Byeong Kil Yeon

A randomized, double-blind, crossover comparison of risperidone and haloperidol in Korean dementia patients with behavioral disturbances.

OBJECTIVE Behavioral disturbances in dementia are extremely prominent and distressful, and often result in serious physical, social, and economic consequences. The authors compared the efficacy and tolerability of risperidone and haloperidol in the treatment of behavioral and psychological symptoms of dementia (BPSD) in institutionalized elderly Korean patients with Alzheimer disease, vascular dementia, or mixed dementia. METHODS This was an 18-week double-blind, crossover study involving 120 patients who were randomly assigned to receive flexible doses (0.5-1.5 mg/day) of risperidone or haloperidol. BPSD were assessed using the Korean version of the Behavioral Pathology in Alzheimers Disease Rating Scale (BEHAVE-AD-K), the Korean version of the Cohen-Mansfield Agitation Inventory (CMAI-K), and the Clinical Global Impression of Change scale (CGI-C). Safety and tolerability assessments included the Extrapyramidal Symptom Rating Scale and the incidence of adverse events. RESULTS Both risperidone and haloperidol were efficacious in alleviating BPSD. However, when receiving risperidone, patients showed significantly greater improvement than when receiving haloperidol in the total and subscale scores of the BEHAVE-AD-K, the total and subscale scores of the CMAI-K, and the scores on the CGI-C scale. Also, risperidone had an additional benefit on aggressiveness and anxieties/phobias. The risk of antipsychotic-induced parkinsonism throughout this study was significantly lower with risperidone than with haloperidol. CONCLUSION Risperidone had a favorable efficacy and tolerability profile compared with haloperidol in the treatment of BPSD in this patient population.

Suicide by Burning in Korea

Of 2,143 admissions following suicide attempts over a seven year period (1980-1986) in Seoul, Korea, there were 38 cases (1.8%) of suicide by burning. These cases were matched by age and sex with a control group of suicide attempts in general and were investigated for psychosocial differences from other suicide attempters. No significant differences were found in social factors such as education, religion, marital status, seasonal change and occupation. The majority of suicide attempts by burning were in a public place (73.7%) and were eventually fatal despite intensive medical treatment (78.9%). Half (52.7%) suffered from significant mental disorders and marital disharmony.Of 2,143 admissions following suicide attempts over a seven year period (1980- 1986)in Seoul, Korea, there were 38 cases (1.8%) of suicide by burning. These cases were matched by age and sex with a control group of suicide attempts in general and were investigated for psychosocial differences from other suicide attempters. No significant differences were found in social factors such as education, religion, marital status, seasonal change and occupation. The majority of suicide attempts by burning were in a public place (73.7%) and were eventually fatal despite intensive medical treatment (78.9%). Half (52.7%) suffered from significant mental disorders and marital disharmony.

Comparison of efficacy and safety of milnacipran and fluoxetine in Korean patients with major depression.

ABSTRACT Object: To compare efficacy and safety of milnacipran and fluoxetine in a population of Korean patients with major depression. Research design and methods: The design was a multi-centre, randomised, comparative clinical study. Patients with major depression (DSM‐IV diagnostic criteria) scoring over 17 points on the 17-item Hamilton Depression Scale (HAM‐D) and over 21 points on the Montgomery-Asberg Depression Rating Scale (MADRS) were recruited and randomised to receive milnacipran (50 mg/day increasing after 1 week to 100 mg/day) or fluoxetine (20 mg/day) for 6 weeks. All previous medication was stopped at least 7 days before entry into the study. Patients were evaluated (HAM‐D, MADRS and clinical global impression scale, CGI) at baseline and after 1, 2, 4 and 6 weeks of treatment. All adverse events which developed during the study period were recorded. Results: 70 patients (milnacipran 39; fluoxetine 31) were included in the study. Total score on both HAM‐D, MADRS and CGI decreased significantly in both groups after 1 week and continued to decrease throughout the study. There was no significant difference between the two groups for any measurement at any time point. Both antidepressants were well tolerated. In the milnacipran group, 13 patients reported 28 adverse reactions, and in the fluoxetine group 11 patients reported 18 adverse reactions. Two patients discontinued due to adverse events in the milnacipran group and three in the fluoxetine group. There were no clinically significant modifications in vital signs, routine blood laboratory tests, biochemistry or ECG throughout the study. Nausea and headache were the most frequently reported adverse events with milnacipran while digestive disturbances, diarrhoea and insomnia were more common with fluoxetine. Conclusion: Milnacipran, like fluoxetine, was found to be effective and well tolerated for the treatment of major depression in this population of depressed Korean patients. Principal limitations of the study were its open design, its small sample size and its relatively short duration.

