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PubMed | Soonchunhyang University, Ecole Normale Superieure de Lyon, Seoul National University, Kyunggi Provincial Hospital for the Elderly and 8 more.
Type: Journal Article | Journal: Journal of Alzheimer's disease : JAD | Year: 2016

Measurements of patient quality of life (QoL) play a major role in the management of dementia.We investigated the self-proxy discrepancy of QoL ratings in the elderly and the impact of dementia severity on the discrepancy.QoL of 718 patients with dementia and 651 non-demented elderly were rated by themselves and their caregivers (CG) using the Quality of Life-Alzheimers Disease (QoL-AD). The impact of the rater on the total and item scores of QoL-AD was analyzed using repeated measures ANOVA and differential response patterns between self and proxy were analyzed using differential item functioning (DIF) analysis.Self-rated scores were higher than CG-rated scores in all diagnostic groups. The interaction between rater and diagnostic group was significant in total QoL-AD score and 5 item scores (memory, marriage, chores around the house, do things for fun, and life as a whole). The strength of the DIF increased with advancing dementia in these items.Self-proxy rating discrepancy of QoL was influenced by the presence and severity of dementia only in five items.


Jhoo J.H.,Kangwon National University | Lee D.Y.,Seoul National University | Choo I.H.,Seoul National University | Seo E.H.,Seoul National University | And 7 more authors.
Psychiatry Research - Neuroimaging | Year: 2010

This study aimed to compare the discrimination accuracy of hippocampal volume (HC-Vol), parahippocampal cingulum fractional anisotropy (PHC-FA), hippocampal glucose metabolism (HC-Glu), and any combination of the three measurements among normal control (NC), mild cognitive impairment (MCI), and Alzheimer's disease (AD). Three-dimensional MRI, diffusion tensor imaging, and FDG-PET were applied to age- and gender-matched 17 NC, 17 MCI, and 17 mild AD patients. Subjects also underwent a neuropsychological test battery including three verbal episodic memory tests. Logistic regression analyses were systematically conducted to select the best model for between-group discrimination. PHC-FA plus HC-Vol model, HC-Glu only model, and the model combining all three modalities were finally chosen for NC vs. MCI (discrimination accuracy: 79.4%), MCI vs. AD (73.5%), and NC vs. AD discrimination (94.1%), respectively. All the three imaging measures also showed significant correlation with all three episodic memory tests. These findings support that each imaging measure, respectively, and their combination have a stage-specific potential as a useful neuroimaging marker for detection and progression monitoring of early stage of AD. © 2010 Elsevier Ireland Ltd.


PubMed | Jeonju City Welfare Hospital for the Elderly, Catholic University of Korea, Seoul National University, Haeundae Paik Hospital and 9 more.
Type: Journal Article | Journal: Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology | Year: 2015

We examined the difference in responses to donepezil between carriers and non-carriers of the A allele at the +4 position of the choline acetyltransferase (ChAT) gene in Koreans.Patients who met the criteria for probable Alzheimers disease (AD) (n=199) were recruited. Among these, 145 completed the 12-week follow-up evaluation and 135 completed the 26-week scheduled course. Differences and changes in the Korean version of the mini-mental state examination (MMSE-KC) score, Korean version of the Consortium to Establish a Registry for Alzheimers Disease Neuropsychological Assessment Battery (CERAD-K[N]) wordlist subtest score (WSS), CERAD-K(N) total score (TS), and the Korean version of geriatric depression scale (GDS-K) score between baseline and 12 weeks or 26 weeks were assessed by the Students t-test.At 12 weeks, the changes in the MMSE-KC score, CERAD-K(N) WSS, and CERAD-K(N) TS from baseline were not significant between ChAT A allele carriers and non-carriers; however, at 26 weeks, these changes were significantly larger in ChAT A allele carriers than in non-carriers (p=0.02 for MMSE-KC and p=0.03 for CERAD-K(N) WSS respectively).Our findings in this study suggested that presence of the A allele at the +4 position of ChAT might positively influence the treatment effect of donepezil in the early stages of AD in Koreans.


