ 0.008). Using a three-range reference, BD-p-Tau217 achieved positive predictive value (PPV) and negative predictive value (NPV) of 90% and 97%, respectively. Proportion of participants in the intermediate-risk group was 7% (n = 14). Applying a binary reference, BD-p-Tau217 achieved both a specificity and sensitivity of 92%, with PPV and NPV of 86% and 96%, respectively. BD-p-Tau217-derived high-risk group exhibited faster cognitive decline than the low-risk group. Conclusions: Risk stratification for PET Aβ+ based on plasma BD-p-Tau217 suggests superior diagnostic and prognostic utility, warranting further validation.
INTRODUCTION:Cortical cerebral microinfarcts (CMIs) are associated with cognitive dysfunction and dementia, while their evolution on sequential magnetic resonance imaging (MRI) remains unclear. METHODS:The study enrolled 490 patients (72.5 ± 7.9 years) from a memory-clinic cohort, with 5-year follow-up. Cortical CMIs were graded at baseline and year 2 to identify incident lesions and other evolutionary patterns. Cognitive function was assessed annually. Clinical events, including dementia, stroke, and mortality, were recorded with time to event. RESULTS:Forty-one (8.4%) patients showed incident cortical CMIs at year 2. Additionally, 12 had CMIs becoming invisible, and six showed CMIs incorporated into new large infarctions. Baseline cortical CMIs and large cortical infarcts showed the strongest association with incident CMIs. Incident cortical CMIs were associated with cognitive decline, white matter hyperintensity progression, and incident dementia, independent of prevalent lesions. DISCUSSION:Cortical CMI evolution may reflect dynamic changes in brain vascular pathology and represent a potential target for interventions aimed at preserving cognitive function.
Introduction:The quality of face-to-face teaching (F2FT) of eye-examination is often suboptimal amidst busy clinics as it demands faculty time for teaching and feedback. Flipped Classroom (FC) and Mental Rehearsal (MR) are established methods to teach clinical skills. A learning module (Supplementary Clinical Ophthalmology Preparatory E-learning [SCOPE]) that combines FC and MR may address this practical problem. This quasi-experimental study compared the efficacy and Faculty Contact Time of SCOPE against F2FT in teaching fourth-year medical undergraduates eye-examination. Method:The SCOPE group (n = 95) received the same content as F2FT but delivered in deliberate sequence: e learning (instructional videos and Video Modelling Examples), followed by structured, audio guided MR, then face-to-face practice with feedback. The F2FT group (n = 51) learned in a single face-to-face session with live faculty demonstration and Video Modelling Examples, without instructional videos or MR. Results:Baseline pre-intervention mean Multiple Choice Questions (MCQ) scores were comparable (22.31 versus 22.24, independent t-test, p = .94). Post-learning cognitive assessments found the SCOPE group to have greater gain in total MCQ scores with higher estimated marginal means (p < .001), and higher mean End-of-Rotation Test scores (43.37 versus 40.85, independent t-test, p = .048). On psychomotor assessments, the SCOPE group had superior Micro-CEX performances (three skills, all p < .001, Fisher's Exact test). SCOPE also shortened Faculty Contact Time, saving on average 57.48 minutes (p < .001, independent t-test). Discussion:SCOPE improved psychomotor and cognitive performances, and was more faculty time-efficient than F2FT in teaching eye examination skills. These positive results may be attributed to the synergistic effects of its multiple learning components. SCOPE, which combined FC and MR, may better facilitate clinical skill development through deliberate practice than F2FT.