IMPROVEMENTS IN BRAIN CONNECTIVITY IN PATIENTS WITH COGNITIVE IMPAIRMENTS AFTER SMARTPHONE-BASED COGNITIVE TRAINING: A PRELIMINARY STUDY

GDS: Geriatric Depression Scale, CDR: Clinical Dementia Rating, CDR SOB: Clinical Dementia Rating Sum of Box, K-IADL: Korean version of Instrumental Activities of Daily Livint, K-MMSE: Korean version of Mini-Mental State Examination,M:Male, F: Female, AD: Alzheimer’s Disease, MCI: Mild Cognitive Impairment, SD: Standard Deviation K-MMSE, Korean version of the Mini-Mental Status Examination; RLA, Rancho Los Amigos; GSI, Global synchronization index; tDCS 10, 10 days after Transcranial direct current stimulation; tDCS 20, 20 days after Trancranial direct current stimulation

Dementia Care by Healthy Elderly Caregivers Is Associated with Improvement of Patients' Memory and the Caregivers' Quality of Life: A Before and After Study

Objective The provision of care for elderly people with dementia by healthy elderly caregivers is one of the new health-care paradigms in South Korea. The aim of this study was to determine whether this type of care, which includes cognitive stimulation, would improve the cognitive function of dementia patients and the quality of life of the healthy elderly caregiver. Methods Totals of 132 dementia patients and 197 healthy elderly caregivers participated in this study. We evaluated the cognitive function of the dementia patients at baseline and after providing the program for 6 months using the Korean version of the Consortium to Establish a Registry for Alzheimers disease, 1st Edition (CERAD-K). We also evaluated the quality of life of the healthy elderly caregivers using the World Health Organization Quality of Life-Short Version (WHOQOL-BREF) at baseline and after 6 months. Results The word-list memory results of CERAD-K for the included dementia patients improved after 6 months (Z=-2.855, p=0.004). The WHOQOL-BREF score among the elderly caregiver also improved significantly (Z=-2.354, p=0.019). Conclusion These data suggest that dementia care is associated with improvements in both the cognitive function of dementia patients and the quality of life of the healthy elderly caregivers.

IN VIVO TAU DEPOSITION REFLECTS NEUROPSYCHIATRIC SYMPTOMS IN COGNITIVELY IMPAIRED PATIENTS

Methods:A convenience sample of 88 AD patients was graduated in very mild to mild to moderate severity using the clinical dementia rating (CDR) (CDR 0,5, n1⁄421); (CDR 1 1⁄444 & CDR 2 n1⁄4 23). They were assessed with measures of global cognition, executive functions, episodic memory; NPS, apathy, depression and functionality (technology-activities of daily living questionnaire (T-ADLQ)). Lineal regression models were done to assess the better predictors for functional impairment in the global group and in the mild and moderate severity patients separately. Results:Functional impairment was 35618 % in the total sample, increasing it proportion according to disease severity (CDR 0,5&11⁄429% CDR2&31⁄446%). At least one behavioral symptom was present in 87% of AD patients, depressive symptoms were present in about half of the patients. Apathy (defined as AES-i >41) was present in 44 % of AD patients. Significant predictors of global functional impairment were education, NPS, global cognition and apathy; in mild AD patient’s apathy was the best predictor. Conclusions:Apathy alone explained one third of functional impairment in AD patients, been especially important in the mild severity group, it was even more relevant than measures of episodic memory, executive functions or depression. These results remark the importance of apathy evaluation to fully understand AD patient’s behavior. Funded by FONDECYT 1140423, REDES 150134, Proyecto Anillo ACT1403.