PubMed | Inha University, Catholic University of Korea, Seoul National University, Kyunggi Provincial Hospital for the Elderly and 8 more.
Type: | Journal: Archives of gerontology and geriatrics | Year: 2016

Lack of knowledge about a disease could impede early diagnosis and may lead to delays in seeking appropriate medical care. The aim of this study was to explore knowledge of dementia (KOD) and to find the determinants of KOD among three groups: older adults with normal cognition, mild cognitive impairment (MCI), and dementia.A representative nationwide sample of 6141 Korean elders aged 65 years or older participated in face-to-face interviews and answered 14 questions pertaining to general information, etiology, symptoms, and treatment of dementia. Stepwise multiple regressions and path analyses probed the relationships between various sociodemographic variables and KOD.The percentage of correct responses was only 62%. The item A person who remembers things that happened in the past does not have dementia was answered correctly (false) by only 24.8-27% of the respondents in all groups. Older adults with normal cognition had higher KOD scores than those with MCI or dementia. In the normal-cognition group, KOD scores were higher among highly educated, younger, and literate women with no depression and a family history of dementia. In contrast with the determinants in the normal-cognition group, only the ability to read and write predicted KOD scores in the dementia group.Efforts to enhance KOD in elder adults are needed. Public education regarding the differences between dementia and healthy aging may increase KOD among normal elders and those with MCI. Among elders with dementia, educational materials that do not require literacy may be more helpful in increasing KOD with the aim of preventing treatment delay.


Park J.H.,Jeju National University | Lee J.J.,Daegu University | Lee S.B.,Dankook University | Huh Y.,Seoul National University | And 6 more authors.
Journal of Affective Disorders | Year: 2010

Objective: We investigated the prevalence, risk factors and impact of major depressive disorder (MDD) and minor depressive disorder (MnDD) in a randomly selected community-dwelling Korean elderly population. Method: This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A study population of 1118 Korean elders was randomly sampled from residents of Seongnam, Korea aged 65 years or older. Standardized face-to-face interviews and neurological and physical examinations were conducted on 714 respondents using the Korean version of Mini International Neuropsychiatric Interview. MDD was diagnosed according to the DSM-IV criteria, and MnDD according to research criteria proposed in Appendix B of the DSM-IV criteria. Results: Age-, gender-and education-standardized prevalence rates in Korean elders aged 65 years or older were estimated as 5.37% (95% CI = 3.72-7.03) for MDD, 5.52% (95% CI = 3.84-7.19) for MnDD, and 10.89% (95% CI = 8.60-13.17) for overall late-life depression (LLD). A prior MDD episode (OR = 3.07, 95% CI = 1.38-6.82 in MDD, OR = 3.44, 95% CI = 1.49-7.94 in MnDD), female gender (OR = 3.55, 95% CI = 1.53-8.24 in MDD, OR = 2.68, 95% CI = 1.19-6.04 in MnDD) and history of stroke or TIA (OR = 3.45, 95% CI = 1.62-7.35 in MDD, OR = 2.95, 95% CI = 1.34-6.52 in MnDD) were associated with the risks of both MDD and MnDD. Lack of formal education (OR = 2.75, 95% CI = 1.30-5.85) and low income (OR = 2.83, 95% CI = 1.02-7.88) were associated with the risk of MDD only. Quality of life (QOL) of the MDD and MnDD patients was worse than that of non-depressed elders (P < 0.001, ANOVA). Conclusion: MnDD was as prevalent as MDD in Korean elders and impacted QOL as MDD did. MnDD patients may increase in the future with accelerated population aging and westernization of lifestyle in Korea. © 2010 Elsevier B.V. All rights reserved.


