The Ministry of Health (MOH) has updated the clinical practice guidelines on Dementia to provide doctors and patients in Singapore with evidence-based treatment for dementia. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Dementia, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical/2013/ cpgmed_dementia_revised.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Virchow-Robin spaces are pial-lined, interstitial fluid-filled structures that do not directly communicate with the subarachnoid space, and accompany penetrating arteries and veins. They are common, incidental, "leave me alone" lesions that should not be mistaken for more ominous disease. They are frequently seen in the supratentorial white matter, basal ganglia region, around the anterior commissure, and surrounding penetrating lenticulostriate arteries, thalamus, midbrain, cerebellum, insular cortex, corpus callosum, cingulate gyrus, extreme capsule, along the optical tracts, and in the hippocampus. Most are small, well-defined fluid-filled cysts less than five mm in diameter, and are isointense to CSF on all pulse sequences. They are often mistaken for lacunar infarcts, cystic neoplasms or infectious cysts. We retrospectively analyzed various appearances of VRS as seen on magnetic resonance imaging of brain in 100 cases, in an attempt to provide a better understanding of these lesions and their significance in various physiological and pathological conditions.
ObjectiveWe aimed to evaluate the accuracy of three-dimensional laser scanning as an objective method for detecting facial changes. MethodsFacial laser scanning was performed at baseline and repeated after a median of 10 months in 24 HIVinfected patients, 12 with ongoing lipodystrophy, five with 410% weight loss and seven with 410% weight gain. Surface volume change was estimated using a standardized technique, and compared with change in cheek fat measured by magnetic resonance imaging (MRI). ResultsThe median laser scanning surface volume changes were À 2.1 (range À 4.6 to À 0.8) mL in the lipoatrophy group, À1.5 (range À6.8 to À1.3) mL in the weight loss group and 13.1 (range À 0.2 to 1 5.4) mL in the weight gain group (the median MRI cheek fat changes were À 4.6, À 3.7 and 1 7.0 mL in the three groups, respectively). Laser scanning and MRI measurements were not significantly associated in lipoatrophy patients (r 5 0.34, P 5 0.28), but there was a good association in patients who changed weight (r 5 0.71, P 5 0.01). ConclusionsLaser scanning detects changes in the appropriate direction, although it underestimates MRImeasured cheek fat changes. Laser scanning may be useful as an objective measure of cheek surface volume changes, but needs further validation in larger clinical cohorts.Keywords: accuracy, fat, HIV, laser scanning, lipoatrophy, magnetic resonance imaging, reproducibility IntroductionChanges in facial appearance are one of the most distressing aspects of the lipodystrophy syndrome for patients with HIV disease. The resulting stigma and psychological morbidity may adversely affect quality of life and result in compromised adherence to antiretroviral therapy (ART) [1][2][3][4]. Consideration of lipoatrophy risk influences the selection of drugs for new antiretroviral regimens [5].A number of research studies have evaluated potential interventions for facial lipoatrophy, including switching to regimens without thymidine analogues [6][7][8] and injection of facial fillers such as polylactic acid [9][10][11] and silicone [12]. However, there is currently no accepted objective method for measuring the onset and progress of lipodystrophy or for assessing the reversibility of the changes that occur as a result of therapeutic interventions. Evaluation of lipodystrophy in clinical trials is currently based on patient self-assessment and/or physician assessments, although these are subjective and have been shown to be insensitive for detecting changes over time [13]. Although dual-energy X-ray absorptiometry is often used to measure changes in peripheral lipoatrophy in clinical research, this method is not suitable for detecting facial fat changes. Facial magnetic resonance imaging (MRI) and computerized tomography (CT) have been used successfully in measuring facial soft tissue volumes, but these techniques Three-dimensional laser scanning has been used in research and clinical practice to generate images of facial contour that may be used for planning maxillofacial surgery, measuring craniofacial deformit...
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