Kim K.W.,Seoul National University | Han S.B.,Seoul National University | Han E.R.,Seoul National University | Woo S.J.,Seoul National University | And 3 more authors.
Investigative Ophthalmology and Visual Science | Year: 2011

Purpose. A population-based cross-sectional study to investigate the association between depression and dry eye disease (DED) in a community-dwelling elderly population. Methods. The subjects were 657 Korean elders ≥ 65 years of age randomly selected from an official household registration database in Yongin, Korea. DED symptoms were assessed using the six-item Dry Eye Questionnaire. DED signs were evaluated using the Schirmer test, fluorescein stain score, tear film break-up time (BUT). Depression was assessed using the Korean version of the Short Geriatric Depression Scale (SGDS-K). The association between DED and depression was evaluated using logistic linear analyses. Results. The SGDS-K score correlated with the number of positive responses in the Dry Eye Questionnaire (r = 0.229, P < 0.001), but not with tear film break-up time (r = 0.041, P = 0.139) or Schirmer test score (r = 0.048, P = 0.642). In the binary logistic regression model, female sex (P = 0.014), residence in urban areas (P < 0.001), depression (P < 0.001), and Schirmer score of ≤5 mm (P = 0.035) were associated with the risk of DED. Depression was associated with the risk of DED (P < 0.001) in the patients with Schirmer score > 5 mm but not in those with Schirmer score ≤ 5 mm (P = 0.290). Conclusions. Depression was associated with DED symptoms in subjects with normal or mildly reduced tear production. © 2011 The Association for Research in Vision and Ophthalmology, Inc.


Youn J.C.,Kyunggi Provincial Hospital for the Elderly | Lee D.Y.,Seoul National University | Jhoo J.H.,Kangwon National University | Kim K.W.,Seoul National University | And 2 more authors.
Archives of Gerontology and Geriatrics | Year: 2011

This study aimed to estimate the prevalence and explore the multidimensional complexity of the neuropsychiatric syndromes of AD. Neuropsychiatric symptoms and syndromes of 216 subjects with probable and possible AD diagnosed by NINCDS-ADRDA criteria were evaluated by the Korean version of behavior rating scale for dementia (BRSD-K). The prevalence rate of six neuropsychiatric syndromes (depressive symptoms, inertia, vegetative symptoms, irritability/aggression, behavioral dysregulation, psychotic symptoms) and comorbid neuropsychiatric syndromes were calculated according to the Clinical Dementia Rating scale. To investigate the relationship among neuropsychiatric syndromes, logistic regression analyses were performed. About 95% of patients with AD had one or more neuropsychiatric symptoms and syndromes during the past month. Among the neuropsychiatric syndromes, irritability/aggression (76.2%) was the most frequent, followed by apathy (72.3%) and depressive symptoms (68.0%). About 90% of the subjects had one or more comorbid neuropsychiatric syndromes. The mean numbers of comorbid neuropsychiatric syndromes were significantly varied according to the severity of disease (p< 0.05). Depressive symptoms were significantly associated with vegetative symptoms and irritability/aggression (p< 0.05). Inertia and psychotic symptoms were significantly associated with vegetative symptoms and behavioral dysregulation, respectively (p< 0.05). This study demonstrated that neuropsychiatric syndromes of AD were highly prevalent and involved complex relationships among them. © 2010 Elsevier Ireland Ltd.


Choo I.L.H.,Seoul National University | Lee D.Y.,Seoul National University | Oh J.S.,Seoul National University | Lee J.S.,Seoul National University | And 7 more authors.
Neurobiology of Aging | Year: 2010

This study aimed to investigate the atrophy of the posterior cingulate cortex (PCC) and medical temporal lobe (MTL) structures (i.e., the entorhinal cortex (ERC) and hippocampus) and the regional disruption of the cingulum bundle in mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients. The relationships between atrophy of these structures and regional cingulum disruption were also explored. Three-dimensional MRI and diffusion tensor imaging were applied to 19 MCI, 19 probable AD patients, and 18 normal controls (NC). Fractional anisotropy (FA) values were obtained from three different regions of the cingulum. Both MCI and AD patients showed decreased PCC volumes compared with NC. ERC atrophy was also significant in AD and MCI, while hippocampus atrophy was significant only in AD. MCI patients showed a significant FA decrease in the parahippocampal cingulum (PH-C), whereas AD patients had lower FA values in the posterior cingulate cingulum (PC-C) and PH-C, as compared with NC. However, the middle cingulate cingulum (MC-C) showed no significant FA differences between groups. Moreover, the volumes of MTL structures were significantly correlated with PH-C and PC-C FA values. In terms of PCC functional deficit in MCI or early AD, our results support both the direct effect of PCC atrophy itself and the indirect effect of cingulum fiber degeneration secondary to MTL atrophy. © 2008 Elsevier Inc.


PubMed | Kyunggi Provincial Hospital for the Elderly, Catholic University of Korea, Jeonju City Welfare Hospital for the Elderly, Konkuk University and Seoul National University
Type: Journal Article | Journal: Journal of Alzheimer's disease : JAD | Year: 2016

We developed and evaluated the effect of Multimodal Cognitive Enhancement Therapy (MCET) consisting of cognitive training, cognitive stimulations, reality orientation, physical therapy, reminiscence therapy, and music therapy in combination in older people with mild cognitive impairment (MCI) or mild dementia. This study was amulti-center, double-blind, randomized, placebo-controlled, two-period cross-over study (two 8-week treatment phases separated by a4-week wash-out period). Sixty-four participants with MCI or dementia whose Clinical Dementia Rating was 0.5 or 1 were randomized to the MCET group or the mock-therapy (placebo) group. Outcomes were measured at baseline, week 9, and week 21. Fifty-five patients completed the study. Mini-Mental State Examination (effect size=0.47, p=0.013) and Alzheimers Disease Assessment Scale-Cognitive Subscale (effect size=0.35, p=0.045) scores were significantly improved in the MCET compared with mock-therapy group. Revised Memory and Behavior Problems Checklist frequency (effect size=0.38, p=0.046) and self-rated Quality of Life - Alzheimers Disease (effect size=0.39, p=0.047) scores were significantly improved in the MCET compared with mock-therapy. MCET improved cognition, behavior, and quality of life in people with MCI or mild dementia more effectively than conventional cognitive enhancing activities did.


PubMed | Korea University, Seoul National University, Kyunggi Provincial Hospital for the Elderly, Jeju National University and 3 more.
Type: | Journal: Journal of affective disorders | Year: 2015

There are no cross-sectional or longitudinal epidemiological studies present on MRI-defined vascular depression in community populations. The purpose of this study was to estimate the prevalence rates of both vascular and non-vascular late life depression (LLD) at baseline, to examine the natural course of LLD, and to investigate the influence of White matter hyperintensities (WMHs) on depression after three years.The baseline study employed a two-stage design, Phase I population survey (n=783) and Phase II diagnostic evaluation (n=122). In the 3-year follow-up study, baseline participants completing the second phase were reassessed with the same methodology. WMHs severity was rated visually by the modified Fazekas scale and WMHs volume was calculated using an automated method.The prevalence rates of vascular major depressive disorder (MDD) and vascular non-major depressive disorder (nMDD) were 2.39% (56.2% of MDD) and 4.24% (34.0% of nMDD). Subjects with a score of 2 or more on the modified Fazekas scale in either deep white matter hyperintensities or subcortical gray matter ratings had an 8.1 times greater risk of developing a depressive disorder in the 3-year follow-up study. Greater Log WMHs volume (odds ratio=5.78, 95% CI, 1.04-31.72) at baseline was an independent predictor for depressive disorder in the 3-year assessment.Response rate and follow-up rate were relatively low.Vascular depression is common and makes up about a half of MDD in elders. Greater WMHs severity is a crucial factor predicting future depression risk, which supports the previous vascular depression hypothesis.

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